Rheumatoid arthritis (RA) belongs to a class of autoimmune disorders that cause chronic joint inflammation as well as inflammation of the tissues surrounding the joints (Goronzy & Weyand, 2001, p. 55). Other organs in the body are also affected when the cells fail to differentiate self from non-self. The failure of the immune cells to differentiate the body’s own cells from the foreign or intruding cells leads to autoimmunity where the immune cells attack the body’s own cells. Usually, the immune system is organized in a way that it seeks and destroys the body’s invaders particular the pathogens.
The antibodies in patients with autoimmune diseases always target the body’s own tissues and cause inflammation. The effects resulting from the self-attack spreads to multiple body organs and this condition is commonly referred to as rheumatic arthritis (Arthritis Foundation, 2010). Epidemiology Rheumatoid arthritis is perhaps the commonest of all rheumatoid diseases and it affects about 1. 3 million people in the U. S alone (Arthritis Foundation, 2010). Women are three times as riskier than men to be afflicted by the disease although the disease is common among all races in equal magnitude (Clair, Pisetsky, & Haynes, 2001, p. 1).
The numbers of women suffering from rheumatoid arthritis are currently on the increase despite the recorded decline in numbers a few decades ago. The use of contraceptive pills containing insufficient estrogen as birth control measures has been blamed for the reduced immunity among women thus the increased cases of RA (Clair, Pisetsky, & Haynes, 2001, p. 5). Environmental factors such as cigarette smoking are also to blame for the increase in disease cases among women. Although the general smoking rates have declined in the United States, the rates of women smokers, separately considered, have not declined though.
While genetic factors such as the role of human leukocyte antigen (HLA) DRB1 alleles have for long been suspected to cause aberrations in proteins in immune cells, this has not been proved yet (Clair, Pisetsky, & Haynes, 2001, p. 5). The risk among women has also been linked to the deficiency of vitamin D. Rheumatoid arthritis usually afflicts individuals of a wide range of ages although it is commonly begins after one has attained the age of 40 although it is rare beyond the age of 60 (Silman & Pearson, 2002, p. 267). It has also been shown that rheumatoid arthritis can occur in multiple members of the same family.
This observation suggests the propensity that the disease is inheritable (Goronzy & Weyand, 2001, p. 55). A specific gene is suspected to be the underlying reason for the strange behavior of the immune cells attacking the body’s own cells. Pathophysiology and Pathogenesis Arthritis refers to some form of inflammation that occurs at the joints. Joints are points where two bones join each other and are critical for locomotion process. Rheumatoid arthritis results to the inflammation of the joint which is accompanied with severe pain, swelling, redness and stiffness in the joints.
Rheumatoid arthritis can also lead to severe inflammation in tissues surrounding the joints such as ligaments, tendons and muscles. Chronic inflammation in some patients with rheumatoid arthritis can result into complete destruction of the bones, cartilage and ligaments thus leading to serious joint deformities. Usually, destruction of the joints can occur in early stages if development but gets worse as one advances in age (Arthritis Foundation, 2010). The main cause of RA is not well known although bacteria, viruses and fungi have for long been in the suspect list without any of the biological agents been proved.
As for this reason, intensive research efforts are being invested in the identification of the causal agents for RA. Genetic causes and environmental infectious agents have been associated with the deranged immune system which goes out of control and attacks the body’s own cells (Goronzy & Weyand, 2001, p. 55). The deranged immune system results into massive joint and organ inflammation which leads to rheumatoid arthritis. The common organs affected include the eyes and the lungs. Specifically, the activation of lymphocytes marks the start of the process of inflammation.
In the inflamed cells, a number of chemical messengers are expressed including the interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor (TNF) (Gupta & Fomberstein, 2002, p. 3). Symptoms of Rheumatoid Arthritis Patients suffering from rheumatoid arthritis experience episodic inflammatory symptoms depending on the extent of individual tissue inflammation. The disease is overly active following extensive tissue inflammation and becomes inactive after inflammation has subsided. The condition undergoes remission following treatment or spontaneously and this can last for several days to years.
In remission stage, patients feel well again until the conditions flares (return of symptoms and course of the disease). Active symptoms of RA include energy loss, lack of appetite, fatigue, joint and muscle pain, stiffness and low-grade fever. The reddening and swelling of the joints at the point of inflammation is indicative of RA. The joints also become tender and overly painful and the synovium, which is the tissue lining the joints, gets inflamed leading to overproduction of joint fluids or synovial fluid (Clair, Pisetsky, & Haynes, 2001, p. 26).
