- What is rheumatoid arthritis?
- What causes rheumatoid arthritis?
- Is rheumatoid arthritis inherited?
- Who is at risk of rheumatoid arthritis?
- Is drug treatment available for rheumatoid arthritis?
- Can rheumatoid arthritis be treated without drugs?
- Is it possible to prevent rheumatoid arthritis?
- Can people with rheumatoid arthritis become crippled?
- Are there any promising experimental treatments for rheumatoid arthritis?
Rheumatoid arthritis is a disease that causes inflammation of multiple joints over time. Both sides of the body tend to be affected in the same way — that is, the signs and symptoms of arthritis are usually "symmetric." If one wrist is swollen and painful, the other wrist also tends to be. Rheumatoid arthritis is relatively common, affecting about 1 percent of the population. Symptoms may develop in parts of the body other than the joints. Examples include fatigue, low-grade fever, lumps under the skin and eye inflammation.
The cause of rheumatoid arthritis is unknown, but most experts believe it is an autoimmune disease. In an autoimmune disease, the immune system attacks the body's own tissues rather than attacking outside threats such as infection. One theory suggests that people who develop rheumatoid arthritis are born with an immune system that is prone to abnormal function, especially if stimulated by a trigger (an example of a trigger could be an infection). Somehow, in rheumatoid arthritis, the combination of an abnormally functioning immune system and an outside trigger provokes the body to attack its own joints and other tissues.
The disease is more common among family members of persons with rheumatoid arthritis, but if a parent or sibling has rheumatoid arthritis, there is no guarantee that others in the family will have it also. In other words, the risk is increased among family members (suggesting that rheumatoid arthritis is inherited), but the risk is well below 100 percent.
Rheumatoid arthritis affects women more often than it does men. For example, of the more than 2 million Americans with rheumatoid arthritis, 75 percent are women. Onset is most common between the ages of 20 and 50. A family history of rheumatoid arthritis increases a person's risk of getting this disease, but most persons with this disease are the only ones in the family with it. Besides genetic factors and female gender, smoking also appears to increase the risk of developing rheumatoid arthritis.
A person with rheumatoid arthritis has a number of treatment options, many of which were not available only 10 years ago. It is predicted that many more options will become available in the next few years. The following are drugs that may provide significant relief of arthritis pain and other symptoms:
- Pain relievers and anti-inflammatory drugs relieve symptoms. Examples include acetaminophen, ibuprofen and prednisone (a corticosteroid).
- Disease-modifying drugs may reduce the activity of rheumatoid arthritis and protect the joints. The most commonly prescribed drugs in this group are hydroxychloroquine, sulfasalazine, methotrexate, leflunomide, adalimumab, etanercept and infliximab. They may be taken individually or in combination. Other options include certolizumab, golimumab, abatacept, rituximab, toclizumab and tofacitinib.
- There are many others, including some complementary and alternative therapies (such as herbal remedies and nutritional supplements).
A number of nondrug approaches are available for the treatment of rheumatoid arthritis. These tend to be recommended in addition to drug therapy, not as a replacement, because medications can slow or stop joint damage while these nondrug treatments cannot. Nondrug approaches include:
- Physical and occupational therapy (wearing splints, exercising, learning ways to protect the joints), shoe inserts, warm wax treatments or ultrasound may be helpful.
- Complementary and alternative therapies, including massage, acupuncture and chiropractic care, are unproven. However, many people report improvement with these approaches
- Joint replacement, removal of inflamed tissue and repair of injured tendons near the inflamed joints are examples of surgical options that may help relieve rheumatoid arthritis. Surgery is usually offered as a last resort if other approaches have not been effective and symptoms are severe.
Unfortunately, there is no known way to prevent the development of rheumatoid arthritis. Complications of this disease may be prevented with exercise (to maintain motion). And treatment can protect joints from further damage.
Although rheumatoid arthritis used to be called "the crippling arthritis," severe disability related to rheumatoid arthritis is now much less common than in the past. A number of drugs, taken one at a time or in combination, are effective for most patients, and surgery prevents disability in those persons for whom drug treatment is inadequate in protecting the joints.
A number of prospects are being investigated for the treatment of rheumatoid arthritis. Among these are new drugs that target the chemicals responsible for joint inflammation (tumor necrosis factor, interleukin-1 and others) or those that target a type of white blood cell involved in antibody formation (rituximab). Others (such as tofacitinib) target enzymes within immune cells that are involved in inflammation. Some researchers believe that, in the future, rheumatoid arthritis may be treated using gene therapy.