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Severe rheumatoid arthritis (RA) is an autoimmune disease affecting the synovium, or joint lining, that causes pain and extensive damage. RA typically affects people who are 20-60 years old but can strike younger victims. The cause is not known. Treatments for this disease include medication, surgery and physical therapy. Long-term severe RA can raise the risk of other serious health problems, including disability and vision complications.
Unlike osteoarthritis, which is found in older individuals and involves wear and tear of joints, severe rheumatoid arthritis can occur in children, known as juvenile RA. Inflammatory cells release cytokines, causing changes in the synovium of the affected area. The lining becomes thicker, and cartilage is eventually destroyed, making joints unstable. Usually the hands, wrists, feet and ankles are affected first. Eventually, the knees, hips, elbows and shoulders will begin to show signs of the disease.
The first symptoms that people who have severe rheumatoid arthritis might notice at onset are stiffness and pain in the joints, usually on both sides of the body. Swelling, redness and fatigue are common. As the disease progresses, serious damage will occur, causing reduction of motion, bone destruction and deformation that can render the patient nearly immobile. A patient who has long-standing severe rheumatoid arthritis might have a distinctive claw-like hand resulting from ulnar contraction toward the pinky finger.
Although the causes of chronic inflammatory diseases such as severe rheumatoid arthritis are not known, genetic factors are suspected to increase susceptibility. Environmental triggers such as viral infection seem to activate the disease. It is most commonly seen in women who are 40-60 years old. Identifying RA can be difficult and typically takes place with time and observation. Blood tests for an elevated erythrocyte sedimentation rate (ESR), rheumatoid factor and certain antibodies can help diagnose the disease.
Treatment must begin quickly to reduce disability. Severe rheumatoid arthritis can affect other organs in the body, particularly the eyes and lungs. Drugs called disease-modifying anti-rheumatic drugs (DMARDs) slow the disease but are not a cure. Immunosuppressants and anti-inflammatory medications attack the immune response that causes the symptoms. Aspirin, ibuprofen and other over-the-counter medications can help ease RA pain.
Physical therapy along with regular exercise will help keep stiffness at bay. Occupational therapy teaches patients to perform tasks in alternative ways to reduce painful joint stress. There are a number of assistive devices on the market to give patients help walking or cooking and let them retain independence. When the joints have been decimated, replacement surgery can allow severe rheumatoid arthritis patients to function again.
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