FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

RA IS THE MOST SERIOUS FORM OF ARTHRITIS, CAN OCCUR AT ANY AGE

Question: My mother-in-law was recently diagnosed with rheumatoid arthritis. I know it is an inherited problem. Does this mean my husband will get it? Are there things he can do to prevent the disease? What exactly are we dealing with?

Answer: First, I need to point out that there are two kinds of arthritis that are sometimes confused. The more common kind is known as osteoarthritis. It results from normal wear and tear on your joints, and causes aches and pains -- especially in older people. The kind of arthritis you are asking about -- rheumatoid arthritis -- affects a wider range of ages and can cause more serious symptoms, such as severe pain, extreme swelling of joints, joint deformity and fever.

Specifically, rheumatoid arthritis (RA) is considered a chronic inflammatory disease of the joints. It affects about 20 million Americans and is two to three times more common in women than in men.

While the peak age at which RA first appears is about 50, it can develop at any stage of life from childhood to old age. The exact cause is not known, but there does seem to be a genetic factor that increases the likelihood that a person will get RA. There are theories suggesting environmental and hormonal causes as well as bacterial and viral. A great deal of research is underway around this issue.

It may sound contradictory to say that RA might be caused by a germ and at that same time be hereditary. This is not necessarily the case. Let me explain. Some scientists think that in some circumstances an infection might trigger an abnormally strong response in those who have inherited a certain predisposition for an overly aggressive immune system. That is, the immune system not only identifies and fights an infecting “bug” but also accidentally starts to attack the body’s own joint tissue. When this happens, your immune system produces inflammation within your body’s joints that subsequently cause them to deteriorate.

While our knowledge of what starts the RA process is still mainly conjecture, we do know that once it begins, the immune process that I’ve described causes inflammation in the joints. This causes the damage to the cartilage and lining of the joints. Fluid accumulates there. The joints become painful, red, swollen and warm to the touch. One of the most common symptoms is joint stiffness in the morning. RA can flare up and go into remission during its course, but it usually causes permanent damage to the bones, leaving some disfigurement.

Most people with RA have a specific antibody in their blood. This antibody, however is also found in people who do not have RA because some other illnesses produce the same antibody. That results in what we call “false positives.” In other words, getting this blood test can be reassuring if it is negative, but it does not tell us too much if it is positive.

Currently there is nothing that can be done to prevent this condition. However, if the actual cause is uncovered through further research, it’s certainly possible that a prevention may eventually be developed. As with any chronic illness, the sooner it is diagnosed and proper treatment has begun, the better the outcome and quality of life .
Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.