Taking a closer look at rheumatoid arthritis


We all suffer from aching muscles and creaking joints from time to time, particularly as we get older. But for 2.5 million people in the United States -- the majority of them women -- these symptoms are associated with rheumatoid arthritis, a painful disease that can occur at any age from childhood to old age.

Women are affected two to three times more often than men and the rate increases with age, from about 2 percent of women of all ages to 3 percent of women aged 55 to 65 years and 5 percent of women aged 65 years and older.

I spoke to Dr. Mary Betty Stevens in the division of rheumatology at the John Hopkins School of Medicine to find out more about rheumatoid arthritis.

Q: What is rheumatoid arthritis?

A: Rheumatoid arthritis is a chronic inflammation of the joints. Patients have painful swelling and tenderness and often redness of joints characteristically in the hands, wrists, toes, feet and knees, although other joints also may be involved.

One way to distinguish rheumatoid arthritis from other forms of arthritis is by looking at the pattern of joints affected by the disease. It tends to affect the same joints of both hands, both wrists, both knees, etc. It is very painful and can limit a person's ability to move around easily.

Treatment aims at alleviating pain and preventing deformities that may cripple the patient.

Rheumatoid arthritis should not be confused with osteoarthritis, which involves a degeneration of the major weight-bearing joints and does not involve the inflammation found in rheumatoid arthritis.

Q: What causes rheumatoid arthritis?

A: We don't really know. There is evidence that genetic, hormonal and environmental factors can interact to predispose some people to the disease, but it is not inherited, as many people believe. We do know that it involves a breakdown in the immune system, and some scientists believe that it is triggered by an infection.

Q: How do I know if I have rheumatoid arthritis?

A: The diagnosis of rheumatoid arthritis is quite complicated. Because the symptoms can be found in many other illnesses, it is important to rule all these out before making a diagnosis of rheumatoid arthritis.

The best way to do this is to have a thorough history and physical exam. Some patients test positive for an antibody in their blood called the rheumatoid factor, but this is only found in two-thirds of rheumatoid patients. And since it can also be found in people who do not have the disease, it is not a reliable indicator of the disease. Therefore, you must rely on the expertise of your doctor to assemble all the facts and make the diagnosis.

Q: Can rheumatoid arthritis be cured?

A: It is not possible to completely cure a disease if we don't know what causes it. But it is possible to alleviate the symptoms of rheumatoid arthritis, and with the right treatment, the progression of the disease can be slowed. With the right diet, plenty of rest and appropriate exercise and medications most people can lead productive, fulfilling lives in spite of this disease. For some women, both pregnancy and the use of oral contraceptives may be associated with improvement.

Q: What is the treatment for rheumatoid arthritis?

A: Drugs are used to treat the inflammation caused by the disease, with the aim of minimizing destruction and deformity of the joints and the resulting dysfunction.

In addition, physical therapy is very important to maintain muscle strength and ability to move. Often this is hard to do since movement is painful.

Generally, you should rest more when the disease is active and exercise when it settles down. You should not exercise if this causes pain or increased swelling in the joints. Finally, damaged joints can be surgically replaced, resulting in improvement in movement and pain reduction. Planning for treatment of this disease with drugs and exercise requires close continued cooperation between patient and physician.

Q: What about diet?

A: Some people with rheumatoid arthritis find that certain foods aggravate or help their disease, but despite many careful studies, scientists have not been able to prove that diet plays a specific role in treating rheumatoid arthritis. However it is still important to follow a balanced healthy diet and include plenty of protein and calcium. Maintain a sensible weight to avoid stress, especially on knee joints.

For more information, contact the Arthritis Foundation, P.O. Box 19000, Atlanta, Ga. 30326; (800) 283-7800.

Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.

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