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Rheumatoid Arthritis (RA) is a chronic, progressive, inflammatory disease.

Although it is a
systemic disorder , RA is characterized by its effect on synovial joints. The disease has a peak
onset in people 20 to 40 years of age and it is common in women than in men. It affects an
estimated 1 to 3 % of the population in the United States. The course of the disease is variable,
ranging from minimal symptoms to severe debilitation. RA can affect any part of your body,
from your eyes to your heart to your toes. Rheumatoid arthritis (RA) tends to begin slowly with
minor symptoms that come and go, usually on both sides of the body, and progress over a period
of weeks or months. Symptoms of this chronic disease vary from person to person and can
change from day to day. Bouts of disease activity are called flare-ups, while inactive periods are
called remission.

Sometimes it can be difficult to tell whether your symptoms are those of RA or the more
common wear and tear arthritis called osteoarthritis. Either diagnosis should be confirmed by
someone who is an expert in arthritic diseases, usually a rheumatologist.

Here are six rheumatoid arthritis warning signs and how they differ from signs of osteoarthritis.

1. Usually with RA, one or more of your finger-knuckle joints will be swollen. The swelling
is more likely to be in the middle or large knuckles of your hands not the knuckles at the tips
of your fingers next to your fingernails. It is often in joints on both hands. The swelling does not
feel bony, but rather tender and slightly soft. With RA, you may also feel warmth and notice
redness over the joint.

2. If at least one of your middle or large knuckles has been swollen and painful for more
than six weeks, for no clear reason or explanation, it could be a sign of RA. Large joints such as
your ankles, knees, shoulders, or elbows may be involved, but you must have swelling and pain
in at least two joints to be diagnosed with rheumatoid arthritis.

On the other hand, swelling or pain in your small fingertip knuckles, at the base of your thumbs,
and in your big toe joints will more often be due to osteoarthritis.

3. The balls of your feet are also targets for RA. Often, people with rheumatoid arthritis
experience a feeling of walking on golf balls or swelling under the foot, especially first thing
in the morning when youre getting out of bed.

This pain will feel different from pain caused by a bunion. Pain from a bunion is usually at the
base of the big toe, and feels worse when you wear tight shoes.

4. You just dont feel well, and you may notice bumps on your elbows. With RA, you may
have flu-like symptoms such as low-grade fevers and fatigue.

Occasionally, small tender bumps or nodules under the skin will develop with RA, often near the
back of the elbow. These are called rheumatoid nodules.
5. Your joints are particularly stiff for more than an hour in the morning. With rheumatoid
arthritis, you may find it difficult to completely make a fist. You may have unusually tender
swelling on the top of your wrists. If your elbows are involved, it may be difficult for you to
straighten them completely.

Usually, you wont have swelling or pain in your hip joints early in the course of RA. Painful hip
joints more often are due to osteoarthritis, and most people feel the pain in the front of the hip or
in the groin region.

6. Certain blood tests may help determine whether you have RA. These are usually ordered
by your health provider, but there are companies that allow you to order these tests yourself
(Hint: Google search order your own lab tests).

Four important tests are usually ordered for an RA diagnosis. Two measure proteins in your
blood called antibodies: Rf (rheumatoid factor) and CCP (anti-cyclic citrullinated peptide). The
other two measure inflammation: ESR (erythrocyte sedimentation rate) and CRP (C-reactive
protein). With RA, at least one Rf or CCP test must be positive and at least one CRP or ESR test
must be abnormal.

Predisposing factors for RA include:

Gender. Women account for approximately 70% of RA sufferers. Recent studies show
that the incidence of RA in women has increased modestly in the past 15 years whereas the
disease had declined in the years prior to that. Experts say many factors may have led to the
increase. These include an increase in cigarette smoking in women whilst a similar decline has
occurred in men, vitamin-D deficiency and declining estrogen levels in oral contraceptives,
among others.

Age. Although RA can occur at any age, the onset of the disease is most common in
adults age 45-65.

Recent pregnancy. About 80% of women with RA notice an improvement in their


symptoms during pregnancy. However, the condition may appear or get worse in the first year
after a child is born. This suggests that hormones, or changes in certain hormones, may
change the appearance of RA or even shift its incidence from one time period to another.
Although this observation has been around for over 50 years, we still don't understand why
this happens.

Genetics. Certain genetic factors predispose people to RA.

Smoking. Need another reason to quit? We've long known that there are many health risks
associated with smoking cigarettes and breathing in secondhand smoke. Recent studies have
shown that there's a strong link between smoking and triggering RA as well as increasing its
severity if you smoke. Talk to your doctor about the best ways to kick the habit. It is also
possible that the lung may be the portal of entry for other environmental triggers for RA some
recent studies have shown that there is a greater incidence of RA in people living near a freeway
compared to living in rural areas.

The main treatment goals with rheumatoid arthritis are to control inflammation and slow or stop
the progression of RA.

Treatment is usually a multifaceted program that consists of medications, occupational or


physical therapy, and regular exercise. Sometimes, surgery is used to correct joint damage. Early,
aggressive treatment is key to good results. And with todays treatments, joint damage can be
slowed or stopped in many cases.

Drugs for Rheumatoid Arthritis

NSAIDs

As part of rheumatoid arthritis treatment, your doctor will probably prescribe a nonsteroidal anti-
inflammatory drug (NSAID). These drugs reduce pain and inflammation but do not slow
progression of RA. Therefore, people with moderate to severe RA often require additional drugs
to prevent further joint damage.

Over-the-counter NSAIDs include ibuprofen (Advil or Motrin) and naproxen sodium (Aleve).
Most people with RA require a prescription NSAID as they offer a higher dose with longer
lasting results and require fewer doses throughout the day. There are many prescription NSAIDs
to choose from.

All prescription NSAIDs carry a warning regarding the increased risk of heart attack and stroke.
NSAIDs can also raise blood pressure. In addition, NSAIDs can cause stomach irritation, ulcers,
and bleeding.

You and your doctor can weigh the benefits of NSAIDs against the potential risks. You may have
to try a few different ones to find the one thats right for you.

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