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Rheumatoid Arthritis: Systemic Autoimmune Disease

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Rheumatoid arthritis (RA) is a systemic autoimmune disease that occurs when the body’s immune system attacks the tissue that lines the inside of the joints (synovium). Over time cartilage and bone within the joint is destroyed and the joint spacing between bones become smaller. According to the text Understanding Pathophysiology by Huether and McCance cartilage damage in RA is the result of three processes: (1) neutrophils and other cells in the synovial fluid become activated, degrading the surface layer of articular cartilage; (2) cytokines, particularly tumor necrosis factor alpha (TNF-α), stimulate syntheses of preinflammatory compounds, including interleukin-1 (IL-1), interleukin-6 (IL-6), and interleukin-8 (IL-8), and cause the chondrocytes …show more content…

Signs and symptoms of rheumatoid arthritis may include joint pain, tenderness, swelling or stiffness for six weeks or longer, morning stiffness for 30 minutes or longer, firm bumps of tissue under the skin on the arms (rheumatoid nodules), fatigue, loss of appetite and a low-grade fever. Early rheumatoid arthritis tends to affect smaller joints symmetrically first such as the wrist, certain joints of the hands, and feet. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. Symptoms may flare (periods of increased disease activity) lasting for days or months. It is difficult to diagnose RA in its early stages because the signs and symptoms resemble other inflammatory diseases. No single test can confirm RA. The rheumatologist will ask questions about personal and family medical history as well as recent and current symptoms (pain, tenderness, stiffness, difficulty moving.) During the physical exam, the doctor will examine each joint, looking for tenderness, swelling, warmth and painful or limited movement. Blood tests will measure erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. Although not specific to RA, these levels indicate the presence of an inflammatory process in the body. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) are antibodies found in a large number of people with RA. An X-ray, ultrasound or magnetic resonance imaging scan may be recommended to look for joint

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