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WIKIPEDIA
http://en.wikipedia.org/wiki/Rheumatoid_arthritis
Rheumatoid arthritis
From Wikipedia, the ree en!"!#opedia
Rheumatoid arthritis
Classifcation and external resources
A hand a$e!ted %" rheumatoid arthritis
ICD-10 &'()&'*
ICD-9 +-
OMIM '''
DiseasesD
B
('*
MedlinePlu
s
'''-
eMedicine arti!#e/+(arti!#e/0**1(arti!#e/'(-+arti!#e/-'0+arti!#e/(*arti!#e/'
-1
MeSH D''+0
Rheumatoid arthritis 2RA3 is a !hroni!, s"stemi! in4ammator" disorder that ma" a$e!t man"
tissues and organs, %ut prin!ipa##" atta!ks 4e5i%#e 2s"no6ia#3 7oints. 8he pro!ess in6o#6es an
in4ammator" response o the !apsu#e around the 7oints 2s"no6ium3 se!ondar" to swe##ing
2h"perp#asia3 o s"no6ia# !e##s, e5!ess s"no6ia# 4uid, and the de6e#opment o 9%rous tissue
2pannus3 in the s"no6ium. 8he patho#og" o the disease pro!ess oten #eads to the destru!tion o
http://en.wikipedia.org/wiki/Rheumatoid_arthritishttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/ICD-10_Chapter_Mhttp://apps.who.int/classifications/icd10/browse/2010/en#/M05http://en.wikipedia.org/wiki/ICD-10_Chapter_Mhttp://apps.who.int/classifications/icd10/browse/2010/en#/M06http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=714http://en.wikipedia.org/wiki/OMIMhttp://omim.org/entry/180300http://en.wikipedia.org/wiki/Diseases_Databasehttp://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb11506.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000431.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://emedicine.medscape.com/article/331715-overviewhttp://emedicine.medscape.com/article/1266195-overviewhttp://emedicine.medscape.com/article/305417-overviewhttp://emedicine.medscape.com/article/401271-overviewhttp://emedicine.medscape.com/article/335186-overviewhttp://emedicine.medscape.com/article/808419-overviewhttp://emedicine.medscape.com/article/808419-overviewhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2012/MB_cgi?field=uid&term=D001172http://en.wikipedia.org/wiki/Systemic_diseasehttp://en.wikipedia.org/wiki/Systemic_diseasehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Synovial_jointshttp://en.wikipedia.org/wiki/Synoviumhttp://en.wikipedia.org/wiki/Hyperplasiahttp://en.wikipedia.org/wiki/Pannushttp://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/ICD-10http://en.wikipedia.org/wiki/ICD-10_Chapter_Mhttp://apps.who.int/classifications/icd10/browse/2010/en#/M05http://en.wikipedia.org/wiki/ICD-10_Chapter_Mhttp://apps.who.int/classifications/icd10/browse/2010/en#/M06http://en.wikipedia.org/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problemshttp://en.wikipedia.org/wiki/List_of_ICD-9_codeshttp://www.icd9data.com/getICD9Code.ashx?icd9=714http://en.wikipedia.org/wiki/OMIMhttp://omim.org/entry/180300http://en.wikipedia.org/wiki/Diseases_Databasehttp://en.wikipedia.org/wiki/Diseases_Databasehttp://www.diseasesdatabase.com/ddb11506.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://en.wikipedia.org/wiki/MedlinePlushttp://www.nlm.nih.gov/medlineplus/ency/article/000431.htmhttp://en.wikipedia.org/wiki/EMedicinehttp://emedicine.medscape.com/article/331715-overviewhttp://emedicine.medscape.com/article/1266195-overviewhttp://emedicine.medscape.com/article/305417-overviewhttp://emedicine.medscape.com/article/401271-overviewhttp://emedicine.medscape.com/article/335186-overviewhttp://emedicine.medscape.com/article/808419-overviewhttp://emedicine.medscape.com/article/808419-overviewhttp://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://www.nlm.nih.gov/cgi/mesh/2012/MB_cgi?field=uid&term=D001172http://en.wikipedia.org/wiki/Systemic_diseasehttp://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Synovial_jointshttp://en.wikipedia.org/wiki/Synoviumhttp://en.wikipedia.org/wiki/Hyperplasiahttp://en.wikipedia.org/wiki/Pannushttp://en.wikipedia.org/wiki/Rheumatoid_arthritis
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arti!u#ar !arti#age and ank"#osis 2usion3 o the 7oints. Rheumatoid arthritis !an a#so produ!e di$use
in4ammation in the #ungs, mem%rane around the heart 2peri!ardium3, the mem%ranes o the #ung
2p#eura3, and white o the e"e 2s!#era3, and a#so nodu#ar #esions, most !ommon in su%!utaneous
tissue. A#though the !ause o rheumatoid arthritis is unknown, autoimmunit" p#a"s a pi6ota# ro#e in
%oth its !hroni!it" and progression, and RA is !onsidered a s"stemi! autoimmune disease.
A%out o the wor#d;s popu#ation has rheumatoid arthritis, women three times more oten than
men.
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Contents
Chide
Oigns and s"mptoms
o . oints
o .0 Okin
o . ?ungs
o .- Kidne"s
o .( >eart and %#ood 6esse#s
o .*
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o (. Disease modi"ing anti)rheumati! drugs
(.. 8raditiona# sma## mo#e!u#ar mass drugs
(..0 Mio#ogi!a# agents
o (.0 Anti)in4ammator" agents and ana#gesi!s
o (. Ourger"
o (.- istor"
o . ota%#e !ases
1 Reeren!es
' E5terna# #inks
CeditOigns and s"mptoms
Whi#e rheumatoid arthritis primari#" a$e!ts 7oints, pro%#ems in6o#6ing other organs o the %od" are
known to o!!ur. E5tra)arti!u#ar 2Goutside the 7ointsG3 maniestations other than anemia 2whi!h is
6er" !ommon3 are !#ini!a##" e6ident in a%out (N0( o indi6idua#s with rheumatoid arthritis. C( It
!an %e di!u#t to determine whether disease maniestations are dire!t#" !aused %" the rheumatoid
pro!ess itse#, or rom side e$e!ts o the medi!ations !ommon#" used to treat it N or e5amp#e, #ung
9%rosis rom methotre5ate or osteoporosis rom !orti!osteroids.
Ceditoints
http://en.wikipedia.org/wiki/Rheumatoid_arthritis#Disease_modifying_anti-rheumatic_drugshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Traditional_small_molecular_mass_drugshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Biological_agentshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Anti-inflammatory_agents_and_analgesicshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Surgeryhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Other_therapieshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Prognosishttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Prognostic_factorshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Mortalityhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Epidemiologyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Historyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Notable_caseshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Referenceshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#External_linkshttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=1http://en.wikipedia.org/wiki/Jointshttp://en.wikipedia.org/wiki/Jointshttp://en.wikipedia.org/wiki/Problemshttp://en.wikipedia.org/wiki/Problemshttp://en.wikipedia.org/wiki/Organshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-pmid12860726-5http://en.wikipedia.org/wiki/Methotrexatehttp://en.wikipedia.org/wiki/Methotrexatehttp://en.wikipedia.org/wiki/Osteoporosishttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=2http://en.wikipedia.org/wiki/Rheumatoid_arthritis#Disease_modifying_anti-rheumatic_drugshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Traditional_small_molecular_mass_drugshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Biological_agentshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Anti-inflammatory_agents_and_analgesicshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Surgeryhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Other_therapieshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Prognosishttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Prognostic_factorshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Mortalityhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Epidemiologyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Historyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Notable_caseshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#Referenceshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#External_linkshttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=1http://en.wikipedia.org/wiki/Jointshttp://en.wikipedia.org/wiki/Problemshttp://en.wikipedia.org/wiki/Organshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-pmid12860726-5http://en.wikipedia.org/wiki/Methotrexatehttp://en.wikipedia.org/wiki/Osteoporosishttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=2
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A diagram showing how rheumatoid arthritis a$e!ts a 7oint
8he arthritis o 7oints known as s"no6itis is in4ammation o the s"no6ia# mem%rane that #ines 7oints
and tendon sheaths. oints %e!ome swo##en, tender and warm, and sti$ness #imits their mo6ement.
With time RA near#" a#wa"s a$e!ts mu#tip#e 7oints 2it is a po#"arthritis3, most !ommon#" sma## 7oints
o the hands, eet and !er6i!a# spine, %ut #arger 7oints #ike the shou#der and knee !an a#so %e
in6o#6ed. O"no6itis !an #ead to tethering o tissue with #oss o mo6ement and erosion o the 7oint
sura!e !ausing deormit" and #oss o un!tion. C
Rheumatoid arthritis t"pi!a##" maniests with signs o in4ammation, with the a$e!ted 7oints %eing
swo##en, warm, painu# and sti$, parti!u#ar#" ear#" in the morning on waking or o##owing pro#onged
ina!ti6it". In!reased sti$ness ear#" in the morning is oten a prominent eature o the disease and
t"pi!a##" #asts or more than an hour. Hent#e mo6ements ma" re#ie6e s"mptoms in ear#" stages o
the disease. 8hese signs he#p distinguish rheumatoid rom non)in4ammator" pro%#ems o the 7oints,
oten reerred to as osteoarthritis or Gwear)and)tearG arthritis. In arthritis o non)in4ammator"
!auses, signs o in4ammation and ear#" morning sti$ness are #ess prominent with sti$ness t"pi!a##"
#ess than hour, and mo6ements indu!e pain !aused %" me!hani!a# arthritis. C* In RA, the 7oints are
oten a$e!ted in a air#" s"mmetri!a# ashion, a#though this is not spe!i9!, and the initia#
presentation ma" %e as"mmetri!a#.
http://en.wikipedia.org/wiki/Arthritishttp://en.wikipedia.org/wiki/Arthritishttp://en.wikipedia.org/wiki/Synovitishttp://en.wikipedia.org/wiki/Synovial_membranehttp://en.wikipedia.org/wiki/Synovial_membranehttp://en.wikipedia.org/wiki/Polyarthritishttp://en.wikipedia.org/wiki/Polyarthritishttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Foothttp://en.wikipedia.org/wiki/Cervical_spinehttp://en.wikipedia.org/wiki/Cervical_spinehttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Majithia2007-1http://en.wikipedia.org/wiki/Osteoarthritishttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-6http://en.wikipedia.org/wiki/Arthritishttp://en.wikipedia.org/wiki/Synovitishttp://en.wikipedia.org/wiki/Synovial_membranehttp://en.wikipedia.org/wiki/Polyarthritishttp://en.wikipedia.org/wiki/Handhttp://en.wikipedia.org/wiki/Foothttp://en.wikipedia.org/wiki/Cervical_spinehttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Majithia2007-1http://en.wikipedia.org/wiki/Osteoarthritishttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-6
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As the patho#og" progresses the in4ammator" a!ti6it" #eads to tendon tethering and erosion and
destru!tion o the 7oint sura!e, whi!h impairs range o mo6ement and #eads to deormit". 8he
9ngers ma" su$er rom a#most an" deormit" depending on whi!h 7oints are most in6o#6ed. &edi!a#
students are taught to #earn names or spe!i9! deormities, su!h as u#nar de6iation, %outonniere
deormit", swan ne!k deormit" and G)thum%,G %ut these are o no more signi9!an!e to diagnosis
or disa%i#it" than other 6ariants, sin!e the" o!!ur in osteoarthritis as we##. G)thum%G or G)
deormit"G !onsists o h"pere5tension o the interpha#angea# 7oint, 95ed 4e5ion and su%#u5ation o
the meta!arpopha#angea# 7oint and gi6es a GG appearan!e to the thum%.
