Health and Pills Guide To Good Health and Drugs: Tablets, Capsules, Gels

Rheumatoid arthritis (RA) is an autoimmune disorder of unknown etiology in which the synovium, or joint lining, is attacked by the immune system; the resulting inflammation leads to destruction of the synovium and surrounding joint. A chronic disease, rheumatoid arthritis requires early diagnosis and aggressive treatment in order to minimize the morbidity associated with its advancement. Rheumatoid arthritis affects 1% of the population — approximately 2.5 million Americans. Most patients diagnosed are between the ages of 35–50; however, about 20% of patients are diagnosed with rheumatoid arthritis after the age of 60, with an overall prevalence of disease in the over-60 population of 2%–3%. Women are three times more likely than men to develop rheumatoid arthritis and typically experience a more severe and debilitating form of the disease. There appears to be a genetic tendency in developing rheumatoid arthritis since first-degree relatives of patients seropositive for rheumatoid factor have a three- to four-fold increased risk of developing rheumatoid arthritis themselves.

Rheumatoid arthritis mainly affects the small joints of the hands, wrists, and feet, although larger joints such as hips, knees, and shoulders, may also be involved. Joint swelling, erythema, stiffness, warmth, and pain are classic symptoms of early disease. As rheumatoid arthritis progresses, joint deformities such as subluxation of the wrists, swan-neck and Boutonniиre deformities of the fingers develop, resulting in permanent disfiguration and disability. Patients may also develop extra-articular manifestations, such as soft tissue nodules, pericarditis, neuropathies, muscle atrophy, and fatigue.

Rheumatoid arthritis is associated with several clinical laboratory abnormalities. Normochromic, normocytic anemia (anemia of chronic disease) is present in about half of patients. The erythrocyte sedimentation rate (ESR) is elevated in 85%–95% of patients due to the inflammatory component of rheumatoid arthritis. ESR is not diagnostic for rheumatoid arthritis, and the results should be interpreted carefully since this value may increase with normal aging, infection, or inflammatory conditions. Aspirate of the synovial fluid from affected joints will show increased numbers of white blood cells and is often turbid in appearance, another indication of inflammation. Rheumatoid factor is present in 60%–70% of patients with rheumatoid arthritis. While the test is not specific for rheumatoid arthritis, it does provide a marker to gauge the severity of disease. By performing serial dilutions, one can determine the concentration of rheumatoid factor. Higher dilutional titers usually indicate more severe disease. Patients may also have elevated C-reactive protein (CRP) and decreased serum albumin.
Rheumatoid arthritis is a difficult disease to manage due to the waxing and waning nature of the symptoms, and prognosis is directly related to onset of disease. Approximately 80% of rheumatoid arthritis patients experience a cyclical pattern, in which periods of remission lasting up to a year are followed by disease flares. About 10% of patients will have one acute episode of arthritis and then enter a spontaneous permanent remission. Another 10% have a severe, debilitating form of the disease that leads to severe bone erosion and joint deformity. Patients with a rapid, sudden onset are more likely to have remission within the first year. A more gradual onset, over 6 months, is indicative of a persistent disease that may not remit. Poor prognostic indicators include high levels of rheumatoid factor, extra-articular manifestations, diagnosis at younger than 30 years of age, and female gender.