Rheumatoid arthritis
Zeev Weitz MD
What does the word ‘arthritis’ mean? Is it joint pain? Is it joint swelling? Is it redness? The answer, simply, is YES: it is pain, swelling and redness individually and in combination. The word arthritis is defined as an inflammation of the joints, and the primary features of inflammation are pain, swelling and redness.
Rheumatoid arthritis is an inflammatory disease of the joints. It is a systemic disease which attacks multiple organs in the human body. This disease commonly affects the small joints of the hands excluding the spinal column.
This illness does not discriminate based upon age. It inflicts the young, the adult and the elderly alike. Females, however, do suffer from rheumatoid arthritis at a higher rate than males. The most common symptom of rheumatoid arthritis is symmetric involvement in the small joints of the hands. This specifically affects the knuckles, often creating significant pain, deformities and disability if untreated.
Rheumatoid arthritis is not difficult to diagnose if the presentation is typical with symmetric involvement of the small joints of the hands, feet, and occasionally the larger joints such as elbows, shoulders, knees and hips.
Some people believe, incorrectly, that the diagnosis of rheumatoid arthritis can be verified by a single blood test to identify an antibody called the Rheumatoid Factor. This is due to the fact that approximately 70% of positively diagnosed patients have positive rheumatoid factor. Nevertheless, many patients who test positive for the presence of rheumatoid factor do not have the disease. There are other medical conditions characterized by the presence of rheumatoid factor which have no association with rheumatoid arthritis. However, it should be stated that patients with rheumatoid arthritis, as a general rule, tend to have more severe symptoms if they carry this antibody.
Recent research has identified a more specific antibody which is associated with rheumatoid arthritis, named CCP. This antibody aids physicians in establishing a more reliable diagnosis of rheumatoid arthritis.
It is vital that physicians identify and diagnose this disease as early as possible in order to aggressively intervene. Failing to diagnose and treat this progressive disease may lead to permanent disfiguration and disability.
The initial evaluation of patients with suspected rheumatoid arthritis should include blood work for inflammatory parameters, the presence of the specific antibodies, baseline x-rays of the involved joints and a general physical exam.
Following the establishment of a positive diagnosis, there are a large variety of optional treatments available for the suffering patient. However, non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen are not appropriate management for rheumatoid arthritis.
The most universally accepted medication for initial treatment of rheumatoid arthritis is methotrexate. Methotrexate is a well-established medication which was originally utilized to treat cancer patients. Currently, very low and safe doses of methotrexate are used to treat patients suffering from rheumatoid arthritis. For circumstances in which methotrexate proves unsuccessful in treating this illness, there are additional medications available with different safety profiles. Most of these medications are prescribed solely by rheumatologists due to the complexity of these medications, as well as the potential risks involved. Furthermore, these medications are costly and often require insurance pre-authorizations.
In conclusion, rheumatoid arthritis is an inflammatory disease which, in light of the new and advanced therapies available, can be managed safely, and with significant pain and disability being prevented in the majority of cases.
