Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic disease, involving various joints in the body, characterized by inflammation leading to joint pain, swelling and stiffness. Progressive untreated disease can lead to joint damage loss of function.

Inflammation in the joint due to abnormal immune system function produces destructive molecules leading to cartilage damage, narrowing of the joint space and eventually damage to the bone. This inflammatory process not only affects cartilage and bones but can also harm organs in other parts of the body.

Symptoms

Morning Stiffness in the Joints

The hallmark symptom of rheumatoid arthritis is morning stiffness that lasts for at least an hour. (Stiffness from osteoarthritis, for instance, usually resolves within half an hour.) This same stiffness can occur with prolonged inactivity. These symptoms usually improve with movement.

Swelling and Pain

Swelling and pain in the joints must occur for at least six weeks before a diagnosis of rheumatoid arthritis is considered. The inflamed joints are usually swollen and often feel warm and “boggy” when touched. The pain often occurs symmetrically but may be more severe on one side of the body, depending on which hand the person uses more often.

Specific Joints Affected

Although rheumatoid arthritis almost always develops in the wrists and hands, the knees and joints of the ball of the foot are often affected as well. Indeed, many joints may be involved, even causing the spine to become misaligned. It does not usually affect the fingertip joints, which is common in osteoarthritis, but joints at the base of the fingers are often painful.

Nodules

In about 20% of people with rheumatoid arthritis, inflammation of small blood vessels can cause nodules, or lumps, under the skin. They may be the size of a pea or slightly larger, and are often located near the elbow, although they can develop anywhere. Nodules can occur throughout the course of the disease. Rheumatoid arthritis nodules may become sore and infected, particularly if they are in locations where stress occurs, such as the ankles. On occasion, these nodules may signify the presence of rheumatoid vasculitis, a condition that can affect blood vessels in the lungs, kidneys, or other organs.

Risk Factors

Rheumatoid arthritis (RA) is a condition of ancient times. Bone changes indicating the condition have been identified in skeletons thousands of years old. Rheumatoid Arthritis affects an estimated 2.1 million Americans, or 1% of the US population.

Age

Although the disease can occur at any age from childhood to old age, it usually develops in young adulthood, with the age of onset peaking between 20 and 45. Still, about 50,000 children may be afflicted with the juvenile rheumatoid arthritis.

Gender

Up to three quarters of rheumatoid arthritis sufferers are women. (The risk for women is slightly lower if they have been pregnant.) They are at risk for a more aggressive progressive disease.

Family History

The risk increases in those with relatives who have rheumatoid arthritis.

Other Risk Factors

Other factors may place certain susceptible individuals at higher risk for developing rheumatoid arthritis:

  • Long-Term tobacco smoking
  • History of blood transfusion
  • Obesity

Coffee Consumption.

A 2000 Finnish study reported a direct association between coffee consumption and an increased risk for rheumatoid arthritis, possibly because coffee’s effect on rheumatoid factor. The study did not account for other factors, however, such as other behaviors or habits, or the way coffee is prepared (typically without filters in Finland). Further investigation is needed.

Silicone Implants.

Most studies do not find any association between silicone breast implants and rheumatoid arthritis or other autoimmune disease (except possibly Sjogren’s syndrome).

The Role of Allergies

Reports from a Dutch study suggest that hay fever sufferers have a reduced risk of developing rheumatoid arthritis, and, conversely, arthritis patients are less likely to have hay fever.

Causes

Rheumatoid Arthritis is unlikely to be due to a single cause, but rather a combination of genetic and environmental factors that trigger an abnormal immune system response.

Genetic Factors

Although much has been learned about the inflammatory process leading to rheumatoid arthritis, researchers have yet to uncover a specific factor that is most responsible. One prevalent theory is that a combination of factors trigger rheumatoid arthritis, including genetic susceptibility, an abnormal autoimmune response, and a viral infection.

