Article Print

Rheumatoid arthritis (RA) is a chronic autoimmune disease that continues indefinitely, fluctuates in severity and may never completely go away.

Left untreated, the disease almost certainly will result in the progressive development of various degrees of joint destruction, joint deformity and a significant decline in a patient’s ability to function. In fact, rheumatoid arthritis is considered the leading cause of chronic disability in the United States.

Years into the disease, many people who suffer from the condition find themselves having difficulty carrying out the simplest tasks of daily living such as standing, walking, dressing, washing, using the toilet, preparing food and carrying out household chores. As many as half of all people with rheumatoid arthritis will be unable to work 10 to 20 years after the condition is diagnosed.

Although it is impossible to predict the course each case of rheumatoid arthritis will take, certain factors appear to play a role in how severe it will become. Research suggests that the presence of an antibody called rheumatoid factor, particularly at high levels, is associated with more severe joint damage and complications in other organs and tissues. However, only one in five people tests positive for it in the early stages of the disease.

Likewise, the presence of inflammation in more than 20 joints is also likely to result in severe joint damage. Serious inflammation that persists for more than one year, being over the age of 60 years at the time of diagnosis and having X-rays that show evidence of bone damage are also likely to indicate that severe joint damage will occur.

The Stages of Rheumatoid Arthritis
Most cases of rheumatoid arthritis are characterized by a pattern of painful flare ups (relapses) and less painful periods (remissions) where the disease does not seem to be a major problem. If a long-term remission is going to occur, it is most likely to occur in the first year of disease.

It is during the first few years that researchers believe the joint damage associated with rheumatoid arthritis progresses most rapidly. That explains why diagnosing it at the earliest possible stage and beginning effective treatment immediately is so important.

In most cases, the symptoms of rheumatoid arthritis come on gradually and include feelings of malaise and fatigue. Often those symptoms are accompanied by diffuse pain that usually involves the small joints in the fingers and toes. Numbness or tingling is also typical, as is the presence of Raynaud’s phenomenon in which the skin discolors, especially at the tips of the digits. Severe morning stiffness that limits function and generally lasts more than an hour is another notable symptom.

A little over 10 percent of patients with rheumatoid arthritis develop deformity of the small joints in the hands within the first two years of the disease. Up to one third of patients develop the joint deformity over a more extended period of time. The joint deformity develops as the structures supporting those joints are damaged by the inflammatory process that is typical of the disease.

By the time deformity has developed, the presence of rheumatoid arthritis is clear. In fact, within two years of a diagnosis, about 70 percent of patients have some signs of joint damage that can be seen on X-rays. The damage is likely to lead to a deterioration of a patient’s physical function during those first few years. That loss tends to progress over time.

Rheumatoid arthritis usually exhibits a symmetric pattern. This means the same joints—hands, wrists, elbows or shoulders—on both sides of body are affected.

X-rays are often used to determine the degree of joint destruction. Although they are not useful in the early stages of rheumatoid arthritis, before bone damage is evident, they are important in monitoring the progression of the disease.

The Importance of Regular Monitoring
Regular medical care is important to monitor the course of rheumatoid arthritis. It typically includes regular visits to a doctor who will determine the effectiveness and any side effects of medications and who will change therapies as needed. In most cases, that doctor is a rheumatologist, a physician who specializes in musculoskeletal conditions. However, a primary care physician will also play an important role in monitoring the disease. Depending on how severe the disease is, he or she may oversee the treatment, watch for other medical conditions that might result and also address the psychological and social effects of the disease.

The severity of the rheumatoid arthritis may also determine whether other health professionals are needed. A physical therapist, for example, can help patients regain any loss of movement that may occur. An occupational therapist can help patients improve and recover their ability to perform daily tasks involved in living and working. A surgeon and a psychiatrist or psychologist may also become involved to help with the debilitating effects and emotional stress of the condition.

Early Diagnosis and Treatment is Key
Early diagnosis and treatment of rheumatoid arthritis is critical for patients who want to continue to lead productive lifestyles. In fact, there seems to be a therapeutic window of opportunity in which early diagnosis and intervention can halt or significantly reduce progression and disability of rheumatoid arthritis. Studies have shown that early, aggressive treatment can limit joint damage. That limits the loss of movement, the decreased ability to work, the high medical costs and the potential for future surgeries.

Powerful drugs and the use of drug combinations instead of one medication alone have also been shown to be more effective in reducing or preventing joint damage. Most important, however, is the evidence that treatment should be started regardless of how far along the disease is. The bottom line is it is never too early, nor too late to initiate therapy.