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What Is Rheumatoid Arthritis?
- Rheumatoid arthritis causes pain and swelling in the joints, typically the hands, feet, and hips.
- Rheumatoid arthritis can disfigure hands, paralyze joints, weaken the connective tissue in the heart and other vital organs, and create fatigue, depression, and severe pain.
- The symptoms of rheumatoid arthritis can flare up, causing pain for a period of time, and then disappear in 15% to 20% of patients. Sometimes, but rarely, they disappear for years.
- In most cases, rheumatoid arthritis gets worse over time, and should be treated early to prevent more damage to the affected joints.
- Several drugs are available that can relieve the pain and swelling associated with rheumatoid arthritis.
- Rheumatoid arthritis and related diseases afflict almost 37 million people in the United States, and that number keeps growing. The cost of treatment and lost productivity has been estimated to be as high as $50 billion per year in the United States alone.
- Between 43% and 85% of people with rheumatoid arthritis will be unable to work within 8 to 11 years after the disease begins. Almost 27% of patients are disabled within three years.
Debra Jones, homemaker and mother, had just returned home from the hospital after the birth of her fourth child. "Congratulations! A girl at last!" exclaimed her friends and relatives. But Debra was so exhausted she could barely muster the enthusiasm expected of her. She knew it was not just the exhaustion of trying to perform all of herhousehold chores while caring for her new baby and the rest of her family. She had lost a lot of blood during the delivery; maybe it was just that. After four weeks of struggling to get through the days and nights with her new baby, Debra noticed that the joints in both of her hands and wrists were swollen and painful. As if that was not enough, the middle joint of each finger was swollen, making it difficult for her to use her hands. She was so weak that she could hardly lift the baby. Her toes were also swollen and her feet hurt so badly that she could hardly walk. When she went outside and it was chilly, not even really cold, she lost sensation in her fingers. She did not know what was happening -- she had felt great during her pregnancy; why was this happening now?
Debra went to her family doctor, who performed a complete physical examination. He found that the swelling and tenderness in her fingers and toes made her joints so painful that he could not even touch them. She complained that she felt stiff when she got out of bed -- It's like I've suddenly become an old woman -- and that this lasted for over an hour every morning. "How am I supposed to get three kids ready for school and change the baby's diaper when I can hardly move?" she asked. "My husband helps as much as he can, but he's trying to get ready for work!" It was not only the pain. Debra also had overwhelming exhaustion. "I feel like I'm dying of something," she claimed. "I pull my poor, stiff body out of bed and try to function, but it's like I'm moving through thick cotton instead of air."
Debra's doctor took X rays of her hands and wrists, which showed a lot of swelling of the tissue surrounding the joints. The bones of the joints had just started to erode, and the bones had begun to blanch (because of loss of bone tissue). Laboratory tests done on her blood showed a high level of rheumatoid factor and a high erythrocyte sedimentation rate.
Debra's diagnosis was early rheumatoid arthritis: morning stiffness, pain and swelling of the joints on both hands, and X-ray evidence of loss of bone tissue made this a fairly clear diagnosis. Her doctor prescribed an anti-inflammatory agent (ibuprofen) and a disease-modifying drug (methotrexate). He told her to be sure to rest until the drugs took effect and the pain went away.
The pain may subside, but the disease itself will not go away. Debra's doctor informed her that she would have to make a few changes in her life. He suggested that she get help caring for the children, especially the baby, as picking up the baby and doing the small manipulations necessary to feed and change a tiny baby put extra stress on joints. He recommended that a family member help out during the day, or that a babysitter be hired part time, if she and her husband could afford that; any household help would save wear and tear on Debra's joints. The doctor also 'suggested that Debra's husband take over the nighttime feedings so that Debra could be well rested, and that she nap when the baby napped, even if that meant leaving the laundry undone and the house messy. In general, the family would have to pitch in a little more with the household tasks that a stay-at-home mother usually does herself.
Debra's doctor also referred her to a physical therapist to set up an exercise plan to keep her joints moving and muscles strong without stressing the joints. He also suggested that she see an occupational therapist to help her figure out how best to perform the tasks at home, and how to allocate tasks to other family members so that she doesn't get too tired. He made an appointment for Debra to return in three months to check on the medication and her symptoms.
The presentation of Debra's disease is not an uncommon one. Rheumatoid arthritis often strikes women during the child-bearing years, and the symptoms are often masked during pregnancy. The disease can take a serious toll -- it's not going to be easy for Debra to restructure her life, especially if her symptoms continue to get worse, with four small children and a household to take care of -- but with the support offered by the physical and occupational therapists, and the continued vigilance of her doctor, Debra will be able to live a happy and productive life.
The Arthritis Solution. Copyright © by Robert Lahita. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.