Rheumatoid Arthritis: A Common Autoimmune Condition

The Diagnosis

Today I'm writing about a subject, for me at least, is very close to home. Rheumatoid arthritis is a common inflammatory disorder affecting at least 1% of the population. I've learnt about this condition the hard way. My wife started to complain of joint pain after the birth of our son 25 years ago. What began as a vague feeling of being unwell and random joint ache rapidly progressed until one day, my wife Karen, couldn't get out of bed. The doctors performed blood tests, X-rays and clinical assessments and rapidly came to the diagnosis of rheumatoid arthritis.

Types of Arthritis

So, what is rheumatoid arthritis (RA) and how do we contract it? First off it is necessary to distinguish RA from another common form of arthritis, called osteoarthritis. Osteoarthritis is due to degeneration of the joints caused by wear and tear and is a disease, in the main, of the elderly. RA causes joint damage but this is not due to normal wear and tear experienced by osteoarthritis sufferers and is not confined to the elderly and can afflict people of all ages.

An Autoimmune Disease

RA belongs to a group of conditions known as autoimmune disorders. For some reason, and the cause of the disease is still somewhat of a mystery, the body's immune system begins to attack healthy joint tissue. What is known is that there is a genetic component to the disease and it is thought that an environmental trigger is required to initiate the disease in genetically predisposed individuals. The onset is usually rapid and without effective medical intervention widespread joint damage may occur. Not everyone is affected to the same degree and the condition may not be restricted to joint damage; other bodily systems can be adversely affected.

There are a variety of treatments for RA, although there is no cure. Often multiple pharmacological approaches are taken to arrest the disease. The aim of the treatment is to prevent the inevitable joint deterioration due to disease progression. Surgery is employed as a last resort to repair the ravages of the diseases.

Doctors often apply the 'rule of thirds' to disease. It can provide a rough and ready guide to treatment and prognosis in some, but not all diseases. If we apply this 'rule' to RA and response to treatment we can rudely state: About a third of the patients respond very well and remain stabilised, a third will experience some benefit and a third will get worse.

One More Op

Karen belongs to the last category. On an average day she will consume 14 separate medications, including opiate based pain killers. Unfortunately the best efforts of modern medicine haven't prevented her from having 24 operations in the past 4 years. As I write my wife is packing for hospital and is about to undergo her 25th operation. This time it is to fuse several cervical vertebrae in her neck in an effort to stop the excruciating neck pain that is preventing her from enjoying life. My wife is stoic and tough; her resilience in the face of this disabling disease inspires me. We are hoping that this may be her last operation, although on past experience we may well be wrong.