Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder that causes the body's immune system to attack the bone joints. It is a disabling condition, and often thought of as a disease.

The synovium can become irritated and thickened with this condition, and sometimes it must be surgically removed.

Diagnosis

Diagnosis is with immunological studies, such as rheumatoid factor (a specific antibody) which can be negative; when this happens the arthritis is seronegative.

The American College of Rheumatology has defined (1987) the following criteria for Rheumatoid Arthritis [1]:

  • Morning stiffness of >1 hour.

  • Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups

  • Arthritis of hand joints

  • Symmetric arthritis

  • Subcutaneous nodules in specific places

  • Rheumatoid factor at a level above the 95th percentile

  • Radiological changes suggestive of joint erosion

Four criteria have to be met, although many patients are treated despite not meeting the criteria.

Treatment

Treatment is with NSAIDs, although most patients will proceed to treatment with steroids, DMARDs (disease-modifying antirheumatic drugs), and monoclonal antibodies (anti-TNF-alpha, e.g. infliximab or etanercept). Other therapies are weight loss, physiotherapy and special tools to improve hard movements (e.g. special tin-openers).

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