CeditOkin
8he rheumatoid nodule, whi!h is sometimes !utaneous, is the eature most !hara!teristi! o
rheumatoid arthritis. It is a t"pe o in4ammator" rea!tion known to patho#ogists as aGne!rotiJing granu#omaG. 8he initia# patho#ogi! pro!ess in nodu#e ormation is unknown %ut ma" %e
essentia##" the same as the s"no6itis, sin!e simi#ar stru!tura# eatures o!!ur in %oth. 8he nodu#e
has a !entra# area o 9%rinoid ne!rosis that ma" %e 9ssured and whi!h !orresponds to the 9%rin)
ri!h ne!roti! materia# ound in and around an a$e!ted s"no6ia# spa!e. Ourrounding the ne!rosis is a
#a"er o pa#isadingma!rophages and 9%ro%#asts, !orresponding to the intima# #a"er in s"no6ium and
a !u$ o !onne!ti6e tissue !ontaining !#usters o #"mpho!"tes and p#asma !e##s, !orresponding to
the su%intima# Jone in s"no6itis. 8he t"pi!a# rheumatoid nodu#e ma" %e a ew mi##imetres to a ew
!entimetres in diameter and is usua##" ound o6er %on" prominen!es, su!h as the o#e!ranon,
the !a#!anea# tu%erosit", the meta!arpopha#angea# 7oint, or other areas that sustain repeated
me!hani!a# stress. odu#es are asso!iated with a positi6e RF 2rheumatoid a!tor3 titer and se6ere
erosi6e arthritis. Rare#", these !an o!!ur in interna# organs or at di6erse sites on the %od".
Oe6era# orms o %asculitis o!!ur in rheumatoid arthritis. A %enign orm o!!urs as mi!roinar!ts
around the nai#o#ds. &ore se6ere orms in!#ude #i6edo reti!u#aris, whi!h is a network 2reti!u#um3 o
er"thematous to purp#ish dis!o#oration o the skin !aused %" the presen!e o an o%#iterati6e
!utaneous !api##aropath".
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• #o%u#ar panni!u#itis
• atroph" o digita# skin
• pa#mar er"thema
• di$use thinning 2ri!e paper skin3, and skin ragi#it" 2oten worsened %" !orti!osteroid use3.
Cedit?ungs
Fi%rosis o the #ungs is a re!ogniJed response to rheumatoid disease. It is a#so a rare %ut we##
re!ogniJed !onse=uen!e o therap" 2or e5amp#e with methotre5ate and #e4unomide3. ap#an;s
s"ndrome des!ri%es #ung nodu#es in indi6idua#s with rheumatoid arthritis and additiona# e5posure
to !oa# dust. P#eura# e$usions are a#so asso!iated with rheumatoid arthritis. Another !omp#i!ation o
RA is Rheumatoid ?ung Disease. It is estimated that a%out one =uarter o Ameri!ans with RA
de6e#op Rheumatoid ?ung Disease.C+
CeditKidne"s
Rena# am"#oidosis !an o!!ur as a !onse=uen!e o !hroni! in4ammation.C Rheumatoid arthritis ma"
a$e!t the kidne" g#omeru#us dire!t#" through a 6as!u#opath" or a mesangia# in9#trate %ut this is
#ess we## do!umented 2though this is not surprising, !onsidering immune !omp#e5)mediated
h"persensiti6ities are known or pathogeni! deposition o immune !omp#e5es in organs where
%#ood is 9#tered at high pressure to orm other 4uids, su!h as urine and s"no6ia# 4uidC13. 8reatment
with Peni!i##amine and go#d sa#ts are re!ogniJed !auses o mem%ranous nephropath".
Cedit>eart and %#ood 6esse#s
Peop#e with rheumatoid arthritis are more prone to atheros!#erosis, and risk o m"o!ardia#
inar!tion 2heart atta!k3 and stroke is marked#" in!reased.C'C
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Cedit
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Osteoporosis
?o!a# osteoporosis o!!urs in RA around in4amed 7oints. It is postu#ated to %e partia##"
!aused %" in4ammator" !"tokines. &ore genera# osteoporosis is pro%a%#" !ontri%uted to %"
immo%i#it", s"stemi! !"tokine e$e!ts, #o!a# !"tokine re#ease in %one marrow and
!orti!osteroid therap".
#"mphoma
8he in!iden!e o #"mphoma is in!reased in RA, a#though it is sti## un!ommon.C-C(
CeditDiagnosis
CeditImaging
@)ra" o the hand in rheumatoid arthritis.
http://en.wikipedia.org/wiki/Osteoporosishttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-14http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-15http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=8http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=9http://en.wikipedia.org/wiki/Osteoporosishttp://en.wikipedia.org/wiki/Lymphomahttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-14http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-15http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=8http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=9
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Appearan!e o s"no6ia# 4uid rom a 7oint with in4ammator" arthritis.
Oigns o destru!tion and in4ammationonu#trasonograph" and magneti! resonan!e imaging in the
se!ond meta!arpopha#angea# 7oint in esta%#ished rheumatoid
arthritis. 8hin arrows indi!ate an erosi6e !hange thi!k arrows
indi!ate s"no6itis. B#trasonograph" 2#et side o image3 in the 2a3
#ongitudina# and 2%3 the trans6erse p#anes shows %oth signs o
destru!tion and in4ammation. A5ia# 8)weighted magneti! resonan!e
images were o%tained 2!3 %eore and 2d3 ater !ontrast
administration, a#so demonstrating s"no6itis. Additiona##", a !orona#
8)weighted magneti! resonan!e image 2e3 %eore !ontrast
http://en.wikipedia.org/wiki/Medical_ultrasoundhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Metacarpophalangeal_jointhttp://en.wikipedia.org/wiki/Metacarpophalangeal_jointhttp://en.wikipedia.org/wiki/Synovitishttp://en.wikipedia.org/wiki/Medical_ultrasoundhttp://en.wikipedia.org/wiki/Magnetic_resonance_imaginghttp://en.wikipedia.org/wiki/Metacarpophalangeal_jointhttp://en.wikipedia.org/wiki/Synovitis
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Me!ause o this #ow spe!i9!it", new sero#ogi!a# tests ha6e %een
de6e#oped, whi!h test or the presen!e o the anti)!itru##inated
protein anti%odies 2APAs3 or anti)P. ?ike RF, these tests are
positi6e in on#" a proportion 2*+3 o a## RA !ases, %ut are rare#"
positi6e i RA is not present, gi6ing it a spe!i9!it" o around 1(.
C As with RF, there is e6iden!e or APAs %eing present in man"
!ases e6en %eore onset o !#ini!a# disease.Ccitation needed
8he most !ommon tests or APAs are the anti)P 2!"!#i!
!itru##inated peptide3 test and the Anti)& assa" 2anti%odies against
mutated !itru##inated imentin3. Re!ent#" a sero#ogi!a# point)o)!are
test 2P
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signi9!ant point o the AR !riteria rom 1+.C00 8his !riterion no
#onger is regarded to %e re#e6ant, as this is 7ust the t"pe o damage
that treatment is meant to a6oid.
8he !riteria are not intended or the diagnosis or routine !#ini!a#
!are the" were primari#" intended to !ategoriJe resear!h
2classifcation !riteria3. In !#ini!a# pra!ti!e, the o##owing !riteria app#":
Ccitation needed
• two or more swo##en 7oints
• morning sti$ness #asting more than one hour or at #east si5
weeks
• the dete!tion o rheumatoid
a!tors or autoanti%odies against APA su!h as autoanti%odies
to mutated !itru##inated 6imentin !an !on9rm the suspi!ion o
rheumatoid arthritis. A negati6e autoanti%od" resu#t does not
e5!#ude a diagnosis o RA.
CeditDi$erentia# diagnoses
Oe6era# other medi!a# !onditions !an resem%#e RA, and usua##" need
to %e distinguished rom it at the time o diagnosis:C0C0-
• r"sta# indu!ed arthritis 2gout, and pseudogout3 N usua##"
in6o#6es parti!u#ar 7oints 2knee, &8P, hee#s3 and !an %e
distinguished with aspiration o 7oint 4uid i in dou%t. Redness,
as"mmetri! distri%ution o a$e!ted 7oints, pain o!!urs at night
and the starting pain is #ess than an hour with gout.
•
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• epatitis N RA)#ike s"mmetri!a# sma##)7oint po#"arthritis ma"
o!!ur in the !onte5t o this !ondition. >epatitis ma" a#so indu!e
Rheumatoid Fa!tor auto)anti%odies
Rarer !auses that usua##" %eha6e di$erent#" %ut ma" !ause 7oint
pains:C0
• Oar!oidosis, am"#oidosis, and Whipp#e;s disease !an a#so
resem%#e RA.
• >emo!hromatosis ma" !ause hand 7oint arthritis.
• A!ute rheumati! e6er !an %e di$erentiated rom RA %" a
migrator" pattern o 7oint in6o#6ement and e6iden!e o
ante!edent strepto!o!!a# ine!tion. Ma!teria# arthritis 2su!h as
strepto!o!!us3 is usua##" as"mmetri!, whi#e RA usua##" in6o#6es
%oth sides o the %od" s"mmetri!a##".
• Hono!o!!a# arthritis 2another %a!teria# arthritis3 is a#so initia##"
migrator" and !an in6o#6e tendons around the wrists and ank#es.
