Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is the most common and serious form of arthritis. There is damage to bone and cartilage, and joint deformities, loss of joint movement, and limitations of activities requiring use of joints.

The exact cause is currently unknown, however it is thought that genetic predisposition plays a role. Elements of the immune system gather in the synovium causing inflammation and subsequent joint damage as a result of excess tumor necrosis factor (TNF) and other inflammatory mediators such as IL-6.

RA usually begins in middle age, but can start at any age including during childhood [2-3 times more common in women]. Symptoms in early disease include general fatigue, soreness or aching, and stiffness, particularly in the morning.

Joint pain and swelling usually occurs in the hands or feet, but can affect wrists, elbows, shoulders, the neck, knees, hips and ankles. Some patients develop nodules at the back of elbows or along the forearm.

The diagnosis is based on medical history, physical examination, x-rays and laboratory tests. Distinction needs to made from more than 200 different types of arthritis and related conditions.

Common laboratory tests include rheumatoid factor, C-reactive protein and the erythrocyte sedimentation rate; x-rays are used to assess damage to cartilage and bone.

Early rheumatology intervention and the start of appropriate treatment is important in the prevention of long-term damage to joints. The treatment goals are to reduce joint swelling, relieving stiffness, preventing joint damage, and maintaining normal joint function.

Aspirin-like drugs called nonsteroidal anti-inflammatory drugs (NSAIDS) and corticosteroids (prednisone) help reduce joint pain, stiffness and swelling. Drugs referred to as disease-modifying anti-rheumatic drugs (DMARDs) include methotrexate, hydroxychloroquine, sulphasalzine, leflunomide, gold salts and a new class of drugs called biologics.

Treatment most often involves some combination of exercise, rest, joint protection, use of heat or cold to reduce pain, and physical and occupational therapy. Surgery is available to relieve pain and improve function of damaged joints.

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Private appointments: 01892 741 127 or email nush@arthritiscentre.org (self referral or via GP or another clinician)

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