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Rheumatoid Arthritis - The aches and pains of a joint disease |
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Written by Lev Prasov
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Apr 08, 2006 at 02:54 PM |
Rheumatoid Arthritis (RA) is an autoimmune disease that affects the joints. It can lead to joint pain, swelling, and eventually deformity through chronic inflammation. Many new treatments have been developed for RA.
Many of us have suffered joint pain at one time or another, perhaps from a long game of basketball or a heavy workout. Now, imagine that you always wake up with pain and stiffness your joints and eventually you lose some of the function in your arms and legs due to the stiffness and chronic inflammation. This is the plight of millions of patients with rheumatoid arthritis (~1 % of the population).
Figure I: The effects of Rheumatoid Arthritis on joints. (Image courtesy of the National Institute of Health )
Rheumatoid arthritis (RA) is an autoimmune disease that primarily targets the joints. As in many autoimmune diseases, the exact cause is unknown. However, something seems to trigger an immune response against the joints. T cells recognize these substances (possibly viral peptides or peptides specifically expressed in the joint) and stimulate inflammatory cells to attack the synovium (lining) of the joint (Figure I). This response is the same as the one that causes a bump or cut to be swollen, red, warm, and painful.
In addition to causing pain, swelling, and stiffness, this reoccuring inflammation can lead to scarring and thickening of the lining of the joint. In turn, this can cause limited mobility at the affected joints. In later stages, the inflamed cells can release enzymes that will eat away the surrounding bone and cartilage, further decreasing the mobility of the joints and also causing permanent deformities, especially in the hands and feet. There are several hand deformities that are often associated with rheumatoid arthritis. First, the wrist is often not in line with the forearm, but instead rotated outwardly from the body (ulnar deviation). Also, Boutonniere or Swan neck deformities are commonly observed.
While the joint pain, swelling, and eventual deformity cause patients enough problems, rheumatoid arthritis can also affect other organ systems. Many patients suffer from anemia (low amounts of oxygen-carrying red blood cells), either directly from the disease or as a result of some of the treatments. Scarring of the lungs may result from long-standing RA. Additionally, patients with RA have an increased risk of pericarditis, inflammation of the sac that holds the heart. This can lead to chest pain and accumulation of fluid in the sac, putting a potentially deadly strain on the heart. Protein aggregates that form as a result of chronic inflammation can lead to clogging of the kidneys in a condition known as amyloidosis.
Although there is no cure for RA, there are many available treatments, from ones that help with join pain stiffness to others that curb the progression of the disease. Analgesics, such as Tylenol or the more powerful opiates (morphine, codeine, etc.), can be used to help with the joint pain. More commonly, non-steroidal anti-inflammatory agents, such as aspirin and Ibuprofin, are prescribed to help prevent the pain and swelling of the joints. These drugs work by inhibiting cyclooxygenase, a key enzyme in the synthesis of prostoglandins, which are themselves powerful mediators of inflammation. Steroids, namely the glucocorticoids, can also be used to suppress the immune response. Other drugs, such as TNF-a inhibitors, IL-1 blockers, and methotrexate, stop the immune reaction at an earlier step in the cascade by blocking the activation of T-cells or the mediators that they send out to activate other cells. In addition to these mainstream treatments, there are numerous alternative therapies that have been tried for treating RA, including acupuncture, cod liver oil, and various other supplements. All of these treatments may help stop the progression of the disease and the pain, swelling, and stiffness associated with it. However, in the long-term, patients may still lose mobility, suffer from chronic pain, and suffer other complications. Thus, while we have come far in treating this disease, the cure is still not in sight.
For more information on Rheumatoid Arthritis, check out the following resources:
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