By: Yasmeen Charafeddine, Mary Truong-Nguyen, & Ellen Wadler RHEUMATOID ARTHRITIS

General Definition Rheumatoid arthritis is an autoimmune chronic inflammatory disorder The immune system attack’s its own body tissues, in this case, the joints, starting with the small joints in the hands and feet With progression, RA eventually results in joint deformity and bone erosion

Symptoms Of the joints: Tenderness Swelling Lasting stiffness Rheumatoid nodules = firm bumps of tissue under the skin of the arms Occurs in the more aggressively diseased patients Other: Fatigue, fever, weight loss Symptoms come and go and can vary in severity Increased activity period = flare Decreased activity period = relative remission Rheumatoid nodule

Causes The immune system attacks the synovium Synovium = the lining of the membranes surrounding the joints Inflammation thickens the synovium The thickening will eventually invade and destroy the cartilage and bone in a joint The joint is held together with tendons and ligaments which lose elasticity (become weaker and stretch) with the progression of the disease With time, the joint loses shape and alignment, causing the characteristic image of rheumatoid arthritis

What is affected? In the beginning symptoms occur in: Smaller joints attaching fingers to hands and toes to feet With progression symptoms spread to: Knees Ankles Elbows Hips Shoulders

Diagnostic Tests Hard to detect in early stages Signs and symptoms of early stages are similar to other diseases During physical exam, joints will be checked for swelling, redness, and warmth Reflexes and muscle strength are also checked Blood tests Look for elevated erythrocyte sedimentation rate (ESR)  shows presence of inflammatory processes in body Also looks for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies X-rays Used to track the progression of the arthritis

Treatment As of now, there is no cure Various drugs can be used to reduce inflammation, relieve pain, and prevent/slow the joint damage Some have potentially serious side effects, so the ones with fewest side effects are prescribed first Physical therapy can teach the patient how to protect the joints If the damage is already severe, surgery may be necessary

Drugs Nonsteroidal anti-inflammatory drugs (NSAIDs) Relieves pain and reduces inflammation Over the counter = Advil, Motrin, Aleve, etc. Stronger NSAIDs must be prescribed Side effects: stomach irritation, heart problems, liver/kidney damage, ringing in the ears Steroids Corticosteroids = reduce inflammation and pain as well as slow the damage in the joints (ex. Prednisone) Side effects: bone thinning, cataracts, weight gain, diabetes These are very strong and prescribed to relieve acute symptoms; the goal is to eventually taper off the medication

Drugs (cont.) Disease modifying antirheumatic drugs (DMARDs) Slow the progression of RA and can save the joints and other tissues from permanent damage Examples: methotrexate, ieflunomide, hydroxychloroquine, sulfasalazine, minocycline, etc. Side effects: liver damage, bone marrow suppression, severe lung infections Immunosuppressants Tames the immunes system because it is the immune system that is out of control in RA Examples: azathioprine, cyclosporine, cyclophosphamide Side effects: increase the patient’s susceptibility to infections

Drugs (cont.) Tumor necrosis factor (TNF)-alpha inhibitors TNF-alpha is an inflammatory substance naturally produced by the body Inhibitors reduces pain, stiffness, tenderness, and swelling Examples: etanercept, infliximab, adalimumab, golimumab, certolizumab Side effects: increased risk of serious infections, congestive heart failure, certain cancers are more potentially possible Other drugs Target a variety of processes involved with inflammation Examples: anakinra, abatacept, rituximab, tocilizumab Side effects: itching, severe abdominal pain, headache, runny nose, sore throat

Surgery Procedures Total joint replacement = removing the damaged parts of the joint and inserting a metal or plastic prosthesis Tendon repair = tendons can loosen and rupture so the surgeon may be able to repair them Joint fusion = a joint can be surgically fused to stabilize or realign a joint; also for pain relief if replacement is not an option Surgery is a last option when medications have failed to prevent or slow the progression of joint damage

