What Is Rheumatoid Arthritis
Rheumatoid arthritis is a chronic form of arthritis that causes stiffness, pain, and loss of mobility in the joints. Unlike more common forms of arthritis caused by wear and tear on the joints over time, RA is a type of autoimmune disorder.
In RA, the immune system attacks otherwise healthy joint tissue, causing inflammation and degeneration of the joints. Over time, cartilage, bone, and ligaments of a persons joint can wear away and can cause the joint to become bent, twisted, or scarred.
Rheumatoid arthritis usually occurs in a symmetrical way. For example, if one wrist is affected, the other wrist is likely affected as well. Although RA most often affects the wrists and fingers, it can also impact other joints, including the elbows, neck, shoulders, hips, knees, and feet. RA may also cause other health conditions of the blood vessels, heart, lungs, nerves, eyes, and skin.
Although the cause of rheumatoid arthritis is unknown, researchers believe that this condition may develop when a person with an increased risk for RA is exposed to factors in their environment that trigger inflammation. Increasing age, female sex, and genetics increase a persons risk for RA, while environmental triggers that can lead to inflammation and RA include certain bacterial infections, cigarette smoking, and stress.
How Does A Normal Joint Work
A joint is where two bones meet. Most of our joints are designed to allow the bones to move in certain directions and within certain limits.
For example, the knee is the largest joint in the body and one of the most complicated. It must be strong enough to take our weight and must lock into position, so we can stand upright.
It also has to act as a hinge, so we can walk, and needs to twist and turn when we run or play sports.
The end of each bone is covered with cartilage that has a very smooth, slippery surface. The cartilage allows the ends of the bones to move against each other, almost without rubbing.
The joint is held in place by the synovium, which contains thick fluid to protect the bones and joint.
The synovium has a tough outer layer that holds the joint in place and stops the bones moving too far.
Strong cords called tendons anchor the muscles to the bones.
Testing For Rheumatoid Arthritis
Understand the lab and imaging tests used to diagnose and monitor disease activity in RA.
Diagnosing rheumatoid arthritis can take time. Like other forms of arthritis, a diagnosis is based largely on the findings from a medical exam and your symptoms. These may include joint pain, tenderness and swelling that affects the same joint or joints on both sides of your body fatigue and fever. Lab tests and imaging tests can help your doctor make the diagnosis.
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What Conditions May Be Confused With Ra
People with this condition often feel pain all over, in all their muscles and joints, and have multiple tender points when examined. They will also often have a degree of early morning stiffness. Poor unrestorative sleep is often present, with associated fatigue and low mood, and often there are associated symptoms of headaches and irritable bowels and bladder. Investigations tend to be normal. It is important to distinguish this condition from rheumatoid arthritis as their management is very different, although sometimes both conditions are present.
This condition causes pain and stiffness of the shoulders and thighs and tends to occur in people over 65 years of age. It is more common in females. Sometimes elderly people with RA present with similar symptoms. PMR is treated by a course of steroid tablets where the dosage is gradually reduced over months and can generally be stopped after about 18 months 2 years. In people with RA presenting with PMR type symptoms, the correct diagnosis of RA usually becomes apparent when the patient is unable to reduce the steroid dosage below 10mg.
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Living With Rheumatoid Arthritis
Research shows that people who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life.
Self-care can help you play a role in managing your RA and improving your health. You can:
- Learn about rheumatoid arthritis and its treatments.
- Use exercises and relaxation techniques to reduce your pain and help you stay active.
- Communicate well with your health care team so you can have more control over your disease.
- Reach out for support to help cope with the physical emotional, and mental effects of rheumatoid arthritis.
Participating in your care can help build confidence in your ability to perform day-to-day activities, allowing you to lead a full, active, and independent life.
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Who Treats Rheumatoid Arthritis
Diagnosing and treating rheumatoid arthritis requires a team effort involving you and several types of health care professionals. These may include:
- Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.
- Primary care providers, such as internists, who specialize in the diagnosis and medical treatment of adults.
- Orthopaedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries.
- Physical therapists, who help to improve joint function.
- Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
- Dietitians, who teach ways to eat a good diet to improve health and maintain a healthy weight.
- Nurse educators, who specialize in helping people understand their overall condition and set up their treatment plans.
- Mental health professionals, who help people cope with difficulties.
What Imaging Techniques May Be Used To Diagnose Arthritis
Imaging techniques may give your healthcare provider a clearer picture of what is happening to your joint. Imaging techniques may include the following:
X-ray. X-rays may show joint changes and bone damage found in some types of arthritis. Other imaging tests may also be done.
Ultrasound. Ultrasound uses sound waves to see the quality of synovial tissue, tendons, ligaments, and bones.
Magnetic resonance imaging . MRI images are more detailed than X-rays. They may show damage to joints, including muscles, ligaments, and cartilage.
