Rheumatoid arthritis: Symptoms and treatments

Oct 22, 2008 at 4:18 p.m. ET

Did you know women are two to three times more likely to develop rheumatoid arthritis (RA) than men? Experts estimate that approximately 1.3 million people in the US have RA, including young women - the disease commonly strikes people between 30 and 50 years old - as well as almost 300,000 children. Though you may think RA is a disease that only affects older people, it can occur at any age, and is considered one of the most debilitating forms of arthritis because it can cause deformity and disability in addition to chronic pain and discomfort. If you are suffering joint tenderness, stiffness, muscle weakness, and flu-like symptoms that don't seem to go away, read on for more information on RA as well as expert advice in treating it.

Young Woman in Pain

No known cause of rheumatoid arthritis

RA is a chronic disease that affects multiple joints, causing pain, stiffness and motion restriction. The disease most commonly begins in the smaller joints of the fingers, hands and wrists and is usually symmetrical, which means you are likely to experience pain on both sides of the body at once.

Though the exact causes of RA are elusive, experts do know that it is an auto-immune disorder. People with RA experience an abnormal immune response to their own bodies. In a healthy immune system, white blood cells produce antibodies that protect the body against foreign substances, but in people with RA the immune system mistakes healthy tissue for a foreign invader and attacks it.

Although the causes of RA are not completely understood, tumor necrosis factor (TNF), a type of protein, has been shown to be an important part of the inflammatory process associated with RA. TNF is a component of all healthy immune systems, but people with RA overproduce TNF, which is linked to the swelling, pain and joint damage that RA causes.

Is rheumatoid arthritis on the rise?

Though it may seem like more people are getting RA, it is actually just being more accurately diagnosed. National medical advisor to the Arthritis Foundation Dr. Hayes Wilson, chief of the Department of Rheumatology at Piedmont Hospital in Atlanta, Georgia says, "Because of awareness through programs like GeneRAtions (a website dedicated to providing up to date information on RA), the diagnosis is being made sooner in younger adults."

Dr Wilson also explains that with the advent of new effective therapies and the understanding that early treatment has a profound impact on disability and joint damage, doctors are now more inclined to look for the diagnosis.

Are you at risk?

Risk factors for RA include being female, genetics, and, in people who have a genetic susceptibility, environmental triggers such as a bacterial or viral agent.

In addition, Dr Wilson says, "Cigarette smoking appears to be a risk factor, and miners exposed to mineral dust have an increased susceptibility."

The disease doesn't discriminate. Even people who are, otherwise, in good health can get RA. "My first symptoms appeared about six years ago, when I was 34, as I was preparing for the 2003 World Cup and the Olympics in Athens," says Joy Fawcett, former US Olympic soccer player.

"My hands starting swelling a lot, and it was difficult to move my joints. I also experienced a new level of fatigue…and I assumed that I was getting older and my body was starting to give out from all my years of playing," she recalls.

On the contrary, Fawcett's RA was unrelated to her physically demanding career. "Rheumatoid arthritis is an auto-immune disease, distinct from osteoarthritis, which results from wear and tear on the joints," says Dr Wilson.

Symptoms and diagnosis of rheumatoid arthritis

Since RA is viewed as a disease that affects the older population, young people may contribute the symptoms of RA to other causes, like sports or work, in hopes the symptoms will just go away. If you have RA, your symptoms won't go away — and will likely get worse — until you get a proper diagnosis and start an effective treatment plan.

"One of the benefits of being a professional athlete is having immediate access to doctors, so I was diagnosed early. My team doctors suggested that I go to a rheumatologist, and that is who diagnosed me," says Fawcett.

Since treatment is much more successful if RA is diagnosed early, see your doctor if you experience the following:
  • Joint tenderness, swelling, loss of motion
  • Fatigue and weakness
  • Muscle pain
  • Stiffness or pain in the morning or after prolonged periods of immobility
  • Flu-like symptoms, including a low-grade fever
  • Rheumatoid nodules or lumps of tissue under the skin
  • Loss of appetite, depression, weight loss, anemia, cold and/or sweaty hands and feet
  • More severe disease activity is characterized by joint erosion, damage to connective tissue and bone, deformity and instability in the joints
Your doctor will likely refer you to a rheumatologist who will utilize a number of tools to diagnose and evaluate your RA symptoms. The most common way to diagnose RA is through a physical exam, taking into account lab tests, x-rays and your medical history.

And don't be afraid to get a second opinion if your healthcare provider suggests you don't have RA. A survey posted on the GeneRAtions website indicates that nearly 40 percent of those with RA for at least 21 years had to visit three or more doctors before being accurately diagnosed.

Next up...treatments and tips to manage rheumatoid arthritis

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