Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune condition which arises when we start to attack our own synovium, the material that lines our joints. Any joint may be affected, the onset may be acute and severe or slow and creeping, there may be one attack that resolves or repeated attacks over a lifetime and there may be involvement of other systems such as the eyes (where there is dryness - see eye disorders in the head section) or the lungs, causing among other things pleurisy. Initially the attack on the synovium produces a hot and swollen joint which is tender and stiff, the symptoms being worse in the morning. The inflamed synovium is called pannus, and it releases enzymes which degrade the cartilage and, if untreated, will destroy the joint. Over a period of time it causes tendons to snap producing characteristic deformities - for example the wrists may be bent towards the side of the little finger (called ulnar deviation), knees may be distorted causing either bowlegs or knock-knees. While there are often characteristic changes on X-rays, such as thickening of the synovium or holes called erosions at the edges of the joint, and blood tests may demonstrate the presence of the agents that are attacking the synovium, sometimes these changes are not present, at least in the early stages, and in some cases it may be difficult to differentiate this from other causes of arthritis, when it is termed sero-negative arthritis (because the blood, or serum, test is negative). In acute attacks the only symptoms may be of malaise, joint and muscle pain and an intermittent fever, which may persist for weeks. Besides treating the pain and swelling with painkillers such as non-steroidal anti-inflammatory agents and rest of the affected joint, agents to modify the progress of the disease such as gold or steroids may preserve joint function. Surgery may be required to stabilise, re construct or replace damaged joints. Though this disease is associated with a particular tissue type, its cause is unknown.
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