When your joints get red, swell, cry out and hurt!

Rheumatoid arthritis is a common disease throughout the world. It is a complicated disease so a short article like this cannot tell you everything about it.

Rheumatoid arthritis is also a disease which varies a great deal from person to person. Do not be afraid to ask questions about your disease and about your treatment from your rheumatologist and other health professionals. The more you know, the easier it will be for you to cope with your disease.

Do not be afraid to tell your rheumatologist about all your problems.The more he knows about how the disease is affecting you the better he can tailor your treatment for your needs.

What is rheumatoid arthritis?

Rheumatoid arthritis is a disease which makes the joints in the body become inflamed. To understand how rheumatoid arthritis develops you need to understand how a normal joint works. A joint is where two bones meet. Most of our joints are designed to allow the bones to move in certain directions.

For example,the knee is the largest joint in the body and also one of the most complicated because it has many important jobs. It must be strong enough to take our weight and must lock into position so we can stand upright. But it also has to act as a hinge so we can walk. It must withstand extreme stresses, twists and turns, such as when we run or play sports.

The end of each bone is covered with cartilage which has a smooth slippery surface.The cartilage allows the ends of the bones to move against each other almost without friction. It also acts as a shock absorber. The joint is surrounded by a membrane (the synovium) which produces a small amount of thick fluid (synovial fluid).

This fluid acts as a lubricant to keep the cartilage slippery and helps the joint to move smoothly.

The synovium has a tough outer layer of ligaments called the capsule which holds the joint in place and stops the bones moving too much.

Inflammation takes place within the synovium.The result is similar to inflammation which you may have seen taking place within your eye - it goes red, it swells, it cries and it hurts.The redness is caused by the flow of blood increasing. As a result, the inflamed joint may feel warm.The swelling is caused partly by a build-up of fluid and cells in the synovium. The 'crying' of the joint also produces swelling. In this case it is not tears but extra synovial fluid which is produced.

The joint hurts because of two types of pain:

Is it the same as osteoarthritis?

No, osteoarthritis is a different disease. Rheumatoid arthritis is caused by inflammation in the lining of the joint. Osteoarthritis is more like a wear process, in which the cartilage in the joint fails to withstand the loads placed on it. Some inflammation does occur in osteoarthritis, but it is not the same as that in rheumatoid arthritis.

Some wear may take place in damaged joints in rheumatoid arthritis, but this is a late complication of the disease.

The two diseases are quite different in their treatment and it is important not to confuse the two. If you have any doubt about which type of arthritis you have, ask your rheumatologist.

How does rheumatoid arthritis affect different people?

Our bodies normally produce inflammation to destroy things, such as bacteria,which cause illness. We do not know what sets off the inflammation in the joints of someone with rheumatoid arthritis, but the result is the same - some thing is attacked and perhaps destroyed. Unfortunately, in rheumatoid arthritis our own tissues in the joints are attacked. This causes damage to the cartilage and sometimes the bone itself. It may also damage any ligaments within the joints.

The extent to which this happens varies a great deal from person to person. Some people have little or no damage to the joints, or suffer only minor damage to a few joints. Most people with rheumatoid arthritis have some damage in a number of joints, and a few people - about 1 in every 20 with rheumatoid arthritis (5%) - have quite severe damage in a lot of joints.

Once joints have been damaged by inflammation they are not good at healing. Because of this, modern treatment tries to suppress the inflammation as much as posssible to reduce the amount of damage it causes to the joint. Suppressing inflammation early is one of the important ways in which treatment has advanced. And this is one of the reasons why rheumatoid arthritis is more effectively treated than it used to be.

Rheumatoid arthritis does not just affect the joints. Tendons are like ropes which run in lubricated tubes.The lubricating system is similar to that in the joints themselves, so it is not surprising that tendons can also be affected by rheumatoid arthritis. In a few people, other parts of the body such as the lungs and the blood vessels become inflamed.

Inflammation in the joints can make some people feel generally ill. Sometimes this leads to overwhelming tiredness or fatigue,which may be more difficult to cope with than the painful joints. 'Feeling tired' is a symptom which may get little sympathy from those around you, who must be told that this is an important symptom of your disease.

One problem with rheumatoid arthritis is that the symptoms tend to come and go with no particular pattern.You may have 'flare ups' - periods when the joints become more inflamed and painful. Sometimes this has an obvious cause - either physical, such as unaccustomed physical exertion or another illness, or emotional, such as a bereavement. Usually there is no obvious cause. This unpredictability is frustrating and sometimes makes it difficult to plan ahead.

Rheumatoid arthritis can be a serious disease with a lot of symptoms. But for most people, especially if treated appropriately, there may be few symptoms, giving the opportunity for a normal life.

(The writer is a Consultant Rheumatologist at Sri Jayewardenepura Hospital)