Preventing Joint Damage From Rheumatoid Arthritis

Preventing Joint Damage From Rheumatoid Arthritis

When rheumatoid arthritis flares up, it makes joints feel stiff and achy. That discomfort may go away at times, but there may still be permanent damage. Eventually rheumatoid arthritis can harm joints so they don't work as well even when the disease itself is not active. How does joint damage occur, and how can it be prevented?

Doctors call the active periods of rheumatoid arthritis disease activity. During disease activity, infection-fighting cells (white blood cells) are mistakenly allowed into the joint. No one understands why this happens, but it's clear the infection fighters don't belong there.

Inside the joint, these cells produce chemicals that they usually use to kill invading microorganisms - only none are there. Instead, the chemicals damage the healthy joint tissue. During high levels of disease activity, you experience a flare - joints become swollen, stiff, and painful. You can also have low levels of disease activity that come and go without your feeling any symptoms.

There are two main ways this process can cause joint damage:

* The infection-fighting chemicals cause cartilage to slowly weaken. Cartilage is the cushion between bones in a joint. Over time, putting stress on the joint or bearing weight on it can wear down the weak cartilage more. This is called degenerative disease, and it is similar to what happens in "regular" arthritis (osteoarthritis) - only it happens faster in people with rheumatoid arthritis.
* The inflammation inside the joint stimulates the joint lining (synovium) to grow and spread where it doesn't belong. If it continues long enough, it can harm healthy cartilage or bone.

The simple rule of thumb is, the "longer" and "stronger" the disease activity, the more joint damage is probably occurring.

* A person with joint swelling and stiffness every day is more likely to have joint damage than a person with these symptoms once a month. (Longer disease activity)
* Someone with a lot of joint swelling is more likely to have damage than a person with just a little bit. (Stronger disease activity)

How can you tell if you are having disease activity? It can sometimes be difficult.

* You can be feeling a lot of pain, yet suffer no damage to your joints.
* Joint damage can also occur without feeling any pain.
* Joint swelling is a reliable sign, though. For the most part, having joint swelling is proof of having ongoing disease activity.
* The length of morning stiffness each day is also useful. Ask yourself, after getting up, "How long does it take until I'm feeling as loose as I'll feel for the day?" The longer you feel stiff, the more likely it is that your rheumatoid arthritis is active.
* Another sign you can look for is a "boggy" joint. When the joint lining begins to grow abnormally, it may give a joint a mushy texture. This boggy condition will remain even when you are not having a flare. If you notice this happening, you should see your rheumatologist.
If you are diagnosed with rheumatoid arthritis, your doctor will do a complete joint examination and get X-rays and blood tests soon after. At later visits, you will be checked for any changes to your tests, and your doctor will address possible joint damage with you.

Now that you know how rheumatoid arthritis causes joint damage, and what to look for, you should also know how to prevent it.

Because treatment for rheumatoid arthritis is improving, many experts believe people who have it today, taken as a group, will develop less joint damage than ever before. You can gain control of it and improve your chances.

* Get treated early. Much of the joint damage that eventually becomes serious starts soon after rheumatoid arthritis is discovered. The earlier you are treated, the less the chance of joint damage.
* Get treatment often. People who see their rheumatologist regularly (several times a year) have less joint damage than people who do not.
* Exercise! You can exercise without causing joint damage. In fact, just the opposite is true - regular exercise makes joints stronger. Your doctor will help you with an exercise plan that is safe, effective, and personalized for your fitness level and condition.
* Rest when you need to. Finding the balance between rest and exercise is important so you don't overdo it.
* Use a cane in the opposite hand from a painful hip or knee. This reduces wear-and-tear on the affected joint.

View Article Sources Sources

SOURCES: Harris, E., Kelley's Textbook of Rheumatology, 7th edition, W.B. Saunders, 2005. Klippel, J. Primer on the Rheumatic Diseases, 12th edition, Arthritis Foundation, 2001. van Leeuwen, M., Journal of Rheumatology, 1994; vol 21: p 3. Ward M., Archives of Internal Medicine, 1993; vol 153: p 2229. Wolfe F., Journal of Rheumatology, 1991; vol 18: p 1290.
Reviewed by Marc C. Levesque, MD on March 24, 2008