Rheumatoid Arthritis

Introduction:

Rheumatoid arthritis(RA) is the most common connective tissue disorder. It was in the past responsible for most of the chronic crippling images, but even now with all of the newer treatments it remains an important cause of disability and cause of premature death.

In severe cases life expectancy is reduced by 4 years for men and by 10 years for women (Ref. 1). The rate of occurrence of RA in Western countries is about 2% of the population. At a younger age women are affected more often than men with a frequency of 3:1. However, in elderly people the ratio between male and female is equal.

There seems to be a genetic predisposition: people with the surface membrane antigen type HLA-DR4 in Caucasians are significantly more prone to develop this disease. This leads to a modification of the immune system, which starts producing antibodies directed against synovial membranes of small joints. The most severe cases involve small joints and large, weight bearing joints that are affected in a crippling manner (Ref. 2). For rapid diagnosis the rheumatoid factor can be readily obtained through a simple blood test, which will be discussed further under "diagnostic tests for rheumatoid arthritis". The multitude of treatment approaches can be found under the "treatment of rheumatoid arthritis" link above.

Summary

Rheumatoid arthritis is a common generalized polyarthritis. It is an autoimmune disease, where the synovial membrane gets chronically inflammed and eventually the ligaments and the cartilage get destroyed resulting in joint stiffness, severe disability and premature death. Present research is concentrating on more specific drugs, which would inhibit the autoimmune response without inhibiting normal immune functions. Genetic approaches to solve the puzzle of this disease are also sought.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 10.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 50.

3. J O'Dell  J Rheumatol Suppl 2001 Jun;62:21-26.

4. ET Koh  Ann Acad Med Singapore 2001 Mar;30(2):170-173.

5. AJ Ostor et al. Aust Fam Physician 2001 Apr;30(4):314-320.

6. C Richard-Miceli et al. BioDrugs 2001;15(4):251-259.

7. B. Sears: "The age-free zone".Regan Books, Harper Collins, 2000.

8. B. Sears: "Zone perfect meals in minutes". Regan Books, Harper Collins, 1997.

Last Modified: March 21, 2012