Rheumatoid Arthritis as a Chronic Illness

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The human body is arguably among the most complex form ever to be studied. Over the years, scientists and other specialists have dedicated significant efforts towards trying to understand how different parts of the bodywork. Through these studies, the origins of various ailments have been discovered and solutions to the same developed. However, there are some ailments that up to date still puzzle experts in regard to their causes and possible solutions. Despite these challenges, various interventions have been developed to help people suffering from such diseases cope and live with their conditions. Rheumatoid Arthritis is among such diseases. This paper shall set out to explore various aspects of this disease. To this end, an overview of the suspected causes, symptoms, diagnosis and possible treatments shall be provided.

Background Information

According to Scott, Wolfe and Huizinga (2010), the discovery of Rheumatoid Arthritis can be traced as far back as the mid-19^th century. However, Gary (2003) states that it existed in the 17^th century as can be evidenced from examined skeletal antiquities from Europe and North Africa. According to the author, skeletal remains examination from these regions showed different forms of Arthritis including Osteoarthritis, ankylosing spondylitis and gout (Aceves-Avila, Baez-Molgado and Fraga, 1998; as cited by Gary, 2003). However, it was not until 1939 that Waaler originally discovered Rheumatoid factors. According to Gary (2003), it was during this era that researchers realized that self-reactivity played a central role in RA. This was discovered when Rheumatoid factors were identified in the blood of the patients.

Pathophysiology of Rheumatoid Arthritis (RA)

Wolfe and Huizinga (2010), state that RA can best be described as a clinical syndrome that covers a variety of diseases. They attribute this to the fact that Rheumatoid Arthritis consists of different disease subsets that involve a number of inflammatory cascades. Finally, these inflammatory cascades lead to a common pathway that is characterized by the presence of persistent synovial inflammation and damage to articular cartilage and underlying bones.

Inflammation

According to Wolfe and Huizinga (2010), the overproduction and overexpression of TNF are among the main inflammatory cascades that lead to RA. They assert that overproduction of TNF is a result of interaction between T and B lymphosytes, synovial-like fibroblasts and macrophanges (Wolfe & Huizinga, 2010, p. 1094). According to the authors, this interaction leads to the overproduction of cytokines, which in turn contribute to persistent inflammation and joint destructions. As such, they assert that this pathway drives these symptoms of RA.

Synovial and cartilage cells

Wolfe and Huizinga (2010), state that synovial and cartilage cells are the common local population of joint cells that are affected by RA. There are two categories of synovial cells. They include fibroblast-like and microphage-like synoviocytes. The latter is believed to lead to excess production of proinflammatory cytokines, while abnormal behaviors in RA are attributed to fibroblast-like synoviocytes (Wolfe & Huizinga, 2010).

Epidemiology of the illness

Frequency

Wolfe and Huzinga (2010), observe that recent studies indicate a 0.5%-1% prevalence rate of rheumatoid arthritis among adults in developed countries. In addition, women are three times more likely to get the disease than men. Age has been noted as being a significant contributor to the prevalence of the disease. Studies indicate that the prevalence rate is higher among women over the age of 65. This is attributed mainly to a hormonal imbalance among this population, which could have a pathogenic role in the prevalence of the disease.

The authors further assert that the frequency estimates of the disease depend on the methods used to establish the presence of Rheumatoid Arthritis. They further state that the incidence of the disease in developed countries ranges from 5 to 50 per 100, 000 adults. Similarly, recent studies have shown that geographic location plays an influential role in the prevalence of RA (Wolfe & Huizinga, 2010). They attribute this to the fact that the disease is more prevalent in northern Europe and North America as compared to rural West Africa among other areas. This shows that there may be genetic as well as environmental risk factors that come into play when it comes to determining the prevalence rate of RA within a given populace.

A study conducted by Helmick et al (2008) on the prevalence rate of Rheumatoid Arthritis and other conditions in the United States indicated that an average of 21% of adults within U. S. were diagnosed as having various forms of arthritis. This percentage amounts to 46.4 million Americans. More specifically, the results from this study showed that 1.3 million adults had Rheumatoid Arthritis (using the 2005 census results). This number was significantly low as compared to the 2.1 million adults reported in a 1995 study (Helmick et al, 2008).

On the same note, the study also showcased results of the prevalence rate of other forms of arthritis. From these results, it was evidenced that primary Sjogren s syndrome affected a larger number of adults (0.4 million to 3.1 million) in America (Melmick et al, 2008). Using the results from this study, the authors concluded that arthritis and other rheumatic conditions pose a serious health problem to the adult population in America.