Cedit&onitoring progression
8he progression o rheumatoid arthritis !an %e o##owed using s!ores
su!h as /isease cti%it0 1core o$ &2 !oints 2DAO03. It is wide#" used
as an indi!ator o RA disease a!ti6it" and response to treatment, %ut
http://en.wikipedia.org/wiki/Psoriatic_arthritishttp://en.wikipedia.org/wiki/Lyme_diseasehttp://en.wikipedia.org/wiki/Reactive_arthritishttp://en.wikipedia.org/wiki/Sacroiliachttp://en.wikipedia.org/wiki/Sacroiliachttp://en.wikipedia.org/wiki/Urethritishttp://en.wikipedia.org/wiki/Urethritishttp://en.wikipedia.org/wiki/Urethritishttp://en.wikipedia.org/wiki/Conjunctivitishttp://en.wikipedia.org/wiki/Iritishttp://en.wikipedia.org/wiki/Keratoderma_blennorrhagicahttp://en.wikipedia.org/wiki/Keratoderma_blennorrhagicahttp://en.wikipedia.org/wiki/Ankylosing_spondylitishttp://en.wikipedia.org/wiki/Hepatitis_Chttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Merckmanual-23http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Merckmanual-23http://en.wikipedia.org/wiki/Sarcoidosishttp://en.wikipedia.org/wiki/Sarcoidosishttp://en.wikipedia.org/wiki/Whipple's_diseasehttp://en.wikipedia.org/wiki/Hemochromatosishttp://en.wikipedia.org/wiki/Streptococcalhttp://en.wikipedia.org/wiki/Gonococcalhttp://en.wikipedia.org/wiki/Tendonshttp://en.wikipedia.org/wiki/Tendonshttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=13http://en.wikipedia.org/wiki/Psoriatic_arthritishttp://en.wikipedia.org/wiki/Lyme_diseasehttp://en.wikipedia.org/wiki/Reactive_arthritishttp://en.wikipedia.org/wiki/Sacroiliachttp://en.wikipedia.org/wiki/Urethritishttp://en.wikipedia.org/wiki/Conjunctivitishttp://en.wikipedia.org/wiki/Iritishttp://en.wikipedia.org/wiki/Keratoderma_blennorrhagicahttp://en.wikipedia.org/wiki/Ankylosing_spondylitishttp://en.wikipedia.org/wiki/Hepatitis_Chttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Merckmanual-23http://en.wikipedia.org/wiki/Sarcoidosishttp://en.wikipedia.org/wiki/Whipple's_diseasehttp://en.wikipedia.org/wiki/Hemochromatosishttp://en.wikipedia.org/wiki/Streptococcalhttp://en.wikipedia.org/wiki/Gonococcalhttp://en.wikipedia.org/wiki/Tendonshttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=13
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is not a#wa"s a re#ia%#e indi!ator o treatment e$e!t.C0( 8he 7oints
in!#uded in DAO0 are 2%i#atera##"3: pro5ima# interpha#angea#
7oints 2' 7oints3, meta!arpopha#angea#
7oints 2'3,wrists 203, e#%ows 203, shou#ders 203 and knees 203. When
#ooking at these 7oints, %oth the num%er o 7oints with tenderness
upon tou!hing 2$%!&'3 and swe##ing 2S(&'3 are !ounted. In
addition, the er"thro!"te sedimentation rate 2%SR3 is measured. A#so,
the patient makes a su%7e!ti6e assessment 2SA3 o disease a!ti6it"
during the pre!eding + da"s on a s!a#e %etween ' and '', where '
is Gno a!ti6it"G and '' is Ghighest a!ti6it" possi%#eG. With these
parameters, DAO0 is !a#!u#ated as:
C0*
From this, the disease a!ti6it" o the patient !an %e !#assi9ed as
o##ows:C0*
Current
DAS&'
DAS&' decrease )rom initial *alue
Q .0 Q '.* %ut T .0 T '.*
T .0 Ina!ti6e Hood impro6ement &oderate impro6ement o im
Q .0 %ut T
(.&oderate &oderate impro6ement &oderate impro6ement o im
Q (. er" a!ti6e &oderate impro6ement o impro6ement o im
Ceditauses
Rheumatoid arthritis is a orm o autoimmunit", the !auses o whi!h
are sti## not !omp#ete#" known. It is a s"stemi! 2who#e %od"3 disorder
prin!ipa##" a$e!ting s"no6ia# tissues. 8here is no e6iden!e that
ph"si!a# and emotiona# e$e!ts or stress !ou#d %e a trigger or the
disease. 8he man" negati6e 9ndings suggest that either the trigger
6aries, or that it might in a!t %e a !han!e e6ent inherent with the
immune responseC0+
CeditHeneti!s
It is strong#" asso!iated with the inherited tissue t"pe &a7or
histo!ompati%i#it" !omp#e5 2&>3 antigen >?A)DR- 2most spe!i9!a##"
http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-25http://en.wikipedia.org/wiki/Bilateralhttp://en.wikipedia.org/wiki/Proximal_interphalangeal_jointhttp://en.wikipedia.org/wiki/Proximal_interphalangeal_jointhttp://en.wikipedia.org/wiki/Metacarpophalangeal_jointhttp://en.wikipedia.org/wiki/Metacarpophalangeal_jointhttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Elbowhttp://en.wikipedia.org/wiki/Shoulderhttp://en.wikipedia.org/wiki/Shoulderhttp://en.wikipedia.org/wiki/Kneehttp://en.wikipedia.org/wiki/Kneehttp://en.wikipedia.org/wiki/Erythrocyte_sedimentation_ratehttp://en.wikipedia.org/wiki/Erythrocyte_sedimentation_ratehttp://en.wikipedia.org/wiki/Erythrocyte_sedimentation_ratehttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Prevoo1995-26http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Prevoo1995-26http://en.wikipedia.org/wiki/More_thanhttp://en.wikipedia.org/wiki/More_thanhttp://en.wikipedia.org/wiki/Less_than_or_equal_tohttp://en.wikipedia.org/wiki/Less_than_or_equal_tohttp://en.wikipedia.org/wiki/Less_than_or_equal_tohttp://en.wikipedia.org/wiki/Less_than_or_equal_tohttp://en.wikipedia.org/wiki/More_thanhttp://en.wikipedia.org/wiki/More_thanhttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=14http://en.wikipedia.org/wiki/Etiologyhttp://en.wikipedia.org/wiki/Etiologyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-27http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=15http://en.wikipedia.org/wiki/Major_histocompatibility_complexhttp://en.wikipedia.org/wiki/Major_histocompatibility_complexhttp://en.wikipedia.org/wiki/Human_leukocyte_antigenhttp://en.wikipedia.org/wiki/Human_leukocyte_antigenhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-25http://en.wikipedia.org/wiki/Bilateralhttp://en.wikipedia.org/wiki/Proximal_interphalangeal_jointhttp://en.wikipedia.org/wiki/Proximal_interphalangeal_jointhttp://en.wikipedia.org/wiki/Metacarpophalangeal_jointhttp://en.wikipedia.org/wiki/Metacarpophalangeal_jointhttp://en.wikipedia.org/wiki/Wristhttp://en.wikipedia.org/wiki/Elbowhttp://en.wikipedia.org/wiki/Shoulderhttp://en.wikipedia.org/wiki/Kneehttp://en.wikipedia.org/wiki/Erythrocyte_sedimentation_ratehttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Prevoo1995-26http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Prevoo1995-26http://en.wikipedia.org/wiki/More_thanhttp://en.wikipedia.org/wiki/Less_than_or_equal_tohttp://en.wikipedia.org/wiki/Less_than_or_equal_tohttp://en.wikipedia.org/wiki/More_thanhttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=14http://en.wikipedia.org/wiki/Etiologyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-27http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=15http://en.wikipedia.org/wiki/Major_histocompatibility_complexhttp://en.wikipedia.org/wiki/Major_histocompatibility_complexhttp://en.wikipedia.org/wiki/Human_leukocyte_antigen
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DR'-' and '-'-3Uhen!e ami#" histor" is an important risk a!tor.
Ccitation needed
CeditIne!tious triggers
It has #ong %een suspe!ted that !ertain ine!tions !ou#d %e triggers
or this disease. 8he Gmistaken identit"G theor" suggests that an
ine!tion triggers an immune response, #ea6ing %ehind anti%odies
that shou#d %e spe!i9! to that organism. 8he anti%odies are not
su!ient#" spe!i9!, though, and set o$ an immune atta!k against
part o the host. Me!ause the norma# host mo#e!u#e G#ooks #ikeG a
mo#e!u#e on the o$ending organism that triggered the initia# immune
rea!tionUthis phenomenon is !a##ed mo#e!u#ar mimi!r". Oomeine!tious organisms suspe!ted o triggering rheumatoid arthritis
in!#ude 30co4lasma, r0si4elothrix ,par6o6irus M1 and ru%e##a, #ut
these associations ha%e ne%er #een su44orted in e4idemioloical
studies. or has !on6in!ing e6iden!e %een presented or other t"pes
o triggers su!h as ood a##ergies.
Epidemio#ogi!a# studies ha6e !on9rmed a potentia# asso!iation
%etween RA and two herpes6irus ine!tions: Epstein)Marr 6irus 2EM3
and >uman >erpes irus * 2>>)*3.C0 Indi6idua#s with RA are more
#ike#" to e5hi%it an a%norma# immune response to the Epstein)Marr
6irus.C01C' 8he a##e#e >?A)DRMV'-'- is asso!iated with #ow
re=uen!ies o 8 !e##s spe!i9! or the EM g#"!oprotein' and
predisposes one to de6e#op RA.C
Cedititamin D
8he dis!o6er" o the 6itamin D re!eptor 2DR3 in the !e##s o the
immune s"stem and the a!t that a!ti6ated dendriti! !e##s produ!e
the 6itamin D hormone suggested that 6itamin D !ou#d ha6e
immunoregu#ator" properties.C0 DR, a mem%er o the nu!#ear
hormone re!eptor superami#", was identi9ed in mononu!#ear !e##s,
dendriti! !e##s, antigen)presenting !e##s, and a!ti6ated 8)M
#"mpho!"tes. In s"nthesis, the most e6ident e$e!ts o the D)hormone
on the immune s"stem seem to %e in the downregu#ation o the 8h)
dri6en autoimmunit". ?ow serum #e6e#s o 6itamin D might %e
partia##" re#ated, among other a!tors, to pro#onged dai#" darkness
http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=16http://en.wikipedia.org/wiki/Molecular_mimicryhttp://en.wikipedia.org/wiki/Molecular_mimicryhttp://en.wikipedia.org/wiki/Molecular_mimicryhttp://en.wikipedia.org/wiki/Mycoplasmahttp://en.wikipedia.org/wiki/Erysipelothrixhttp://en.wikipedia.org/wiki/Parvovirushttp://en.wikipedia.org/wiki/Parvovirushttp://en.wikipedia.org/wiki/Rubellahttp://en.wikipedia.org/wiki/Rubellahttp://en.wikipedia.org/wiki/Herpesvirushttp://en.wikipedia.org/wiki/Epstein-Barr_virushttp://en.wikipedia.org/wiki/Epstein-Barr_virushttp://en.wikipedia.org/wiki/Human_Herpesvirus_Sixhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-28http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Ferrell-29http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-30http://en.wikipedia.org/wiki/T_cellshttp://en.wikipedia.org/wiki/T_cellshttp://en.wikipedia.org/wiki/Glycoproteinhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-31http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=17http://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Cutolo-32http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Cutolo-32http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Cutolo-32http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=16http://en.wikipedia.org/wiki/Molecular_mimicryhttp://en.wikipedia.org/wiki/Mycoplasmahttp://en.wikipedia.org/wiki/Erysipelothrixhttp://en.wikipedia.org/wiki/Parvovirushttp://en.wikipedia.org/wiki/Rubellahttp://en.wikipedia.org/wiki/Herpesvirushttp://en.wikipedia.org/wiki/Epstein-Barr_virushttp://en.wikipedia.org/wiki/Human_Herpesvirus_Sixhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-28http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Ferrell-29http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-30http://en.wikipedia.org/wiki/T_cellshttp://en.wikipedia.org/wiki/Glycoproteinhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-31http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=17http://en.wikipedia.org/wiki/Vitamin_Dhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Cutolo-32
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2redu!ed a!ti6ation o the pre 6itamin D %" the u#tra 6io#et M
sun#ight3, di$erent geneti! %a!kground 2i.e. 6itamin D re!eptor
po#"morphism3 and nutritiona# a!tors, and e5p#ain the #atitude)
re#ated pre6a#en!e o autoimmune diseases su!h as rheumatoid
arthritis 2RA3, %" !onsidering the potentia# immunosuppressi6e ro#es
o 6itamin D. 0(23D p#asma #e6e#s ha6e %een ound in6erse#"
!orre#ated at #east with the RA disease a!ti6it" showing a !ir!annua#
rh"thm 2more se6ere in winter3. Re!ent#", greater intake o 6itamin D
was asso!iated with a #ower risk o RA, as we## as a signi9!ant !#ini!a#
impro6ement was strong#" !orre#ated with the immunomodu#ating
potentia# in 6itamin D)treated RA patients.C0C
It is too ear#" to te## whether administering 6itamin D dire!t#" a$e!ts
disease a!ti6it".C-
CeditPathoph"sio#og"
8he ke" pie!es o e6iden!e re#ating to pathogenesis are:
. A geneti! #ink with >?A)DR- and re#ated a##ot"pes o &>
#ass II and the 8 !e##)asso!iated protein P8P00.
