Rheumatoid Arthritis

By David G. Hack

If you wake in the morning and have pain or stiffness of joints that lasts for 30 minutes or longer, if you have tender, warm, swollen joints, if you have fatigue, occasional fever and a general sense of not feeling well, you should see your doctor. You may have one of the more than 100 forms of arthritis, rheumatoid arthritis, but only a physician can diagnose this disease, and only after careful observation and testing.

According to the Arthritis Foundation rheumatoid arthritis is a systemic disease that affects the entire body and is one of the most common forms of arthritis. It is characterized by the inflammation of the membrane lining the joint, which causes pain, stiffness, warmth, redness and swelling. The inflamed joint lining, the synovium, can invade and damage bone and cartilage. Inflammatory cells release enzymes that may digest bone and cartilage. The involved joint can lose its shape and alignment, resulting in pain and loss of movement.

Rheumatoid arthritis affects 2.1 million Americans, mostly women. Onset of the disease is usually in middle-age, but it also affects children and young adults. The cause of the disease is not yet known. However, it appears to be a failure of the body’s natural immune system to react in a normal manner. Some researchers suspect that a trigger, perhaps a virus, may start the disease in some people who have an inherited tendency for the disease.

According to Dr. John S. Cowdery, MD, professor of internal medicine and rheumatology and acting chief of staff at the VA Medical Center in Iowa City, “we have become much more aggressive in early treatment.” Drug treatments are the primary attack against the disease but where we once used medications for reducing joint pain, stiffness and swelling until there was damage to the bone, we now use those medications in combination with disease-modifying drugs that help prevent the joints from being damaged in the first place.

“The new drugs are very promising,” Cowdery added, “but they are very expensive and have only been applied to large numbers of patients for less than 5 years. Their use is closely monitored as we don’t know the long term side effects. However, when one considers the risk of the medications, you have to consider the near certainty of the progressive joint destruction and disability.”

Sandy Colberg, Marion, was diagnosed with rheumatoid arthritis in her mid 20s. In the last 25 years she has seen many changes in medication from large doses of aspirin to the newer stronger drugs that require regular blood work to make sure any adverse side effects are avoided. Colberg has had one knuckle joint replaced and thinks it’s wonderful not to have to live with the pain in that joint.

“The chronic pain can lead to great depression,” she said. “The emotional side of the disease is almost as bad as the physical pain.”

Colleen Benedict, Cedar Rapids, was also diagnosed with rheumatoid arthritis while in her mid 20s. She, too, has experienced the changes in medication during the past 20 years. However, the disease has seriously disabled her, leading to 26 operations, including replacing each hip three times. She is unable to work, and her husband, Joe Benedict, said of the disease, “You get to redefine your goals. Simple things, such as who’s going to pull the kids around on their sled.” The disease causes great modifications of lifestyle. When planning vacations, for example, care has to be taken to plan activities that don’t require much walking.

There is a positive outlook for the future for people with rheumatoid arthritis. In a recent study, doctors at Stanford University School of Medicine looked at the treatment histories of patients between 1977 and 1998. This corresponds to the time when the drug methotrexate became a standard treatment. They reported that because of new and more powerful drugs and more aggressive treatment with these drugs, there has been a 40 percent decline in the average disability levels in patients with rheumatoid arthritis.

In addition to treatment with drugs, it is important for patients with rheumatoid arthritis to get a good balance of rest and exercise, rest while the disease is active and exercise when it is less active in order to maintain healthy and strong muscles, maintain flexibility, and preserve joint mobility. To ease the great emotional challenge of the disease, stress reduction activities are also recommended. Exercise programs, support groups, meditation may all help maintain emotional balance. An overall nutritious diet with enough but not an excess of calories, protein, and calcium is important. To date, there is little scientific evidence that any specific foot or nutrient helps or harms most people with rheumatoid arthritis.

Websites of interest: www.arthritis.org The official website of The Arthritis Foundation

www.niams.nih.gov The website of the National Institute of Arthritis and Musculoskeletal and Skin Diseases

Mind & Body, Cedar Rapids Gazette, March 2004

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