Arthroscopy. This procedure uses a thin tube containing a light and camera to look inside the joint. The arthroscope is inserted into the joint through a small incision. Images of the inside of the joint are projected onto a screen. It is used to evaluate any degenerative and/or arthritic changes in the joint to detect bone diseases and tumors to determine the cause of bone pain and inflammation, and to treat certain conditions.
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Erythrocyte Sedimentation Rate Test
An erythrocyte sedimentation rate test evaluates how much inflammation is present in your body. The test measures how quickly your red blood cells, called erythrocytes, separate from your other blood cells in a lab when they are treated with a substance that prevents clotting.
Red blood cells clump together when theres inflammation in your body, making them separate from your other blood cells much faster. Low ESR levels indicate low levels of inflammation while high ESR results indicate high levels of inflammation.
Doctors use this test to diagnose rheumatoid arthritis because this condition causes inflammation throughout your body. An ESR test on its own, however, is not enough to diagnose rheumatoid arthritis.
Inflammation and a rise in ESR levels can be caused by other chronic conditions, and by infections or injuries. However, your ESR rate can help point doctors in the right direction. For example, very elevated ESR levels would likely indicate an infection and not rheumatoid arthritis.
How Likely Is Rheumatoid Arthritis To Affect Your Knees
As a major joint in your body, it is quite likely that, once diagnosed with RA, you will develop rheumatoid arthritis in the knee at some point. It isnt usually the first joint to be attacked that is normally taken by your hands or feet. However, given the significance to you of your knees for your overall mobility, looking after them is no less important.
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The Role Of Rheumatoid Arthritis Testing
Rheumatoid arthritis testing is used to diagnose RA, evaluate the severity of a patients disease, monitor treatment, and detect potential side effects of treatment drugs:
- Diagnosis: Diagnostic testing helps determine the cause of a patients symptoms. If a doctor is concerned that a patients symptoms may be related to rheumatoid arthritis, testing can assist in diagnosing RA and ruling out other health conditions.
- Evaluating severity: The results of several laboratory tests can inform doctors about the severity of a patients RA, the amount of joint damage, and the prognosis or expected course of the disease.
- Treatment monitoring: Monitoring patients diagnosed with RA involves regular medical care, including doctors visits, laboratory testing, and imaging tests. Combining these strategies can assist doctors in tracking the progression of RA and understanding if treatment is effective.
- Detecting side effects: Testing may also be used to detect side effects caused by treatment drugs, as well as other health conditions that are more common in patients with rheumatoid arthritis, including osteoporosis, heart disease, and diabetes.
Has Monthly Blood Monitoring But It Is Difficult To Get A Sample She Likes To Know And
Most people understood what the blood tests were for: to ensure the liver and kidneys were functioning properly to check the red blood cell/haemoglobin levels to test for anaemia to ensure there werent excessive white blood cells and to measure the Erythrocyte Sedimentation Rate and C-reactive protein which indicate the level of inflammation and disease activity. Several people commented that the ESR value reflected how they felt.If results were abnormal, patients were notified promptly and asked to stop taking the particular medication likely to be causing the problem and have further tests. Two people were found to have anaemia and were prescribed iron tablets. People had record charts of their blood results and were responsible for taking them to both the GP and rheumatologist as part of Shared Care arrangements.
Occasionally, people may need further investigations if problems occur such as abnormal blood results, bleeding or if an ulcer is suspected. An endoscopy may be performed a small camera on a long tube is passed down the gullet into the stomach , or similarly colonoscopy, where a camera is passed on a tube though the rectum into the bowel. These can identify problems with the digestive system. Three people had experienced one or both of these procedures. Two were reassured that there were no significant problems, but in one man bacteria were found which were causing his stomach problems.
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Diagnosis Of Rheumatoid Arthritis
- Ordering laboratory tests.
- Ordering imaging studies, such as x-rays or ultrasound.
It can be difficult to diagnose rheumatoid arthritis when it is in the early stages because:
- The disease develops over time, and only a few symptoms may be present in the early stages.
- There is no single test for the disease.
- Symptoms differ from person to person.
- Symptoms can be similar to those of other types of arthritis and joint conditions.
As a result, doctors use a variety of tools to diagnose the disease and to rule out other conditions.
What Happens If Ra Is Left Untreated
RA is a systemic inflammatory disease, which can affect various organs throughout the body. That is why timely and effective treatment is crucial for better long-term outcomes. If an RA diagnosis is missed or if RA is left untreated, chronic inflammation can lead to long-term disability and organ damage.
What Is The Difference
Rheumatoid arthritis vs. osteoarthritis
Rheumatoid arthritis and osteoarthritis are both common causes of pain and stiffness in joints. But they have different causes. In osteoarthritis, inflammation and injury break down your cartilage over time. In rheumatoid arthritis, your immune system attacks the lining of your joints.
