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Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is an autoimmune condition that affects the joints and causes swelling of the joint lining (synovium). This condition can involve any joint, but most commonly affects the small joints of the hands and feet.  RA is a condition that often requires the specialized care of a rheumatologist.  It is unknown how one develops this condition, but research is currently being done on the subject.  Family history often plays a role and it has been suggested that climate may also be a factor.  RA is more common in women in their thirties and forties, and symptoms tend to increase with age.

Clinical Presentation and Symptoms

RA is characterized by a swollen, painful, and hot joint (or joints).  This condition typically affects multiple joints in the body. Symptoms tend to come on gradually, making it a difficult condition to diagnose. There are some blood tests that can help a rheumatologist determine the presence of the condition in a patient. Anemia, rheumatoid factor, and a high erythrocyte sedimentation rate can be signs that a patient has RA.  With RA, a patient typically undergoes painful flare-ups rather than having continuous pain. These flare-ups tend to be acute and come and go in waves,  One flare can occur, with another flare-up not occurring for months after.  Although the flare-ups themselves are of concern, the damage that they cause to the joints are also problematic. Arthritic symptoms tend to present in the joints that have sustained cartilage damage from a RA flare-up. Even if the condition is completely managed, the damage from the flare-up must still be addressed.

Imaging Studies

X-rays can be helpful in diagnosing RA. A classic x-ray finding of RA is peri-articular erosions.  This is characterized by the erosion of bone at the origination of a joint capsule.  Rheumatoid nodules can also appear with RA, which are best visualized with an MRI.

Non-Operative Treatment

There is no cure for RA. Therefore, treatment of the condition is based on controlling the disease. As more becomes understood about this condition, a more aggressive approach to treatment has become popular. There are now a series of potentially helpful treatment options available for patients with RA. Anti-inflammatory medications and injections are available in addition to disease modifying agents just as Humera, Enbel, and methotrexate. The goal of the treating rheumatologist is to get the condition under control and keep it under control. There is a wide range of how extensive the rheumatoid arthritic involvement can be for each patient. Each patient requires a specialized treatment plan to control his or her disease.  Some patients require constant medication, while others only need to be on it occasionally.  Aggressive treatment of flare-ups should be done to prevent permanent damage to the involved joints.

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