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Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a condition that causes pain, swelling and distortion in the joints. Hands, feet and wrists are commonly affected, but it can also damage other parts of the body.

The condition is estimated to affect 400,000 people in England and Wales and occurs more frequently in women than men. It is most common between the ages of 40 and 70, but it can affect people of any age.

Persistent inflammation over time can damage affected joints and the severity can vary from mild to severe. Treatments include disease-modifying medicines to suppress inflammation, which can prevent or delay the progression of the disease, and medication to ease pain. The earlier treatment is started, the less joint damage is likely to occur. Surgery is needed in some cases if a joint becomes badly damaged.

RA is thought to be an auto-immune disease. This is when the immune system, which usually fights infection, attacks the cells that line the joints, making them swollen, stiff and painful. Over time, this can damage the joint itself, the cartilage and nearby bone. Some people have a tendency to develop autoimmune diseases. In such people, something might trigger the immune system to attack the body's own tissues bit the trigger is not known.

The most commonly affected joints are the small joints of the fingers, thumbs, wrists, feet, and ankles; however, any joint may be affected. The knees are quite commonly affected; less commonly, the hips, shoulders, elbows, and neck are involved. It is often symmetrical; so, for example, if a joint is affected in a right arm, the same joint in the left arm is also often affected. In some people, just a few joints are affected; in others, many joints are involved.

The symptoms of rheumatoid arthritis usually vary over time. Sometimes, symptoms only cause mild discomfort; at other times, they can be very painful, making it difficult to move around and do everyday tasks. The most common symptoms are pain and stiffness of affected joints. The stiffness is usually worse first thing in the morning, or after rest. The inflammation causes swelling around the affected joints.

When symptoms become worse, this is known as a flare-up or flare. A flare-up is impossible to predict, making rheumatoid arthritis difficult to live with.

Other symptoms

  • A variety of extra-articular (outside of the joints) symptoms may occur; the cause of some of these is not fully understood:
  • Inflammation around tendons can arise because the tissue which covers tendons is similar to that around the joints.
  • Small painless lumps (nodules) develop on the skin over the elbows and forearms in about 1 in 4 cases, but usually do no harm.
  • Anaemia and tiredness are common; fever, weight loss, as well as occasional muscle aches and pains.
  • In a few cases, inflammation develops in other parts of the body, such as the lungs, heart, blood vessels, or eyes. This is uncommon but can cause various symptoms and problems which are sometimes serious.

Currently, rheumatoid arthritis cannot be prevented as the exact trigger of the condition is unknown. Viruses and bacteria are thought to be involved, but extensive research so far has proved inconclusive.

There is no known cure for RA; however, early diagnosis and treatment can control symptoms and help prevent further disability.

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A new rheumatoid arthritis drug considered to be the first of its kind was recently backed by a Food and Drug Administration (FDA) advisory panel in the USA, putting the drug a step closer to hitting the market.

The panel of health advisers voted 8-2 in favour of Pfizer's Tofacitinib for patients who have not responded to one or more other drugs, although they recommended follow-up studies to gauge the pill's long-term side effects.

The FDA is not required to follow the group's advice, though it often does; a final decision is expected soon. If approved, Tofacitinib would be the first pill for rheumatoid arthritis from a new class of pain medications called JAK inhibitors. The drugs work by interfering with enzymes that contribute to the inflammation process that causes joint pain, particularly in the hands and feet.

 

Rheumatoid Arthritis

 
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