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Rheumatoid or "crippling arthritis" affects 1%
of the population and is characterized by
progressively worsening painful swelling of
joints on both sides of the body especially in
the morning, immobility, leading to severe
deformity, esp. in the hands and feet. It is an
inflammatory disease produced by tumor
necrosis factor and other inflammatory
substances which cause the normally thin joint
lining (synovium) to become very thickened
with a subsequent increase in production of
joint fluid. This causes the joint to become
inflamed, red, warm, and swollen. Other joints
are involved esp. the neck, shoulders, knees,
hips, and ankles. It is a systemic disease with
other symptoms such as generalized fatigue,
fevers, anemia, etc. Usually joint swelling
occurs during periods of immobility such as
during the night resulting on severe pain in the
morning. Ultimately, joint destruction and
deformity results with cartilage and bone
involvement. Diagnosis is made on physical
exam and history in addition to a blood test,
rheumatoid factor. However, the rheumatoid
factor may be absent in 20% of patients with
rheumatoid arthritis. Xrays of the hands may
demonstrate joint destruction with angulation
of the joints. Early treatment is very important
since most of the destruction of the joint takes
place within 2 years after the onset of
symptoms.   Proper rest, exercise, avoidance of
long periods of inactivity, and diet can be
helpful in preventing progression and in pain
control. Ultimately, surgery may be necessary
with tendon or joint replacement surgery.
Enbrel and Remicade are some of the latest
advances, blocking the inflammatory agent at
the onset. These are frequently used with
other agents such as methotrexate, which is a
chemotherapeutic agent used to treat
rheumatoid arthritis. Combination treatment
with methotrexate and Enbrel is more effective
than either alone. There are several other new
agents used to treat rhematoid arthritis. Older
therapies which are frequently used first
include the NSAIDs. Frequent repeated steroid
injections which may ultimately worsen the
condition but intermittent occasional steroid
injections may be beneficial.   Physical therapy
may be useful but the most beneficial element
to physical therapy is maintaining mobility of
the joints. Mobilizing the joints (movement)
will help wash out some of the accumulated
toxins (tumor necrosis factor) in the joints.