What is rheumatoid arthritis?

• Rheumatoid arthritis causes inflammation with swelling to the lining of the joint and/or other internal organs.
  
• It can affect any joint, but most commonly the hands or feet.
  
• Abnormal activity of the body's immune system causes persistent inflammation of the lining of the joints and sometimes other tissues.
  

How common is rheumatoid arthritis?

• Rheumatoid arthritis affects 300,000 (1 in 100) Canadians and twice as many women as men.
  
• It can develop at any age however most people develop it between the ages of 25 and 50.
  

What causes rheumatoid arthritis?

• The exact cause is unknown.
  
• There may be a family history but in many people there is no known relative with rheumatoid arthritis.
  

How do you know if you have rheumatoid arthritis?

• Rheumatoid arthritis may start gradually or with a sudden severe attack.
  
• Symptoms include:
  • Pain, swelling and tenderness causing inflammation of the joints. Joints tend to be involved in a symmetrical pattern. That is, if the knuckles on the right hand are swollen, the knuckles on the left hand will be too.
    
  • Stiffness of joints and muscles, particularly morning stiffness
    
  • Low energy and fatigue.
    
• Early diagnosis is important so that treatment can start right away to avoid the chance of deformity or disability
  
• The diagnosis will be based on your family and medical history as well as physical examination. Certain tests such as blood tests and x-rays will be ordered.
  

How is rheumatoid arthritis treated?

• If your doctor thinks you have rheumatoid arthritis, he or she will usually refer you to a rheumatologist. A rheumatologist is a doctor who has received special training in the diagnosis and treatment of problems with joints, muscles and bones.
  
• Although there is no cure, treatment that is started early can keep the disease under control and help avoid disability.
  
• There are steps you can take to deal with the pain and cope with the disease.
  
• It is important that you know as much as you can about this disease. Speaking with people who are specialists in arthritis care can provide you with the necessary information.
  

Medication

• Four types of drugs may be used to treat rheumatoid arthritis:
  
• Nonsteroidal anti-inflammatory drugs (NSAIDs). They reduce pain and swelling but will not prevent joint damage. NSAIDs may increase your risk of stomach upset and bleeding in the gut. Let your doctor know if you experience stomach pain, indigestion or black stools.
  
• Cyclooxygenase-2 selective inhibitors (COX-2 SIs), a recently approved class of medications. Like other NSAIDS, COX-2 SIs have similar effectiveness to older NSAIDs in reducing pain and swelling. COX-2 SIs do not prevent joint damage. They may be used if you are at risk of stomach upset or other gastrointestinal (GI) risk factors. Recent studies have suggested that COXIBs may be associated with an increased risk of cardiovascular side effects and this should be discussed with your doctor.
  
• Disease-modifying anti-rheumatic drugs (DMARDS). They take about two to six months before they begin to work and may prevent joint damage.
  
• Oral cortisone (called prednisone). It can control the inflammation and swelling. Prednisone may cause side effects such as bone loss (osteoporosis), and your doctor will attempt to give you the lowest dose for the shortest time necessary to control your symptoms. After about six months of taking prednisone, your doctor will try to slowly reduce the dosage and eventually you may no longer need to take it.
  

For medications prescribed by your doctor, it is important to know:

• Name(s) (generic and brand):
• How much to take:
• When to take it:
• How quickly will it work:
• For how long should it be taken:
• Side effects to look out for:

Exercise

• Exercise helps reduce pain, prevent further joint damage and maintains a healthy weight.
  
• Not using a sore joint will cause the muscles around it to become weak and result in pain.
  
• There are three types of exercise:
  • Range-of-motion: reduces stiffness and helps keep joints flexible
    
  • Strengthening: helps maintain or increase muscle strength
    
  • Endurance: strengthens your heart, gives you energy and controls your weight. Walking, swimming and cycling are types of endurance exercise.
    

Heat/Cold

• Heat helps relax aching muscles, joint pain and soreness, for example, a hot shower
  
• Cold helps numb an area, for example, an ice pack.
  

Protect Your Joints

• Pace yourself by alternating heavy or repeated tasks with easy ones or rest
  
• Position your body to avoid stress on joints.
  
• Use helpful devices in your daily tasks such as carts, enlarged handles, canes and grab bars.
  

Relaxation

• Relaxing the muscles reduces joint pain.
  
• Relaxation can include deep breathing exercises, listening to music, visualization, prayer, meditation or listening to relaxation tapes.
  

Surgery

• May be an option if the joint becomes severely damaged or the pain is unbearable.
  

For More Information…

This fact sheet is just a brief look at rheumatoid arthritis. Other people who may be able to help you are physiotherapists and occupational therapists. Physiotherapists design programs that help keep the affected joint(s) active while maintaining its natural range of motion. Sometimes the inflamed joints may be too sore to move. Physiotherapists are trained in pain management and can help find ways of reducing pain. Occupational therapists can also help with pain management.

For more information or if you have any questions, ask your doctor or call The Arthritis Society at 1-800-321-1433. You can also visit The Arthritis Society's website at www.arthritis.ca.

Questions to ask your doctor at your next visit:

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This information is brought to you by an educational grant by McNeil Consumer Healthcare, the makers of TYLENOL* (acetaminophen)

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