Rheumatoid Arthritis

Rheumatoid arthritis is a chronic systemic inflammatory disease of unknown cause that primarily affects the peripheral joints in a symmetric pattern.

RA causes joint destruction and thus often leads to considerable morbidity and mortality.

Why do people Get RA ?

- An infectious etiology has been speculated
- Associated with a number of autoimmune responses
- Whether autoimmunity is a secondary or primary event is still unknown
- RA has a significant genetic component

Frequency :

The worldwide incidence of RA is approximately 3 cases per 10,000 population

Mortality/Morbidity:

- Daily living activities are impaired in most patients
- Life expectancy for patients with RA is shortened by 5-10 years

Signs and Symptoms:

- Morning stiffness
- Arthritis of 3 or more joint areas
- Arthritis of hand joints - At least one swollen area
- Symmetric arthritis with simultaneous involvement
- Rheumatoid nodules

Progression of RA :

Stage 1 (early RA)

- No destructive changes observed on x-ray
- Radiographic evidence of osteoporosis possible

Stage II (moderate progression)

- Radiographic evidence of periarticular osteoporosis with or without slight subchondral bone destruction
- Slight cartilage destruction possible
- Joint mobility possibly limited; no joint deformities observed
- Adjacent muscle atrophy
- Extra-articular soft tissue lesions (eg, nodules, tenosynovitis)

Stage III (severe progression)

- Radiographic evidence of cartilage and bone destruction in addition to periarticular osteoporosis
- Joint deformity
- Extensive muscle atrophy

Stage IV (terminal progression)

- Criteria of stage III
- Fibrous or bony ankylosis - stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint

Remission:

Remission of RA - Five or more of the following conditions present for at least 2 consecutive months:

- Duration of morning stiffness not exceeding 15 minutes
- No fatigue
- No joint pan
- No joint tenderness or pain with motion
- No soft tissue swelling in joints or tendon sheaths
- ESR of less than 30 mm/h for a female or less than 20 mm/h for a male

Lab Studies:

No pathognomonic test is available to help confirm the diagnosis of RA. The diagnosis is made using clinical, laboratory, and imaging features. Clinicians will analyze the following:

- Markers of inflammation, such as ESR and CRP
- Synovial fluid analysis
- Rheumatoid factor - Present in approximately 60-80% of patients with RA over the course
- Antinuclear antibodies - These are present in approximately 40% of patients with RA

Treatments:

Disease-modifying antirheumatic drugs:
- Leflunomide (Arava)
- Methotrexate
- Sulfasalazine
- Etanercept (Enbrel)
- Infliximab (Remicade)

Nonsteroidal anti-inflammatory drugs

Analgesics

Glucocorticoids

Immunomodulators:

- Anakinra (Kineret)
- Abatacept (Orencia)

Shoe Advice from the APMA

A Shoe for Every Sport

Shoes, shoes, and more shoes. There seems to be a shoe designed for every sport out there. But there’s a method to the madness. Sport-specific shoes really can change your game. See the tips below to learn why the shoe you choose could make or break your day on the court or field.

Basketball — Whether you’re making the perfect pass or
finishing off the high-flying dunk, basketball shoes have
several features that will help you prevent injury.
• A thick, stiff sole gives support while running and landing
from jumps.
• High ankle construction supports the ankle during
quick changes in direction. A basketball shoe should
have the strongest support on either side of the ankle.

Racquetball/Tennis — On the surface, court shoes for tennis and
racquetball may look like any other athletic sneaker, but it’s
what’s on the inside that makes the difference.
• A court shoe supports both sides of the foot because of all
the quick lateral movements and weight shifts in court sports.
• It provides a flexible sole for fast changes of direction.
• It has less shock absorption than a running or basketball
shoe.

Running — The running shoe is perhaps the most personal and intricate of all athletic shoes. Every runner has different needs and there
are a multitude of choices out there.
• A running shoe must provide maximum shock absorption to help
runners avoid ailments such as shin splints and knee pain.
• The shoe should control the way your heel strikes the ground, so
the rest of your foot can fall correctly.
• Know your foot type (high, medium, low arch) so you can get the
shoe with the right support for your foot.