Rheumatoid arthritis vs. gout
Rheumatoid arthritis and gout are both painful types of arthritis. Gout symptoms include intense pain, redness, stiffness, swelling and warmth in your big toe or other joints. In gout, uric acid crystals cause inflammation. In rheumatoid arthritis, its your immune system that causes joint damage.
Then Theyll Run More Tests
Doctors will also likely measure your overall level of inflammation using two common tests: C-reactive protein and the erythrocyte sedimentation rate . Not everyone with rheumatoid arthritis has elevated levels, but when the numbers are high, the findings can help confirm the diagnosis. If a patient has elevated ESR and/or CRP levels, it would imply they have an inflammatory kind of arthritis, versus osteoarthritis, Dr. Cohen says. Your doctor may continue to use these tests to monitor your disease and inflammation levels over time.
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The 2010 Acr/eular Classification Criteria Guidelines
Sometimes people who have been diagnosed with RA take part in studies or clinical trials perhaps to try a promising drug or study ways to improve quality of life.
To identify RA patients with typical features of RA who are suitable for these important studies, scientists use a set of guidelines created by the American College of Rheumatology and the European League Against Rheumatism. These are called the 2010 ACR/EULAR classification criteria.
For classification purposes to be considered for enrollment into studies, patients must first have at least one inflamed joint that cant be explained by another condition. Then theyre evaluated for classification based on the following:
- Joint involvement. Which joints are swollen? How many are affected? Are they large or small?
- Serology test results. What are the results of RF and/or ACPA tests?
- Acute-phase reactant test results. Are the results of CRP and/or ESR tests normal or abnormal?
- Duration of symptoms. Have symptoms been around more or less than six weeks?
Others who may be eligible for studies include long-time RA patients whose past symptoms fulfill the criteria, those with joint damage very characteristic of RA, and those with new RA who are receiving treatment.
What Will My Results Tell Me
The rheumatoid arthritis at-home test can tell you if you have elevated biomarkers that might indicate a high likelihood of rheumatoid arthritis. You can use your results report to engage with your primary care physician or a rheumatologist for further diagnostics and treatment if necessary. Read more about RA blood testing.
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Expert Q& A: How Often Do I Need Blood Tests With Methotrexate
Learn why frequent blood tests are necessary when taking methotrexate.
Question: I have been taking 15 mg of methotrexate weekly for the past seven years. I have had blood work done at least every other month during that time however, my doctor wants me to have blood tests every month. Since none of my past blood tests have shown any problems, I am wondering why I need to have these tests so often. Wouldnt every few months suffice?
Answer: No, I wouldnt recommend having those tests any less frequently than your doctor recommends. In general, patients taking methotrexate should have the tests monthly. Just because you havent had any problems for the past seven years doesnt mean you cant develop problems at any time in the future.
Methotrexate can cause liver or kidney problems. Frequent blood tests may detect subtle abnormalities that could alert your doctor to modify your methotrexate dose before a serious problem occurs. If you still have concerns about the frequency of your lab tests, I would recommend bringing up the subject with your doctor at your next appointment. In the meantime, I know its a hassle to have the tests monthly, but in doing so, you may save yourself serious problems down the road.
Bernard Rubin, DO
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Other Causes Of Hand And Finger Symptoms
RA hand symptoms can mimic those of other conditions, such as osteoarthritis. Some members of myRAteam discovered their hand pain was actually related to secondary Raynauds disease, a vascular condition that affects 10 percent to 20 percent of people with RA. Psoriatic arthritis, another autoimmune disease, can also cause hand and finger dysfunction as can pinched nerves in the neck.
A rheumatologist can diagnose the specific cause of symptoms in the hand with a physical exam and X-rays. X-rays can detect narrowing of joint space or erosions of the bone that could signal RA. Ultrasound and MRI technology has improved the ability to spot joint damage earlier in the course of the disease.
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What Types Of Lifestyle Changes Can Help With Rheumatoid Arthritis
Having a lifelong illness like rheumatoid arthritis may make you feel like you dont have much control over your quality of life. While there are aspects of RA that you cant control, there are things you can do to help you feel the best that you can.
Such lifestyle changes include:
When your joints are inflamed, the risk of injury to your joints and nearby soft tissue structures is high. This is why you need to rest your inflamed joints. But its still important for you to exercise. Maintaining a good range of motion in your joints and good fitness overall are important in coping with RA.
Pain and stiffness can slow you down. Some people with rheumatoid arthritis become inactive. But inactivity can lead to a loss of joint motion and loss of muscle strength. These, in turn, decrease joint stability and increase pain and fatigue.
Regular exercise can help prevent and reverse these effects. You might want to start by seeing a physical or occupational therapist for advice about how to exercise safely. Beneficial workouts include:
- Range-of-motion exercises to preserve and restore joint motion.
- Exercises to increase strength.
- Exercises to increase endurance .