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Rheumatoid Arthritis

Rheumatoid arthritis is part of general rheumatoid disease that involves the connective tissues of the body and may affect many organs. However, in most people the most noticeable effect is on the joints.

The cause of rheumatoid disease is not known. It occurs in about three per cent of people, and can appear at any age but more commonly starts between forty and fifty years of age. About sixteen per cent of women over sixty-five are affected, and six per cent of men over seventy-five. Still's disease is an allied disorder, in children.

Symptoms

The first signs of general rheumatoid disease are tiredness, malaise, aches and pains and stiffness of the joints on waking in the morning. The disease involves the lining of the joints (synovial membrane) which swells and thickens and may produce excess synovial fluid. The result is swelling, stiffness, and pain when the joints are moved. Over a period of time, the cartilage lining the joints may be destroyed and the underlying bones damaged. Eventually the bones may fuse together and the joint becomes rigid.

The disease may remit spontaneously, at any time, leaving only minor changes in the joints, as happens in about forty per cent of cases. However, about ten per cent suffer from a persistent form of the disease which leads ultimately to destruction of the joints and deformity. Although the cause is unknown, there is evidence to suggest that the body's immune system is involved. A protein (the rheumatoid factor) is present in the blood of many patients with rheumatoid arthritis, and this protein is a form of antibody, stimulated by an antigen which is an altered form of a normal blood protein. The exact significance of the rheumatoid factor is as yet unclear.

Treatment

No cure is yet known, but there are various ways of treating rheumatoid arthritis and rheumatoid disease. Rest can be useful in the early stages, to prevent damage to the joint, and is often required in combination with drugs and other treatment. Pain-killing drugs which may relieve inflammation (aspirin) and anti-inflammatory drugs, such as corticosteroids, are often effective in reducing swelling, pain and stiffness. However, there are side-effects which need to be carefully monitored. In severe cases, drugs that suppress the immune response of the body may control the disease.

Physiotherapy and occupational therapy can be useful in coping with day-to-day living. Surgery is performed in some cases, either to try and prevent damage to the joint by removing the swollen synovial membrane or by reconstructing or replacing damaged joints.

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