Immune Attack: Rheumatoid Arthritis

Rheumatoid arthritis is a chronic, inflammatory, multi-system, autoimmune disorder that causes the immune system to attack the joints. It is a disabling and extremely painful condition and can lead to a substantial loss of mobility due to pain and joint destruction. Rheumatoid arthritis is systemic and also often affects different tissues throughout the body, including the skin, blood vessels, heart, lungs and muscles. Rheumatoid arthritis most frequently affects those between ages 20-40, but can start at any age. Family history is an important risk factor. It is three times more common in women than men and up to four times more common in smokers than in non-smokers.

The symptoms that distinguish rheumatoid arthritis from other forms of arthritis are the inflammation and soft-tissue swelling of many joints at the same time. This is known as polyarthritis. The joints are usually affected asymmetrically and then progress in a symmetrical fashion as the disease progresses. Unlike other forms of arthritis, such as osteoarthritis, the pain generally improves with the use of the affected joints.

As the disease progresses, the inflammatory activity leads to erosion and destruction of the joint surface, impairing their range of movement and therefore leading to deformity. In the fingers, the bones typically deviate outwards, towards the pinky finger and assume unnatural shapes. Deformities in those suffering from rheumatoid arthritis include the Boutonniere deformity, the swan neck deformity, and the "Z-Thumb" deformity.

Since rheumatoid arthritis is a multisystem disease, other diseases and conditions may form as a result of it. Many patients with rheumatoid arthritis also have anemia. Anemia is a deficiency of red blood cells and/or hemoglobin and results in the reduced ability of oxygen to be carried to the tissues. It is a chronic disease. Sufferers may also experience splenomegaly (the enlargement of the spleen), Felty's syndrome, and Sjögren's syndrome (an autoimmune disorder in which immune cells attack and destroy exocrine glands that produce saliva and tears). Dermatological affects include nodules on exterior surfaces. Fibrosis may occur in the lungs either spontaneously or as a result of treatments.

There are several criteria for diagnosing rheumatoid arthritis. Stiffness in the morning that persists for longer than one hour is an example, as is arthritis and soft-tissue swelling of more than three out of 14 joints or joint groups. Arthritis of hand joints, symmetric arthritis, subcutaneous nodules in specific places, a rheumatoid factor at a level above the 95th percentile and radiological changes suggested of joint erosion are also a part of the criteria. At least four of these criteria have to be met in order to establish a diagnosis.

Treatments for rheumatoid arthritis are divided into disease-modifying antirheumatic drugs (DMARDs), anti-inflammatory agents and analgesics. DMARDs are known to produce durable remissions and delay or halt disease progression, preventing bone and joint damage in particular. Anti-inflammatory agents and analgesics improve pain and stiffness but do not prevent joint damage or slow down the disease progression.

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