RHEUMATOID ARTHRITIS (RA)

Patient Advocacy Links:
Arthritis Foundation
American College of Rheumatology
The European League Against Rheumatism

RA is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well.

The stiffness seen in active RA is typically worst in the morning and may last anywhere from one to two hours to the entire day. This long period of morning stiffness is an important diagnostic clue, as not many other arthritic diseases behave this way. For example, osteoarthritis does not generally cause prolonged morning stiffness. While RA can affect any joint, the small joints in the hands and feet tend be involved more frequently than others. This produces a pattern of joint disease that rheumatologists regard as characteristic of RA.

Other symptoms that can occur in RA include:

  • loss of energy
  • low-grade fevers
  • loss of appetite
  • dry eyes and mouth from an associated condition known as Sjogren’s syndrome
  • firm lumps called rheumatoid nodules beneath the skin in areas such as the elbow and hands

What causes rheumatoid arthritis?

RA is classified as an autoimmune disease, which develops because certain cells of the immune system malfunction and attack healthy joints. While the cause of RA remains unknown, exciting and rapidly advancing research is revealing the factors that are important in producing inflammation. The primary focus of the inflammation is in the synovium, which is the lining tissue of the joint. Inflammatory chemicals released by the immune cells cause swelling and damage to cartilage and bone. This research is giving us a better understanding of the immune and genetic factors that may be involved in the disease. As a result of this work, new medications have been developed that specifically block certain signals in the body from the immune system that are important in causing RA symptoms and joint damage.

Who gets rheumatoid arthritis?

RA is the most common form of inflammatory arthritis. More than 2 million Americans suffer from RA. About 75 percent of those affected are women, and 1–3% of women may develop rheumatoid arthritis is their lifetime. The disease most often begins between the fourth and sixth decades of life; however, RA can develop at any age.

How is rheumatoid arthritis diagnosed?

RA can be difficult to diagnose because it may begin gradually with subtle symptoms. Many diseases, especially early on, behave in a manner similar to RA. For this reason, patients suspected of having RA should be evaluated by a rheumatologist, a physician with the necessary skill and experience to reach a precise diagnosis and develop the most appropriate treatment plan.

The diagnosis of RA is based on the symptoms described and physical examination findings such as warmth, swelling and pain in the joints. Certain laboratory abnormalities commonly found in RA can help in establishing a diagnosis. Tell-tale abnormalities include:
anemia (a low red blood cell count);
rheumatoid factor (an antibody eventually found in approximately 80% of patients with RA, but in only 30% at the start of the arthritis); and
an elevated erythrocyte sedimentation rate or “sed rate” (a blood test that in most patients with RA tends to correlate with the amount of inflammation in the joints).

X-rays can be very helpful in diagnosing RA but may not show any abnormalities in the first 3–6 months of arthritis. X rays are useful in determining if the disease is progressing.

It is important to remember that for most patients with this disease (especially those who have had symptoms for less than six months), there is no single test that “confirms” a diagnosis of RA. Rather, diagnosis is established by skillfully evaluating the appropriate symptoms, physical examination findings, laboratory tests and X-rays.

For additional information on RA, please visit www.rheumatology.org

For information about Trubion clinical trials for RA currently underway, please visit:
TRU-015 (Phase 2b)
SBI-087 (Phase 1)