The inflammation of the synovium (synovitis) results mainly from its thickening. A number of organs and other body parts are affected in rheumatoid arthritis because the disease is a systemic condition. Specifically, the disease affects several body joints which are inflamed in a symmetrical manner mainly involving the small joints of the wrist and the hands (Clair, Pisetsky, & Haynes, 2001, p. 12). The wrists and the hands are affected and the patients afflicted by the disease get it difficult to even open jars and turn door knobs. RA also affects a number of small joints of the feet.
However, when a single joint is affected, the arthritis presents as joint infection or gout. Damage to tissues, bones and cartilages results from chromic inflammation and this can eventually lead to a complete cartilage loss and bone and muscle weaknesses and erosion. Joints will become deformed, destroyed or may completely lose function. The vocal cords can be affected to a level of influencing the voice tone. The effect to the cricoarytenoid joint has been suggested to influence the voice tone and cause voice hoarseness of the afflicted individuals.
Inflammation of the glands located in the mouth and eyes often cause dryness, a condition known as Sjogren’s syndrome. Chest pain associated with shortness of breath, deep breathing or coughing results from pleuritis or the inflammation of the linings of the lungs (Clair, Pisetsky, & Haynes, 2001, p. 18). Lungs tissues may become scarred, inflamed or rheumatoid nodules may form in the lungs. The pericardium or the tissues that surround the heart may become inflamed (pericarditis) and lead to massive chest pain especially when afflicted individuals lean forward or lie down (Clair, Pisetsky, & Haynes, 2001, p. 19).
The total erythrocytes and leucocytes count immensely reduces and a reduction in red blood cells leads to anemia while a decrease in leucocytes results to the enlargement of the spleen, a condition known as the Felty’s syndrome (Clair, Pisetsky, & Haynes, 2001, p. 17). The region around the fingers and elbows may experience firm lumps known as the rheumatoid nodules (Clair, Pisetsky, & Haynes, 2001, p. 16). While rheumatoid nodules do not lead to any significant symptoms, they can be infected occasionally. In RA patients, the nerves may become pinched around the wrist area and result to carpal tunnel syndrome.
While it is rare for patients to suffer from vasculitis, the condition is one of the serious complications associated with RA and can totally impair the supply of blood to the tissues and lead to necrosis or tissue death. In vasculitis, tiny black spots around the beds of nails or ulcerations of the legs are commonly visible. Treatments To date, there is no specific known treatment for rheumatoid arthritis. However, modern interventions have been directed towards reducing pain and inflammation of the joints and maximizing the functioning of the joints.
With proper management such as X-ray monitoring, the damage to joints and improvement of joint functions can be achieved. A combination of medication, sufficient rest, joint protection, patient education and exercise to strengthen the joints has been proved effective (Clair, Pisetsky, & Haynes, 2001, p. 146). The treatment plan is not uniform among all patients but depends on the disease activity, general health of the patient, the age and occupation of the patient and the type of joints affected by RA.
In all the treatment plans, there should be total cooperation between the patient, doctor and the family members. There are two main classes of drugs used in the management of RA: the first-line drugs or the fast-acting drugs and the second-line or the slow acting drugs. Among the first-line drugs include aspirin and corticosteroids such as cortisone which are used in the management of joint inflation and pain. Second-line or slow acting medications, also known as disease-modifying antirheumatic drugs (DMARDs) include agents such as methotrexate, hydroxycholoroquine and gold (Arthritis Foundation, 2010).
These agents increase the chances for disease remission and prevent any progressive destruction of the joints but do not act as anti-inflammatory agents (Arthritis Foundation, 2010). Since the level of destructiveness from RA varies with individuals, treatment options also differ among individuals. For instance, patients with less destructive forms of RA can be advised to have sufficient rest or given analgesic or anti-inflammatory drugs to manage the condition.
Second-line medications can be administered in a timely manner to improve the function and minimize joint destruction and disability within a short period following disease diagnosis. However, a great percentage of individuals suffering from aggressive form of RA require second-line drugs like methotrexate as well as the anti-inflammatory drugs. Different second-line drugs can also be given in combination regiment. In severe deformities of the joints, surgical procedure may be recommended to correct the deformities (Arthritis Foundation, 2010).
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