By Qaiser Rehman, M.D., Internist and Rheumatologist, South Central Kansas Bone & Joint Center

Rheumatoid arthritis (RA) is the most common inflammatory arthritis that affects 1 percent, or 2.1 million Americans. It is characterized by pain, stiffness, swelling and loss of function in the joints. It usually affects the feet, the wrists and the finger joints closest to the hand in a symmetric fashion. In addition, patients have significant fatigue, occasional fever and a general sense of not feeling well (malaise). Occasionally, RA is associated with nodular lumps under the skin, dryness of the eyes and mouth, shortness of breath and sharp chest pains that worsen with deep breaths.

The disease course varies from person to person. For some, it lasts a few months to a few years and goes away without causing much joint damage. In others, it is moderately severe with intermittent exacerbations and remissions. However, in most patients, it can be a progressive disease with persistent swelling, pain and tenderness that leads to irreversible joint damage and deformities.

New studies have indicated that joint damage can occur as early as 6 months into the disease. Fifty percent of patients with RA are disabled at 10 years. The number increases to 70% within 15 years. Patients with severe uncontrolled RA have a shortened life expectancy by 3 to 15 years, a prognosis similar to lymph node malignancy (Hodgkin`s disease).

Fortunately, we have learned a great deal about the process of joint destruction and the chemicals that cause damage. With early diagnosis and institution of treatment, we can not only slow the progress of joint damage and disability, but even arrest the process altogether. The newer, stronger medicines called "biologics" and combination of existing drugs have proven to be more effective and safe. A patient with RA today can expect to have a normal active life, both in terms of quality and duration. Early diagnosis and referral can help prevent bone loss and irreversible joint damage.

Features of Rheumatoid Arthritis

• Tender, warm, swollen joints.
• Symmetrical pattern. For example, if one knee is affected, the other one is also.
• Joint inflammation often affecting the wrist and finger joints closest to the hand; other affected joints can include those of the neck, shoulders, elbows, hips, knees, ankles, and feet.
• Fatigue, occasional fever, a general sense of not feeling well (malaise).
• Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest.
• Symptoms that can last for many years.
• Symptoms in other parts of the body besides the joints.
• Variability of symptoms among people with the disease.