Rheumatoid arthritis

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disease that can affect multiple joints in the body. Although its cause is still unknown, RA is believed to be the result of a malfunctioning immune system. With RA, inflammation manifests in the lining of the joints, causing pain, swelling, joint damage and deformity. It can occasionally involve other internal organs, such as the nerves, eyes, lungs or heart.

ARTHRITIS AND JOINT PAIN
Aching or pain in the joints (without swelling) in inflammatory bowel disease (IBD) is called arthralgia. Between 10% to 20% of people with IBD have joint pain at some point. Arthralgia can occur in various joints of the body, such as the knees, ankles, and hands. IBD-associated arthralgias do not damage the joint. Arthralgia is often relieved by treating the active symptoms in the gastrointestinal (GI) tract. Arthritis, or inflammation (pain with swelling) of the joints, is the most common extraintestinal complication of IBD. It may affect as many as 30% of people with Crohn’s disease or ulcerative colitis. Although arthritis is typically associated with advancing age, in IBD it often strikes younger patients as well. In addition to joint pain, arthritis also causes swelling of the joints and a reduction in flexibility. It is important to point out that people with arthritis may experience arthralgia, but many people with arthralgia may not have arthritis.

Early Signs of RA:
The onset of RA usually starts over a period of weeks to months, with more joints affected over time. You should see your doctor if you experience one or more of the following symptoms for more than six weeks:
• pain and stiffness in multiple joints, sometimes affecting the same joints on both sides of your body
• stiff joints in the morning lasting 60 minutes or more
• reduced range of motion, such as difficulty making a fist
• joint swelling, sometimes feeling hot to touch
• fever, fatigue, weight loss or decreased appetite
• nodules (growth that forms under your skin), most commonly on the elbows, hands and feet; this occurs in 20 per cent of people

Treatment
In the general population, people with peripheral arthritis may use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. However, as a rule, these medications—which include aspirin and ibuprofen—are not a good option for everyone with IBD because they can irritate the intestinal lining and increase the inflammation. (It should be noted, though, that some people with IBD can tolerate NSAIDs and find these medications helpful in relieving symptoms of arthritis. It is important to discuss medication usage with your doctor.) Corticosteroids also may be used to treat the arthritis symptoms as well as IBD.
In most cases, doctors manage the symptoms of peripheral arthritis by controlling the inflammation within the colon.
Only axial arthritis seems not to improve as the intestinal inflammation resolves. Once inflammation has decreased, possibly after a course of a medication such as prednisone or sulfasalazine (or other 5-aminosalicylates), joint pain generally disappears. Because they take months to work, the immunomodulators azathioprine and/or 6-mercaptopurine are not used specifically to control joint inflammation. However, the immunomodulator methotrexate can be an effective treatment for IBD-associated joint pain. Similarly, the newer biologic agents such as infliximab (Remicade®), adalimumab (Humira®), and certolizumab (Cimzia®) have all been shown to be very effective in reducing joint inflammation and swelling. Infliximab and adalimumab have even shown good results as a primary treatment for ankylosing spondylitis, preventing joint damage and destruction.
In addition to medication, doctors may recommend resting the affected joint, occasional use of moist heat, or range of motion exercises, as demonstrated by a physical therapist.