Medicines can slow joint dam­age

Daily Freeman (Kingston, NY) - - YOUR DAILY BREAK - An­thony Ko­maroff Ask Dr. K

I have rheuma­toid arthri­tis. Can you ex­plain what is hap­pen­ing in my body to cause such un­com­fort­able symp­toms?

Rheuma­toid arthri­tis (RA) is a chronic (long-term) dis­ease. It causes painful and some­times dis­abling in­flam­ma­tion of the joints. RA can also af­fect other tis­sues in the body, such as the skin, eyes, lungs and blood ves­sels.

RA is an au­toim­mune dis­ease. That means the im­mune sys­tem mis­tak­enly iden­ti­fies nor­mal, healthy cells as dan­ger­ous and at­tempts to de­stroy them. Why does this hap­pen? Do the nor­mal, healthy cells some­how “look” for­eign to the im­mune sys­tem? Or is there some­thing in the nor­mal cells, like a virus that hasn’t yet been dis­cov­ered, that at­tracts the at­ten­tion of the im­mune sys­tem? There are a lot of sci­en­tists try­ing to fig­ure that out.

In RA, the im­mune sys­tem tar­gets syn­ovial joints, the mov­able joints found in the shoul­ders, el­bows, wrists, fin­gers, hips, knees, an­kles and toes. In these joints, a pro­tec­tive layer of car­ti­lage cov­ers the ends of the bones where they meet. The joints take their name from the syn­ovium, a mem­brane that lines the joint.

The syn­ovium pro­duces syn­ovial fluid, a thick, sticky, yel­low­ish liq­uid. It lu­bri­cates the joint and min­i­mizes fric­tion. It also forms a seal that al­lows neigh­bor­ing bones to slide freely against each other with­out pulling apart.

RA oc­curs when the im­mune sys­tem mis­tak­enly at­tacks the syn­ovium. The at­tack­ing cells re­lease in­flam­ma­tory chem­i­cals that in­crease blood flow to the site. They di­rect an army of white blood cells, germ-fight­ers and other sub­stances into the in­vaded tis­sue. White blood cells pro­duce in­tense in­flam­ma­tion.

In re­sponse to the in­flam­ma­tion, syn­ovial cells also be­gin to mul­ti­ply. This causes the nor­mally smooth syn­ovium to form a rough, grainy tis­sue called pan­nus. The pan­nus grows into the pre­vi­ously empty space in the joint. In ad­di­tion, syn­ovial cells and other cells pro­duce chem­i­cals that eat away at the car­ti­lage in the joint.

To­gether, the pan­nus and the in­flam­ma­tory chem­i­cals badly dam­age the joint. If the ten­dons be­come in­flamed, they may shorten and pre­vent the joint from bend­ing. If the ten­dons rup­ture, the joint may be­come loose or floppy.

In a nor­mal im­mune sys­tem re­sponse, in­flam­ma­tion sub­sides when the threat is re­moved. But in RA, the im­mune re­sponse is not nor­mal; it con­tin­ues in­def­i­nitely. This pro­longed in­flam­ma­tion can be dev­as­tat­ing. The re­sult is swelling, red­ness, heat and pain in the joints. Ul­ti­mately, the joints can be so badly dam­aged that they be­come de­formed. Peo­ple with RA can have great dif­fi­culty walk­ing, bend­ing, lift­ing or us­ing their hands.

As RA pro­gresses, it can limit a per­son’s abil­ity to carry out nor­mal daily ac­tiv­i­ties such as dress­ing, bathing and walk­ing. How­ever, with med­i­ca­tions, good self-care and, if nec­es­sary, surgery, most peo­ple with RA can avoid dis­abil­ity. In the past decade, re­search has led to pow­er­ful new medicines that pre­vent the slow de­struc­tion of the joints in many peo­ple with RA. I hope your doc­tor has pre­scribed one of these medicines for you.

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