Rheumatoid arthritis, often called RA, is an autoimmune, or self-attacking, disease that results in inflammation of the joints.
It is unusual because unlike other forms of arthritis, the symptoms are symmetrical, meaning that if one wrist or knee is affected, the other is as well.
Much about the disease is still unknown, including the cause and the way those who suffer from it are affected. For some people the disease is acquired for only a few months and disappears with little damage. Others are affected for years with periods of remission and painful flare-ups. In severe cases the disease may be active for most of the time and last an entire lifetime.
Rheumatoid arthritis can prove very debilitating for many who suffer from it. The disease can disrupt normal daily activities, and limit job opportunities for those who have it. Because of the way that the disease affects everybody differently, it is important to plan your pregnancy with your doctor early. You will need to discuss the impact of rheumatoid arthritis and the effects of the drugs you are using to control the disease to plan a strategy that will work for you.
Human joints contain two or more bones, the ends of which are covered by cartilage. This is surrounded by a capsule lined with a tissue called synovium that produces a clear fluid that lubricates and nourishes the cartilage and bones. Rheumatoid arthritis causes the white blood cells associated with the immune system to travel to the synovium resulting in a thickening and swelling of the tissue and damage to the cartilage and bones of the joints. This weakens the ligaments and tendons that support and stabilize the joint. Many experts believe the bones in the joints can be damaged within a year of contracting the disease, so early diagnosis and treatment is very important.
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Symptoms of rheumatoid arthritis include tender, swollen joints that may feel warm. The disease often affects the joints of the wrist, and the finger joints closest to the hands. Other joints including the neck, shoulders, elbows, hips, knees, ankles and feet can also be affected. Unlike other forms of arthritis, RA affects joints symmetrically, so if a joint on the left of your body is affected, the same joint on the right side will have the same symptoms.
People who suffer from rheumatoid arthritis often complain of fatigue and occasionally fever. Stiffness and pain lasting for half an hour when you get up in the morning is a common symptom. It seems that rheumatoid arthritis reduces production of the red blood cellsA concave disk containing hemoglobin surrounded by a lipoid membrane. It is the major cellular element of the circulating blood and it serves primarily to transport oxygen. The number of red blood cells is about 4 and 4.5 million per cubic millimeter in women (4.5 and 5 million per cubic millimeter in men).
The average lifespan of a red blood cell is between 110 and 115 days after which it is removed from the bloodstream. New red blood cells are produced at about the rate of 1% daily to keep levels constant. Red blood cells originate in the marrow of long bones. Also called erythrocytes.
Visit our comprehensive glossary for more pregnancy terms and definitions., and many people with RA become anemic. Dry eyes and mouth are common side effects and in rare cases, there may be inflammation of the lining of the lungs, or the sac enclosing the heart.
Unfortunately rheumatoid arthritis can be a difficult disease to diagnose early. The symptoms vary in form and severity from person to person. With no single test available to confirm the diagnosis, and a variety of symptoms that are similar to other complaints, it can take time to conclusively confirm the presence of RA.
If you and your doctor suspect that you may be suffering from rheumatoid arthritis, your joints, skin, reflexes and muscle strength will all be tested for function to confirm that they are working correctly. A thorough physical exam forms an important part of the diagnosis. Your medical history will also be examined. Clues such as a history of pain and stiffness and the way these symptoms change with time may indicate the presence of the disease.
Confirmation of the diagnosis may be attempted by testing for the presence of rheumatoid factor in the blood. These antibodiesA protein immunoglobulin which is produced naturally by the body and is essential to the immune system by working to combat foreign bodies, germs or bacteria. They are produced by thelymphoid tissue and consist of different classes each of which is designed to fight specific antigens. They include agglutinins, bacteriolysins, opsonins and preciptin.
Visit our comprehensive glossary for more pregnancy terms and definitions. are formed by the immune system to help fight foreign substances such as infection or disease. Unfortunately the presence of rheumatoid factor is not always present during the early stages of the disease, and some people who do test positive never develop rheumatoid arthritis.
