Rheumatoid Arthritis (cont.)
What causes 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. 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.
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 increases the risk of developing rheumatoid arthritis.
What are the symptoms
and signs of rheumatoid arthritis?
The symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation. When body
tissues are inflamed, the disease is active. When tissue inflammation subsides,
the disease is inactive (in remission). Remissions can occur spontaneously or with
treatment and can
last weeks, months, or years. During remissions, symptoms of the disease
disappear, and patients generally feel well. When the disease becomes
active again (relapse), symptoms return. The return of disease activity and symptoms
is called a flare. The course of rheumatoid arthritis varies from patient
to patient, and periods of flares and remissions are typical.
When the disease is active, symptoms can include fatigue,
loss of energy, lack of appetite, low-grade fever, muscle and joint aches, and
stiffness. Muscle
and joint stiffness are usually most notable in the morning and after periods
of inactivity. Arthritis is common during disease flares. Also during flares,
joints frequently become red, swollen, painful, and tender. This occurs because the
lining tissue of the joint (synovium) becomes inflamed, resulting in the
production of excessive joint fluid (synovial fluid). The synovium also
thickens with inflammation (synovitis).
In rheumatoid arthritis, multiple joints are usually
inflamed in a symmetrical pattern (both sides of the body affected). The small
joints of both the hands and wrists are often involved. Simple tasks of
daily living, such as turning door knobs and opening jars, can become difficult
during flares. The small joints of the feet are also commonly
involved. Occasionally, only one joint is inflamed. When only one
joint is
involved, the arthritis can mimic the joint inflammation caused by other forms of arthritis, such as gout or joint
infection. Chronic inflammation can cause damage to body tissues, including cartilage and
bone. This leads to a loss of cartilage and erosion and
weakness of the bones as well as the muscles, resulting in joint deformity, destruction, and loss of function. Rarely, rheumatoid arthritis can even affect the joint that is responsible for the tightening
of our vocal cords to change the tone of our voice, the cricoarytenoid joint. When this joint is inflamed, it can cause hoarseness of
the voice.
Since rheumatoid arthritis is a systemic disease, its
inflammation can affect organs and areas of the body other than the joints. Inflammation of the
glands of the eyes and mouth can cause dryness of these areas and is referred to
as Sjogren's syndrome. Rheumatoid inflammation of the lung lining (pleuritis)
causes chest pain with deep breathing, shortness of breath, or coughing. The lung tissue itself can also become inflamed,
scarred, and sometimes nodules of inflammation (rheumatoid nodules) develop within the
lungs. Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause a chest pain that typically changes in intensity when lying
down or leaning forward. The rheumatoid disease can reduce the number of red blood cells
(anemia) and white blood cells. Decreased white
cells can be associated with an enlarged spleen (referred to as Felty's
syndrome) and can increase the risk of infections. Firm lumps under the skin
(rheumatoid nodules) can occur around the elbows and fingers where there is
frequent pressure. Even though these nodules usually do not cause symptoms,
occasionally they can become infected. Nerves can become pinched in the wrists to cause carpal tunnel syndrome. A rare, serious complication, usually
with long-standing rheumatoid disease, is blood vessel inflammation
(vasculitis). Vasculitis can impair blood supply to tissues and lead to tissue
death (necrosis). This is most often initially visible as tiny black areas around the nail
beds or as leg ulcers.
Next: How is rheumatoid arthritis diagnosed? »
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