0. An undenia%#e #ink to the pathogenesis o 6as!u#ar disease o
man" t"pes, in!#uding the possi%i#it" o a strong !ausa#
!onne!tion to rheumatoid 6as!u#itis, a t"pi!a# eature o this
!ondition.C(
. A remarka%#e de!e#eration o disease progression in man"
!ases %" %#o!kade o the !"tokine 8F 2a#pha3.
-. A simi#ar dramati! response in man" !ases to dep#etion o M
#"mpho!"tes, %ut no !ompara%#e response to dep#etion o 8
#"mpho!"tes.
(. A more or #ess random pattern o whether and when
predisposed indi6idua#s are a$e!ted.
*. 8he presen!e o autoanti%odies to IgHF!, known
as rheumatoid a!tors 2RF3, and anti%odies to !itru##inated
peptides 2APA3.
http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Cutolo-32http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-33http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-34http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=18http://en.wikipedia.org/wiki/HLA-DR4http://en.wikipedia.org/wiki/MHC_Class_IIhttp://en.wikipedia.org/wiki/MHC_Class_IIhttp://en.wikipedia.org/wiki/MHC_Class_IIhttp://en.wikipedia.org/wiki/PTPN22http://en.wikipedia.org/wiki/PTPN22http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-AlbanoSantana-Sahagun2001-35http://en.wikipedia.org/wiki/Tumor_necrosis_factorshttp://en.wikipedia.org/wiki/Tumor_necrosis_factorshttp://en.wikipedia.org/wiki/B_lymphocytehttp://en.wikipedia.org/wiki/B_lymphocytehttp://en.wikipedia.org/wiki/B_lymphocytehttp://en.wikipedia.org/wiki/T_lymphocytehttp://en.wikipedia.org/wiki/T_lymphocytehttp://en.wikipedia.org/wiki/T_lymphocytehttp://en.wikipedia.org/wiki/T_lymphocytehttp://en.wikipedia.org/wiki/Rheumatoid_factorhttp://en.wikipedia.org/wiki/Anti-citrullinated_protein_antibodyhttp://en.wikipedia.org/wiki/Anti-citrullinated_protein_antibodyhttp://en.wikipedia.org/wiki/Anti-citrullinated_protein_antibodyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Cutolo-32http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-33http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-34http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=18http://en.wikipedia.org/wiki/HLA-DR4http://en.wikipedia.org/wiki/MHC_Class_IIhttp://en.wikipedia.org/wiki/MHC_Class_IIhttp://en.wikipedia.org/wiki/PTPN22http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-AlbanoSantana-Sahagun2001-35http://en.wikipedia.org/wiki/Tumor_necrosis_factorshttp://en.wikipedia.org/wiki/B_lymphocytehttp://en.wikipedia.org/wiki/B_lymphocytehttp://en.wikipedia.org/wiki/T_lymphocytehttp://en.wikipedia.org/wiki/T_lymphocytehttp://en.wikipedia.org/wiki/Rheumatoid_factorhttp://en.wikipedia.org/wiki/Anti-citrullinated_protein_antibodyhttp://en.wikipedia.org/wiki/Anti-citrullinated_protein_antibody
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8hese data suggest that the disease in6o#6es a%norma# M !e##N8 !e##
intera!tion, with presentation o antigens %" M !e##s to 8 !e##s 6ia >?A)
DR e#i!iting 8 !e## he#p and !onse=uent produ!tion o RF and APA.
In4ammation is then dri6en either %" M !e## or 8 !e## produ!ts
stimu#ating re#ease o 8F and other !"tokines. 8he pro!ess ma" %e
a!i#itated %" an e$e!t o smoking on !itru##ination%ut the sto!hasti!
2random3 epidemio#og" suggests that the rate #imiting step in genesis
o disease in predisposed indi6idua#s ma" %e an inherent sto!hasti!
pro!ess within the immune response su!h as immunog#o%u#in or 8
!e## re!eptor gene re!om%ination and mutation. 2Oee entr"
under autoimmunit" or genera# me!hanisms.3
I 8F re#ease is stimu#ated %" M !e## produ!ts in the orm o RF or
APA )!ontaining immune !omp#e5es, through a!ti6ation o
immunog#o%u#in F! re!eptors, then RA !an %e seen as a orm o 8"pe
III h"persensiti6it".C*C+ I 8F re#ease is stimu#ated %" 8 !e## produ!ts
su!h as inter#eukin)+ it might %e !onsidered !#oser to t"pe I
h"persensiti6it" a#though this termino#og" ma" %e getting somewhat
dated and unhe#pu#.C 8he de%ate on the re#ati6e ro#es o immune
!omp#e5es and 8 !e## produ!ts in in4ammation in RA has !ontinued
or ' "ears. 8here is #itt#e dou%t that %oth M and 8 !e##s are essentia#to the disease. >owe6er, there is good e6iden!e or neither !e## %eing
ne!essar" at the site o in4ammation. 8his tends to a6our immune
!omp#e5es 2%ased on anti%od" s"nthesised e#sewhere3 as the
initiators, e6en i not the so#e perpetuators o in4ammation.
&oreo6er, work %" 8hur#ings and others in Pau#)Peter 8ak;s group and
a#so %" Arthur Ka6anagh;s group suggest that i an" immune !e##s are
re#e6ant #o!a##" the" are the p#asma !e##s, whi!h deri6e rom M !e##s
and produ!e in %u#k the anti%odies se#e!ted at the M !e## stage.Ccitation
needed
A#though 8F appears to %e the dominant, other !"tokines 2!hemi!a#
mediators3 are #ike#" to %e in6o#6ed in in4ammation in RA. M#o!kade
o 8F does not %ene9t a## patients or a## tissues 2#ung disease and
nodu#es ma" get worse3. M#o!kade o I?), I?)( and I?)* a#so ha6e
%ene9!ia# e$e!ts and I?)+ ma" %e important. onstitutiona#
s"mptoms su!h as e6er, ma#aise, #oss o appetite and weight #oss are
a#so !aused %" !"tokines re#eased in to the %#ood stream.
http://en.wikipedia.org/wiki/Citrullinationhttp://en.wikipedia.org/wiki/Citrullinationhttp://en.wikipedia.org/wiki/Autoimmunityhttp://en.wikipedia.org/wiki/Autoimmunityhttp://en.wikipedia.org/wiki/Fc_receptorhttp://en.wikipedia.org/wiki/Type_III_hypersensitivityhttp://en.wikipedia.org/wiki/Type_III_hypersensitivityhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-urlSUNY_Stony_Brook_Pathology_Department_HBP310_Immunology-36http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-urlHypersensitivity_reactions-37http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-urlHypersensitivity_reactions-37http://en.wikipedia.org/wiki/Interleukin-17http://en.wikipedia.org/wiki/Interleukin-17http://en.wikipedia.org/wiki/Interleukin-17http://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttp://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttp://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-urlLecture_14:_Hypersensitivity-38http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Interleukin_15http://en.wikipedia.org/wiki/Interleukin_15http://en.wikipedia.org/wiki/Interleukin_6http://en.wikipedia.org/wiki/Interleukin_17http://en.wikipedia.org/wiki/Interleukin_17http://en.wikipedia.org/wiki/Citrullinationhttp://en.wikipedia.org/wiki/Autoimmunityhttp://en.wikipedia.org/wiki/Fc_receptorhttp://en.wikipedia.org/wiki/Type_III_hypersensitivityhttp://en.wikipedia.org/wiki/Type_III_hypersensitivityhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-urlSUNY_Stony_Brook_Pathology_Department_HBP310_Immunology-36http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-urlHypersensitivity_reactions-37http://en.wikipedia.org/wiki/Interleukin-17http://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttp://en.wikipedia.org/wiki/Type_IV_hypersensitivityhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-urlLecture_14:_Hypersensitivity-38http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Cytokineshttp://en.wikipedia.org/wiki/Interleukin_15http://en.wikipedia.org/wiki/Interleukin_6http://en.wikipedia.org/wiki/Interleukin_17
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As with most autoimmune diseases, it is important to distinguish
%etween the !ause2s3 that trigger the pro!ess, and those that ma"
permit it to persist and progress.
CeditA%norma# immune response
8he a!tors that a##ow an a%norma# immune response, on!e initiated,
to %e!ome permanent and !hroni!, are %e!oming more !#ear#"
understood. 8he geneti! asso!iation with >?A)DR-, as we## as the
new#" dis!o6ered asso!iations with the gene P8P00 and with two
additiona# genes,C1 a## imp#i!ate a#tered thresho#ds in regu#ation o
the adapti6e immune response. It has a#so %e!ome !#ear rom re!ent
studies that these geneti! a!tors ma" intera!t with the most !#ear#"de9ned en6ironmenta# risk a!tor or rheumatoid arthritis, name#"
!igarette smokingC-'C- owe6er, one possi%i#it" is that negati6e eed%a!k me!hanisms that
norma##" maintain to#eran!e o se# are o6ertaken %" a%errant positi6e
eed%a!k me!hanisms or !ertain antigens su!h as IgH F! 2%ound %"
RF3 and !itru##inated 9%rinogen 2%ound %" APA3 2see entr"
on autoimmunit"3.
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progresses in !on!ert with ormation o granu#ation tissue at the
edges o the s"no6ia# #ining 2pannus3 with e5tensi6e angiogenesis
and produ!tion o enJ"mes that !ause tissue damage. &odern
pharma!o#ogi!a# treatments o RA target these mediators.
