Health and Fitness : Rheumatoid arthritis

Rheumatoid arthritis (RA) causes premature mortality, disability and compromised quality of life in the industrialized and developing world (1). Rheumatoid arthritis is a systemic inflammatory disease which manifests itself in multiple joints of the body. The inflammatory process primarily affects the lining of the joints (synovial membrane), but can also affect other organs. The inflamed synovium leads to erosions of the cartilage and bone and sometimes joint deformity. Pain, swelling, and redness are common joint manifestations. Although the causes are unknown, RA is believed to be the result of a faulty immune response. RA can begin at any age and is associated with fatigue and prolonged stiffness after rest. There is no cure for RA, but new effective drugs are increasingly available to treat the disease and prevent deformed joints. In addition to medications and surgery, good self-management, including exercise, are known to reduce pain and disability.

Background
Rheumatoid arthritis (RA), an autoimmune condition, is a chronic inflammatory polyarthritis (arthritis that affects 5 or more joints).

The natural history of RA varies considerably with at least three possible disease courses:
1. Monocyclic: Have one episode which ends within 2-5 years of initial diagnosis and did not reoccur. This may result from early diagnosis and/or aggressive treatment.
2. Polycyclic: The levels of disease activity fluctuate over the course of the condition
3. Progressive: RA continues to increase in severity and is unremitting

Radiographic erosion is typically fastest in the first year of disease.

One natural history study found that 75% of people with RA experienced remission within five years of diagnosis

Diagnosis of RA
Ideally, RA is diagnosed early -- within 6 months of symptom onset -- so that treatment can begin as soon as possible to slow or halt disease progression. Early diagnosis is challenging because the symptoms of early RA can be non-specific (e.g., malaise, fatigue, weakness, muscle soreness, low-grade fever, weight loss) and may actually be symptoms of other conditions.

RA is diagnosed clinically, but classified according to the 2010 American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) classification criteria for rheumatoid arthritis http://www.rheumatology.org/practice/clinical/classification/ra/ra_2010.asp.

Prior to the 2010 criteria, the 1987 ACR criteria were the standard for diagnosis and study of RA (http://www.rheumatology.org/practice/clinical/classification/ra/ra.asp). Comparison of the 2010 and 1987 criteria indicate that the 2010 criteria are better at identifying people with early RA.

Treatment
Historically, treatment for most people started with corticosteroids/non-steroidal anti-inflammatory drugs (NSAIDs), then slowly progressed for fewer people to non-biologic disease-modifying antirheumatic drugs (DMARDs) and finally progressed for even fewer people to biologic DMARDs if people had not responded to the previous drugs.

Today, a much more aggressive treatment approach is advocated for people with RA, with prescription of non-biologic DMARDs within three months of diagnosis to reduce disease activity and prevent joint deformity.

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Source: CDC