Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Rheumatoid arthritis is a chronic disease
characterized by periods of disease flares and remissions.
In rheumatoid arthritis, multiple joints are usually,
but not always, affected in a symmetrical pattern.
Chronic inflammation of rheumatoid arthritis can
cause permanent joint destruction and deformity.
Damage to joints can occur early and does not
always correlate with the severity of RA symptoms.
The "rheumatoid factor" is an antibody that can be found in the blood of 80% of
people with rheumatoid arthritis.
There is no cure for RA. The treatment of rheumatoid arthritis optimally
involves a combination of patient education, rest and
protection, medications such as NSAIDs, DMARDs, TNF alpha inhibitors, immunosuppressants,
and steroids, and occasionally surgery.
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. The immune system contains a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies and immune cells in their blood that target their own body tissues, where they can be associated with inflammation. While inflammation of the tissue around the joints and inflammatory arthritis are characteristic features of rheumatoid arthritis, the disease can also cause inflammation and injury in other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. Rheumatoid arthritis that begins in people under 16 years of age is referred to as juvenile idiopathic arthritis (formerly juvenile rheumatoid arthritis).
Picture of a joint with rheumatoid arthritis
While rheumatoid arthritis is a chronic
illness, meaning it can last for years, patients may experience long
periods without symptoms. However, rheumatoid arthritis is typically a progressive illness that has the potential to cause
significant joint destruction and functional disability.
A joint is where two bones meet to allow movement of body
parts. Arthritis means joint inflammation. The joint inflammation of rheumatoid
stiffness, and redness in the
joints. The inflammation of rheumatoid disease can also occur in tissues around the
joints, such as the tendons, ligaments, and muscles.
In some people with
rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing
deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.
Rheumatoid arthritis is a common rheumatic disease, affecting approximately 1.3 million people in the United States, according to current census data. The disease is three times more common in women as in men. It afflicts people of all races equally. The disease can begin at any age and even affects children (juvenile
idiopathic arthritis), but it most often starts after 40 years of age and before 60 years of age.
Though uncommon, in some families, multiple members can be affected, suggesting a genetic basis for the disorder.
What are causes and risk factors of rheumatoid arthritis?
The cause of rheumatoid arthritis is unknown. Even though infectious agents such as viruses, bacteria, and fungi have long been suspected, none has been proven as the cause. The cause of rheumatoid arthritis is a very active area of worldwide research. It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited (hereditary). Certain genes have been identified that increase the risk for rheumatoid arthritis. It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body's own tissues. This leads to inflammation in the joints and sometimes in various organs of the body, such as the lungs or eyes.
It is not known what triggers the onset of rheumatoid arthritis. Regardless of the exact trigger, the result is an immune system that is geared up to promote inflammation in the joints and occasionally other tissues of the body. Immune cells, called lymphocytes, are activated and chemical messengers (cytokines, such as
tumor necrosis factor/TNF, interleukin-1/IL-1, and interleukin-6/IL-6) are expressed in the inflamed areas.
Environmental factors also seem to play some role in causing rheumatoid arthritis. For example, scientists have reported that
smoking tobacco, exposure to silica mineral, and chronic periodontal disease all increase the risk of developing rheumatoid arthritis.
While early symptoms of rheumatoid arthritis can actually be mimicked by other diseases, the symptoms are very characteristic of rheumatoid disease. Rheumatoid arthritis symptoms and signs include the following:
Stiffness of joints, particularly worse in the morning