Rheumatoid arthritis (RA) is a disease that affects millions of individuals around the world every year.
Many RA sufferers express pain, not only in the smaller joints of the hands and feet, but neck pain, back pain, and even sciatica in severe manifestations.
Approximately one per cent of the world's population, one in ten thousand individuals, are affected by rheumatoid arthritis.
There appears to be a significant, gender-based difference, with three to five times as many women as men presenting with symptoms.
Interestingly, smokers appear to be at significantly greater risk than non-smokers, up to four times as many smokers as non-smokers exhibit the disorder, although the reasons for this disparity are not clear.
Rheumatoid arthritis is characterized by morning stiffness, arthritis at three or more joint areas, arthritis of the hand joints, symmetrical arthritis, rheumatoid nodules, serum RF, and radiographic changes.
Rheumatoid arthritis principally affects the joints, both large and small, but may impact other organs as well.
Extra-articular expressions of RA, evident in as high as twenty-five percent of all individuals with the disorder, may impact the skin, lungs, kidneys, heart, blood and blood vessels, eyes, liver, and even the nerves.
Rheumatoid arthritis may also lead to chronic fatigue, loss of appetite and weight, malaise, listlessness and, in some cases, a low-grade fever.
Osteoporosis and lymphoma have also been diagnosed in patients with rheumatoid arthritis, although a causal link is still unclear.
Given the constellation of symptoms, it is not surprising that pain is expressed as being widespread, ranging from mild to acute, and fleeting to often chronic, particularly in advanced stages.
Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that specifically affects the smaller joints of the hands and feet in the earlier stages and involves the larger joints in the later stages.
RA ultimately results in chronic pain over widespread areas of the body, to include neck pain, back pain, and sciatica.
It is nonsuppurative but finally results in the destruction of cartilage and joints.
It also may produce lesions of the heart valves, pericardium, myocardium, and pleura.
The pathophysiologic manifestations appear to result from the development antibody against IgG.
IgG makes up about 80% of the antibodies in plasma.
Plasma is the fluid portion of blood.
IgG is a crucial actor in the body's ability to respond to and fight and sort of antigen, foreign matter in the body.
These antibodies, called rheumatoid factor, belong to the IgM, IgG, and IgA classes.
The rheumatoid factor or RF is present in eighty-five to ninety percent of individuals with rheumatoid arthritis.
RA may be stimulated by a self-antigen; or an antigen in the synovial cavity, the space between the joints where fluid to lubricate the joints is present and necessary for movement; or an infective antigen, foreign agent or body causing an adverse reaction.
The rheumatoid arthritis continues to interact with IgG even in the absence of any specific antigen or invading foreign body.
Chronic antigen stimulation, such as occurs in chronic respiratory infections, causes the production and destruction of large amounts of antibody needed to fight infection.
The RF-IgG complexes are present in the rheumatoid lesions and apparently activate complement or prostaglandins or other substances that promote the inflammatory response.
The inflammatory response may vary in degree and location depending on the myriad of factors, to include age at onset and location of the specific inflammatory response.
In older RA sufferers, the pain is frequently felt in the neck and deep in the low back, among other areas, even resulting in sciatica in severe incidents of low back pain spreading into the buttocks and legs.
The arthritis associated with RA is due to an inflammation in the synovial capsule, specifically of the synovial membrane.
Synovial fluid is crucial for joint movement and, when synovitis is present, the joints become stiff, swollen, and extremely painful.
We will discuss rheumatoid arthritis's impact on the body, and its many extra-articular expressions, to include areas most affected by deformity, loss of function, and pain.
Treatment strategies for rheumatoid arthritis include a multitude of factors, clearly a holistic approach is required.
Pain, first localized in the smaller joints, particularly those of the hand, spreads and grows in intensity as the disease progresses until finally pain is chronic and widespread.
The fact that RA impacts the joints exacerbates degeneration and consequently leads to often acute and chronic neck pain, back pain, and sciatica in the latter stages of the disorder.
Specific strategies for dealing with this disorder, beyond those medications prescribed, will be discussed in the next article on this topic.
Until then, know that relief is possible and long lasting, provided certain strategies are implemented and adhered to.
Again, we will discuss those in part two, tomorrow.