WHAT IS RHEUMATOID ARTHRITIS?
Rheumatoid arthritis (RA) is a chronic disease characterized by the inflammation of the lining of the joints. This can lead to long-term joint damage resulting in chronic pain and disability. The disease progresses in three stages. The first stage involves swelling, redness, stiffness and pain around the joints. In the second stage there is rapid cell division, leading to thickening of the joints. The third stage is characterized by the enzymatic destruction of bone and cartilage, which may cause the joint to become misshapen or misaligned, leading to further pain and stiffness.    

WHAT ARE THE SYMPTOMS?
Symptoms of RA often begin in the smaller joints, such as those of the hand or wrist, and the involvement of these joints is typically symmetrical. Stiffness, weakness and pain are common, as is fatigue. Many people experience flares of the disease, followed by remission or disease inactivity. About 20% of people with RA experience rheumatoid nodules, or lumps of tissue under the skin, on the elbows.  

HOW IS IT DIAGNOSED?
There are several pieces of information a physician may use to make a diagnosis of RA. This information may include:

            Medical history - to look for patterns of joint pain and/or stiffness
            Physical exam - to check for joint swelling, misalignment or loss of motion
            Complete Blood Count - to check for elevated or depressed cell counts
            Erythrocyte Sedimentation Rate (ESR or sed rate) - to measure inflammation
            C-Reactive Protein - also used to measure inflammation
            Rheumatoid Factor - to check for proteins associated with RA
            MRI - to detect early inflammation

HOW IS IT TREATED?
Treatment options vary depending on the severity and progression of the disease. While none of the treatments available today cure RA, many of them are effective in slowing the disease progression, alleviating inflammation or relieving pain. The main drug categories used to treat RA alone or in combination are:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
These drugs are used to relieve inflammation and pain. Some examples are ibuprofen, aspirin, valdecoxib and rofecoxib.          

Disease Modifying Antirheumatic Drugs (DMARDs)
These are often used in conjunction with NSAIDs to slow the joint damage caused by RA. Some drugs in this class are methotrexate, penicillamine, azathioprine, chloroquine, and sulfasalazine.          

Biologic Response Modifiers
These drugs modify various components of the immune system to reduce inflammation. Examples are etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), and leflunomide (Arava.)

Glucocorticoids or Prednisone
These drugs are typically given in low doses as maintenance therapy to prevent joint damage.

WHAT IS THE PROGNOSIS?
Rheumatoid arthritis can range from moderate to severe in its effects. While some people do undergo a more severe disease course, others experience a spontaneous remission. With the advances in treatments for RA, as well as more aggressive treatment protocols, many people are able to control their disease.

SUPPORT GROUPS
For more detailed information, or to find a support group near you, contact the Arthritis Foundation.