Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic, systemic, inflammatory disease that chiefly affects the synovial membranes of multiple joints in the body. Because the disease is systemic, there are many extra-articular features of the disease as well. For example, neuropathy, scleritis, lymphadenopathy, pericarditis, splenomegaly, arteritis, and rheumatoid nodules are frequent components of the disease. In addition, the potential for involvement of the renal, pulmonary, and cardiovascular systems exist. In most cases of RA, the patient has remissions and exacerbations of the symptoms. This means that there are periods of time when the patient "feels good" and times when the patient "feels worse". There will likely be times that a patient with RA "feels cured". It is important to understand that there are very few patients that have complete remission of the disease and it is essential that the RA patient does not stop the treatment program established by knowledgable health care practitioners.

Rarely does the disease "go away", although at times the symptoms might temporarily remit. The disease is considered an autoimmune disease that is acquired and in which genetic factors appear to play a role. The presence of HLA-DR4 antibody in 70 percent of patients with RA lends support to the genetic predisposition to the disease. Rheumatoid Factor(s) (RF) are antibodies to IgG, and are present in 60-80 percent of adults with the disease. High titers of RF are usually associated with more severe and active joint disease, greater systemic involvement, and a poorer prognosis for remission. RA, as well as other autoimmune diseases, includes widespread immunologic and inflammatory alterations of connective tissue. Because the autoimmune diseases share many clinical findings, making a differential diagnosis is often difficult. Although the autoimmune disorders are considered acquired diseases, their causes usually cannot be determined. The prevalence of the disease is 1-2 percent of the general population and is found world-wide. Females with RA outnumber males by a 3:1 margin.

Onset of the disease in adults is usually between the ages of 40 to 60 years, although it can occur at any age. The etiology of RA remains unknown. Metabolic and nutritional factors, the endocrine system, geographic, psychologic, and occupational data have been extensively studied with no conclusive findings. It now appears that an unknown antigen initiates the autoimmune response resulting in RA.