RHEUMATOID ARTHRITIS Wendy Kuhns Northern Arizona University Symptoms, Treatment and Incidence

GENERAL SYMPTOMS Painful Swelling in Joints Fatigue Loss of Function Joint Erosion Decreased Range of Motion Physical Deformity

WHAT IS RHEUMATOID ARTHRITIS? A chronic non-contagious, non-infectious autoimmune disorder for which there is currently no cure. Rheumatoid arthritis causes the immune to mistakenly attack health cells and tissues. More prominent in women then men aged 30 to 50 years of age at a 3:1 ratio Positively identified by increased levels of inflammation in the blood and the presence of the rheumatoid factor (RF) Prolonged inflammation leads to joint erosion, physical deformity and organ damage (Smolen, 2008)

RA SYMPTOMS PROGRESSION (Rennie, Hughes, Lang, Jebb, 2010)  Joint swelling, stiffness and redness are the hallmark symptoms for those suffering from rheumatoid arthritis.  Early symptoms are dry mouth, inflamed eyes, difficulty sleeping and general weakness or fatigue.  Fatigue, swollen joints, especially the hands and ankles, and stiffness are the common complaints.  Flu-like symptoms, prolonged fevers without causation.  Nodules form in about 20% of people. These nodules are caused from inflammation of small blood vessels. Usually the size of a pea, they are commonly located near the elbow however they can show up anywhere.

DIAGNOSIS Rheumatologists prefer to utilize 2 standard lab tests to help in the diagnosis of the disease: Rheumatoid factor and Anti-cyclic Citrullinated Peptide (Anti-CCP) antibody. The rheumatoid factor (RF) test measures the amount of RF antibody in the blood through sampling blood from a vein on the inside of the elbow or the back of the hand. Those with a low number or normal result, usually less than u/mL, are not considered to have rheumatoid arthritis, however 61 u/mL and above are diagnosed with having the disease. those with high RF levels will usually be referred for more tests such as the Anti-CCP antibody blood test which is used on individuals who tested on the high side of rheumatoid factor levels. History has shown this antibody has been present in 70% of patients and it can be detected between 1.5 and 9 years prior to the onset of symptoms Rheumatologists prefer to utilize 2 standard lab tests to help in the diagnosis of the disease: Rheumatoid factor and Anti-cyclic Citrullinated Peptide (Anti-CCP) antibody. The rheumatoid factor (RF) test measures the amount of RF antibody in the blood through sampling blood from a vein on the inside of the elbow or the back of the hand. Those with a low number or normal result, usually less than u/mL, are not considered to have rheumatoid arthritis, however 61 u/mL and above are diagnosed with having the disease. those with high RF levels will usually be referred for more tests such as the Anti-CCP antibody blood test which is used on individuals who tested on the high side of rheumatoid factor levels. History has shown this antibody has been present in 70% of patients and it can be detected between 1.5 and 9 years prior to the onset of symptoms (Visser, Cessie, Vos, Breedveld, & Hazes, 2002, p. 363)

STAGES OF RA DISEASE PROGRESSION Begins slowly. Symptoms come and go Persistent swelling in hands with joint stiffness Joint erosion, permanent physical deformity especially in the hands (Rennie, Hughes, Lang, Jebb, 2010)

STAGES OF RECOVERY, DISABILITY, OR DEATH  Since there is currently no cure for rheumatoid arthritis, so people will not experience a full recovery.  “RA Flares” are when symptoms are being experienced but usually dissipate after a week or 2.  Treatment for RA is aimed at reducing inflammation, preventing damage to bones and ligaments, and preserving range of motion through medications and joint injections.  Surgical interventions can be helpful for individuals who have severe deformities and disabilities.  People diagnosed with RA usually do not experience shorter life spans due to rheumatoid arthritis, however they do seem to have higher risks of developing serious diseases such as infections and cancers as well as heart, lung and stomach problems due to the medications, such as azathioprine and corticosteroids.  Since there is currently no cure for rheumatoid arthritis, so people will not experience a full recovery.  “RA Flares” are when symptoms are being experienced but usually dissipate after a week or 2.  Treatment for RA is aimed at reducing inflammation, preventing damage to bones and ligaments, and preserving range of motion through medications and joint injections.  Surgical interventions can be helpful for individuals who have severe deformities and disabilities.  People diagnosed with RA usually do not experience shorter life spans due to rheumatoid arthritis, however they do seem to have higher risks of developing serious diseases such as infections and cancers as well as heart, lung and stomach problems due to the medications, such as azathioprine and corticosteroids. (Starkbaum, 2014), (Killian, 2015). Movement is key to decreasing painful stiffness

