Rheumatoid arthritis is a systemic disease characterized by painful, swollen, inflamed joints. It can occur at any time from infancy on, affecting not only particular joints and muscles, but in extreme cases, vital organs as well. It most commonly occurs between the ages of 20 and 35, with women three times as vulnerable as men until the age of 50, when the difference narrows. Of the 6.5 million Americans affected, about one-third are free of symptoms for long periods of time; of the children with juvenile rheumatoid arthritis, two-thirds recover completely by adulthood.
No one knows exactly why rheumatoid arthritis occurs or how to prevent it. However, the disease is most likely to occur in genetically susceptible people when some factor disturbs their immune system. An increasing number of researchers believe that this factor may be a virus, with particular emphasis focused on the Epstein-Barr virus, a herpes-like organism that is commonly associated with infectious mononucleosis. Thus, while osteoarthritis is a wear-and-tear disease essentially restricted to the weight-bearing joints, rheumatoid arthritis is best described as an autoimmune disease, which means the body attacks its own tissues. The result is not only stiffness and pain in specific areas, but general malaise and fatigue as well as fever and weight loss.
Classic Rheumatoid Arthritis
While there may be differences of opinion about what triggers the onset of rheumatoid arthritis (some specialists think it begins as part of another severe illness; some associate it with unusual emotional stress; still others point to infectious agents), there is general agreement about what happens once the autoimmune system goes awry.
Joints are normally lubricated by a secretion from the membrane that forms their lining. This lining is called the synovial membrane. In rheumatoid arthritis, synovial tissue becomes inflamed, leading to an abnormally rapid proliferation of the synovial cells, crowding their way into the joint itself. The inflamed synovial tissue eventually eats into the cartilage and may even begin to erode the bone.
The disease typically affects the joints of the hands and feet, often on both sides, but it may also be situated in the elbows, shoulders or hips. Damage may extend into related ligaments and tendons, causing nearby muscles to go into painful spasms as they begin to waste away through disuse. If the disease progresses untreated and the tissue damage is unchecked, the affected joints may become misshapen and lose function.
Symptoms of Rheumatoid Arthritis
In its early stages, the affected joints become swollen and red, increasingly painful and abnormally warm. In some cases, the joint symptoms are accompanied by general malaise, fever and loss of appetite. Joint stiffness is more likely to develop when the body is at rest, diminishing very gradually as muscles are reactivated. A doctor is usually consulted when pain interferes with sleep, or when stiffness and swelling prevent normal function or when self-treatment with aspirin proves ineffective.
Treatment of Rheumatoid Arthritis
Although there is no cure for rheumatoid arthritis, most cases can be managed through treatment aimed at relieving symptoms and preserving joint function. Indeed, prompt treatment is critical in halting the irreversible tissue damage that may result from neglect. Because therapy may combine different regimens and particular kinds of drugs, professional supervision and the cooperation of the patient are essential elements in controlling the disease.
A number of treatments are available, and the regimen for a particular patient must be tailored to his or her individual needs. An anti-inflammatory drug, which may be large doses of aspirin or one of the newer non-steroidal anti-inflammatory drugs, is usually prescribed to ease pain and control the inflammation. In cases where the joints have been severely damaged, other drugs, such as gold salts, may be prescribed to stop the destruction of the cartilage and synovial membrane caused by advanced inflammatory disease. Injections of steroids directly into the joints also may be recommended for short-term treatment of the inflammation In some patients, combinations of therapies may be needed; but in any instance, close supervision of treatment by a doctor is usually required to minimize effects of the disease.
A common-sense approach to living with the disease is also an important factor in controlling rheumatoid arthritis. This may call for an adjustment of daily routines to include naps and rest periods during the day. Physiotherapy usually includes special exercises to retain joint function and application of hot compresses. Splinting of affected joints, particularly the fingers, may also be considered advisable. Where weight loss has contributed to general debility, a special diet may be initiated. Only in the most advanced and immobilizing cases is orthopedic surgery considered for the replacement of diseased joints.
Importance of Attitude
Attitude is a very important element in the overall treatment of rheumatoid arthritis. Many people fear the potentially crippling effects of the disease, and retreat from normal activities. Others try to ignore the condition and carry on as usual, despite pain and other symptoms. Both approaches can lead to unnecessary exacerbation of the disease. Most people experience long periods of remission, during which they have few or no symptoms. But flare-ups may occur without warning. A cooperative, positive attitude helps one cope with the unpredictable nature of the disease.
Very few people become so severely affected that they cannot carry on normal activities. Renoir continued to paint magnificent pictures despite severe rheumatoid arthritis, and there are any number of other inspiring examples of people who have lived long, rich, productive lives despite the disease. There are a number of aids, ranging from special eating utensils and button-hooks to raised toilet seats and electric stair chairs, which make performing routine daily tasks easier.
Summing Up
While rheumatoid arthritis is more severe than osteoarthritis, it is considerably rarer and usually can be successfully controlled when symptoms are brought to the doctor's attention promptly. It may take some time and patience to arrive at the right medication in the proper dosage, but the combination of drugs, exercise, rest and good nutrition can usually reduce symptoms to the point where they do not interfere with most normal activities.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
