What is rheumatoid arthritis?
Dr. W. Hayes Wilson: Rheumatoid arthritis is a disease that effects about two to two-and-a-half million Americans. It's the second most common type of arthritis. It is the first though that we think of, when we think of inflammatory arthritis. An inflammation of course, has several characteristics. If it's red, it's hot, it's swollen and painful. Then it's probably inflamed. And if that inflammation is in a joint, then it's an inflammatory type of arthritis. Rheumatoid arthritis is the most common inflammatory type of arthritis.
Dr. Caryn Hasselbring: The prevalence of it increases with age, until you get into the mid 70s. It is much more common in women than men and it occurs probably three to four time more often in females than it does in males.
What is the cause of RA?
Dr. W. Hayes Wilson: I wish I knew. If we knew the cause of rheumatoid arthritis, we could probably cure it. But right now, we don't. But we're getting closer.
Dr. Caryn Hasselbring: We know that there is a certain strong hereditary predisposition to the disease. There are certain markers on the HLA part of the chromosome that occur with a much higher frequency in patients with rheumatoid arthritis, the main marker for rheumatoid arthritis, HLA-DR4. There are others being identified. There are combinations of markers that seem to really greatly increase your risk of developing rheumatoid arthritis. But it doesn't look like, just having those markers is the whole story.
We think that you probably have to come and contact with something in the environment that stimulates your immune system. And then because you are genetically predisposed, you get this aberrant immune response that turns on your body and causes the disease.
What are the hallmark symptoms of RA?
Dr. W. Hayes Wilson: Well, really the hallmark symptoms are, it is bilaterally symmetrical, meaning it's on both sides of the body. Usually in the small joints, usually in the small joints of the hands, particularly the metacarpophalangeal joints which are just the first knuckles. Often, the middle knuckles as well. And the wrist, that where we consider the carpal joints, which are the back of the hand or the wrist. Those are commonly involved on both sides of the body. And of course in the feet, it would be the base of the toes.
Dr. Caryn Hasselbring: Other types of inflammatory arthritis might involve only maybe one knee and an ankle on the other side of body. This will usually involve the wrist, the knuckles and the hands, the knees, the ankles and all the joints in the toes. And it will usually involve the same joints on both sides of the body.
The patients are usually extremely stiff in the morning. Typically, you'll get stiffness for more than an hour. So, it takes them more than an hour to get going in the morning. When you look at the patient, you'll see the swelling; you feel this kind of boggy, squishy feeling to the joints. Sometimes the joints will be red and warm to the touch.
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