"Rheumatoid arthritis" is a name applied to a group of joint troubles sometimes called "arthritis deformans," "atrophic arthritis," or "chronic infectious arthritis." It is an ancient disease, evidences of it having been found in Egyptian mummies.
Doctors say that rheumatoid arthritis develops as the combined result of several factors: an infection, a background of malnutrition, disorders of endocrine glands, or maladjustment to life, this latter now considered an important cause. The disease may be due to viruses, poisons, or toxins produced by bacteria; but no pus or disease germs have been found present in the joint fluid of people suffering from it. Physical or emotional shock, injuries, fatigue, exposure to cold and dampness, and, especially, hereditary predisposition and climate may prepare the way for the development of this disease, according to doctors. The disease is considerably more common in women than in men.
The disease usually appears after childhood and before the age of forty, but occasionally as late as the sixties and seventies. Doctors warn that its onset may be rapid but is more often gradual. At first, there is a low-grade fever, headache, and a general feeling of debility. The knees and fingers are usually affected first, then the shoulders, wrists, ankles, and elbows. In extensive cases, nearly every joint in the body may finally be attacked. The joints are swollen because of active inflammation of the synovial membranes and other structures in and about them. The pain may be only moderate, but it is often severe. The disease manifests itself principally in the joints, though it is a systemic malady involving the whole body.
Rheumatoid arthritis is sometimes apparently curable; but as a rule it recurs again and again after apparent cure. It is best for the person with rheumatoid arthritis to face up to the prospect that he will be troubled with this handicap for the rest of his life. But by cooperating with his physician, he will probably be able to live productively even though handicapped.
One basic program of treatment for the early stage of rheumatoid arthritis serves to benefit all cases, severe and less severe. In less severe cases, this basic program, by itself, may control the disease for long periods of time. It consists of six items:
1. Rest. The patient should avoid straining the joints involved, and reduce his activities so as to conserve his vitality.
2. Psychological adjustment. The patient should be provided with knowledge regarding his disease. He should be encouraged to become reconciled to the handicaps his disease produces. On the positive side, he should plan his future so that he can be productive and can experience the rewards of success.
3. Relief of pain. This is accomplished by the use of dry heat to affected parts of the body and otherwise by pain-relieving medicines. The usual medicines for this purpose are the salicylates, especially aspirin. The use of pain-relieving medicines introduces the danger of anemia, for these medicines may have a damaging effect on the blood-forming tissues.
4. Measures to combat anemia. The physician in charge of the case will arrange for frequent blood tests to determine whether anemia is developing and, if so, its degree. He may recommend corrective measures as necessary.
5. Therapeutic exercise. The exercise program must be adapted to the particular case to keep the muscles in good condition, prevent or reduce deformities, and help the patient to maintain his vitality.
6. A well-balanced diet. It is important for the person with rheumatoid arthritis to maintain general health and vitality as much as possible. His diet should be simple but liberal, with plenty of vitamins, vegetables, and fruits.
For the more severe and rapidly progressing cases, doctors recommend adding a more drastic program of treatment consisting of four items: intensive physical and occupational therapy, orthopedic devices, potent drugs, and orthopedic surgery.
In the later stages of rheumatoid arthritis, efforts are made to restore functions lost earlier in the course of the disease. The patient needs to be taught to carry on his activities inspite of his handicap. In addition, doctors confirm that many cases are benefited by surgery in which the joints are replaced or reconstructed, and in which tendons may be transplanted to restore lost functions.