Rheumatoid Arthritis Pictures Slideshow (cont.)
When the disease is active, symptoms can include fatigue, lack of appetite, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. Arthritis is common during disease flares. Also during flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).
What Are the Symptoms of Rheumatoid Arthritis? (cont.)
In rheumatoid arthritis, multiple joints are usually inflamed in a symmetrical pattern (both sides of the body affected). The small joints of both the hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars can become difficult during flares. The small joints of the feet are also commonly involved. Chronic inflammation can cause damage to body tissues, cartilage, and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, destruction, and loss of function.
Rheumatoid Arthritis and Inflammation of Organs
Since rheumatoid arthritis is a systemic disease, its inflammation can affect organs and areas of the body other than the joints. Examples of other areas that may be affected include the following:
- Sjögren's syndrome is the result of inflammation of the glands of the eyes and mouth and causes dryness of these areas.
- Rheumatoid inflammation of the lung lining (pleuritis) causes chest pain with deep breathing or coughing.
- Tissue inflammation surrounding the heart, called pericarditis, can cause chest pain that typically changes in intensity when lying down or leaning forward.
- Rheumatoid disease can reduce the number of red blood cells (anemia) and white blood cells.
- Decreased white cells can be associated with an enlarged spleen (Felty's syndrome) and can increase the risk of infections.
- Firm lumps under the skin (rheumatoid nodules) can occur around the elbows and fingers where there is frequent pressure.
- A rare and serious complication is blood-vessel inflammation (vasculitis). Vasculitis can impair blood supply to tissues and lead to tissue death. This is most often initially visible as tiny black areas around the nail beds or as leg ulcers.
Who is a rheumatologist?
A rheumatologist is a medical doctor who specializes in the nonsurgical treatment of rheumatic illnesses, especially arthritis. Rheumatologists have special interests in unexplained rash, fever, arthritis, anemia, weakness, weight loss, fatigue, joint or muscle pain, autoimmune disease, and anorexia. They often serve as consultants, acting like detectives for other doctors. Rheumatologists have particular skills in the evaluation of the over 100 forms of arthritis and have special interest in rheumatoid arthritis, spondylitis, psoriatic arthritis, systemic lupus erythematosus, antiphospholipid syndrome, Still disease, dermatomyositis, Sjogren's syndrome, vasculitis, scleroderma, mixed connective tissue disease, sarcoidosis, Lyme disease, osteomyelitis, osteoarthritis, back pain, gout, pseudogout, relapsing polychondritis, Henoch-Schonlein purpura, serum sickness, reactive arthritis, Kawasaki disease, fibromyalgia, erythromelalgia, Raynaud's disease, growing pains, iritis, osteoporosis, reflex sympathetic dystrophy, and others.
How Is Rheumatoid Arthritis Diagnosed?
The first step in the diagnosis of rheumatoid arthritis is a meeting between the doctor and patient. A doctor with special training in arthritis and related diseases is called a rheumatologist. The doctor reviews the history of symptoms, examines the joints for inflammation and deformity, the skin for rheumatoid nodules, and other parts of the body for inflammation. Certain blood and X-ray tests are often obtained. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and the blood and X-ray findings. Several visits may be necessary before the doctor can be certain of the diagnosis. The distribution of joint inflammation is important to the doctor in making a diagnosis. In rheumatoid arthritis, the small joints of the hands, wrists, feet, and knees are typically inflamed in a symmetrical distribution (affecting both sides of the body). When only one or two joints are inflamed, the diagnosis of rheumatoid arthritis becomes more difficult. The doctor may then perform other tests which 'are described on the next slides.
RA Diagnostic Test: Citrulline Antibody Test
Abnormal blood antibodies can be found in patients with rheumatoid arthritis. A blood antibody called "rheumatoid factor" can be found in 80% of patients. Citrulline antibody is present in most patients with rheumatoid arthritis. It is useful in the diagnosis of rheumatoid arthritis when evaluating patients with unexplained joint inflammation. A test for citrulline antibodies is most helpful in detecting the cause of previously undiagnosed inflammatory arthritis when the traditional blood test for rheumatoid arthritis, rheumatoid factor, is not present. Citrulline antibodies are also indicators of potentially more aggressive disease. Citrulline antibodies have been felt to represent the earlier stages of rheumatoid arthritis in this setting. Another antibody called "the antinuclear antibody" (ANA) is also frequently found in patients with rheumatoid arthritis.
RA Diagnostic Test: Sedimentation Rate (Sed Rate)