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Rheumatoid arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis is a disease of the joints, usually the smaller joints of the body. Many people believe wrongly that this is always a disabling, severe condition. In fact, it may be mild and can be well controlled using modern medicine. It is not infectious. There is no cure for this condition, but all patients can be treated.

What causes rheumatoid arthritis?

No one is able to say what triggers rheumatoid arthritis. What we do know is that the body's immune system begins to attack the delicate lining of certain joints, and so this disease is called an autoimmune disease. This tissue becomes swollen, hot and painful, making the joint stiff and hard to move.

What are the symptoms?

The symptoms will vary a great deal from person to person, as well as from day to day. However, some of the common symptoms include:

stiffness and tenderness of the small joints, especially of the wrist, hands and feet (the base of the fingers, thumbs or toes can be affected; less commonly it can affect the larger joints such as the knee, shoulder, ankle and neck)

tiredness, which may be due to anaemia (low red blood cell count) or to the immune reaction (inflammation) at many joints

morning stiffness

In summary, the main symptoms are pain, stiffness and swelling of the small joints.

How is it diagnosed?

After being suspected b the doctor upon examination, rheumatoid arthritis can usually be diagnosed by tests, including X-rays of the hands and special blood tests.

How common is the problem?

About 2 persons in 100 suffer to some extent from rheumatoid arthritis. It is more common in females. Most sufferers are between 40 and 60 years of age, but the disease can affect people in any age group. However, the majority of patients have little or no long-term problems and only 1 patient in 10 is severely affected.

What are the risks?

In severe cases the swollen and deformed joints may become partly or completely dislocated, causing considerable discomfort and problems with walking if the knee or foot joints are affected. The tendons may become so weak that they can snap. A special problem is the neck, which can become unstable so that manipulative procedures can be dangerous and cause paralysis. If severe, the disease may affect the blood vessels, the heart, the lungs and the nerves.

What is the treatment?

Exercise: It is important to keep fit. Walking and swimming are to be encouraged. Many local councils and physiotherapists offer swimming and other forms of hydrotherapy in heated pools. Home exercise routines to prevent muscle weakening can be provided by your doctor or a physiotherapist.

Rest: Rest is important and depends on how you feel. It must be sensibly balanced with exercise. If an exercise causes pain, it should be altered or reduced.

Joint movement: Each joint affected should be put through a daily full range of motion to keep it mobile and to reduce stiffness. Protect any weakened joints or tendons by lifting gently and smoothly rather than in a jerking motion.

Heat and cold: For stiff joints a hot-water bottle, warm water or a heat lamp can help. For morning stiffness an electric blanket or a warm shower can be helpful. Sometimes cold packs or water are appropriate, for example over a hot, tender joint.

Diet: There is no special diet. No specific food has caused arthritis and no specific diet will cure it. However, a nourishing and well-balanced diet including adequate fibre will promote health and a sense of well-being. Maintain a normal weight to lessen the burden on your joints.

Medication: There are many effective pain-killing and anti-inflammatory drugs available to treat rheumatoid arthritis. The basic drug is likely to be aspirin in high doses, but it can cause ringing in the ears and other unpleasant effects. Your doctor may have to experiment for a time before finding the best possible pain-killing and anti-inflammatory drugs for you.

Surgery: Occasionally surgery may help if a particular joint is severely inflamed by removing the inflamed lining called the synovium. In later stages it may be possible to replace a badly damaged joint with an artificial joint.

What about natural remedies?

Rheumatoid arthritis is a condition that has its ups and downs, and some practitioners are willing to take advantage of this when claiming amazing cures. Check with your doctor before using expensive 'natural' remedies. Excellent leaflets and practical help are available from the Arthritis Foundation in each capital city. These include information about and access to a wide range of inexpensive equipment and tools that can assist your daily living.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia