Rheumatoid Arthritis - Research Paper Example

Soha Alkhaldi Prof. Michael Rachkovsky & ID Number: 28 April This paper presents a research study on rheumatoid arthritis which is a condition that affects the bones and cartilages of the body. It also discusses the etiology, nature, causes, signs and symptoms, the proper management and recommended solutions of this medical condition to enhance the quality of life for people with this affliction especially activities of daily living. Title: Rheumatoid Arthrities (an independent research study) I. Introduction Rheumatoid arthritis is one of the three kinds of arthritis, the other two being gout arthritis (swelling of a joint due to presence of urate crystals from high uric acid levels that cause sever pain) and osteoarthritis which is the most common form of arthritis (also called as “wear-and-tear arthritis” as the protective cartilage on bone joints wears down over time). The type of rheumatoid arthritis is an autoimmune disease mainly due from a chronic and systemic inflammation of the synovial joints. It typically affects the small joints of the hands and feet; it affects the lining of these joints, causing a painful swelling that later erodes the bone joints which in turn cause bone deformities. The bodys immune system mistakenly attacks its own tissues and besides joint problems, rheumatic arthritis affects body organs like the lungs, eyes, skin, and blood vessels. It affects more women than men and usually manifests at age 40. Both rheumatoid arthritis (RA) and osteoarthritis (OA) have no known cures but the disease progression can be slowed down by medication and lifestyle changes to relieve pain by improving joint function. Elderly people are at greater risk for RA because of low calcium absorption resulting in lowered levels of calcified bones. People suffering from RA are at risk to ankylosis which is the fusion of joints resulting in a permanent impaired joint mobility. II. Discussion Medical research is making progress towards greater understanding of the etiology of RA, its probable treatment by medication, modification and intervention to make life more bearable of the person afflicted with this disease that primarily affects the bone joints through calcification of the synovial aspects of the bones. These joints allow for locomotion and other movements necessary for walking, sitting, lying down, or picking up and holding an object. It is vital these joints are free from pain and rigidity resulting from ankylosis which is abnormal adhesion of these joints, restricting movement depending on the severity of the disease. 1. Etiology of RA - there are a variety of factors which cause rheumatoid arthrities. Rheumatioid arthritis is primarily the disease that develops when the synovial fluid within the joint membrane are decrease that will result into calcification of the cartilages which in turn make the bone joints hard and brittle instead of being soft and supple. However, these factors can be classified into two general categories as listed and discussed below: a. Modifiable etiology – these are the causes which can be modified by the individual patient concerned to lessen the risks of getting RA and reduce the ensuring progression of the disease by making changes to his or her lifestyle. A person can take steps to avoid its causes. a.1 Diet modfication – the diet of a person is a primary causative factor in getting RA and so a person who is aware of this should try to implement changes in his or her diet. This can be done by avoiding fatty foods, salty foods, and sugary foods which aggravates an RA if already active or present in that person (Lucas 754). This prohibition includes all highly-processed food items because the food chemicals and additives in them can accumulate and create an auto immune response which in turn cause the joint inflammation. Sugar should be avoided also if possible as high blood sugar levels create crystals in the synovial fluids and in turn inhibit the calcification process that affects negatively bone density (Liao et al. 280). a.2 Smoking – it is considered as a contributing factor to the development of RA and people should avoid smoking if possible and quit smoking. A smoker inhales about 500 different toxic substances in the tobacco product and these enter the bloodstream through the lungs. Carcinogenic substances include benzene, ethylene oxide, vinyl chloride, and butadiene (Hong & Hait 388) that kill blood cells which are then carried by blood circulation and accumulates in the joints as dead cells are deposited and joints get bigger due to bacterial growth (White & Judkins 155) and it is a serious concern as the person gets older. Moreover, smoking impacts negatively on absorption of calcium by degrading the calcification process; this causes the bone to become brittle and accelerates bone erosion on the synovial process. a.3 Drinking alcohol – alcoholic beverages also contribute to RA if done excessively while some studies showed moderate drinking can reduce the severity of RA symptoms. This is thought or suspected by the alcohol suppressing the activities of the immune system and it may influence the pathways by which RA develops (Mitchell 183). However, moderation is a key word here as other studies indicated heavy drinking can provoke the symptoms