Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is a chronic condition of the autoimmune system. RA is characterized by inflammation, swelling, tenderness and stiffness in various joints. The disease process begins in the synovium, a membrane that surrounds joints and creates a protective sac. This sac is filled with synovial fluid, a lubricant that cushions the joints and supplies nutrients and oxygen to cartilage. The cartilage is a slippery tissue that coats the ends of bones and is composed primarily of collagen.

Collagen is the structural protein in the body, which forms a mesh to give support and flexibility to joints. In rheumatoid arthritis, continuous inflammation of the synovium gradually destroys the collagen, narrowing the joint space and eventually damaging the bone and causing joint deformity.

In progressive RA, cartilage destruction accelerates when the fluid and inflammatory cells accumulate in the synovium to produce a pannus — a growth composed of thickened synovial tissue. The pannus produces more enzymes that destroy nearby cartilage, aggravating the area and attracting more inflammatory white cells, thereby perpetuating the process. This process not only affects cartilage and bones, but can also damage other organ systems.

RA can be difficult to diagnose early on because it may begin gradually with subtle symptoms. Blood tests and X-rays may initially be normal. The disease varies among individuals with respect to severity of symptoms and the number of involved joints.

The treatment plan for rheumatoid arthritis depends upon many factors, such as the severity of the disease, dysfunction and pain, the type and location of the pain, as well as patient’s age, ongoing medical conditions and ability to tolerate other medical therapies. The doctor will take all of these factors into consideration when prescribing a treatment plan.

Because there is no cure for rheumatoid arthritis, treatment is aimed at early diagnosis and aggressive drug therapy with disease-modifying anti-rheumatic drugs (DMARDs) to slow the course of the disease and relieve symptoms of pain. A new category of drugs that target the action of a protein called tumor necrosis factor (TNF) has also shown promise in RA.