What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is a systemic, autoimmune disease.

What does that mean?

An autoimmune disease is where the body’s immune system sees a particular, normal body cell as an intruder; The cytokines of the immune system attack these cells creating inflammation, swelling and eventually damage.

In the case of rheumatoid arthritis, the immune system attacks the synovial membranes in the body. This membrane lines all the moveable joints, the sheaths of tendons and ligaments, and bursae in the body.

As an example, it can affect the joints in the inner ear, the jaw, the joints in the hand and in the feet. It can affect the cervical spine. RA usually starts its attack in the joints of the hands and the feet.

Rheumatoid arthritis is considered a systemic disease. This means that it doesn’t just affect the joints. It affects the whole body. It can also affect different organs, such as the eye and the lungs, as well as the joints.  Onset of RA may vary with each individual. Small joints of the hands and the feet are usually affected first.

RA may start with one inflamed, swollen joint or it may start with many. Extreme fatigue and a feeling of being sick are common. Pain may be sharp like the feeling of having shards of glass in a joint. Pain may be an unremitting deep burning.

A hallmark of RA is that joint involvement becomes bilateral, both hands, both feet, both wrists, etc. Joints may swell. They can become extremely painful, have a burning feeling. They might feel warm. Low grade temperature of 99-100 degrees is common. Fatigue is frequently present.

RA is about a malfunctioning immune system. It is about inflammation. And it is progressive in 80% of the cases. That means that it cannot be cured and will get worse over time. It is considered a chronic disease.

Rheumatoid arthritis can start at any age. It usually begins in middle age and increases with frequency in older people. Older teenagers and young adults may also be diagnosed. Children and young teenagers may be diagnosed with juvenile idiopathic arthritis, a condition similar to rheumatoid arthritis.

RA affects about 1% of the population. It is the most common inflammatory arthritis in the group of more than 80 autoimmune diseases. Autoimmune diseases include Lupus, MS, and Type one diabetes.

In the 1990s Methotrexate became the relatively safe drug of choice to squash the symptoms and slow the progression of RA. In 1998 Etanercept, Enbrel, was the first biologic approved for the treatment of RA. It was quickly followed by other biologics. These drugs have changed the course of a debilitating disease for many.  

The rheumatologist, the doctor who treats RA, now has many tools in his arsenal. Early and aggressive treatment is important for the best outcome. Those diagnosed with RA today have more treatment options than they did 30 years ago.

However, about a third of those with RA have not found relief with these drugs. Research is continuing. There is hope that maybe a cure can be found in our genes.

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