of an RA (Hammond & Hamer 149) because alcohol is high in calorie content and can trigger gout too. b. Non-modifiable etiology – there are also other factors over which a person with an RA has no control whether he develops it or not later in life or even in his younger years. It is considered as a part of life no matter what the person does to avoid rheumatoid arthrities if he can help it; some of these factors include heredity, hormonal changes, and age of the patient. b.1 Heredity – people whose parents and grandparents had experienced RA are more than likely to also get rheumatoid arthritis as they grow older. Heredity is a predisposing kind of factor in the development of RA and what an individual in this situation can do is to avoid a lifestyle that can trigger the start of rheumatoid arthritis because once it has started, then it is no longer curable and the best one can do and hope is adopt lifestyle modifications. b.2 Hormonal changes – the onset of RA is influenced by the hormones in the body. For males, it is the hormone testosterone which is mainly responsible for the development of rheumatoid arthritis as a lower level of this hormone affects muscle tone and in turn affects the bones as the bones are now more vulnerable to stress in the absence of enough muscles to counteract the strains and stresses of the activities of daily living (ADL). For the females, the two hormones of estrogen and progesterone are the hormones responsible for developing the right bone density and in proper metabolism of calcium and other nutrients for the right bone density. Females are particularly vulnerable to rheumatoid arthritis when these two hormones decline such as during the start of menopause and they are well advised to take supplements. b.3 Age of the person – no matter what a person does to avoid RA, it is unavoidable to develop this disease as he or she grows older because bones and joints are degraded over a period of time. While a person can take precautions by living a healthy lifestyle, RA will soon develop in most people because rheumatoid arthritis is a “wear-and-tear” disease that will manifest itself because it can be considered as a part of the growing process of getting older. Although RA may develop in younger persons, it is the older person who usually gets it. 2. Genetic changes – the changes occuring in RA are related to the genes HLA-DR4 and PTPN22 which inhibit the development of muscoloskeletal integrity. Genetic changes can be considered as response complications from a persons lifestyle in which there is autonomic response to the toxic substances found in the external environment. They trigger autoimmune response in which radical cells affect the immunoglobulin that may impair all chromosomes (Kotsirilos, Vitetta, & Sali 825). Genetic factors contribute 50% to 60% of the incidence rate for RA. Pathogens, free radicals, dead cells, and waste products that are oxidizing in the fluid of the synovial process trigger an aggressive immunologic response that can cause the RA in which there is a relationship between synovitis and bone changes (Ginsburg & Willard 850). 3. Signs and symptoms – not all individuals afflicted with RA can share or exhibit the same symptoms. There are also times when the symptoms show periods of an increased severity (called as “flares”) and then followed by periods of seeming remission when the pain and swelling disappear for a while but then come back again in a continuing cycle. Some of the more common signs and symptoms of RA include pain, swelling of the joints indicated by warnth and tenderness, stiffness of the joints in the morning (that could last for several hours), fatigue, fever, weight loss, and rheumatoid nodules that appear as bumbs on muscles under the skin of both arms (Mayo Clinic Staff para. 2). The symptoms first appear on smaller joints like the fingers and toes but progess to bigger joints like the neck, hips, knees, and elbows. 4. Disease management – rheumatoid arthritis is basically an incurable disesea but it can be managed well to slow down its progression and minimize the symptoms mainly pain and the accompanying swelling of the joints. Like any ailment, it is best to seek treatment early from licensed medical professionals. There are three main ways to achieve this. a. Lifestyle modifications – the best medicine is prevention and people at risk for RA should alter their diet by reducing intake of salty, fatty, and sugary foods. Moreover, they will have to cut down on smoking and drinking as these two activities are known to interfere with calcium resorption. It is also strongly advised to take additional vitamin supplements such as vitamin D complex that is combined with calcium supplementation. Increased intake of fibers found in fruits and vegetables is likewise strongly encouraged which help to improve both the bone density and bone marrow production. These food sources can increase body resistance to various infections which could help to prevent complications associated with RA. b. Pharmacologic approaches – these involve the use of certain anti-rheumatism drug formulations like the use of NSAIDs (non-steroidal anti-inflammatory drugs) that help to decrease pain, which is always indicated for patients who are already suffering from the said medical issue. NSAID aims to help