Arthritis: Rheumatoid Arthritis

This disease affects 1% of the population and is characterized by progressive symmetrical painful swelling of joints, immobility, leading to severe deformity, esp. in the hands and feet. 

It is an inflammatory disease produced by tumor necrosis factor and other inflammatory substances which cause the normally thin joint lining (synovium) to become very thickened with a subsequent increase in production of joint fluid.  This causes the joint to become inflamed, red, warm, and swollen. 

Other joints are involved esp. the neck, shoulders, knees, hips, and ankles. 

It is a systemic disease with other symptoms such as fatigue, fevers, anemia, etc.  Usually joint stiffness occurs during the night resulting on severe pain in the morning.  Ultimately, joint destruction and deformity results with cartilage and bone involvement. 

Early treatment is very important since most of the destruction of the joint takes place within 2 years after the onset of symptoms.   Proper rest, exercise, avoidance of long periods of inactivity, and diet can be helpful in preventing progression and in pain control. 

Ultimately, surgery may be necessary with tendon or joint replacement surgery.  Enbrel is one of the latest advances, blocking the inflammatory agent at the onset.  NSAIDs are frequently used as the primary treatment.  Frequent repeated steroid injections which may ultimately worsen the condition.  Another commonly used treatment include methotrexate (a chemotherapeutic agent) and gold injections.  Physical therapy may be useful.


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