Arthritis and Rheumatism

Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a systemic autoimmune disease that primarily causes joint inflammation. Approximately 1% of the North American population, at any given time, is affected by the disease.1 RA can occur at any age but is commonly seen in people between 40 and 70.2

What happens to the body

The inflammation of RA may cause changes of joints and surrounding anatomy. These changes may include the proliferation of the joint lining (synovial membrane) or structural damage to cartilage, bone, and ligaments. The severity of RA is variable, ranging from self-limited to mild, chronic activity to severe, destructive arthritis. While the joint inflammation may certainly cause the symptom of pain, the destructive potential of the disease can also lead to joint deformity, joint dysfunction, and functional decline of an individual.

Classification of Rheumatoid Arthritis

The most widely used tool for classifying RA is the American College of Rheumatology (formerly the American Rheumatism Association) 1987 revised criteria for the classification of rheumatoid arthritis. Listed below are some common clinical characteristics of RA used by the classification criteria:

• Chronic arthritis – 6 or more weeks
• 3 or more joints effected simultaneously
• Symmetric arthritis – effects similar joints on the right and left side of the body
• Spares the most distal joints of the fingers
• Morning stiffness of 1 hour or longer before maximal improvement
• Elevated Rheumatoid Factor blood test
• X-ray changes showing typical destructive changes associated with RA
• Rheumatoid skin nodules
• Treatment

There are three goals for the treatment of RA:

• Reduce or relieve joint pain and swelling
• Slow or halt the progression of joint damage
• Prevent disability and disease-related illnesses

Current therapies available do not allow for a cure of the disease; however, medications may helpful in obtaining one or more goals of treatment. Medications that help slow or halt the progression of joint damage are considered Disease Modifying Anti-Rheumatic Drugs (DMARD’s). Medications may be used alone or in combination in order an attempt to reach the desired goals. Below is a table of some, but not all, medications used for the treatment of RA.

Your health care provider may use a number of tools or questions to assess your response to medications prescribed for the treatment of RA. Your provider may assess the number of tender and/or swollen joints that you have in comparison to previous visits. They may ask you the time it takes to reach maximal improvement of your morning stiffness awakening. X-rays may be taken over specific intervals to assess for progression or lack of progression of RA-induced joint damage.