prevent further progression of the signs and symptoms of rheumatoid arthritis by decreasing the level of pain and swelling. Another class of drugs used to treat RA are the glucocorticoids which are steroids that would help the bones to regain bone density. Still another drug is medrxyprogesterone acetate that aids in the regeneration of bone density which causes the eroded joints to calcify and reduce the prevalence of rheumatoid arthritis. Steroids have been an effective medication for patients who are suffering from rheumatism for the reason that the injured or eroded bones can have the chance to be partially restored over time. These drugs are also strongly indicated for the other forms of bone disease such as osteoporosis because these tend to increase bone density. c. Surgical interventions – management by surgical operation is done mainly to draw out the extra fluid accumulated in the synovial joints. This procedure aims to extract any fluid retention that is causing the joint to be persistently inflamed which affect the joint endings at the synovial aspect of the bones. The fluid extraction also serves another purpose which is to prevent secondary infectious complications arising from the any bacterial accumulation. This surgical intervention can be supplemented with close monitoring of the patient through X-ray scanning and other imaging techniques for better management together with the use of other types of drugs such as immunosuppresants, TNF-alpha inhibitors, and also disease-modifying anti-rheumatic drugs (DMARDs) but should be stopped if there are any adverse side effects. 5. Epidemiology – incidence rate of RA is about 10 per 100,000 of population (.01%) but is rising due to modern lifestyles such as eating too much junk food (fast-food meals high in salt, sugar, and fat) while the prevalence rate is also increasing because RA is a chronic, progressive, and incurable disease. The mortality rate from RA is because it is a co-morbid factor to other diseases like diabetes and osteoporosis that contribute to other health hazards like falling from stairs, slipping on the floors, and reduced physiological functions associated with it like inability to perform simple daily tasks such that it reduces life span by 12 years. 6. Economic Impact – like lifestyle diseases of obesity, diabetes, and hypertension, rheumatoid arthritis has a big cost in terms of its negative economic implications. Insurance and health care policies to treat these ailments are quite expensive together with the health care that is required over a long period of time because these are chronic diseases, and in case of rheumatoid arthritis, has no known cure. The management of RA is an expensive type of health care management and the financial burden is heavy enough such that some patients end up selling their properties and other assets to sustain medical treatment and pay hospital costs; over a period of time, they often fall into the poverty level (lower social status), quality of life is degraded, and their lifespans are considerably shortened by accidents (Ebringer 4). III. Conclusion Millions of people around the world suffer from rheumatoid arthritis because it has no cure yet despite the best efforts of modern science. However, considerable progress made in the last few decades enabled modern diagnostics to have an 85% accuracy so immediate or appropriate interventions can be implemented right away (Wasserman 1245). Many people are often misguided and misled into thinking rheumatoid arthritis is something they can manage on their own and so the tendency is to self-medicate which is a big mistake. RA is a disease that needs intensive treatment by a licensed medical practitioner (Baker & Wen 105). Works Cited Baker, J. F., and H. Wen. "Vitamin D, immuno-regulation, and rheumatoid arthritis: Practical reports on rheumatic & musculoskeletal diseases.” Journal of Clinical Rheumatology 17.2 (2011): 102–7. Print. Ebringer, A. Rheumatoid Arthritis and Proteus. New York, NY, USA: Springer, 2011. Print. Ginsburg, G. S., and H. F. Willard. Genomic and Personalized Medicine. San Diego, CA, USA: Academic Press, 2012. Print. Hammond, A., and A. Hamer. Arthritis: Your questions answered. New York, NY, USA: Penguin Books, 2009. Print. Hong, W. K., and W. Hait. Holland Cancer Medicine. San Francisco, CA, USA: Peoples Medical Publishing House (USA), 2010. Print. Kotsirilos, V., L. Vitetta, and A. Sali. A Guide to Evidence-based Integrative and Complementary Medicine. Chatswood, NSW, Australia: Elsevier, 2011. Print. Liao, K. P., L. Alfredsson, and E. W. Karlson. "Environmental influences on risk for rheumatoid arthritis." Current Opinion in Rheumatology 21.3 (2009): 279–83. Print. Lucas, P. “Dietary fat aggravates active rheumatoid arthritis.” Clinical Research 29 (1981): 754. Print. Mayo Clinic Staff. “Rheumatoid arthritis: Symptoms can vary.” Mayo Clinic, 21 Feb. 2014. Web. 26 Apr. 2014. . Mitchell, D. The Complete Guide to Healing Arthritis. New York, NY, USA: MacMillan Company, 2011, Print. Wasserman, A. M. "Diagnosis and Management of Rheumatoid Arthritis." American Family Physician 84.11 (2011): 1245–52. Print. White, B. and D. Z Judkins. "Clinical inquiry. Does turmeric relieve inflammatory conditions?" The Journal of Family Practice 60.3 (March 2011): 155–6. Print. Read More