What is rheumatoid arthritis?

Rheumatoid arthritis is a disease that causes pain, stiffness, swelling, and sometimes joint deformity. It occurs most commonly in the fingers, wrists, elbows, shoulders, jaw, hips, knees, and toes. It usually affects the same joint on both sides of the body (for example, both hips).

Rheumatoid arthritis often appears first in early adulthood or middle age. However, sometimes it does not occur until the later years. There may be one single attack, but more often the condition comes and goes in repeated episodes. The disease cannot be cured, but medication can reduce the frequency and severity of attacks.

Rheumatoid arthritis affects 1 in every 100 Americans. It is three times more common in women than in men.

How does it occur?

Rheumatoid arthritis is thought to be an autoimmune disease. This means that the body's defenses against infection attack the body's own tissue. In rheumatoid arthritis, the result is that the lining of a joint becomes inflamed, causing swelling, stiffness, and deformity.

Heredity may make some people more likely than others to have rheumatoid arthritis.

What are the symptoms?

The symptoms may include:

• joint pain and stiffness, particularly morning stiffness

• red, warm, or swollen joints

• joint deformity

• mild fever, tiredness

• small lumps or nodules under the skin.

How is it diagnosed?

Your doctor will review your medical history and examine you. Your doctor may order blood tests and x-rays to confirm the diagnosis and measure the extent of the disease.

How is it treated?

The goal of treatment is to keep the joints working properly by reducing inflammation, relieving the pain and stiffness, and stopping or slowing down joint damage.

Your doctor will prescribe medication to control the pain and inflammation. Common medications are aspirin and other anti- inflammatories such as ibuprofen and naproxen. Steroids are also sometimes used. Newer drugs for more severe cases are gold compounds (such as auranofin), methotrexate, and Plaquenil. It may be necessary to inject medication directly into the joint. These medications must be used with caution because of potential gastrointestinal, kidney, and heart complications, as well as other side effects.

Physical therapy helps restore use of affected joints and muscles. Occupational therapy teaches you how to overcome the disability and manage everyday tasks.

You may wear splints to rest inflamed joints and to prevent them from becoming deformed.

Sometimes severely damaged hips and knees are surgically replaced.

How long will the effects last?

You may have just one attack of rheumatoid arthritis in your life. More likely, however, you will have repeated flare- ups, and these flare-ups may become progressively worse. The flare-ups will vary in length and may last weeks.

How can I take care of myself?

No one yet knows how to prevent rheumatoid arthritis. However, you can relieve the symptoms and help prevent the permanent joint deformity that can result from flare-ups by following these guidelines:

• Take the medication your doctor recommends for controlling your arthritis.

• Rest your joints when they are warm, swollen, or painful.

• Follow the advice given by your doctor or a physical therapist on how you can best keep the affected joints mobile.

• Ask an occupational therapist ways you can cope with everyday tasks.

• Try to keep a positive outlook. It will make it easier for you to cope.

• Keep your body healthy by eating a healthy, varied, low- fat diet.

• Follow any other recommendations made by your doctor for controlling your arthritis.