Rheumatoid arthritis

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What is it?

Rheumatoid arthritis (RA) is a chronic disease that affects your joints: hand and wrists most commonly, but also elbows, neck, shoulders, hips, knees, feetand jaw. RA causes swelling, stiffness, pain, and loss of function in the joints. Other symptoms include fatigue, fever and a sense of not feeling well (malaise). Some people with RA develop anaemia. RA also increases the risk of thinning of the bones; osteoporosis, particularly if you are taking corticosteroid drugs such as prednisone. The disease can affect other body organs as well, causing dry eyes and mouth - symptoms of Sjögren’s syndrome.

Rheumatoid arthritis usually develops slowly between the ages of 20 and 45. More than 75% of patients are women. RA is different from osteoarthritis, in which joint tissue wears down from sports injuries or age. RA usually affects joints in a balanced way - if one knee is affected, the other knee is also affected. The disease may be partly inherited through genes, but other factors are probably at work, including some kind of a trigger for the gene, perhaps bacteria or viruses. The disease is not contagious. Some scientists also think that changes in certain hormones may promote RA in people with certain genes who have been exposed to the triggering agent. Smoking is a known risk factor for RA, and is associated with more severe disease.

What tests are used?

Rheumatoid arthritis is diagnosed from your signs and symptoms. The diagnosis can be supported with a blood test for an antibody known as rheumatoid factor (RF). The RF test for the presence of the RF antibody in blood is positive in about 80% of people with RA, though may take many years to become positive. However, this test may be positive in people without the disease.

Recently, a new test which detects another group of antibodies called CCP antibodies (cyclic citrullinated peptide antibodies) has been introduced. This is positive in approximately 60% of patients with RA, including some who are RF negative. The presence of these antibodies is associated with a more aggressive course of the disease.

Other common tests to support a diagnosis of RA and to monitor treatment for it include:

What treatment exist?

Several different types of medication are used to treat RA, including pain relievers, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs, immunosuppressants, and corticosteroids (also known as glucocorticoids). Over the last few years, groups of drugs that are given by infusion (into a vein) or injection (under the skin) have been introduced. These are often termed biologic therapies. These drugs specifically target molecules involved in inflammation or the cells that produce them. These have been particularly useful to treat those with severe disease.

People with RA can also make beneficial lifestyle changes such as getting more exercise and eating moderate diets, resting, avoiding stress and taking special care of joints with well-designed tools and other devices that are easy on joints. Surgery is helpful for some patients.

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