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!orti!osteroid in7e!tion ma" a%ort s"no6itis in a parti!u#ar 7oint or
#ong periods3. Interrupting this pro!ess as ear#" as possi%#e with an
e$e!ti6e D&ARD 2su!h as methotre5ate3 appears to impro6e the
out!ome rom the RA or "ears aterwards. De#a"ing therap" or as
#itt#e as a ew months ater the onset o s"mptoms !an resu#t in worse
out!omes in the #ong term. 8here is thereore !onsidera%#e interest in
esta%#ishing the most e$e!ti6e therap" with ear#" arthritis, when the"
are most responsi6e to therap" and ha6e the most to gain.C-
Disease)modi"ing anti)rheumati! drugs ha6e %een used in the
treatment o rheumati! arthritis or a #ong time now.
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• #e4unomide
• methotre5ate 2&8@3
• mino!"!#ine
• su#asa#aJine 2OO3
"toto5i! drugs:
• "!#ophosphamide
8he most important and most !ommon ad6erse e6ents re#ate
to #i6er and %one marrow to5i!it" 2&8@, OO, #e4unomide,aJathioprine, go#d !ompounds, D)peni!i##amine3, rena# to5i!it"
2!"!#osporine A, parentera# go#d sa#ts, D)peni!i##amine3, pneumonitis
2&8@3, a##ergi! skin rea!tions 2go#d !ompounds, OO3, autoimmunit"
2D)peni!i##amine, OO, mino!"!#ine3 and ine!tions 2aJathioprine,
!"!#osporine A3.
90drox0chloro:uine ma" !ause o!u#ar to5i!it", a#though this is rare,
and %e!ause h"dro5"!h#oro=uine does not a$e!t the %one marrow or
#i6er it is oten !onsidered to %e the D&ARD with the #east to5i!it".
Bnortunate#" h"dro5"!h#oro=uine is not 6er" potent, and is usua##"
insu!ient to !ontro# s"mptoms on its own.Ccitation needed
3ethotrexate is !onsidered %" man" rheumato#ogists to %e the most
important and useu# D&ARD and is oten part o the initia# #ine o
treatment.C-C--C( ðotre5ate does ha6e ad6erse e$e!ts, howe6er,
and patients on this drug must %e monitored regu#ar#". &ain#",
methotre5ate has shown to ha6e to5i! gastrointestina#, hemato#ogi!,
pu#monar", and hepati!.C( 8he most !ommon undesira%#e a$e!t is
that it in!reases the a!ti6it" o #i6er enJ"mes in a#most ( o the
patients.C( It is thus re!ommended that patients who !onsistent#"
demonstrate a%norma# #e6e#s o #i6er enJ"mes and/or ha6e a histor"
o #i6er disease or a#!oho# use undergo #i6er %iopsies.C(0 ðotre5ate
is a#so !onsidered a teratogeni!C- and as su!h, it is re!ommended
patients shou#d use !ontra!epti6es to a6oid pregnan!" and to
dis!ontinue the use o methotre5ate i pregnan!" is p#anned. C(
http://en.wikipedia.org/wiki/Leflunomidehttp://en.wikipedia.org/wiki/Methotrexatehttp://en.wikipedia.org/wiki/Minocyclinehttp://en.wikipedia.org/wiki/Sulfasalazinehttp://en.wikipedia.org/wiki/Cyclophosphamidehttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Wasserman-43http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Wasserman-43http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-NICEguidelines-44http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-ACR2002-52http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-ACR2002-52http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Wasserman-43http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Leflunomidehttp://en.wikipedia.org/wiki/Methotrexatehttp://en.wikipedia.org/wiki/Minocyclinehttp://en.wikipedia.org/wiki/Sulfasalazinehttp://en.wikipedia.org/wiki/Cyclophosphamidehttp://en.wikipedia.org/wiki/Liverhttp://en.wikipedia.org/wiki/Bone_marrowhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Wasserman-43http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-NICEguidelines-44http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-ACR2002-52http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Wasserman-43http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-chapter94-51
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In !#ini!a# tria#s, where one o a range o di$erent D&ARDs were used,
peop#e who were pres!ri%ed methotre5ate sta"ed on their medi!ation
the #ongest 2the others stopped %e!ause o either side)e$e!ts or
ai#ure o the drug to !ontro# the arthritis3.Ccitation needed ðotre5ate is
oten preerred %" rheumato#ogists %e!ause i it does not !ontro#
arthritis on its own then it works we## in !om%ination with man" other
drugs, espe!ia##" the %io#ogi!a# agents.
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side e$e!ts rom h"dro5"!h#oro=uine in!#ude nausea and skin rash.
&ore serious, %one marrow suppression ma" o!!ur, though rare. A#so,
ap#asti! anemia and agranu#o!"tosis !an de6e#op as a resu#t o anti)
ma#aria# therap" and ma" potentia##" !ause the death o the patient.
A mu!h more worrisome side e$e!t rom treatment with anti)
ma#aria#s is the damage that these drugs ma" !ause to
the !ornea and retina. Re!ent studies ha6e shown that i the dosage
o h"dro5"!h#oro=uine gi6en to the patients does not e5!eed
*.( mg/kg, the risks o de6e#oping o!u#ar !omp#i!ations are minima#.
C(
Ho#d !ompounds are a#so options in treating this t"pe o disease.
Ope!ia#ists agree that in7e!ta%#e go#d is mu!h more e$e!ti6e in the
treatment o rheumatoid arthritis than aurano9n. et, this t"pe o
drug has %een shown to %e more e!ient than p#a!e%o and e6en
though its #e6e# o to5i!it" is =uite #ow, aurano9n seems to %e !ausing
more side e$e!ts than an" other t"pe o D&ARD. Aurano9n is
thereore not !onsidered e!ient in the treatment o rheumatoid
arthritis %e!ause o its poor resu#ts and %e!ause it is into#era%#e or
most patients. Oodium aurothioma#ate 2&"o!risin3 on the other hand
is another t"pe o go#d !ompound that is in7e!ted and whi!h appearsto %e as e!ient as su#phasa#aJine, d)peni!i##amine and
methotre5ate. Hi6en that there is not enough proo that go#d
!ompounds are indeed e!ient in pre6enting the progression o
erosions and the high to5i!it" o these drugs, the" are usua##" not
in!#uded in the treatment p#an or rheumatoid arthritis.
A o!hrane s"stemati! re6iew has determined that A%ata!ept was an
e$e!ti6e treatment or rheumatoid arthritis. Against p#a!e%o, it was
ound to in!rease mo%i#it" and make patients twi!e as #ike#" to
a!hie6e a (' impro6ement in s"mptoms.C(- >owe6er o!hrane has
!a##ed or more studies to %e !ondu!ted, gi6en the #a!k o e6iden!e to
distinguish %etween the %io#ogi!s a6ai#a%#e or rheumatoid arthritis.C((
7 edit 8Biological agents
Mio#ogi!a# agents 2%io#ogi!s3 in!#ude:
http://en.wikipedia.org/wiki/Bone_marrow_suppressionhttp://en.wikipedia.org/wiki/Bone_marrow_suppressionhttp://en.wikipedia.org/wiki/Agranulocytosishttp://en.wikipedia.org/wiki/Agranulocytosishttp://en.wikipedia.org/wiki/Agranulocytosishttp://en.wikipedia.org/wiki/Corneahttp://en.wikipedia.org/wiki/Retinahttp://en.wikipedia.org/wiki/Retinahttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-53http://en.wikipedia.org/wiki/Goldhttp://en.wikipedia.org/wiki/Auranofinhttp://en.wikipedia.org/wiki/Auranofinhttp://en.wikipedia.org/wiki/Auranofinhttp://en.wikipedia.org/wiki/Abatacepthttp://en.wikipedia.org/wiki/Abatacepthttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-54http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-54http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-55http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=23http://en.wikipedia.org/wiki/Bone_marrow_suppressionhttp://en.wikipedia.org/wiki/Agranulocytosishttp://en.wikipedia.org/wiki/Corneahttp://en.wikipedia.org/wiki/Retinahttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-53http://en.wikipedia.org/wiki/Goldhttp://en.wikipedia.org/wiki/Auranofinhttp://en.wikipedia.org/wiki/Abatacepthttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-54http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-55http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=23
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• tumor ne!rosis a!tor a#pha 28FX3 %#o!kersC(*C(+
C( N etaner!ept 2En%re#3, in4i5ima% 2Remi!ade3, ada#imuma% 2>u
mira3, !erto#iJuma% pego# 2imJia3, go#imuma% 2Oimponi3
• Inter#eukin 2I?)3 %#o!kers N anakinra 2Kineret3
• mono!#ona# anti%odies against M !e##s N ritu5ima% 2Ritu5an3C(1
• 8 !e## !ostimu#ation %#o!ker N a%ata!ept 2
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su!h as knee rep#a!ement. Postoperati6e#", ph"siotherap" is a#wa"s
ne!essar".
Cedit
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RA is known to redu!e the #iespan o patients %" an"where rom
three to 0 "ears.C- A new #ine o resear!h does, howe6er, show that
the use o new %io#ogi! drug therapies e5tend the #iespan o patients
with RA and redu!e the risk and progression o atheros!#erosis.
C*+ A!!ording to the BK;s ationa# Rheumatoid Arthritis Oo!iet",
Goung age at onset, #ong disease duration, the !on!urrent presen!e
o other hea#th pro%#ems 2!a##ed !o)mor%idit"3, and !hara!teristi!s o
se6ere RAUsu!h as poor un!tiona# a%i#it" or o6era## hea#th status, a
#ot o 7oint damage on 5)ra"s, the need or hospita#isation or
in6o#6ement o organs other than the 7ointsUha6e %een shown to
asso!iate with higher morta#it"G.C* Positi6e responses to treatment
ma" indi!ate a %etter prognosis. A 0''( stud" %" the &a"o
#ini! noted that RA su$erers su$er a dou%#ed risk o heart disease,
C*1 independent o other risk a!tors su!h as dia%etes, a#!oho# a%use,
and e#e6ated !ho#estero#, %#ood pressure and %od" mass inde5. 8he
me!hanism %" whi!h RA !auses this in!reased risk remains unknown
the presen!e o !hroni! in4ammation has %een proposed as a
!ontri%uting a!tor.C+'
CeditEpidemio#og"
Disa%i#it")ad7usted #ie "ear or rheumatoid arthritis per
'',''' inha%itants in 0''-.C+
no data
#ess than -'
-'N('
('N*'
*'N+'
+'N'
'N1'
1'N''
''N'
'N0'
0'N'
'N-'
http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Wasserman-43http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-pharmtreatmentoncard-67http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-68http://en.wikipedia.org/wiki/Mayo_Clinichttp://en.wikipedia.org/wiki/Mayo_Clinichttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-69http://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Cholesterolhttp://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-70http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=30http://en.wikipedia.org/wiki/Disability-adjusted_life_yearhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-71http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Wasserman-43http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-pharmtreatmentoncard-67http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-68http://en.wikipedia.org/wiki/Mayo_Clinichttp://en.wikipedia.org/wiki/Mayo_Clinichttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-69http://en.wikipedia.org/wiki/Diabeteshttp://en.wikipedia.org/wiki/Cholesterolhttp://en.wikipedia.org/wiki/Body_mass_indexhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-70http://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=30http://en.wikipedia.org/wiki/Disability-adjusted_life_yearhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-71
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more than -'
8he in!iden!e o RA is in the region o !ases per ',''' popu#ation
per annum.
