About 2.1 million Americans have rheumatoid arthritis. Rheumatoid arthritis is one of more than 100 forms of arthritis. It is a chronic (ongoing) condition in which the synovium (the tissue that lines and lubricates the joints) becomes inflamed. Large and small joints, as well as both sides of the body, are usually affected. Over time, the joints become deformed and knotted-looking if the disease is not treated properly. However, modern treatment and early recognition of the disease has led to fewer deformities and a much better outlook.
To diagnose rheumatoid arthritis, a doctor will perform a physical examination and discuss the symptoms. If arthritis of any kind is suspected, the patient is referred to a rheumatologist, a specialist who is trained to recognize and treat rheumatoid arthritis, as well as other kinds of arthritis. There are a number of forms of arthritis, and each must be considered and ruled out before a diagnosis can be made. Additionally, conditions like lupus, sarcoidosis, amyloidosis, ankylosing spondylitis and Whipple’s disease can mimic rheumatoid arthritis. The doctor may order the following tests:
Blood tests - These may show a higher than normal level of antibodies called rheumatoid factors. (Higher levels of these factors are also found in a number of other chronic conditions, and a positive test does not necessarily mean rheumatoid arthritis.)
Samples of synovial fluid - During the first months of the disease, only the swelling of the soft tissues around the joint can be seen. As the disease condition progresses, there may be a narrowing of the space in which the joints move and damage to the ends of the bones.
Magnetic resonance imaging (MRI) - This test may be used early in the course of the disease to help make a diagnosis and separate the condition (rheumatoid arthritis) from other possible problems that affect the bones and joints.
During the first year after a diagnosis, three out of four people with rheumatoid arthritis will require a more aggressive approach with drugs that can effectively eliminate pain, reduce functional disability and prevent damage to the joints. Rheumatologists typically use combinations of drugs, even including new agents that have been developed through research into the molecular mechanisms that cause joint inflammation.
Some patients (a minority) will be managed effectively with anti-inflammatory drugs only or local injections of cortisone into the joints. A determination of the risk for disease progression is important for your rheumatologist to make because this assessment will guide therapeutic decisions. In addition to management of the disease with medications, a number of important maneuvers and adjunctive approaches can be employed, including:
Assistive devices that can help relieve stress on your joints
Complete bed rest when the condition is most active and painful. Regular rest may be needed in less severe cases.
Diet
Drug therapy
Exercise
Joint injections or aspiration
Making lifestyle changes that can ease the condition
Managing pain
Physical rehabilitation
If medical approaches do not control the symptoms, surgery may be needed. Available surgical procedures include:
Arthroscopic synovectomy
Arthroplasty, in which parts of the joint are replaced with artificial parts. This may be done if there is joint damage that limits the movement of the joint
Total joint replacement. This is typically done with the hip and knee
Fusion of joints, so that the damaged parts are not moving against each other.