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MOOR GREEN LANE MEDICAL CENTRE 339, MOOR GREEN LANE, MOSELEY, BIRMINGHAM B13 8QS R. RAMACHANDRAM PATIENT INFORMATION LEAFLET Disease focus: Rheumatoid Arthritis Rheumatoid arthritis (RA) is an autoimmune disease. This means that the white cells and antibody proteins in your blood that usually fight infections enter your joints and cause inflammation. This causes heat, swelling and excess fluid to be produced. Eventually, this may lead to thinning of the cartilage that covers the ends of your bones, and may cause the bone to be worn away. RA may also cause inflammation of the sheaths around your tendons. Rarely, the condition can affect other parts of your body, such as your lungs. RA affects more than 350,000 people in the UK and can start at any age. Women are 3 times more likely to develop RA compared to men and the disease runs in some families. Lifestyle factors may also increase your risk, for example, if you smoke or are obese. Symptoms of Rheumatoid Arthritis Initially discomfort may occur in joints such as your fingers, knuckles, wrists or the balls of your feet. RA is a 'symmetrical' arthritis - this means it affects either wrists or both hands in the same way. RA develops slowly in the majority of sufferers but sometimes can progress rapidly. Your symptoms can come and go with little pain, swelling or inflammation in between the flare-ups, which can last a few days to several months. Symptoms include: pain and swelling around the joint, making it tender and warm stiffness in the morning, or if you sit for a long time poor grip strength tiredness, making you feel irritable and depressed flu-like symptoms such as fever weight loss rheumatoid nodules - fleshy lumps that usually appear on your hands, feet and elbows Diagnosis of Rheumatoid Arthritis When you first develop joint pains, it may be difficult for a doctor to say that you definitely have RA. This is because there are many other causes of joint pains. There is no single test, which diagnoses early RA with 100% certainty. However, RA can usually be confidently diagnosed based on the following combination of factors: Typical symptoms - as described above. A blood test for a marker called rheumatoid factor, present in 2 in 3 people with RA but 1 in 20 of normal population so may not be conclusive Anti-CCP antibody testing. This has been found to be more specific than rheumatoid factor in the diagnosis of RA. PATIENT INFORMATION LEAFLET SERIES NO: 92 RHEUMATOID ARTHRITIS MOOR GREEN LANE MEDICAL CENTRE 339, MOOR GREEN LANE, MOSELEY, BIRMINGHAM B13 8QS R. RAMACHANDRAM PATIENT INFORMATION LEAFLET Blood tests for anaemia (a condition when you have too few red blood cells or not enough haemoglobin in your blood) - eight in ten people with RA have anaemia. X-ray, ultrasound or magnetic resonance imaging (MRI) to look for characteristic early damage in your joints. Associated conditions The risk of developing certain other conditions is higher than average in people with RA. These include cardiovascular disease (such as angina, heart attack and stroke), anaemia, infections (joint infections and non-joint infections), and osteoporosis (thinning of the bones). Treatment of Rheumatoid Arthritis It is important to be referred to a specialist to start treatment as early as possible, especially if you have had symptoms for more than three months. Treatment focuses on reducing inflammation to limit the damage to your joints. If left untreated, RA may lead to serious disability. There is no RA, but treatments can reduce symptoms and improve outlook. Painkillers such as paracetamol may help to relieve pain and stiffness. Non-steroidal anti-inflammatory drugs e.g Brufen (NSAIDs) reduce symptoms of inflammation, relieving pain and swelling. Disease-modifying anti-rheumatic drugs (DMARDs) slow down the progression of RA and ease its symptoms. They can take several months to work so it is important to continue taking them. DMARDs have no immediate effect on pains or inflammation and you may need to try one or more. Biological medicines made from animal or human proteins block the progress of RA in your immune system. The chemical TNF-alpha plays an important role in causing inflammation in joints in RA. Blocking the effect of TNF-alpha has been shown to reduce damage to joints, and reduce symptoms. Similarly, Rituximab is another type of monoclonal antibody that suppresses a part of the immune system that is involved in RA given by infusion. Steroids tablets are good at reducing inflammation and a short course of steroids may help to 'damp down' a flare-up of symptoms, which has not responded much to NSAIs.If you have a bad flare-up, you may be offered a corticosteroid injection into a specific joint to reduce inflammation. Other treatments such as physiotherapy, occupational therapy, and surgery may also be advised, depending on the severity of the disease and other factors. E.g. Hip or Knee replacement, synovectomy to remove the lining of an inflamed joint, removal or repair of severely inflamed tendons & surgery to fuse a joint to make it more stable. Complementary therapies such as acupuncture and aromatherapy may relieve pain and make you feel more relaxed but do not affect the progression of the disease Oral hygiene, regular exercise to increase mobility, weight reduction, smoking cessation and healthy diet also helps. More * more ** more** just go on to www.patient.co.uk or www.rheumatoid.org.uk PATIENT INFORMATION LEAFLET SERIES NO: 92 RHEUMATOID ARTHRITIS