INCIDENCE RATES OF RA IN THE UNITED STATES  Overall current and year 2010 prevalence rate of rheumatoid arthritis for the United States was an estimated 1.5 million adults in 2010 compared to 1.3 million people in 2014  Incidence rate based on gender was significantly higher in women than in men in both 2010 and % of women and 19% of men are diagnosed with RA. Never has yearly incidence been higher in men than in women  In 2010, 3.7% of Caucasians, 4.3% African Americans, and 2.7% Hispanics were diagnosed with rheumatoid arthritis. In 2014, prevalence rates increased slightly amongst =the Caucasian population to 3.9%  In 2010, 151 per 100,000 women were diagnosed with RA between the ages of and 41 per 100,000 of men within the same age compared to 103 per 100,000 of women and 40 per 100,000 of men in 2014  Rheumatoid arthritis is common throughout the United States. In both 2010 and 2014 a “statistically significant area of increased risk was identified in the upper northeast including Vermont, New Hampshire, and southern Maine. An area of decreased risk was located in Pennsylvania. The Midwest (Great Plains), northern Maine, and southwest Texas as low population density regions” (Vieira, 2014). (Silman, 2014), (Starkbaum, 2014)

To qualify for this survey, participants had to be RA patients over 18 years old and a US resident or US citizen (RA.Net, 2013)

INSIGHTS AND TRENDS OF RA IN THE UNITED STATES  Managing symptoms affectively can not only reduce the chronic pain associated with RA, but is can help improve the quality of life for those people who are suffering with the disease.  History has shown that women are more prone to developing rheumatoid arthritis at an ratio of 2.7:1 versus that of men however it is not understood why this is.  One trend that is particularly interesting is the lower prevalence of RA diagnosis in rural areas and significantly higher RA prevalence in high density areas such as the Northeastern United States especially Vermont and Maine.  It can be questioned whether air quality and other common city pollutants can contribute to onset and progression of rheumatoid arthritis.  Managing symptoms affectively can not only reduce the chronic pain associated with RA, but is can help improve the quality of life for those people who are suffering with the disease.  History has shown that women are more prone to developing rheumatoid arthritis at an ratio of 2.7:1 versus that of men however it is not understood why this is.  One trend that is particularly interesting is the lower prevalence of RA diagnosis in rural areas and significantly higher RA prevalence in high density areas such as the Northeastern United States especially Vermont and Maine.  It can be questioned whether air quality and other common city pollutants can contribute to onset and progression of rheumatoid arthritis. (Wong & Davis, 2013, p. 23)

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REFERENCES  CDC - Arthritis - Data and Statistics - Arthritis Related Statistics. (n.d.). Retrieved from  Killian, M. (2015). Myths and misconceptions about rheumatoid arthritis. American Nurse Today, 5(7).  Rennie, K. L., Hughes, J., Lang, R., & Jebb, S. A. (2012). Nutritional management of rheumatoid arthritis: a review of the evidence. Journal of Human Nutrition and Dietetics, 4,  Silman AJ, Hochberg MC. Epidemiology of the Rheumatic Diseases. 2nd ed. New York: Oxford University Press; 2001  Smolen, A. (2008). Rheumatoid Arthritis - In-Depth Report - NY Times Health. Retrieved from  Starkebaum, G. (2014, January 22). Rheumatoid arthritis - National Library of Medicine - PubMed Health. Retrieved from  Vieira, V. (n.d.). EHP – Association between Residences in U.S. Northern Latitudes and Rheumatoid Arthritis: A Spatial Analysis of the Nurses’ Health Study, 2014.