Effects of Writing About Stressful Experiences on Symptom Reduction in Patients With Asthma or Rheumatoid Arthritis Research has demonstrated that writing about emotionally traumatic experiences has beneficial effects in healthy individuals Objective of experiment: To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis After 4 months of treatment, RA patients showed improvements in overall disease activity Addressing patients' psychological needs produces both psychological and physical health benefits ticleid= ticleid=189437

Pre-Stage The Prodromal Stage The early symptoms which indicate the start of the disease before specific symptoms occur Includes pain or stiffness in a single joint Stiffness in a joint and ambiguous aching are symptoms called “fibrositis” Ganglion in the wrist Raynaud's phenomenon = a condition where cold temperatures or strong emotions can cause blood vessels to spasm which block blood flow to the fingers, toes, ears, and nose

Mild Stage Stages of Functional Capacity Stage 1: Can complete normal activities without handicap Stage 2: Normal activities can still be completed but discomfort found at some joints and limited motion in one or more joints

Moderate Stage Moderate to severe symptoms appear six months to a year or more after the early symptoms appear The same body parts affected in the prodromal stage may not be affected in the later stages Severe shoulder stiffness may reappear in the wrist joint Symptoms may disappear but than reappear in more aggressive forms

Severe Stage Stages of Functional Capacity Stage 3: Limited only to self-care and can complete little or none of the usual activities Stage 4: Little to no self-care. Bed ridden or confined to a wheel chair

Prognosis Course of disease varies greatly Some people have mild short-term symptoms while for others it is progressive for life Daily living activities are impaired in most individuals After 5 years of disease, approximately 33% of suffers will not be working After 10 years, approximately half will have substantial functional disability Mortality: RA reduces lifespan by 5-10 years

Relationship to other problems: RA can increase risk of developing: Osteoporosis RA medication can trigger significant bone loss Pain and loss of join function caused by RA can result in inactivity which increases osteoporosis risk Carpal tunnel syndrome If RA affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers. Heart problems RA can increase risk of hardened and blocked arteries and inflammation of the sac that encloses your heart Lung disease RA can increase inflammation and scarring of lung tissue These complications can lead to death in the severe cases

Random extra facts: Rheumatoid arthritis occurs with the same frequency in both sexes However remission is more common in men The chronic form is more common in women It occurs in 1-2% of males and 2-5% of females The joints most likely affected are metacarpophalangeals, wrists, proximal interphalangeals, knees, ankles, metatarsophalangeals, and shoulders It most commonly begins between the ages of 40 and 60 Smoking increases the risk of developing the disease Having family members with the disease increases the risk of developing the disease The onset of rheumatoid primarily occurs in the winter

Osteoarthritis versus RA Osteoarthritis is a common form of arthritis involves the wearing away of the cartilage that caps the bones in joints Rheumatoid arthritis is when the synovial membrane that protects and lubricates joints becomes inflamed, causing pain and swelling.

Works Cited Jacoby, R. K., M. I. Jayson, and J. Alan Cosh. "Onset, Early Stages, and Prognosis of Rheumatoid Arthritis: A Clinical Study of 100 Patients with 11- year Follow-up." British Medical Journal (1973): Web. Smyth JM, Stone AA, Hurewitz A, Kaell A. Effects of Writing About Stressful Experiences on Symptom Reduction in Patients With Asthma or Rheumatoid Arthritis: A Randomized Trial. JAMA. 1999;281(14): doi: /jama Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 02 Nov Web. 20 Nov "Raynaud's Phenomenon." PubMed Health. U.S. National Library of Medicine, 28 June Web. 20 Nov "Rheumatoid Arthritis Prognosis." Rheumatoid Arthritis Prognosis. N.p., n.d. Web. 20 Nov "WebMD Rheumatoid Arthritis Guide - Better Information for Better Health." WebMD. WebMD, n.d. Web. 20 Nov