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o epidemi!s o tu%er!u#osis o##owed %" a surge in the num%er o
rheumatoid arthritis !ases a ew generations #ater.C' &o%#e"
attri%utes the spikes in arthritis to se#e!ti6e pressure !aused %"
tu%er!u#osis. A h"per6igi#ant immune s"stem is prote!ti6e against
tu%er!u#osis at the !ost o an in!reased risk o autoimmune disease.
8he art o Peter Pau# Ru%ens ma" possi%#" depi!t the e$e!ts o
rheumatoid arthritis. In his #ater paintings, his rendered hands show,
in the opinion o some ph"si!ians, in!reasing deormit" !onsistent
with the s"mptoms o the disease.CC0 Rheumatoid arthritis appears
to some to ha6e %een depi!ted in *th !entur" paintings.C >owe6er,
it is genera##" re!ognised in art histori!a# !ir!#es that the painting o
hands in the *th and +th !entur" o##owed !ertain st"#ised
!on6entions, most !#ear#" seen in the &annerist mo6ement. It was
!on6entiona#, or instan!e to show the uphe#d right hand o hrist in
what now appears a deormed posture. 8hese !on6entions are easi#"
misinterpreted as portra"a#s o disease. 8he" are mu!h too
widespread or this to %e p#ausi%#e.
8he 9rst re!ogniJed des!ription o rheumatoid arthritis was in ''
%" the Fren!h ph"si!ian Dr Augustin a!o% ?andrL)Meau6ais 2++0N
-'3 who was %ased in the amed Oa#pYtriZre >ospita# in Paris.C- 8he
name Grheumatoid arthritisG itse# was !oined in (1 %" Mritish
rheumato#ogist Dr A#red Maring Harrod.C-
>istori! treatments or RA ha6e a#so in!#uded: rest, i!e, !ompression
and e#e6ation, app#e diet, nutmeg, some #ight e5er!ise e6er" now and
then, nett#es, %ee 6enom, !opper %ra!e#ets, rhu%ar% diet, e5tra!tionso teeth, asting,hone", 6itamins, insu#in, magnets,
and e#e!tro!on6u#si6e therap" 2E83.C( &ost o these ha6e either had
no e$e!t at a##, or their e$e!ts ha6e %een modest and transient, whi#e
not %eing genera#iJa%#e.Ccitation needed
Ceditota%#e !ases
http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-80http://en.wikipedia.org/wiki/Peter_Paul_Rubenshttp://en.wikipedia.org/wiki/Peter_Paul_Rubenshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-pmid7005475-81http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-82http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-82http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-83http://en.wikipedia.org/wiki/Piti%C3%A9-Salp%C3%AAtri%C3%A8re_Hospitalhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Landre1800-4http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Landre1800-4http://en.wikipedia.org/wiki/Alfred_Baring_Garrodhttp://en.wikipedia.org/wiki/Alfred_Baring_Garrodhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-84http://en.wikipedia.org/wiki/RICE_(medicine)http://en.wikipedia.org/wiki/RICE_(medicine)http://en.wikipedia.org/wiki/RICE_(medicine)http://en.wikipedia.org/wiki/Applehttp://en.wikipedia.org/wiki/Applehttp://en.wikipedia.org/wiki/Nutmeghttp://en.wikipedia.org/wiki/Nutmeghttp://en.wikipedia.org/wiki/Nutmeghttp://en.wikipedia.org/wiki/Nettlehttp://en.wikipedia.org/wiki/Nettlehttp://en.wikipedia.org/wiki/Beehttp://en.wikipedia.org/wiki/Beehttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Rhubarb_diethttp://en.wikipedia.org/wiki/Fastinghttp://en.wikipedia.org/wiki/Fastinghttp://en.wikipedia.org/wiki/Fastinghttp://en.wikipedia.org/wiki/Honeyhttp://en.wikipedia.org/wiki/Vitaminhttp://en.wikipedia.org/wiki/Vitaminhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Magnethttp://en.wikipedia.org/wiki/Magnethttp://en.wikipedia.org/wiki/Electroconvulsive_therapyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-85http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=32http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-80http://en.wikipedia.org/wiki/Peter_Paul_Rubenshttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-pmid7005475-81http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-82http://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-83http://en.wikipedia.org/wiki/Piti%C3%A9-Salp%C3%AAtri%C3%A8re_Hospitalhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-Landre1800-4http://en.wikipedia.org/wiki/Alfred_Baring_Garrodhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-84http://en.wikipedia.org/wiki/RICE_(medicine)http://en.wikipedia.org/wiki/RICE_(medicine)http://en.wikipedia.org/wiki/Applehttp://en.wikipedia.org/wiki/Nutmeghttp://en.wikipedia.org/wiki/Nettlehttp://en.wikipedia.org/wiki/Beehttp://en.wikipedia.org/wiki/Copperhttp://en.wikipedia.org/wiki/Rhubarb_diethttp://en.wikipedia.org/wiki/Fastinghttp://en.wikipedia.org/wiki/Honeyhttp://en.wikipedia.org/wiki/Vitaminhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Magnethttp://en.wikipedia.org/wiki/Electroconvulsive_therapyhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-85http://en.wikipedia.org/wiki/Wikipedia:Citation_neededhttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=32
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>a## o Famer Oand" Koua5
• hristiaan Marnard, the 9rst surgeon to perorm a human)to)
human heart transp#ant had to retire owing to the !ondition. >e
a#so wrote a %ook on #i6ing with arthritis.
• Mi##" Mowden, internationa# !ri!ket umpire who had to retire rom
a!ti6e p#a" %e!ause o rheumatoid arthritis.
• Anita arter, !ountr" musi! singer, daughter o &a"%e##e arter.
• ames o%urn !#aimed to ha6e hea#ed the !ondition using pi##s
!ontaining a su#ur)!ontaining !ompound on his return to a!ting.
• Raou# Du", Fren!h artist 2++N1(3, !ontinued to paint despite
RA and was one o the 9rst patients e6er treated with !ortisone,
in a Moston hospita#.
• amie Farr, Ameri!an a!tor, amous or his ro#e as &a5 K#inger on
the 1+'s te#e6ision series &VAVOV>.
• &e#6in Frank#in, %ass singer o the 8emptations. >e treated RA
with !ortisone shots so he !ou#d perorm.
• Doroth" >odgkin, o%e# priJe winning s!ientist, de6e#oped se6ere
deorming rheumatoid arthritis at age 0. In spite o this she
!ontinued her !areer and de6e#oped @)ra" !r"sta##ograph", whi!h
underpins mu!h o the inormation known a%out rheumatoid
arthritis. Ohe a#so dis!o6ered the stru!ture o insu#in and ena%#ed
the dis!o6er" o the geneti! !ode.
http://en.wikipedia.org/wiki/Sandy_Koufaxhttp://en.wikipedia.org/wiki/Christiaan_Barnardhttp://en.wikipedia.org/wiki/Billy_Bowdenhttp://en.wikipedia.org/wiki/Anita_Carterhttp://en.wikipedia.org/wiki/James_Coburnhttp://en.wikipedia.org/wiki/Raoul_Dufyhttp://en.wikipedia.org/wiki/Jamie_Farrhttp://en.wikipedia.org/wiki/Maxwell_Klingerhttp://en.wikipedia.org/wiki/Televisionhttp://en.wikipedia.org/wiki/M*A*S*H_(TV_series)http://en.wikipedia.org/wiki/M*A*S*H_(TV_series)http://en.wikipedia.org/wiki/M*A*S*H_(TV_series)http://en.wikipedia.org/wiki/Melvin_Franklinhttp://en.wikipedia.org/wiki/Dorothy_Hodgkinhttp://en.wikipedia.org/wiki/X-ray_crystallographyhttp://en.wikipedia.org/wiki/X-ray_crystallographyhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Genetic_codehttp://en.wikipedia.org/wiki/Sandy_Koufaxhttp://en.wikipedia.org/wiki/Christiaan_Barnardhttp://en.wikipedia.org/wiki/Billy_Bowdenhttp://en.wikipedia.org/wiki/Anita_Carterhttp://en.wikipedia.org/wiki/James_Coburnhttp://en.wikipedia.org/wiki/Raoul_Dufyhttp://en.wikipedia.org/wiki/Jamie_Farrhttp://en.wikipedia.org/wiki/Maxwell_Klingerhttp://en.wikipedia.org/wiki/Televisionhttp://en.wikipedia.org/wiki/M*A*S*H_(TV_series)http://en.wikipedia.org/wiki/Melvin_Franklinhttp://en.wikipedia.org/wiki/Dorothy_Hodgkinhttp://en.wikipedia.org/wiki/X-ray_crystallographyhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Genetic_code
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• &att Iseman, #i!ensed ph"si!ian and proessiona# !omedian, and
host o Ot"#e etwork;s #ean >ouse.
• Oand" Koua5, an Ameri!an >a##)o)Fame %ase%a## pit!her who
p#a"ed rom 1(( to 1** or the ?os Ange#es Dodgers.
• Erik ?ind%ergh, a6iator and mem%er o the @)PriJe administration.
Erik has %een a spokesman or the arthritis drug En%re#, as a
resu#t o his su!!ess with the treatment.C*
• Mo% &ortimer Mritish !omedian and a!tor.C+
• Auguste Renoir, impressionist painter, whose #ater ;soter; st"#e
might ha6e re4e!ted in some wa" his se6ere disa%i#it".
• Kath#een 8urner and Aida 8urturro ha6e worked to raise pu%#i!
awareness o the !onditionC
• 8heodore Roose6e#t, president o the Bnited Otates, had his #ung
arthritis a!t up or the rest o his #ie, ater the assassination
attempt on him, gi6ing a spee!h with a %u##et #odged in his %od".,edit
http://www.rheumato#og".org/pra!ti!e/!#ini!a#/patients/diseases_and_!onditions/ra.aspAmerican Collee o) Rheumatolo"
Rheumatoid Arthritis
Para Espa[o# haa clic a.u/ .