Researchers have identified a molecule called HLA-DR4, considered a genetic risk factor, which is present in many patients with autoimmune conditions. This HLA molecule may be responsible for the confusion between collagen and an actual foreign antigen in people with rheumatoid arthritis. HLA-DR4, however, is also present in many people who do not contract rheumatoid arthritis, and many experts believe that more than one gene must be involved in order for the disease to develop.

Infectious Triggers

Although many bacteria and viruses have been studied, no single organism has been proven to be the primary trigger for the autoimmune response and subsequent damaging inflammation. Higher than average levels of antibodies that react with the common intestinal bacteria E. coli have appeared in the synovial fluid of people with rheumatoid arthritis, which some experts think may stimulate the immune system to perpetuate rheumatoid arthritis once the disease has been triggered by some other initial infection.

Arthritis and Exercise

Why should people with arthritis exercise?

People who are physically active are healthier and live longer than those who are inactive. This is true for everyone but especially for those with arthritis. Arthritis is one of the most common causes of limited physical activity. Being inactive may increase arthritis problems. Many people who have arthritis are less fit, weaker and less flexible and have more pain due to the complications of inactivity. Pain, stiffness, fatigue and the fear of doing harm can make it difficult to be physically active with arthritis. An appropriately guided exercise program can be very beneficial for those with arthritis.

What kind of exercises are helpful and safe?

Research shows that many people with arthritis can safely participate in appropriate, regular exercise programs and achieve better aerobic fitness. Low impact exercises, walking, swimming and water aerobics may be particularly well tolerated by people with arthritis. The water provides an additional benefit since there is less weight put on the joints. Improved strength, endurance, flexibility, and better ability to walk or perform daily tasks are all benefits of exercise.

There are three major types of exercise. Each plays a role in maintaining or improving health and fitness, and reducing arthritis-related disability and pain.

  • Flexibility or stretching: Gentle, low intensity exercises performed daily to maintain or improve range of motion are the foundation of most therapeutic exercise programs.. Adequate flexibility improves function and reduces the risk for injuries.
  • Muscle conditioning (strength and endurance): These are more vigorous than flexibility exercises and are usually performed every other day. Exercises include lifting the weight of the arm, leg or trunk against gravity, or using weights, elastic bands or weight machines for more resistance. Muscles adapt to the new demands by getting stronger and/or becoming capable of working longer to decrease pain in the joint.
  • Cardiorespiratory or aerobic conditioning: Includes activities that use the large muscles of the body in rhythmic and repetitive movements. Aerobic exercise improves heart, lung and muscle function. There is added benefit of improved weight control, mood and general health. Examples of aerobic exercise are walking, swimming, aerobic dance, aquatic exercise, bicycling or exercising on equipment such as treadmills, rowing machines, Nordictrack or elliptical trainers. Daily activities such as mowing the lawn, raking leaves, sweeping the driveway, playing golf or walking the dog are also aerobic exercise depending on the intensity level.

The most effective and safest intensity for aerobic exercise is moderate exertion. Moderate exertion allows the participant to speak normally, without becoming out of breath or over-heated, while carrying on the activity at a comfortable pace.

Current recommendations for regular aerobic activity are for 30 minutes of moderate aerobic activity on most days of the week. For those with limiting arthritis, this can be accumulated in three 10-minute periods of activity over the course of the day.

How to choose the best exercise program?

An arthritis-based comprehensive exercise program includes flexibility, strengthening and aerobic activities. The content and progression of the program depends upon individual needs and capabilities. Persons with long-standing or severe disease or multiple joint involvement should undertake exercise in collaboration with the health care team so it is individualized to their specific needs. The most successful exercise programs begin with the knowledge and support of people like rheumatologists who are experienced with both arthritis and exercise.

Referrals to occupational and physical therapy may be useful to learn exercises that are safe and to teach one to adapt and progress your program as needed.

Your local Arthritis Foundation is an additional source of information on local exercise programs for arthritis patients. The Arthritis Foundation has an exercise program called People with Arthritis Can Exercise (PACE) and an aquatic program called Arthritis Foundation/YMCA Aquatic Program (AFYAP)).