Rheumatoid Arthritis Overview

Rheumatoid Arthritis Video

HOST ON CAMERA: 
Hello, and welcome to the Answered Patient.  I’m Jane Hanson.Turning a door knob. Peeling a banana. Walking down the street. These aren’t tasks most people consider difficult. But for those with rheumatoid arthritis, even the simplest movements can be nearly impossible to perform. In this episode of the Answered Patient, we’ll explain what rheumatoid arthritis is, and why it can be so painful and devastating. We’ll look at its symptoms…how it’s diagnosed…and the treatment options that are currently available. 

RUSSELL JOHNSON: 
At times when I had it like in my hands all through my wrists where it just got so bad, I mean, if cry would have helped I would have cried.  It was that bad.

NURSE:  How’s the pain? Seven? Oh, it’s up now huh?

HOST NARRATION:
Arthritis is the general term for a number of conditions affecting the joints in the body. Rheumatoid arthritis, or RA, is one of the most debilitating forms of arthritis. It’s a chronic disease that occurs when the lining of the joints becomes inflamed.   It can lead to long-term joint damage…loss of mobility…and persistent, often intense pain. More than two million people in the United States suffer from rheumatoid arthritis.   It can affect anyone, but it appears to be most prevalent in women. In fact, women account for 70 percent of all diagnosed cases.   The disease can also strike at any age, though onset usually occurs in adulthood, between the ages of 30 and 50. 

NURSE:  So Take it easy on that knee today…

Dr. Brown: Rheumatoid arthritis strikes people in the prime of their lives right when they’re entering their job, when they’re starting their family, it really strikes people at the prime of their life.

NURSE:  OK Show me this on your own…ok, and a fist…

HOST NARRATION: 
When Rheumatoid arthritis occurs in children, it’s known as Juvenile Rheumatoid Arthritis, or JRA.   This form of the disease is much less common, affecting about 1 in 1000 children under the age of 16. But it comes with its own set of challenges. 

Dr. Marisa Klein-Gitelman: They experience the same kinds of symptoms that adults with arthritis do.  The critical issue for children is that their bones are growing and so we have a bigger challenge because the persistent inflammation can affect the way the bones grow. One of our goals is to make sure these children grow up with normal joint architecture by the time they’re adults.

HOST ON CAMERA: 
Rheumatoid arthritis is what’s known as an autoimmune disease. Autoimmune diseases, such as Lupus and multiple sclerosis, occur when the body’s immune system mistakenly attacks its own healthy tissues.  In cases of rheumatoid arthritis, the joints of the hands and feet are the primary targets.  But RA can also damage organs -- such as the eyes and lungs -- and the lining around the heart.

DOCTOR: Let’s get a look here, see how we’re doing.

HOST NARRATION: Doctors have identified four stages of rheumatoid arthritis.

DR BROWN NARRATION:
Stage one is the earliest stage in which there’s some degree of pain and swelling and stiffness but not many visible changes in the joint.  Nat pop:  You’ve got maybe a little bit of narrowing…In stage two, the joints are actually inflamed but they’re still in their proper alignment, so things are still properly working.  In stage three of rheumatoid arthritis, the joints are inflamed such as the point is they no longer work properly.  Fingers may not bend, knees may not bend properly, so you begin to have problems gripping, walking, getting up and down stairs, getting on and off the toilet, those kinds of things.  Stage four unfortunately is the worst stage in which the disease and the damage is so profound that people can’t take care of themselves or their activities of daily living and they become housebound or even bed bound.

DOCTOR:  Whoa…this one feels a little puffy and swollen too.

HOST NARRATION:  
There is also a host of symptoms associated with rheumatoid arthritis. These include fatigue, low fever, stiffness,  and muscle and joint aches. During flare-ups, the area around the joints is frequently red, swollen, and painful. Multiple joints are typically affected in a symmetrical pattern… which means, for example, that both wrists will become inflamed at the same time. Left untreated, the persistent swelling of RA can damage tendons and ligaments. Over time, this can decay the bones of the affected joints and cause deformity.

HOST ON CAMERA: While doctors cannot explain what causes rheumatoid arthritis, they do have a number of methods for diagnosing it.

HOST NARRATION: A person showing signs of rheumatoid arthritis will usually need to make an appointment with a specialized doctor called a rheumatologist.

ADULT:  It builds up in your bones…

DR. BROWN:  
The first and most important way to find out about what kind of arthritis you have and whether it is rheumatoid arthritis is to sit down and talk to your doctor…  What do you feel like when you get up the first thing in the morning?  Are you stiff and how long does the stiffness last?  What areas of your body are involved?

HOST NARRATION: 
The doctor will also perform a physical exam…administer blood tests to detect antibodies common to people with RA…and take x-rays to determine if any bone decay has occurred.

HOST ON CAMERA: 
There is no known cure for rheumatoid arthritis.  But there are treatments that can help minimize the pain, and progression, of the disease.  Treatment typically begins with one of two classes of medication: fast-acting “first-line drugs” …and slow-acting “second-line drugs.

HOST NARRATION:  First-line drugs, such as aspirin and cortisone, are used to reduce pain and inflammation.  Second-line drugs combat the disease itself, stopping or slowing inflammation and preventing future joint damage.

DOCTOR…Come down the fibula you see nice smooth bone up there, but you get to the edge of the joint there and again you can see there’s a big hole there.

HOST NARRATION:  For those with severe joint deformity, drug options alone are sometimes not enough, and surgery may be required.

DR DALLE VALLE: There have been a lot of major advances in the medical treatment of rheumatoid arthritis that make the symptoms much more manageable. Where patients do develop end-stage arthritis//we do have very good surgical treatment options for them.

HOST NARRATION: 
Doctors also stress that regular exercise is a key component of treating RA: Physical activity helps maintain joint mobility, and strengthens the muscles around the joints.  

Dr. Skosey:  If you were restricted to writing one single prescription for a patient, it should be a prescription for physical or occupational therapy.  Joint in the patient with rheumatoid arthritis tend to stiffen. The importance of physical therapy is to keep the joints mobile. 

HOST ON CAMERA:
Rheumatoid arthritis can be a challenging and frightening disease, but with the right answers, patients can live happy, healthy, and pain-free lives. In the other chapters of this episode, you can find out more about how rheumatoid arthritis is diagnosed…

HOST NARRATION:
Learn what it does to the body…and discover the latest treatment options. In our “Personal Stories” chapter, you’ll meet real patients who are living with rheumatoid arthritis…and the doctors and family members who are helping them cope with this disease every day.