Peop#e ha6e #ong eared rheumatoid arthritis 2!ommon#" !a##ed RA3 as one o the most disa%#ing
t"pes o arthritis. 8he good news is that the out#ook has great#" impro6ed or man" peop#e withnew#" diagnosed 2dete!ted3 RA.
http://en.wikipedia.org/wiki/Matt_Isemanhttp://en.wikipedia.org/wiki/Sandy_Koufaxhttp://en.wikipedia.org/wiki/Erik_Lindberghhttp://en.wikipedia.org/wiki/X-Prizehttp://en.wikipedia.org/wiki/X-Prizehttp://en.wikipedia.org/wiki/Enbrelhttp://en.wikipedia.org/wiki/Enbrelhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-86http://en.wikipedia.org/wiki/Bob_Mortimerhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-87http://en.wikipedia.org/wiki/Auguste_Renoirhttp://en.wikipedia.org/wiki/Auguste_Renoirhttp://en.wikipedia.org/wiki/Kathleen_Turnerhttp://en.wikipedia.org/wiki/Aida_Turturrohttp://en.wikipedia.org/wiki/Aida_Turturrohttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-88http://en.wikipedia.org/wiki/Theodore_Roosevelthttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=33http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ra.asphttp://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ra-esp.asphttp://en.wikipedia.org/wiki/Matt_Isemanhttp://en.wikipedia.org/wiki/Sandy_Koufaxhttp://en.wikipedia.org/wiki/Erik_Lindberghhttp://en.wikipedia.org/wiki/X-Prizehttp://en.wikipedia.org/wiki/Enbrelhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-86http://en.wikipedia.org/wiki/Bob_Mortimerhttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-87http://en.wikipedia.org/wiki/Auguste_Renoirhttp://en.wikipedia.org/wiki/Kathleen_Turnerhttp://en.wikipedia.org/wiki/Aida_Turturrohttp://en.wikipedia.org/wiki/Rheumatoid_arthritis#cite_note-88http://en.wikipedia.org/wiki/Theodore_Roosevelthttp://en.wikipedia.org/w/index.php?title=Rheumatoid_arthritis&action=edit§ion=33http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ra.asphttp://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/ra-esp.asp
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A8 IO R>EB&A8RI8IO]
RA is a !hroni! 2#ong)term3 disease that !auses pain, sti$ness, swe##ing and #imited motion and
un!tion o man" 7oints. Whi#e RA !an a$e!t an" 7oint, the sma## 7oints in the hands and eet tend to
%e in6o#6ed most oten. In4ammation sometimes !an a$e!t organs as we##, or instan!e, the e"es
or #ungs.
8he sti$ness seen in a!ti6e RA is most oten worst in the morning. It ma" #ast one to two hours 2or
e6en the who#e da"3. Oti$ness or a #ong time in the morning is a !#ue that "ou ma" ha6e RA, sin!e
ew other arthriti! diseases %eha6e this wa". For instan!e,osteoarthritis most oten does not
!ause pro#onged morning sti$ness.
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8here is no !ure or RA. 8he goa# o treatment is to #essen "our s"mptoms and poor un!tion.
Do!tors do this %" starting proper medi!a# therap" as soon as possi%#e, %eore "our 7oints ha6e
#asting damage. o sing#e treatment works or a## patients. &an" peop#e with RA must !hange their
treatment at #east on!e during their #ietime.
Hood !ontro# o RA re=uires ear#" diagnosis and, at times, aggressi6e treatment. 8hus, patients with
a diagnosis o RA shou#d %egin their treatment with disease)modi"ing antirheumati! drugs U
reerred to as D&ARDs. 8hese drugs not on#" re#ie6e s"mptoms %ut a#so s#ow progression o the
disease. R>EB&A8RI8IO
It is important to %e ph"si!a##" a!ti6e most o the time, %ut to sometimes s!a#e %a!k a!ti6ities when
the disease 4ares. In genera#, rest is he#pu# when a 7oint is in4amed, or when "ou ee# tired. At
these times, do gent#e range)o)motion e5er!ises, su!h as stret!hing. 8his wi## keep the 7oint
4e5i%#e.
When "ou ee# %etter, do #ow)impa!t aero%i! e5er!ises, su!h as wa#king, and e5er!ises to %oost
mus!#e strength. 8his wi## impro6e "our o6era## hea#th and redu!e pressure on "our 7oints. A
ph"si!a# or o!!upationa# therapist !an he#p "ou 9nd whi!h t"pes o a!ti6ities are %est or "ou, and
at what #e6e# or pa!e "ou shou#d do them.
http://www.rheumatology.org/practice/clinical/patients/medications/methotrexate.asphttp://www.rheumatology.org/practice/clinical/patients/medications/methotrexate.asphttp://www.rheumatology.org/practice/clinical/patients/medications/leflunomide.asphttp://www.rheumatology.org/practice/clinical/patients/medications/hydroxychloroquine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/hydroxychloroquine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/sulfasalazine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/gold.asphttp://www.rheumatology.org/practice/clinical/patients/medications/gold.asphttp://www.rheumatology.org/practice/clinical/patients/medications/minocycline.asphttp://www.rheumatology.org/practice/clinical/patients/medications/minocycline.asphttp://www.rheumatology.org/practice/clinical/patients/medications/azathioprine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/azathioprine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/azathioprine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/cyclosporine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/abatacept.asphttp://www.rheumatology.org/practice/clinical/patients/medications/rituximab.asphttp://www.rheumatology.org/practice/clinical/patients/medications/tocilizumab.asphttp://www.rheumatology.org/practice/clinical/patients/medications/methotrexate.asphttp://www.rheumatology.org/practice/clinical/patients/medications/leflunomide.asphttp://www.rheumatology.org/practice/clinical/patients/medications/hydroxychloroquine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/sulfasalazine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/gold.asphttp://www.rheumatology.org/practice/clinical/patients/medications/minocycline.asphttp://www.rheumatology.org/practice/clinical/patients/medications/azathioprine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/cyclosporine.asphttp://www.rheumatology.org/practice/clinical/patients/medications/abatacept.asphttp://www.rheumatology.org/practice/clinical/patients/medications/rituximab.asphttp://www.rheumatology.org/practice/clinical/patients/medications/tocilizumab.asp
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Finding that "ou ha6e a !hroni! i##ness is a #ie)!hanging e6ent. It !an !ause worr" and sometimes
ee#ings o iso#ation or depression. 8hanks to great#" impro6ed treatments, these ee#ings tend to
de!rease with time as energ" impro6es, and pain and sti$ness de!rease. Dis!uss these norma#
ee#ings with "our hea#th !are pro6iders. 8he" !an pro6ide he#pu# inormation and resour!es.
Rheumatoid arthritis a$e!ts the wrist and the sma## 7oints o the hand, in!#uding the knu!k#es and
the midd#e 7oints o the 9ngers.
PE R>EB&A8
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oint pain is one o the most !ommon s"mptoms o rheumatoid arthritis 2RA3. It oten
goes a#ong with warmth, redness, tenderness and swe##ing in the 7oints. 8hese s"mptoms
wi## usua##" o!!ur s"mmetri!a##" U on %oth sides o the %od". Another !ommon s"mptom
is sti$ness, espe!ia##" in the morning. A## o these s"mptoms wi## 6ar" depending on the
se6erit" o the disease. 8hese s"mptoms mean that the 7oints are %eing atta!ked, and i
#et untreated, this !an #ead to deormit". 8hat;s wh" it;s important to get a diagnosis as
ear#" as possi%#e.
Be"ond the oints
Peop#e with RA ma" ha6e other s"mptoms that go %e"ond the 7oints. When the immune
s"stem atta!ks the %od", as it does in peop#e with RA, s"mptoms !an %e e#t throughout
the entire %od". 8hese s"mptoms show that RA a$e!ts more than 7ust the 7oints. &an"
peop#e with RA ma" e5perien!e:
•
Fatigue or tiredness• De!reased =ua#it" o #ie
• Di!u#t" perorming dai#" a!ti6ities
•
Peop#e with RA might a#so ha6e trou%#e perorming a!ti6ities the" used to do #ike !#im%ing
stairs or !arr"ing gro!eries. 8he" ma" ee# #ess a%#e to parti!ipate so!ia##", or ee# that
the" ha6e #ess energ" and !an ee# sad or down.
I "ou think "ou ma" %e e5perien!ing RA s"mptoms, make an appointment to see "our
ami#" do!tor or a rheumato#ogist, a spe!ia#ist who dea#s with 7oint diseases. During "our
appointment, %e sure to te## him or her a%out a## o "our s"mptoms, e6en i some o them
on#" happen on!e in a whi#e, or seem unre#ated.
8>E PR
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Ho7 RA proresses
Oimp#" put, a 7oint is where two %ones meet. 8he 7oint is en!#osed %" a !apsu#e that
prote!ts and supports it. 8his !apsu#e is #ined with s"no6ium, a t"pe o tissue that
produ!es s"no6ia# 4uid. 8his !#ear 4uid #u%ri!ates the !arti#age and %ones inside the
7oint\s !apsu#e so that the %ones !an mo6e with ease.
Rheumatoid arthritis !auses in4ammation o the s"no6ium, whi!h is reerred to as
s"no6itis. 8his in4ammation #eads to the pain, swe##ing, redness and warmth oten
asso!iated with RA. As RA progresses, in4ammation ma" !ontinue to destro" the !arti#age
and %one within the 7oint. 8his !an a#so !ause the mus!#es, #igaments and tendons that
norma##" keep the 7oint sta%#e to weaken. om%ined with the in4ammation, this
weakened support s"stem !an #ead to the ongoing 7oint damage and other s"mptoms o
RA.
Keep in mind that as RA progresses and 7oint damage worsens, it !an ha6e a signi9!ant
impa!t on "our =ua#it" o #ie. It ma" %e!ome in!reasing#" di!u#t to perorm a!ti6ities
that were on!e eas" or "ou or that "ou en7o"ed. For these reasons, it;s important to get
an a!!urate diagnosis as ear#" as possi%#e, team with a rheumato#ogist and start on a
!ourse o treatment to !ontro# in4ammation.
Pre*entin )urther oint damae
We understand that ha6ing a progressi6e disease #ike RA !an make "ou ee# s!ared or
hope#ess. >owe6er, "ou ha6e the power to take !ontro#. M" !ommuni!ating e$e!ti6e#"
with "our ph"si!ian, he or she !an gain insight into how "our RA might progress. 8ogether
"ou !an take the ne!essar" steps to pre6ent urther 7oint damage, in!#uding:
• An e$e!ti6e treatment p#an that he#ps re#ie6e pain and atigue and s#ow the
progression o RA
• E$e!ti6e strategies or 7oint prote!tion, su!h as 9nding new wa"s to perorm tasks
without added stress on 7oints
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• Adopting hea#th" #iest"#e ha%its, su!h as e5er!ising regu#ar#" and eating hea#th"
BDERO8ADIH RA: W>A8 8< E@PE8 I 8>E ?owe6er, RA is a disease that
progresses o6er time, so it is a#so important to think a%out the #ong)term e$e!ts that RA
!an ha6e and the wa"s "ou !an he#p in4uen!e its !ourse.
I #et untreated, the #ong)term ph"si!a# e$e!ts o RA ma" in!#ude permanent 7oint
damage, deormit", disa%i#it" and #oss o un!tion and mo%i#it". Rheumatoid arthritis !an
a#so #ead to poor =ua#it" o #ie. ou ma" ha6e di!u#t" doing a!ti6ities that were on!e
eas" or "ou. 8hese a!ti6ities !an range rom sma##, e6er"da" tasks #ike %uttoning a shirt,
to responsi%i#ities at home and work, to things "ou simp#" en7o" doing. 8he good news is
that there are wa"s to get a head start on pre6enting these #ong)term e$e!ts rom ha6ing
a ma7or impa!t on "our #ie and "our hea#th.