Other tests, which can be used to test for rheumatoid arthritis include a white blood cell count, or routine tests for anemia. The erythrocyteA concave disk containing hemoglobin surrounded by a lipoid membrane. It is the major cellular element of the circulating blood and it serves primarily to transport oxygen. The number of erythrocytes is about 4 and 4.5 million per cubic millimeter in women (4.5 and 5 million per cubic millimeter in men).
The average lifespan of an erythrocyte is between 110 and 115 days after which it is removed from the bloodstream. New erythrocytes are produced at about the rate of 1% daily to keep levels constant. Erythrocytes originate in the marrow of long bones. Also called red blood cells.
Visit our comprehensive glossary for more pregnancy terms and definitions. sedimentation rate, or sed rate, which measures inflammation in the body is also performed. A test that measures disease activity called C-reactive protein can also be used to confirm the diagnosis.
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During the later stages of rheumatoid arthritis, x-rays can be used to determine the amount of damage to the joints. While x-rays cannot help diagnose the presence of RA, they can be useful in monitoring the progression of the disease.
Once the diagnosis has been confirmed, you will be required to visit a team of healthcare professionals to manage the disease. You may choose to consult a rheumatologist who specializes in diseases of the joints, muscles and bones. During the later stages of the disease you may also be required to visit occupational therapists, orthopedic surgeons, and for some people psychologists and social workers.
Enrolling in a self-management program or support group can be very beneficial in helping you understand the disease and learn the best ways to cope and reduce pain. This will give you the necessary self-confidence to lead a normal, healthy and active life.
Rheumatoid arthritis affects both men and women of all races and ethnic groups. The incidence of RA is about two or three times higher among women than men. While it most commonly affects the elderly, it often appears in middle age, and can be found in children and young adults.
The cause of rheumatoid arthritis is still unknown. There are several theories, but it is thought that there is an association between certain genesThe part of every cell in which genetic material and inheritance is stored. Introduced by Mendel, the concept is still evolving and is a rapidly growing area of medical science.
In humans, genes occur as paired alleles. They serve numerous purposes, chiefly structural and regulative components that control diferentiation of cells and body tissues.
There are many different types of genes including complementary genes, dominant genes, lethal genes, mutant genes, operator genes, pleiotropic genes, recessive genes, regulator genes, structural genes, sublethal genes, supplementary genes and wild-type genes.
Visit our comprehensive glossary for more pregnancy terms and definitions. that play a role in the immune system and the incidence of RA. While there is evidence that these genetic or inherited factors contribute to rheumatoid arthritis, not everyone with this genetic makeup develops the disease. Some researchers believe that there must be a viral or bacterial infection that triggers the onset of the disease among those who are susceptible to it. This trigger has yet to be identified, and it certainly does not mean that those who have rheumatoid arthritis are contagious.
It is also thought that hormonesA complex chemical substance created in a part or organ of the body. When released it initiates or regulates activity in an organ or group of cells in another part of the body.
Hormones secreted by endocrine glands are transported through the bloodstream to their target organ. The amount of hormone secreted is regulated either by other hormones, by neurotransmitters, or simply when an excess of the organ's activity indicates a need to reduce the amount of the hormone produced.
Other hormones are produced locally by the organs themselves and are common in the digestive tract.
Visit our comprehensive glossary for more pregnancy terms and definitions. play a role in the development of the disease, and this seems to be confirmed by the fact that more women contract the disease than men. The disease often enters a period of remission during pregnancy and may flare up after delivery. Breastfeeding and the use of hormonal contraceptives also seem to affect the incidence of contracting the disease. It is thought that the changing hormone levels found in pregnancy affect the immune system molecules interleukin 12, or IL-12, and tumor necrosis factor - alpha, or TNF-a. Unfortunately the disease has yet to be fully understood and more research is required to better understand the nature of the disease.
