What Is Rheumatoid Arthritis?

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an auto-immune disease, which is characterised by the immune system attacking healthy cells in the body instead of foreign germs, in this case attacking the synovial membrane in the body's joints. This causes the cartilage to become soft and wear away quickly, inflaming the joints and synovial fluid. There are three common types of RA: "monocyclic" convalescents have one episode which ends within 2-5 years of initial diagnosis and does not reoccur, "polycyclic" sufferer's levels of disease activity fluctuate over the course of the condition and "progressive" RA continues to increase in severity and is unremitting. The disease tends to develop symmetrically (so if the right wrist develops RA, the left wrist will too) and is more prominent in females than males. Symptoms of RA can include swollen and painful joints, stiff joints or loss of joint motion, weak muscles, fatigue and rheumatoid nodules (painless lumps under the skin).

The first known reference of rheumatoid arthritis was discovered on the Ebers Papyrus, created around 1500 BC, which describes symptoms that are similar to the disease. There have also been references to the disease in many other cultures, such as in the Charak Samhita in Indian literature, Egyptian mummies as studied by G. Elliot and Hippocrates' studies in Ancient Greece. Between 129 and 216 AD, Galen introduced the term rheumatismus, while Paracelsus suggested that substances that could not be passed in urine were stored in the body, especially in the joints, and this caused arthritis. Thomas Sydenham first described a form of chronic arthritis that was described later by Beauvais in 1880. Brodie researched the progressive nature of this disease and found that RA affected the synovial membrane in the joints, as well as how synovial inflammation and cartilage damage are associated with RA. A.B. Garrod in 1858 named the disease "rheumatoid arthritis" replacing the previous terms "arthritis deformans" and "rheumatic gout", therefore making a distinction between rheumatoid arthritis, osteoarthritis and gout.

In the early part of the 20th century, scientists discovered that gold, taken in any form, could block the immune system and therefore be an effective treatment for rheumatoid arthritis, but this treatment has dangerous side effects, affecting the kidneys, and is now used cautiously. However, today there are three main types of drugs used to treat RA:

1. Analgesics can be used to treat both inflammatory pain and pain from joint deterioration and include drugs such as paracetamol, codeine and opiate drugs (e.g. oxycodone or dihydrocodiene).

2. Non-steroidal anti-inflammatory drugs (NSAIDs) work by preventing an enzyme called cyclo-oxygenase (COX) from making the chemicals involved in causing pain and inflammation, which are known as prostaglandins. However, prostaglandins also protect the stomach acid from eroding the stomach wall and control blood flow through the kidneys, which is why NSAIDs increase the risk of stomach ulcers and bowel problems. Common NSAIDs include diclofenac, ibuprofen and naproxen (also known as Naprosen).

3. Disease-modifying anti-rheumatic drugs (DMARDs) work by preserving the structure and function of the joints, reducing joint damage and therefore decreasing pain and inflammation. DMARDs can take weeks or months to take effect and require regular tests to monitor body parts such as the bone marrow, liver, kidney and blood count as the drugs can have serious side effects. Common DMARDs include penicillamine, corticosteroids (prednisone) and leflunomide (Arava).

Alternative RA therapies such as fish oil, copper bracelets and herbal medicines are another non-mainstream approach to treatment but are mostly unproven to have an effect.

It is estimated that around 250,000 people in Australasia have rheumatoid arthritis and it is the world's most common chronic inflammatory arthritis, affecting nearly one in every hundred adults. Even though there are over 120 varieties of arthritis, RA is considered to be one of the most severe arthritis forms. The exact cause of RA is unknown, but latest theories suggest the disease is influenced by genes and can be inherited.