(hat "ou can do no7
8here;s no wa" to te## e5a!t#" how "our RA wi## progress, %ut the o##owing steps !an he#p
in4uen!e "our #ong)term out!ome:
• ?earning a## "ou !an a%out RA, in!#uding what;s happening in "our %od", signs and
s"mptoms, treatments and !oping strategies
• &onitoring s"mptoms #ike pain, atigue, swe##ing and tenderness, as we## as "our a%i#it"
to un!tion norma##", whi!h 7oints are a$e!ted and e6en how the disease a$e!ts "ou
emotiona##"
• ommuni!ating with "our rheumato#ogist U the more "our do!tor knows, the more
#ike#" "ou wi## %e pres!ri%ed appropriate treatment
• Finding an RA treatment that is right or "ou
8hese steps !an a#so he#p "ou %e!ome an a!ti6e mem%er in "our own hea#th!are.
RH%
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aused %" immune s"stem atta!kingthe %od"
aused %" wear and tear on the%od"
an a$e!t peop#e o an" age, %utmost !ommon#" a$e!ts those
%etween ages 0' and *'
Henera##" a$e!ts peop#e o6er age -'
O"mptoms !an %e e#t throughoutthe entire %od"
Bsua##" on#" a$e!ts the 7oints
A$e!ts more women than men ommon#" ound in %oth men andwomen
DIOEAOEO RA
8here are other diseases that !an %e initia##" !onused with rheumatoid arthritis 2RA3,
%e!ause the" ha6e simi#ar s"mptoms. 8hat;s wh" it;s so important to speak to a do!tor
a%out "our s"mptoms. Oome o these other diseases are:
>i6rom"alia
Fi%rom"a#gia is more !ommon in women than in men. Peop#e with this !ondition ha6e
widespread pain in the mus!#es and tissue around the %ones, usua##" in the %a!k,
shou#ders and ne!k. Bn#ike with RA, there is #itt#e to no in4ammation in the 7oints. 8he
a%sen!e o 7oint pain pro%a%#" means that it is not RA, %ut on#" a do!tor wi## know or
sure. 8he !ause o 9%rom"a#gia is not !urrent#" known.
Psoriatic arthritis
Psoriati! arthritis de6e#ops on#" in peop#e with psoriasis, a !hroni! disease that !auses
red and white s!a#e)#ike pat!hes on the skin. ?ike RA, psoriati! arthritis is !aused when
the immune s"stem !reates too mu!h in4ammation in the %od". In addition to !ausing
mi#d to se6ere 7oint pain, psoriati! arthritis !an a#so !ause swe##ing o the 9ngers and
toes. Psoriati! arthritis !an a#so #ead to 7oint deormit".
#upus
?upus is another disease that in6o#6es the immune s"stem. It !an !ause in4ammation
and pain. ?upus !an damage organs su!h as the kidne". Peop#e with #upus ma" a#so ha6e
7oint pain and a !ertain kind o skin rash. Henera##", peop#e with RA wi## not ha6e this
parti!u#ar t"pe o rash.
#"me disease
?"me disease is !aused %" a %a!teria !arried %" ti!ks. Peop#e %itten %" these ti!ks !an
%e!ome ine!ted. O"mptoms in!#ude e6er, heada!he, atigue and a skin rash. 8he
ine!tion !an !ause in4ammation o the 7oints i #et untreated. ?"me disease !an %e
treated su!!essu##" with FDA)appro6ed anti%ioti!s.
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Bursitis
Mursitis is !aused %" in4ammation and pain o tissue near the 7oints, espe!ia##" in the
shou#der or e#%ow. 8his !an re=uent#" %e !aused %" o6eruse. Mursitis !an oten %e
!onused with RA, whi!h !auses in4ammation and pain in the 7oints themse#6es.
?out
Hout is more !ommon in men than in women. In gout, high amounts o uri! a!id, a waste
produ!t in the %od", orm !r"sta#s in the 7oints. In peop#e with this !ondition, the %od"
isn;t a%#e to get rid o the e5tra uri! a!id. 8his #eads to in4ammation and e5treme pain,
oten in the %ig toe. Hout genera##" doesn;t !ause in4ammation in the hands, %ut RA
re=uent#" does.
(HO ?%$S RA@
A!!ording to the B.O. Department o >ea#th and >uman Oer6i!es 2>>O3, %etween '.(
and o Ameri!ans ha6e rheumatoid arthritis 2RA3. >>O a#so ound that a%out +( o
!ases o!!ur in women. An"one !an ha6e RA, %ut some genera# a!ts are known:
• RA usua##" starts a$e!ting peop#e %etween 0' and *' "ears o#d
• Peop#e with ami#" mem%ers who ha6e RA ma" %e at an in!reased risk o de6e#oping
the disease
ARIH Fere are a ew tips that ma" he#p "ou he#p "our #o6ed one
get the %est re#ie he or she !an.
>ere are some tips to he#p "ou !ommuni!ate with and pro6ide the %est !are or "our
#o6ed one with RA:
• Arm "oursel) 7ith in)ormation
8he more "ou know a%out RA, the %etter %oth "our #i6es wi## %e. 8here;s a wea#th o
inormation a6ai#a%#e on RA. And don;t orget to speak to the do!tor i "ou ha6e an"
=uestions "ou need answered.
• Support dont smother
Me he#pu#. Me !aring. ommuni!ate. Knowing the person and when to he#p is
important. Oometimes, knowing when not to he#p !an %e e6en more important. I "ou
o6erwhe#m "our #o6ed one with he#p, he or she might a!tua##" %e!ome resentu#.
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• See RA 7ith another set o) e"es
Me!ause RA progresses s#ow#", peop#e with the disease ma" %e unaware o the !hanges
in their !ondition o6er time. I "ou noti!e them, "ou !an %e a rea# he#p. It;s not eas" to
ta#k a%out, %ut that;s where good !ommuni!ation !omes in. Adding "our point o 6iew
!an he#p "our riend or #o6ed one get the %est RA treatment possi%#e.
• ?et help i) "ou need it
Don;t %e araid to ask or he#p. 8hat in!#udes ph"si!a# as we## as emotiona# assistan!e.
I "ou;re !aring or someone with RA, "ou;## pro%a%#" ha6e some =uestions a%out RA. Read
re=uent#" asked =uestions a%out RA and get the answers "ou need.
8AKIH ARE e or she !an
determine whether "ou need treatment and/or re!ommend a menta# hea#th proessiona#.
http://www.rheumatoidarthritis.com/ra/additional-resources/faq.htmhttp://www.rheumatoidarthritis.com/ra/additional-resources/faq.htmhttp://www.rheumatoidarthritis.com/ra/additional-resources/faq.htm
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Carei*er resources
8he o##owing organiJations are good sour!es o inormation on taking !are o "our #o6ed
one and, more important#", taking !are o "ourse#.
DIAHe or she might make a diagnosis, %ut
ma" oten send the patient to a spe!ia#ist !a##ed a rheumato#ogist. Rheumato#ogists
spe!ia#iJe in 7oint pro%#ems and are the e5perts when it !omes to RA. In a!t, the" are
usua##" the do!tors that make the diagnosis and treat the disease.
Find a rheumato#ogist in "our area with the Arthritis Foundation;s #o!ator too#.
PREPARIH 8< IOI8 A R>EB&A8
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S"mptom trac:er
8his diar" wi## he#p "ou tra!k "our s"mptoms o6er time. RA !an progress 6er" s#ow#", so it
might %e he#pu# to ha6e a re!ord o how "ou were ee#ing. 8his wa", "ou and "our do!tor
!an get a %etter understanding o how "ou;re managing "our !ondition.
Rheumatoloist discussion uide
8his page !an ser6e as a starting point or a !on6ersation with "our rheumato#ogist. It has
=uestions "ou ma" want to ask a%out the disease and treatment options. 8here is a#so a
spa!e to write down =uestions o "our own, so "ou !an make sure to get a## o the
answers "ou;re #ooking or.
Rheumatoloist *isit chec:list
8his !he!k#ist !ontains some things "ou;## want to keep in mind or "our ne5t 6isit to "our
rheumato#ogist.
>
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#a6 tests Ater gathering spe!i9! inormation rom "ou, the rheumato#ogist wi## then
turn to #a% tests or urther insight and to ru#e out other possi%#e diseases. >ere are some
o the things that the rheumato#ogist ma" #ook or when running tests:
• C-reacti*e protein 3CRP 8his su%stan!e in the %od" indi!ates in4ammation. As the
#e6e# o in4ammation rises, so does the #e6e# o RP. Otudies ha6e shown that peop#e
with high #e6e#s o RP o6er a #ong period o time a#so ha6e more se6ere 7oint damage.
• %r"throc"te sedimentation rate a#so reerred to as EOR or Gsed rateG. &ost peop#e
with RA ha6e an e#e6ated EOR. A person with se6ere RA wi## genera##" ha6e a higher
EOR than one with #ess se6ere RA.
• Rheumatoid )actor 3R> is another su%stan!e that !an indi!ate the presen!e o RA.
When the immune s"stem atta!ks itse# #ike it does in RA, the %od" produ!es RF. A%out
+( o peop#e with RA are RF positi6e.
• C"clic citrullinated peptide 3CCP A person with RA wi## ha6e an unusua##" #arge
amount o a su%stan!e !a##ed !itru##ine in their %#ood. P sees !itru##ine as a threat,
and works to 9ght against it.• Antinuclear anti6od" 3A!A 8his test is usua##" gi6en to peop#e who are
e5perien!ing new s"mptoms o RA, in order to ru#e out other autoimmune diseases.
our rheumato#ogist ma" a#so take @)ra"s to !he!k or swe##ing o sot tissues and #oss o
%one densit" around a$e!ted 7oints and %one s!ans to dete!t in4ammation. &agneti!
resonan!e imaging 2&RI3 and 7oint u#trasound are a#so diagnosti! too#s that !an dete!t
in4ammation and signs o s"no6itis, or in4ammation o the #ining o the 7oint.
Pla"in "our part
Remem%er, the inormation gathered during these steps is !riti!a# and wi## !ontinue to
pro6e 6a#ua%#e in uture o!e 6isits as "our do!tor monitors "our un!tion, medi!ations
and "our we##)%eing. ou !an p#a" "our part %" #earning a## "ou !an a%out RA and keeping
!#ose tra!k o e6er" s"mptom "ou e5perien!e, e6en i it seems unre#ated. 8his wa", "ou
!an arri6e at "our appointments prepared with the inormation ne!essar" or "our do!tor
to pres!ri%e the right treatment and to he#p "ou on "our wa" to %etter #i6ing with RA.
8REA8IH RA
8he s"mptoms and se6erit" o rheumatoid arthritis 2RA3 6ar" rom person to person, and
so wi## treatments.
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Brea:throuhs in RA treatment
ew steps orward are %eing made in RA medi!ations a## the time. our do!tor ma"
re!ommend one o these newer medi!ations as a possi%#e treatment option.
Remem%er, starting the right treatment ear#" !an #imit, and e6en pre6ent, #ong)term 7oint
damage and disa%i#it".
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organiJe white %#ood !e##s. Ea!h %io#ogi! D&ARD works to keep the immune s"stem rom
atta!king the %od".
Mio#ogi! D&ARDs are !urrent#" gi6en in two wa"s. Oome are in7e!ted under the skin, #ike
