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Rheumatoid Arthritis

Donald Aulds, M.D.

Rheumatoid arthritis (RA) is a chronic inflammation that affects the small joints of the hands and feet mainly. It is an autoimmune disease where the body produces antibodies that attack the lining of the joints and produce pain and swelling. It can eventually lead to erosion of the bone and joint deformities. It can also produce other symptoms such as fatigue, fevers, red puffy hands, bumps under the skin of the arms, weight loss and morning stiffness. It has been shown that women are affected two to three times more frequently than men and has been estimated to affect nearly one and a half million adults in the U.S. It is seen in all races and ethnic groups. Although it is usually seen in ages 40 to 60, it may occur even in childhood and young adults. RA usually starts in the smaller joints such as the wrists, hands, and feet. In more advanced states, it can progress to involve the shoulders, elbows, hips, knees, neck and jaw. It usually affects the same joints on both sides of the body. RA may lasts as short as a few months but often can be present for many years or even a lifetime.

How does RA affect one’s life?
The disease usually is mild to moderate and can fluctuate between having flares and remissions of the symptoms. The more severe forms can produce serious joint damage which may lead to disability, and the person may have issues related to:

  • Feelings of helplessness
  • Depression
  • Decreased ability to work and care for one’s family
  • Decreased ability to do hobbies and enjoyable activities that the person was used to doing before the disease
  • Low self-esteem due to inabilities to perform tasks
  • If diagnosed at an early age, a woman may decide to foregoing getting pregnant

What causes RA?
It is not yet known what triggers the body to produce antibodies against its own tissues, but there are factors that have been identified:

  • Genetic factors – Studies have revealed certain genes that seem to be associated with a higher risk of developing RA, but genetics aren’t the only factor known to exist. Studies suggest that the genes may be turned on by other factors that have to be present.
  • Environmental factors – There has been data to suggest that a virus or bacteria may be a factor that turns on the genes thus leading to the disease. It is not contagious, but more research will be needed to see if viruses and bacteria are a major factor.
  • Hormonal factors – Since it seen in women more often than in men, hormones may play a role. It has been shown that RA improves during a pregnancy but will worsen after the end of pregnancy and while breastfeeding. Birth control hormones seem to alter the worsening of the disease and have been used to alter the person’s likelihood of developing the disease. Deficiencies in hormones may promote the developing of RA in genetically susceptible women.

How is RA diagnosed?
There has not been a single test for the diagnosis of RA, so a multiple approach is used. Medical history and a physical is the starting point, with the addition of laboratory tests when indicated. The laboratory tests include Rheumatoid factor, anti-CCP antibodies (a test for a protein that may show up prior to development of RA), blood count for anemia and white blood count, sedimentation rate (a measure of inflammation in the body) and C-reactive protein (a test for inflammation).

How can RA be treated?
A variety of approaches for RA treatment has been used and can include:

  • A balance between rest and exercise – Rest can help reduce active inflammation, while exercise helps preserve joint mobility and flexibility.
  • Stress reduction – Stress can increase the degree of pain associated with RA, and management of stress may be helpful in decreasing pain and allowing for continued mobility and usefulness of the individual
  • Joint care – A consideration of having physical therapy should be a decision between the person and the physician. Physical therapy may be helpful in maintaining flexibility and mobility.
  • Diet – A good, balanced diet seems to be helpful. Alcohol use should be adjusted based on the types of medications that may be used.
  • Medications – The types of medications used in RA are too numerous to be discussed in this article, so the person should discuss this with their physician. Usually medications that seem to help the most reduce the inflammation in the joint or block the production of chemicals in the inflammatory process.
  • Surgery – This is usually only used in very severe forms of RA to reduce pain, improve joint function or improve quality of life. The decision to do surgery must be a decision between the person and the physician.

What can an individual do for themselves when RA is diagnosed?

  • Take control – The person should sit down with their physician and make a plan for managing the RA.
  • Know limitations – One should rest when tired and adjust lifestyle according to abilities.
  • Take time for oneself – Find time for interests, hobbies and exercise which may reduce stress.
  • Connect with others – Find someone to talk to, such as someone who may have the disease or a support group.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.