Rheumatoid arthritis is a systemic and chronic condition that mainly attacks the peripheral joints and surrounding muscles, tendons, ligaments, and blood vessels. This symmetrical inflammatory disease is marked by spontaneous remissions and unpredictable exacerbations, with further potentially crippling outcomes.
Pathophysiology
The cartilage damage that results from inflammation triggers further immune responses, which can include complement activation. The complement in turn attracts polymorphonuclear leukocytes that cause inflammatory mediators to be released causing further joint destruction.
Causes and Chances of Occurrence
The causes of rheumatoid arthritis are unknown but are believed to be possibly influenced by infection from either a viral or a bacterial source, hormonal factors, and lifestyle factors. This disease can strike almost anyone but is three times as likely to strike females as it is males, and is typically more common in people between the ages of 35 and 40.
Characteristics and Complications
The most common characteristic of rheumatoid arthritis is stiff and swollen joints. From this there are a number of complications that can occur they include:
- * Osteoperosis
- * Fibrous or bony ankylosis
- * Soft-tissue contractures
- * Joint deformities
- * Sjӧrgen’s syndrome
- * Recurrent infections
- * Hip joint necrosis
- * Spinal cord compression
- * Carpal tunnel syndrome
Assessment and Symptoms
The symptoms of rheumatoid arthritis start out as the onset of nonspecific symptoms possibly including fatigue, anorexia, malaise, persistent low grade fevers, weight loss, and vague articular symptoms. Later as the disease progresses more specific localized articular symptoms will begin to develop particularly in the fingertips.
Bilateral and symmetrical symptoms, will develop soon after they have developed in the fingertips showing up in the wrists, elbows, knees, and ankles. Some other symptoms may follow including:
- * Stiff joints
- * Stiff, weak, or painful muscles
- * Numbness or tingling in the feet
- * Weakness
- * A loss of sensation in the fingers
Treatment
Treatment for rheumatoid arthritis can be broken down into three groups general, medicines, and surgeries.
General
- * 8 to 10 hours of sleep a night
- * Splinting
- * ROM (range-of-motion) exercises
- * Moist heat application
- * Frequent rest between activities
Medicinal
- * Rituximab
- * Abatacept
- * Interleukin – 1 receptor antagonist like anakinra
- * Tumor necrosis factor blockers
- * Salicylates
- * Nonsteroidal anti-inflammatory drugs
- * Gold salts
- * Corticosteroids
- * Cox-2 inhibitors
- * DMARDS (disease-modifying antirheumatic drugs)
- * Immunosuppressants
Surgeries
- * Metatarsal head and distal ulnar resectional arthroplasty
- * Arthrodesis or joint fusion
- * Synovectomy
- * Osteotomy
- * Repair of ruptured tendon
- * For advanced cases joint reconstruction, or total joint arthroplasty