alt="Bullet"/>
Confirming the diagnosis
Rheumatoid arthritis (RA) is a case of the human body’s good intentions gone awry. Your body is equipped with a very effective immune system that fights off bacteria and other foreign bodies. Specialized immune cells attack these invaders, surround them, paralyze them, and destroy them. A strong, intact immune system is absolutely essential to your survival — without it, you would quickly become consumed by infections and disease. But if your immune system should suddenly go haywire and start attacking your body’s own tissues, it could become your worst enemy. Such is the case with RA. When you have RA, your immune system attacks the tissues that cushion and line your joints, eventually causing entire joints to deteriorate.
RA doesn’t have to be all bad news though; check out the sidebar “Overcoming RA: Lucy’s Story” later in the chapter to learn how actress Lucille Ball stayed active and healthy until the end of her life, despite having rheumatoid arthritis.
Turning on Itself: When the Body Becomes Its Own Worst Enemy
For reasons that aren’t completely understood, in rheumatoid arthritis the white blood cells of the immune system attack the joint lining (synovial membrane) as if it were a foreign object. And pain, swelling, loss of movement, and joint destruction are the unhappy results. After the immune system goes to work on the joint lining, here’s what happens:
1 The assaulted membrane becomes inflamed and painful, the entire joint capsule swells, and the synovial cells start to grow and divide in an abnormal way.
2 Almost as if they’re launching a counterattack, these abnormal cells invade the surrounding tissue — mostly the bone and cartilage.
3 The joint space begins to narrow, and the joint’s supporting structures become weak. At the same time, the cells that trigger inflammation release enzymes that start eating away at the bone and cartilage, causing joint erosion and scarring.
4 Reeling under this many-sided attack, the joint itself deteriorates, eventually becoming misshapen and misaligned.
See Figures 3-1 and 3-2 for comparison of a healthy joint to one with RA.
© John Wiley & Sons, Inc.
FIGURE 3-1: In the healthy joint, the synovial membrane is thin and free from inflammation; the cartilage is smooth, thick, and even. The joint space is well defined, and the joint capsule assumes a normal shape.
© John Wiley & Sons, Inc.
FIGURE 3-2: In the joint affected by RA, the synovial membrane is inflamed and swollen, with infected cells invading both bone and cartilage. The cartilage is thin, the joint space narrowed, and the joint capsule swollen.
Rheumatoid arthritis insidiously makes its way through the body and (in more severe cases) can eventually spread to all of the joints. But the joints are not its only targets. RA is a systemic disease capable of attacking various parts of the body, not just the joints. It can cause inflammation of the eyes, skin, heart, blood vessels, and lungs, generally wreaking havoc on the body as a whole.
Some people have RA for just a short time — a few months or a couple of years — and then it disappears forever. Others suffer through painful periods (flares) that come and go, although they can feel quite well in between episodes. Those with severe forms of RA, however, may be in pain a good deal of the time, experience symptoms for many years, and suffer serious joint damage.
Recognizing the signs and symptoms of RA
If you have rheumatoid arthritis, the first thing you may notice is a dull ache, stiffness, and swelling in two matching joints — for example, both elbows, both knees, or both index fingers. The most typical sites for RA are the fingers and wrists, but it can also settle in the hands, elbows, shoulders, neck, hips, knees, ankles, and feet. See Figure 3-3.
© John Wiley & Sons, Inc.
FIGURE 3-3: The areas where rheumatoid arthritis is most likely to strike.
Although the symptoms of rheumatoid arthritis vary, most people with RA experience one or more of the following:
Pain, warmth, redness, swelling, or tightness in a joint
Swelling of three or more joints for six or more weeks
Joints affected in a symmetrical, mirror-image pattern (for example, both knees, both shoulders, and so on)
Joint pain or stiffness lasting longer than 30 minutes upon arising or after prolonged inactivity
Pea-shaped bumps under the skin (called rheumatoid nodules), especially on pressure points like the elbows or the feet, or overlying affected joints. In bedridden patients, they may also occur at the base of the scalp or on the back side of the hip
Evidence of joint erosion on an X-ray
Loss of mobility
General soreness, aching, stiffness
A general “sick” feeling (malaise)
Fatigue
Periodic
