Rheumatoid arthritis is a chronic autoimmune disease in which the immune system attacks the synovial tissue, the membrane that lines the joints. It is the second most common form of arthritis and usually appears between ages 20 and 40. Although the cause of rheumatoid arthritis is unknown, there is a genetic component: if a close relative is affected, you are more likely to develop the disease. There is no known cure.
In rheumatoid arthritis, the fluid that lubricates the joints contains irritating chemicals that attack and damage the surfaces of the joints. The inflamed membrane swells and thickens, causing a wearing away of the joint cartilage, which leads to erosion of the bone and weakening of supporting tendons, ligaments, and muscles. The small joints in the hands, wrists, feet, ankles, and neck are most frequently affected, but the hips and the knees also can be affected. In most cases, more than one joint is affected and usually the same joints are affected on both sides, such as both hands.
Rheumatoid arthritis alternates between periods during which symptoms are present and periods with no symptoms. These periods can vary in length. When the disease is active, it causes redness, warmth, swelling, tenderness, pain, and stiffness in the affected joints. The severity of symptoms can vary from person to person. The joint damage resulting from the disease is not reversible; in advanced cases, the joints can become deformed.
A diagnosis of rheumatoid arthritis is based on the symptoms and an examination of the joints. The doctor also can use X rays to detect damage—such as erosion of cartilage and bone—in the affected joints. A blood test also may be performed to check for a specific protein (an antibody called rheumatoid factor) that is present in most people who have rheumatoid arthritis.
Treatment of rheumatoid arthritis is similar to the treatment of osteoarthritis (see previous page). If treatment with nonsteroidal anti-inflammatory drugs is not effective, the doctor may prescribe other medications, including gold compounds such as auranofin and aurothioglucose, and oral corticosteroids such as prednisolone and triamcinolone. The doctor also may prescribe antirheumatic drugs such as hydroxychloroquine and penicillamine. In severe cases, medications such as azathioprine, cyclophosphamide, cyclosporine, and methotrexate sometimes are prescribed to suppress the inappropriate immune response.
For most people with rheumatoid arthritis, regular exercise can help maintain flexibility and strength in the joints. Your doctor can recommend suitable exercises and also may recommend that you work with a physical therapist to maintain or restore movement in your joints. For some people, surgery to remove the affected joint lining (a procedure called synovectomy) may provide relief. For severely damaged joints, a total joint replacement (see following page) can reduce pain and restore movement, allowing a person to return to an active life.
Bones and Joints
Joint Replacement Because of engineering and medical advances, surgeons can now replace certain joints and restore their normal function. Joint replacement (called arthroplasty) has been used on the ankles, hands, wrists, and toes, but it is most often performed on the knee and the hip. With total joint replacement, the bone ends and cartilage are replaced with metal and plastic joint components. The metal component is inserted into the canal inside each long bone involved, while the plastic part covers or receives the metal "bone ends" as a cartilagelike cushion, where bone meets bone. The joint components are usually attached to the bone tissue with an acrylic cement.
In hip replacement surgery, the end of the femur is replaced with a metal ball, and a plastic cup is cemented into the pelvis where the acetabulum (pelvic socket) would normally receive the end of the femur. In many patients, particularly younger ones, the plastic cup is not cemented into place to give time (with limited activity) for the natural bone to grow and attach to it. In the knee, damaged bone ends are replaced with metal ends covered with plastic that can permit the same range of motion as a normal knee joint.
Joint replacement surgery lasts approximately 2 to 4 hours and requires a lengthy, structured recuperation period. The amount of recovery time required in the hospital depends on the nature of the surgery, your overall health, and whether you have any complications (such as infection, joint dislocation, or blood clots). You may be walking with support within a day of surgery, and you will start physical therapy immediately. You will probably be hospitalized for about a week, although full recovery can take up to 6 months. It is vital to maintain an appropriate exercise and stretching program after the surgery to keep your new joint in good working order. Although replacement joints usually last at least 20 years, younger and more active patients may need to undergo revision surgery (surgery to repair or replace the artificial joint). Joint replacement surgery has an excellent success rate.
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