American Medical Association Family Medical Guide - American Medical Association [629]
Rheumatoid arthritis causes the joints to become red, warm, swollen, tender, painful, and stiff. The stiffness is usually most noticeable first thing in the morning and subsides with increased joint movement. People with rheumatoid arthritis sometimes feel fatigued because of the iron deficiency anemia (see page 610) that can accompany it. Occasional fever and a general sense of not feeling well are also common.
Some people with rheumatoid arthritis experience the effects of the disorder in parts of the body other than the joints. About one quarter of affected people develop bumps or nodules under the skin near pressure points, such as the elbows. Less common effects include neck pain and dryness of the eyes and mouth. In very rare cases, the blood vessels, the lining of the lungs, or the pericardium (the sac enclosing the heart) may become inflamed.
In severe cases, swollen, deformed joints can collapse and become partly or completely dislocated. This dislocation can cause great discomfort and problems with walking, especially if knee, ankle, or foot joints are affected. Tendons may become so weak that they snap, making it impossible to control certain movements.
Rheumatoid nodule
Some people with rheumatoid arthritis develop small lumps of tissue called nodules under the skin near pressure points, such as the elbows.
Diagnosis
Early diagnosis of rheumatoid arthritis can help prevent joint deterioration, but the disorder can be difficult to diagnose in its early stages. No single test exists for diagnosing rheumatoid arthritis, and the symptoms can vary dramatically from person to person. The symptoms can mimic those of other joint problems, which the doctor will want to rule out. In addition, only a few symptoms may be present in the initial stages of rheumatoid arthritis, forcing the doctor to wait for the full range of symptoms to appear before confirming the diagnosis. For these reasons, doctors use a variety of tools to help make a diagnosis.
A thorough health history—your description of your symptoms and how they began—will help your doctor evaluate your condition and learn how it changes over time. Your doctor will also perform a physical examination of your joints, skin, reflexes, and muscle strength.
The doctor will probably order a blood test to detect rheumatoid factor, an antibody your immune system may have mistakenly produced. Rheumatoid factor is present in the blood of most—but not all—people with rheumatoid arthritis. Other diagnostic blood tests are often performed to detect inflammation, white blood cells, and anemia, which are often present with rheumatoid arthritis.
In later stages of the disease, doctors use X-rays of the joints to monitor the progression of joint damage.
Treatment
Doctors use many different types of treatment to relieve pain, reduce inflammation, and slow joint damage in people with rheumatoid arthritis. Some lifestyle activities—including a balanced program of rest when the disorder is active and exercise when symptoms subside—can help improve joint function. For example, swimming in a heated pool is good for stiff joints. Removable splints that you can strap onto your painful joints when they need rest, and self-help devices such as zipper pullers and bathroom safety bars, can help reduce the stress on painful joints. Using relaxation techniques (see page 59) to relieve emotional stress can help make living with rheumatoid arthritis a little easier. Your doctor may recommend that you apply heat to the affected joints and may refer you to a physical therapist, who can teach you some helpful exercises and provide splints for affected joints.
Nonsteroidal