Risk factors

As mentioned earlier, the main cause of RA is unknown. However, studies conducted over the years show that genetics and environmental factors play a significant role in the development of RA. This fact is supported by Rindfleisch and Muller (2005), who state that sex, older age, smoking, silicate exposure and positive family history contribute significantly to the development of Rheumatoid arthritis. In addition, the authors suggest that intake of decaffeinated coffee (more than three cups), excess vitamin D, and oral contraceptives can also place an individual at the risk of getting RA (Rindfleisch & Muller, 2005). According to the authors, studies have indicated that three in four women suffering from Rheumatoid Arthritis show significant improvements during pregnancy and a decline in progress after giving birth.

Similarly, Wolfe and Huizinga (2010), reiterating that smoking is the predominant environmental risk factor. They state that smoking doubles the risk of an individual developing Rheumatoid Arthritis. They also list intake of coffee, vitamin D, oral contraceptives, and low socioeconomic status as possible risk factors. However, Wolfe and Huizinga (2010) state that evidence supporting these other factors is not as strong as it should be.

Common signs and symptoms

There are various symptoms that have been used to detect the presence of arthritis. The table below shows the symptoms and their definition.

Sign or symptom	definition
Morning stiffness	This refers to stiffness experienced by an individual an hour after he/she initiates movement. The stiffness is always in or around the affected joints.
Arthritis affecting three or more joints	Mainly characterized by persistent pain in and around three or more of the following joints: wrists, PIP, MCP, elbows, MTP, knee or ankle joints. The combination of joints appears to be fluid-filled or have soft tissue swelling.
Hand joint involvement	Symptoms of RA are observed on the wrists, PIP and MCP joints.
Symmetric arthritis	One or more Joints on the left and right sides of the body are affected by arthritis.
Serum rheumatoid factor positive	Positive results from laboratory tests have a 95% or more positive prediction value. This means that the results are positive in no more than five percent of the patients without RA.
Radiographic changes	X-ray films show significant changes of erosion or bone density reduction neighboring the affected joints.

According to Rindfleisch and Muller (2005), patients suffering from Rheumatoid Arthritis complain of pain and stiffness around multiple joints. However, a third of patients diagnosed with RA initially experience pain in one joint before the situation worsens. The symptom may develop over a short or long period of time and are often accompanied by anorexic, weakness and fatigue tendencies (Rindfleisch & Muller, 2005). Joints with a high ratio of synovium to articular cartilage are the most affected and the wrists, PIP (prioximal Interphalangeal) and MCP (metacarpophalangeal) joints are always involved.

Similarly, the authors suggest that rheumatoid joints are boggy, warm and tender to the touch. In addition, some patients complain that their hands are puffy and that they have increased blood flow in and around the inflamed regions (Rindfleisch & Muller, 2005).

Diagnosis of Rheumatoid Arthritis

Rindfleisch & Muller (2005) assert that seven American Rheumatism Association (ARA) criteria are applied in the clinical trials used to diagnose Rheumatoid Arthritis. However, they state that using these criteria may not be as effective in typical outpatient practice since the diagnosis may not be definitive during the early stages of the disease. Rindfleisch & Muller (2005), recommend that patients should be encourage to truthfully descried the degree of pain, the level and duration of fatigue and stiffness, and the functional limitation they experience. In addition, the authors suggest that a joint examination that seeks to identify various symptoms of RA should be carefully conducted (Rindfleisch & Muller, 2005).

On the same note, it is always important to ensure that other disorders that share common symptoms are ruled out. As such, a differential diagnosis is of utmost significance. Rindfleisch and Muller (2005) attribute this to the fact that conditions such as seronegative spondyloarthropathies and systemic lupus erythematosus may have symptoms that are similar to those exhibited by Rheumatoid Arthritis. They further state that since no single diagnostic test can definitively identify RA, several tests should be conducted so that more objective data is collected before declaring a diagnosis. In addition, Rindfleisch and Muller (2005) suggest that blood cell count with deferential, RF (rheumatoid factor) and ESR (erythrocyte sedimentation rate) should form the baseline of all laboratory tests designed to diagnose RA.

Management of the Rheumatoid Arthritis

Dunn and Wilkinson (2005) suggest that complementary and alternative medicines (CAM) are prominently used in the treatment of pain and musculoskeletal problems. As such, the authors state that these therapies have widely been applied in the management of Rheumatoid Arthritis. Naturopathy is the most commonly used modality of CAM. This is because it combines nutritional, herbal and other practices to treat RA. Naturopathic treatments seek to alleviate various symptoms by altering factors that worsens the development of the disease. In regard to RA, these factors include: food allergies, increased gut permeability, increased circulating immune complexes, excessive inflammatory processes, and increased oxidative stress (Dunn & Wilkinson, 2005, p. 87).

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