© John Wiley & Sons, Inc.
FIGURE 3-3: The areas where rheumatoid arthritis is most likely to strike.
Although the symptoms of rheumatoid arthritis vary, most people with RA experience one or more of the following:
Pain, warmth, redness, swelling, or tightness in a joint
Swelling of three or more joints for six or more weeks
Joints affected in a symmetrical, mirror-image pattern (for example, both knees, both shoulders, and so on)
Joint pain or stiffness lasting longer than 30 minutes upon arising or after prolonged inactivity
Pea-shaped bumps under the skin (called rheumatoid nodules), especially on pressure points like the elbows or the feet, or overlying affected joints. In bedridden patients, they may also occur at the base of the scalp or on the back side of the hip
Evidence of joint erosion on an X-ray
Loss of mobility
General soreness, aching, stiffness
A general “sick” feeling (malaise)
Fatigue
Periodic low-grade fever and/or sweats
Difficulty sleeping
Anemia caused by chronic inflammation in the body
Blood tests showing the presence of positive rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibody. These are antibodies that are found in up to 80 percent of RA patients.
As RA progresses, the joints enlarge and can become deformed. They may even freeze in a semicontracted position, making complete extension impossible. The fingers can start to curl up, pointing away from the thumb, as their tendons slip out of place. RA may also attack other parts of the body, causing the following conditions:
Pleurisy: If RA attacks the lungs, it can cause pleurisy (inflammation of the membranes around the lungs), prompting difficulty in breathing, chest pain, and scarring and inflammation of the lungs causing chronic dry cough and difficult breathing, especially with exercise.
Episcleritis or scleritis: If it attacks the tissues covering the white part of the eye, it can cause eye pain, sensitivity to light, and tearing of the eye.
Pericarditis: If it settles in the membrane surrounding the heart (a condition called pericarditis), it can cause chest pain while lying down, or impair the heart’s ability to pump blood properly.
Vasculitis: If it affects the blood vessels (vasculitis), the blood supply to other parts of the body can be cut off, causing nerve damage, skin ulcers, gangrene, and other types of tissue death.
Understanding the causes of RA
The truth is that nobody really knows what causes RA, although some believe it is linked to a defect in the immune system. Many people with RA have a particular genetic marker — HLA-DR4 — so it’s reasonable to suspect that this gene may be to blame. Yet, not everyone with this gene ends up with RA, and not everyone with RA has this gene. And scientists are certain that more than just one gene is involved: Perhaps HLA-DR4 is only one of several genes that can tip the scales in favor of developing RA. Most likely, genetic markers play a part in the development of the disease but aren’t the determining factor. Some researchers believe that RA may be triggered by a virus, or perhaps an unrecognized bacteria, that “wakes up” a dormant genetic defect and sets it in motion. As of yet, no such infectious agent has been discovered, and RA has not been found to be contagious.
Hormones or hormone deficiencies may also play a part, although their possible role is unclear. Women are more likely than men to develop RA, suggesting a possible link to estrogen. But, at present, doctors have more questions than answers about RA.
Pinpointing the most likely victim of RA
Rheumatoid arthritis can strike just about anybody — children, the elderly, the middle-aged, and people of almost all racial or ethnic groups. But RA has a particular affinity for women, especially those between the ages of 20 and 50. Women account for over two-thirds of the 1.5 million Americans who suffer from RA, making them about three times as likely as men to get the disease, although scientists have yet to determine why.
OVERCOMING RA: LUCY’S STORY
Lucille Ball, the famous comedienne and zany star of the I Love Lucy television series, was just 17 years old and working as a model in Hattie Carnegie’s internationally renowned dress shop when she suddenly developed a fiery pain in both her legs. “It was so bad, I had to sit down,” she wrote in her autobiography, Love, Lucy. She had recently recovered from a bout with pneumonia and a high fever; now this!
Hurrying to her doctor, she received the terrifying news: She had rheumatoid arthritis, a crippling disease that becomes progressively worse over time. In fact, it was conceivable that she would spend her life in a wheelchair. Lucy’s doctor sent her to an orthopedic clinic where she waited for three hours, nearly fainting from the pain, before the doctor informed her that there was no cure. He did ask if she would like to try an experimental treatment, though — injections of a kind of “horse serum.” Lucy agreed and received these shots over the next several weeks until she finally ran out of money. Unfortunately, the pain continued.
Discouraged but not about to give up, Lucy went back home to her parents, who massaged her legs, gave her money to continue the horse serum injections, and encouraged her to take better care of her health. Finally, months later, the pain began to ease, and Lucy was able to stand up on weak and shaky legs. Her left leg had shortened a bit during the course of the disease, so she added a 20-pound weight to her corrective shoe to stretch the leg out. (Note: RA is no longer treated with horse serum. We’ve come a long way since then!)
Lucy’s hard work and perseverance paid off. She was able to return to New York; she made several movies and eventually starred in her own television series, one that required vigorous physical comedy, stamina, and energy. She also starred in Broadway plays, performing eight shows a week while managing to sail through energetic song and dance numbers with a seemingly effortless grace and ease. Lucy remained active and healthy until her death in 1989, and in spite of her doctor’s ominous prediction, never spent a single day in a wheelchair.
Diagnosing Rheumatoid Arthritis
Unfortunately, no one test can tell your doctor you definitely have RA. Instead, your doctor looks for