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Rheumatoid arthritis, or RA, is a form of inflammatory arthritis and an autoimmune disease.

For reasons no one fully understands, in rheumatoid arthritis, the immune system which is designed to protect our health by attacking foreign cells such as viruses and bacteria instead attacks the bodys own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation thats systemic meaning it can occur throughout the body. Rheumatoid arthritis is a chronic disease, meaning it cant be cured. Most people with RA experience intermittent bouts of intense disease activity, called flares. In some people the disease is continuously active and gets worse over time. Others enjoy long periods of remission no disease activity or symptoms at all. Evidence shows that early diagnosis and aggressive treatment to put the disease into remission is the best means of avoiding joint destruction, organ damage and disability. Signs and Symptoms The symptoms and course of rheumatoid arthritis vary from person to person and can change on a daily basis. Your joints may feel warm to the touch and you might notice a decreased range of motion, as well as inflammation, swelling and pain in the areas around the affected joints. Rheumatoid arthritis is symmetrical, meaning if a joint on one side of the body is affected; the corresponding joint on the other side of the body is also involved. Because the inflammation is systemic, youre likely to feel fatigued and you may become anemic, lose your appetite and run a low-grade fever. Long-term Effects Rheumatoid arthritis may affect many different joints and cause damage to cartilage, tendons and ligaments it can even wear away the ends of your bones. One common outcome is joint deformity and disability. Some people with RA develop rheumatoid nodules; lumps of tissue that form under the skin, often over bony areas exposed to pressure. These occur most often around the elbows but can be found elsewhere on the body, such as on the fingers, over the spine or on the heels. Over time, the inflammation that characterizes RA can also affect numerous organs and internal systems.

An estimated 1.3 million people in the United States have RA thats almost 1 percent of the nations adult population. There are nearly three times as many women as men with the disease. In women, rheumatoid arthritis most commonly begins between the ages of 30 and 60. It often occurs later in life for men. However, even older teens and people in their 20s can get RA. As many as 300,000 children are diagnosed with a distinct but related form of inflammatory arthritis called juvenile arthritis. The disease occurs in all ethnic groups and in every part of the world. What Causes RA? The cause of rheumatoid arthritis is not yet known. Most scientists agree that a combination of genetic and environmental factors is responsible. Researchers have identified genetic markers that cause a tenfold greater probability of developing rheumatoid arthritis. These genes are associated with the immune system, chronic inflammation or the development and progression of RA. Still, not all

people with these genes develop rheumatoid arthritis and not all people with the disease have these genes. Researchers are also investigating infectious agents, such as bacteria or viruses, which may trigger the disease in someone with a genetic propensity for it. Other suspects include female hormones (70 percent of people with RA are women) and the bodys response to stressful events such as physical or emotional trauma. Smoking may also play a role it not only boosts the risk of developing RA among people with a specific gene, it can also increase the diseases severity and reduce the effectiveness of treatment. Research that deepens our understanding of these genes and other factors that may lead to the development of RA is ongoing.

How Do You Know Its RA? To diagnose rheumatoid arthritis, your physician will take a medical history and perform a physical examination. The doctor will look for certain features of RA, including swelling, warmth and limited motion in joints throughout your body, as well as nodules or lumps under the skin. Your doctor may also ask if you have experienced fatigue or an overall feeling of stiffness. The pattern of joints affected by arthritis can help distinguish rheumatoid arthritis from other conditions. Your physician should recommend certain blood tests to identify antibodies, levels of inflammation and other markers that aid diagnosis and assessments. Hell likely call for X-rays to determine if you have bone loss at the edges of joints called erosions combined with loss of joint cartilage. Although there is no cure for RA, highly effective treatments exist. Once you have adiagnosis, you should begin treatment right away to slow disease progression and lower chances for joint damage. Medications Abound Medications used to treat rheumatoid arthritis can be divided into two groups: those that help relieve symptoms and reduce inflammation (nonsteroidal anti-inflammatory drugs and corticosteroids), and those that can modify the disease or put it in remission (disease-modifying antirheumatic drugs and biologic agents). Your physician may recommend using two or more together. Some medications affect the immune system or have other side effects, making careful monitoring very important. Research on new medications is ongoing, with an influx of new drugs into the pipeline. Lifestyle Changes Can Help Engaging in moderate physical activity on a regular basis helps decrease fatigue, strengthen muscles and bones, increase flexibility and stamina, and improve your general sense of well-being. When your symptoms are under control, work with your health-care team to develop a full exercise program that includes stretching for joint flexibility and range of motion, strength training for joint support and aerobic (cardiovascular) exercise for overall health, weight control, muscle strength and energy level. Overall, eat a balanced, healthy diet. Although scientific studies have not proved that diet changes either cause or relieve symptoms of rheumatoid arthritis, studies do show that a wide variety of

foods, from strawberries to olives to fish, can help reduce RA inflammation, while selenium and vitamin D may have preventative effects. Practice self-management techniques by learning all you can about the disease and knowing what to expect. Discuss it with your family, with your physicians and with other health professionals involved in your care. Contact your local Arthritis Foundation office to find out about educational events and the Life Improvement Series of programs, including aquatic exercise and tai chi.

Years ago, doctors started rheumatoid arthritis treatment with drugs that primarily addressed symptoms, gradually working their way up to DMARDs disease-modifying antirheumatic drugs, a class of medications that address the root causes of immune system malfunction, often at the cellular level. Today, doctors believe theres an early window of opportunity to treat rheumatoid arthritis before the onset of irreparable joint damage. New RA patients are highly likely to begin their treatment regimen with a DMARD. Studies show that taking action quickly may even put the disease into remission. If youre reading this, chances are good youve already been diagnosed with rheumatoid arthritis and are seeing a rheumatologist who will discuss your treatment. In an effort to quickly get people with symptoms of joint inflammation to a rheumatologist, or arthritis specialist, for diagnosis and critical early treatment, the Arthritis Foundation has launched the Inflammatory Arthritis Initiative. If youd like to help researchers in their efforts to find new treatments and ultimately a cure for rheumatoid arthritis, click here for information on enrolling in the Arthritis Foundation supported Arthritis Internet Registry. This is your chance to tell some of the nations leading rheumatologists about your treatments, symptoms and how you manage the disease. Participation in the project, conducted by the National Bank for Rheumatic Diseases, is free and enrollment is secure.