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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.

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