Rheumatoid polyarthritis, often called rheumatoid arthritis, is a disease caused by chronic inflammation of the joints. The inflammation (redness, pain, swelling, heat sensation) occurs when the immune system attacks healthy joints. This is known as an autoimmune disease. Rheumatoid arthritis can affect any joint, but most often affects those in the hands and feet. It can also attack areas other than the joints.

What are the symptoms of rheumatoid arthritis?

Typical symptoms include:

• morning stiffness that lasts more than 30 to 60 minutes
• pain in three or more joints at the same time
• joint pain that persists throughout the night
• pain in the same joint on both sides of the body, and

• weakness and fatigue

Symptoms can vary from person to person. The onset can be gradual or appear quickly in the form of an acute episode accompanied by flu-like symptoms. Some people have a mild form, that is, they have flare-ups (inflammation and pain) and remissions. Others may have a continuous form of the active disease, with progressive worsening of the condition.

What are the consequences of rheumatoid arthritis?

The inflammation causes wearing of the joints and the bone. In severe forms of the disease, the joints can become deformed and too stiff to function, making all movements difficult. Furthermore, about 20% of people affected by the disease have nodules (small lumps) under the skin, often near the elbows. Sometimes, the inflammation affects the heart and lung tissue. Certain parts of the eyes and mouth can also become inflamed, sometimes leading to dry eyes and lack of saliva. Rarely, the blood vessels, the skin, the nerves and other organs can be affected.

What are the possible treatments?

There is no cure for this disease, although certain measures can be taken to control it.

Non-pharmacological measures

• Rest and relaxation
  Resting an inflamed joint, and napping in general, can be beneficial. Alternate periods of rest with periods of activity.
• Exercise
  Due to the pain and stiffness, people with rheumatoid arthritis tend to rely on their healthy joints, which aggravates the decreased mobility in the affected joints. Exercising, such as walking, swimming and cycling, once or twice a week, can improve symptoms of the disease. Patients should ask a kinesiologist for advice in determining which type of exercise is best for them.
• Heat/cold
  Heat helps relax painful muscles and relieve joint pain and stiffness. Cold helps reduce the swelling.
• Protect the joints
  After repetitive movements, take a rest. Do not hesitate to use aids, for example a cart to carry your purchases. Maintain a healthy weight, which will avoid excess stress on your joints.

Pharmacological measures (drugs)

There are a number of drugs used for arthritis. Some of them help to ease pain and swelling (anti-inflammatory drugs, cortisone), others are used to slow down disease progression.

• Anti-inflammatory drugs
  These are used to ease pain and swelling. Some are sold with a prescription, and others are sold over the counter. Never take over-the-counter anti-inflammatory drugs (ibuprofen, naproxen) without discussing it with your pharmacist first.
• Cortisone
  Cortisone derivatives are usually used for acute attacks.
• Disease-modifying anti-rheumatic drugs (DMARD)
  These help to slow down disease progression. Methotrexate, sulfasalazine, azathioprine hydroxychloroquine and leflumomide attempt to decrease the abnormal activity of the immune system.
• Biological response modifiers (BRM)
  This new class of drugs blocks the activity of certain substances that cause inflammation. These agents are very effective in treating inflammation and pain due to rheumatoid polyarthritis. Adalimumab, infliximab, etanercept, certolizumab and golimumab, anakinra, tocilizumab, abatacept and rituximab are some examples.
• Other treatments
  There are other treatments against rheumatoid polyarthritis that are not described in this document. Don’t hesitate to speak to your doctor or pharmacist if you have questions about rheumatoid polyarthritis or for advice regarding treatments and possible side effects from the medications.

You can also contact The Arthritis Society at 1-800-321-1433 or visit www.arthritis.ca