HealthLine: Oh, My Aching Joints!

It is true that some people can tell if it is going to rain by the aches and pains they experience in their joints. It’s called barometric medicine.  One of the most distinctive disorders attributed to such events is rheumatoid arthritis.

Rheumatoid Arthritis is a chronic disorder that affects predominantly the small joints in the hands and feet, caused by inflammation of the lining of the joints, known as the synovium.  It can be thought of as the body not recognizing itself as its own, and develops antibodies to its own tissues.

Approximately 1% of the world’s population is afflicted by rheumatoid arthritis.  It will occur two to three times more frequently in women than men, and generally occurs between the ages of 40 and 60.  As a chronic condition, there is no cure for the disorder, but treatment regimens have drastically improved over recent decades.

Signs and symptoms predominantly occur as; joint pain and swelling, joints tender to touch, red and puffy hands, nodules under the skin, fatigue, morning stiffness lasting a few hours and improving as the day goes on, fever and weight loss.  Smaller joints are affected first; wrists, hands, feet, ankles and larger joints become affected later in time; shoulders, elbows, knees, hips, the jaw and neck.  Rheumatoid Arthritis, in some cases, is known to involve the lung, kidney, heart and blood vessels and with increased severity, cause end organ failure.

Diagnosis can be made through specific blood tests and/or radiological findings such as plain x-ray, MRI scanning or ultrasound.  The American College of Rheumatology has designated three criteria to follow in clinical practice in order to accurately diagnose rheumatoid arthritis at an early stage before advanced destruction; two or more swollen joints, morning stiffness lasting more than one hour for at least six weeks and a lab test detecting rheumatoid factors or antibodies to specific proteins in the blood.

The specific causes for rheumatoid arthritis are unknown, but is it theorized by the medical community that there is a strong genetic factor to the development of rheumatoid arthritis which makes the individual more susceptible to certain environmental factors, i.e. infections with viruses or bacteria that trigger the disease.  The risk factors for rheumatoid arthritis include; female sex, age between 40 and 60, positive family history and smoking. 

Sincere there is no cure for rheumatoid arthritis, the general approach to managing the disease is controlling the symptoms and preventing joint destruction.  Medications can reduce inflammation, occupational and physical therapy provide mobility and surgery will correct damaged joints.

The current recommended medications for treatment of rheumatoid arthritis start with those with the least risk of side effects and work up to more aggressive forms; anti-inflammatory agents, steroids, disease modifying drugs, immunosuppressants and newer, injectable protocols with a higher risk factor.

Therapy emphasizes exercise, applying heat or cold and stress management.  Assistive devices and canes can be prescribed.  If both medications and therapy fail, various surgical procedures can be performed to repair damaged joints; total joint replacement, tendon repair, removal of the synovial lining (synovectomy) and joint fusion.

There are safe and complementary alternative treatments which can be found at certain pharmacies and health food stores; thunder god vine extract, plant oils such as evening primrose, borage and black currant, fish oil.  Interestingly, tai chi which emphasizes movement and deep breathing, has been found in certain small studies to relieve rheumatoid arthritis pain.

Next time Grandma tells you it’s going to rain, grab your umbrella before you go out.

Dr. Ballard is a Board Certified Internist and Geriatrician with a special interest in Women’s Health.  She practices in Enumclaw, 360-825-1389.  Dr. Ballard’s comments are informational only and not to be construed as medical advice.  Consult your personal physician for any medical issues.