Rheumatoid arthritis

Rheumatism is a term referring to all rheumatic diseases, which include more than 400 different kinds. Rheumatoid Arthritis is the most common under the inflammatory types of rheumatic diseases, where the body literally attacks itself, due to a malfunctioning immune system. The disease inflicts the joints- especially those of hands and feet and causes painful inflammations which can even lead to a disfigurement of the affected joints.

Rheumatoid Arthritis (RA) is a chronic, progressive and disabling auto-immune disease affecting 0.8% people in the UK. Women suffer from rheumatic arthritis three times more often than men. A recent survey showed up that the majority of newly diagnosed women are aged between 55 and 64; men between 65 and 75.

What causes Rheumatoid Arthritis?

The exact cause still lies in the dark despite progresses in research. Researchers assume that genetics may be one of the factors causing rheumatoid arthritis. The risk of being afflicted with the disease increases, when it runs in the family. Infections and allergies are also regarded as triggering arthritis.

The general explanation of rheumatoid arthritis is that the body starts an autoimmune process. This means the immune system produces antibodies against healthy tissue (Autoantibodies). These antibodies attack the synovitis (internal dermis of a joint) and cause an inflammation. The joints slowly degenerate, which ironically boosts another batch of antibodies attacking the same joint.

The reason here fore are misguided immune cells, which move into the joints and produce a high amount of two types of messengers (Cytokines) - Interleukin-1 (IL-1) and the Tumor necrosis factor-alpha (TNF-a). They cause the production of antibodies.

The patient suffers from aching joints that swell up, overheat and redden. The patient might even end up with deformed joints and a loss of their function.

The inflammation then proceeds to the articular cartilage and the bones.

How does the Rheumatoid Arthritis develop?

Before the patient suffers from symptoms that indicate rheumatoid arthritis (cardinal symptoms), he goes through a so called unspecific prophase, symptoms that do not necessarily point to rheumatic arthritis: An overall unwell feeling, loss of appetite, fatigue and/or fever. The length of the prophase is undefined and differs from patient to patient. During this phase the disease is seldom discovered.

Cardinal symptoms follow the prophase. Cardinal symptoms are additional symptoms, which usually lead to the diagnosis of rheumatoid arthritis.

Cardinal symptoms:

• A pronounced stiffness of the finger joints in the morning, which lasts longer than 15min.
• Inflamed joints (especially finger joints) that ache are swollen and red. Typical is a symmetric affection of both hands.
• Painful finger joints in the morning and at night.

Every joint could be afflicted. The number of joints and the order in which they are attacked differs from each case. The general rule however is the prior attacking of small joints (hands and feet) before large joints (shoulder, hip, ...). An exception is the spine, apart from the head-cervical-joint. Rarely internal organs and organ systems are afflicted.

Once several joints succumb to the disease, we speak of chronic polyarthritis.

Common symptoms such as fatigue, lack of stamina, fever, night sweat and eventually weight loss indicate the inflammation of the body.

The disease is unpredictable. Periods exist in which the patient can be totally symptom free. Typical rheumatoid signs are cutaneous rheumatoid nodule in the finger and elbow area (20% of the patients)