What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a systemic autoimmune
disease in which immune cells attack and inflame the membranes around various
joints. Like all autoimmune diseases, it is usually chronic and relapsing
and has no known cause. It affects 2% of people worldwide and is three
to four times more common in women than in men.
Resulting symptoms are inflamed, swollen, painful,
and/or deformed joints. Unlike osteoarthritis (OA), which generally affects a
few joints at a time, RA is generally symmetric and affects many joints simultaneously.
It can cause functional limitations in half of its patients within five years of
disease onset and decreases life expectancy as well. RA can also affect
the connective tissues of the body and other organs such as the lungs, heart
and nervous system.
Prevailing myths hold that arthritis is a disease of aging. Yet children
and even infants can be affected from birth with a form of RA called Juvenile
Rheumatoid Arthritis (JRA). This is a much more serious and complicated
form of RA, which affects approximately 300,000 children in the US. JRA is one of the
most prevalent chronic illnesses among youngsters, affecting more children than
juvenile diabetes or cerebral palsy. Thankfully and mysteriously, some
patients eventually go into remission, unfortunately others will battle the symptoms for
their entire lives. Despite the recent availability of
many breakthrough therapies, many patients go untreated because of a lack of awareness
or education, both on their parents' parts and their physicians'.
Like OA, there is no known cause for RA.
It is believed to have genetic, hormonal, environmental, and other factors.
A decline in RA rates since the 1950s suggests that birth control pills may
play an important preventive and ameliorative role. Evidence also
shows a cyclical increase in RA symptoms during menses. The transition
into menopause can also exacerbate symptoms. Pregnancy, on the other hand,
can cause symptoms to go into remission or to improve. A symptomatic flare-up
may occur at 6-8 weeks postpartum, however.
Never having had children is an independent
risk factor for RA. Pregnancy has a protective lifelong benefit.
It is unclear if RA alters fertility, although some studies show that it may
slightly increase tragic pregnancy outcomes such as miscarriage and perinatal
or neonatal deaths.
Family history plays an important role in RA. Those with a first degree
relative with RA (i.e. someone in your immediate family) have a three to four-fold
increased risk of developing the disease, regardless of gender. As with most
chronic illnesses, lower socioeconomic status is associated with worse disease
progression and outcomes in both men and women. Like OA, RA incidence increases
with age. American black and white populations are equally
affected, but certain Native American subpopulations may be at increased risk.
Created: 8/25/2003  - Donnica Moore, M.D.