Your Health  - A to Z of Common Medical Conditions

Arthritis (Rheumatoid Arthritis)

Description - Whereas osteoarthritis (see Arthritis, Osteoarthritis) is a fairly chronic, slow-onset arthritis resulting from wear and tear, usually found in older age groups, rheumatoid arthritis is much more acute in onset causing more pain and disability. It is the second most common arthritic disease after osteoarthritis and can affect most of the joints of the body, commonly the fingers, wrists, feet and ankles, followed by the shoulders, knees and hips. It is an inflammatory arthritis in that the joints are hot, often red swollen, stiff and painful. The illness is, in most cases, symmetrical; both hands are usually affected, for example. It is one of the group of diseases known as " auto-immune disorders". This group of illnesses can affect, amongst other organs, the thyroid gland, the kidneys, the skin and the blood, and seems to result from a situation in which the body produces antibodies against its own tissues. In rheumatoid arthritis there is an inflammation and overgrowth of the synovial membrane lining the joint capsule (see Osteoarthritis) causing swelling and pain. There is also destruction of local tendons and erosion of the surrounding bone causing deformity. Rheumatoid arthritis can occur at any age and a particular form seen in very young children is called "Still's disease". The classical deformity of rheumatoid arthritis is ulnar deviation where destruction and swelling of the knuckles pushes the fingers sideways on the hands rendering them very weak or, in the worst cases, useless. This deformity makes it very difficult for many rheumatoid arthritics to cope. Add to this the possibility of severe arthritis of the knees and hips and you are left with somebody who is chair-bound and almost helpless. Fortunately, many sufferers from rheumatoid arthritis have the disease only fairly mildly and it does eventually burn itself out. - though it may recur a few times first. The diagnosis is made by the classical appearance, the blood tests and X rays which show the typical erosion of the surrounding bone. It is necessary to establish the diagnosis because a number of conditions, such as gout (see Gout) can, partly, mimic it.

Management - The management varies according to the severity. In all cases some kind of pain killers are used, usually NSAIDS ( non-steroidal anti-inflammatory drugs). Rheumatoid arthritis is usually referred to a rheumatologist for specialist advice. A major effort is made to stabilise affected joints with splints etc. so that when the disease eventually burns out deformity is kept to a minimum. Devices are provided to make day to day living easier, such as devices to aid turning taps, putting on shoes etc. In anything but the mildest cases more powerful drugs such as gold injections, methotrexate or penicillamine are used, all of which need monitoring with blood tests. Other medications to help sleep are used and some antidepressants seem to raise the pain threshold. Corticosteroid injections into the joint are often used and in acute flare-ups short courses of high dose steroids are given. Severely damaged joints - hips, knees, fingers etc. - may need to be replaced surgically.

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