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Some of the drugs used to manage rheumatoid arthritis are known to affect fertility. If you are planning to conceive, you should talk to your rheumatologist about developing a lifestyle that will increase your chances of conceiving and minimize problems during pregnancy.
Some drugs such as leflunomide can remain in the body for up to two years after they have been stopped. You will need to talk to your doctor about the best strategy to ensure that you have stopped taking the appropriate drugs in time before conceiving.
If your partner has rheumatoid arthritis it is important for both of you to know that drugs such as azothioprine, methotrexate and sulphasalazine can reduce sperm count. He should consult with his doctor or rheumatologist before you try to conceive.
About three quarters of pregnant women find that their condition improves during pregnancy, especially during trimester two. Experts suggest that the increase in pregnancy hormones and the anti-inflammatory properties of pregnancy related globulin can reduce the pain and swelling associated with rheumatoid arthritis.
There is no increased risk of miscarriage or genetic abnormalities associated with women who suffer from rheumatoid arthritis. Your doctor will recommend that you take about 0.4 milligrams of folic acidA water soluble vitamin with a yellow crystalline construction of the B complex group. Folic acid is necessary for cell growth and reproduction. It works with vitamins B12 and C to breakdown and use proteins, and helps form nucleic acids and heme in hemoglobin.
Folic acid also stimulates the appetite and the production of hydrochloric acid in the digestive tract. It is stored in the liver. Important in pregnancy, natural sources include green leafy vegetables, liver, kidney, asparagus, lima beans, nuts and whole grain cereals. It may also help alleviate menstrual problems. Also known as folacin.
Visit our comprehensive glossary for more pregnancy terms and definitions. supplementation daily to reduce the risk of spina bifidaA relatively common birth defect in which the spine fails to form properly leaving the spinal cord exposed. Spina bifida can result in mental disability and partial paralysis. Also called spinal dysraphia.
Visit our comprehensive glossary for more pregnancy terms and definitions., which can be associated with a previous treatment of methotrexate. Many of the complaints of pregnancy are similar to the symptoms of rheumatoid arthritis. You should talk to your doctor if you are suffering from water retention and swelling, backaches and fatigue.
After the hormone levels associated with pregnancy have subsided you will probably suffer from a flare-up. This will probably occur about six weeks after the delivery of your baby, but the condition will return to normal after the flare up period.
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You will probably find the postpartum period exhausting. Simply managing your life, your condition and your newborn baby can prove overwhelming for many women. It is important that you get the support of your family and friends during this period.
The presence of rheumatoid arthritis should not adversely impact your labor and delivery. If the disease affects your hips, your mobility may be affected, and you should discuss with your doctor or midwife any concerns that you may have about the delivery.
There is no reason why you cannot breastfeed your baby if you have rheumatoid arthritis. But it is important to remember that some drugs used to manage the disease can pass into the breast milk. Depending on the severity of your condition, your doctor may recommend that the benefits of breastfeeding are outweighed by the risks of not taking the drugs necessary to control the disease.
The treatment recommended during pregnancy may be different according the severity of the disease during your pregnancy. If left untreated your baby is at risk of many problems including low birth weight.
Some drugs are best avoided during pregnancy. At the top of this list is methotrexate, although suphasalazine, azathioprine and penicillamine may also cause problems to the baby.
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NSAIDs, or non-steroidal anti-inflammatory drugs, such as aspirin and ibuprofen can be used during the first couple of trimesters, but their use should be limited or avoid during the third trimester.
Corticosteroids can be used safely during pregnancy with no adverse affects on the fetus, but there is an increased risk of hypertension, gestational diabetes and premature rupture of membranes. Hydroxychloroquine is thought to be safe for use during pregnancy.
The goal of managing rheumatoid arthritis during pregnancy during pregnancy is to relieve pain, inflammation and slow down the progression of joint damage. The effect of pregnancy hormones on the severity of your disease will need to be monitored by your doctor, who may adjust the treatment for the disease during the course of your pregnancy. It is important to maintain good communication with your doctor so that the best course of action can be determined when you are trying to conceive and during your pregnancy.
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