Rheumatoid Arthritis – Swollen with Pain, Joint to Joint

If your grandmother or grandfather has contorted hands, you may notice that they often complain of having joint pain; however, this recurrent expression is related to an autoimmune condition that has nothing to do with aging.  Your grandparent likely suffers from rheumatoid arthritis, a well-recognized disease with an archetypical appearance that consists of swollen deformed hands.  Although you might not be familiar with the intricacies of the disease process, you have most definitely witnessed its typical manifestations.  By conservative estimate, 1.5 million Americans suffer from the disease, with the majority of these being females in the 50-75 age range.  Uncontrolled rheumatoid arthritis leads to massive destruction of the joints and, since this is a systemic disease, it can encompass any number of joints, leading patients to major disability as they struggle to perform even the smallest of tasks.  The condition is extremely painful and patients will generally require long-term treatment.  Fortunately, science has made significant progress in this arena and has found that if patients are diagnosed early and treated aggressively, they can resume a productive, pain-free life. Rheumatoid arthritis is a chronic inflammatory disorder affecting the joints and despite the fact that researchers have not been able to elucidate the exact cause, it is thought to be a combination of genetic and environmental factors.  In rheumatoid arthritis, the patient’s immune cells (which normally exist to attack foreign objects such as bacteria and viruses) begin to destroy the body’s own bone and cartilage, causing major degradation of the joints.  Characteristic features include joint pain, difficulty moving the joints in the morning, and symmetrical swelling of the wrist and hand joints.  Yet, rheumatoid arthritis is not isolated to the hands and also commonly affects the knees, ankles, shoulders, and elbows.  It is associated with a vast number of seemingly unrelated manifestations such as:  muscle pain, fatigue, low-grade fevers, weight loss, depression, anemia, painful nodules, nerve pain, and inflammation of the heart, lungs, and eyes.  The diagnosis is made based on the clinical history, physical exam, blood tests, and imaging studies.  Patients who are diagnosed with this disorder should see a rheumatologist, given that the treatment protocol for these patients can be particularly complicated.  For mild symptoms, patients will be started on anti-inflammatory medications such as ibuprofen and in certain cases, if there is a specific problematic joint, the rheumatologist can directly inject steroids into the joint space.  For moderate to severe symptoms, patients will be started on oral steroids as well as a number of medications (e.g. methotrexate, rituximab) that modulate the abnormal immune response. There are several risk factors for rheumatoid arthritis, with the most frequently recognized being cigarette smoking, irregular menstrual periods, occupational exposures (such as to silica), and a number of viruses and bacteria.  Rheumatoid arthritis is a distressing and sometimes agonizing condition, which accounts for the yearly expenditure of $545 million for acute hospitalizations related to rheumatoid pain.  Nowadays, scientists are certain that prompt control of the inflammatory process is the key to modifying the disease outcome.  Consequently, it’s of critical importance that patients start anti-rheumatic drugs early in order to be able to halt this destructive process.  Keep that in mind for your own parents and even yourselves.