Rheumatoid Arthritis

RA is a disease that is often accompanied by a high Rheumatoid factor (RF), however a person can have RA with no RF at all. When this happens it is described as "seronegative rheumatoid arthritis".

RA is an autoimmune disease where the body's own immune system attacks tissue It can cause joint damage, chronic pain, loss of function and disability of joints.

This type of arthritis is a long term chronic illness that can stay with people for many years or life.

Symptoms

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of undetermined etiology involving primarily the synovial membranes and articular structures of multiple joints. The disease is often progressive and results in pain, stiffness, and swelling of joints. In late stages deformity and ankylosis develop.

The symptomsInvolving joints,d nerves and muscles of RA are as follows.

Joint pain

Joint swelling

Joint stiffness

Morning joint stiffness

Joint stiffness after inactivity

Joint tenderness

Warm joints

Ankle arthritis

Symmetrical joint pattern - both sides of the body afflicted.

Weight loss

Fatigue

Decreased appetite

Occasional fever

Bouts of mild fever

Episodic flares with remissions

Variable symptoms - different people experience different effects

Skin bumps (rheumatoid nodules) - about 25% of cases get these

Anemia

Neck pain

Dry eyes

Dry mouth

Tiredness

Afternoon fatigue

Joint involvement is typically polyarticular and symmetrical, (happens in more then one joint at a a time and often affects the same joints on opposite sides of the body.) usually sparing the distal interphalangeal (DIP) joints. Joint involvement and inflammation is evinced by the following:

Edema

Effusion

Warmth

Tenderness to palpation

Destruction of joint in advanced stages

other symptoms may manifest themselves in the skin and other organs of the body.

Subcutaneous rheumatoid nodules,

Swan-neck deformities,

Boutonniere deformities,

Ulnar deviation of fingers at MCP joints in advanced stages.

RA a is a systemic disease, that means its inflammation can affect other organs and areas of the body. RA can cause Inflammation of the glands, eyes and mouth the result being dryness of these areas, This is known as Sjogren's syndrome. Rheumatoid inflammation can also lead to pain in the chest with deep breathing. this is the result of inflammation of the lung lining, pleuritis.it can also lead to shortness of breath, or coughing. Lung tissue becoming inflamed can lead to them being scarred and coughing. rheumatoid nodules can sometimes develop in the lungs. Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause a chest pain that typically changes in intensity when lying down or leaning forward. RA can also lead to anemia. Decreased white cells can be associated with an enlarged spleen (referred to as Felty's syndrome) and can increase the risk of infections. Rheumatoid nodules can occur under the skin around the elbows and fingers where there is frequent pressure. Even though these nodules usually do not cause symptoms, occasionally they can become infected. Nerves can become pinched in the wrists to cause carpal tunnel syndrome. A rare, serious complication, usually with long-standing rheumatoid disease, is blood vessel inflammation (vasculitis). Vasculitis can impair blood supply to tissues and lead to tissue death (necrosis). This is most often initially visible as tiny black areas around the nail beds or as leg ulcers.

Arnica

Arnica Montana

It is claimed that arnica Relieves aches; an anti-inflammatory and immune enhancer

However acording to Arthritis today from the Artritis foundation, it's among supplements to avoid because it can cause miscarriages, allergic reactions, paralysis, heart palpitations, death.

Osinophils are a type of white blood cell usually representing less than 8% of the total white blood cell population. The number of these cells (eosinophil count) with illnesses, such as allergies, asthma, Addison's disease, sarcoidosis, parasite infections, drug reactions, and connective tissue diseases (like rheumatoid arthritis and scleroderma). A high ESR means that there is some sort of inflammation in the system. The ESR is not a test designed to pinpoint the reason for the inflammation. However a high eoeinophil count could explain the high ESR.

• Less than 40-60 u/mL
• Less than 1:80 (1 to 80) titer

A low number (normal result) usually means you do not have rheumatoid arthritis or Sjogren syndrome. However, some people who do have these conditions still have a "normal" or low rheumatoid factor (RF).

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

No there is no evidence that chocolate and Ice cream are two of the foods that can cause arthritis. As a matter of fact there is no evidence that any foods cause arthritis aside from purines in food in the case of gouty arthritis.These foods however may well lead to weight gain if eaten to excess which in turn can leas to damaged arthritic joints having to bear more load then they are capable of carrying The cause for Osteoarthritis aside from that caused by trauma is however not known. To find more information about the best diet for this condition, see the page link, further down this page, listed under Sources and Related Links.

This sedimentation rate in females should normally be under 20, with slight variation depending in the lab doing the testing. 50 indicates that there is some sort of inflammation some where in the body. A sedimentation rate will indicate inflammation, however it does not indicate what is causing it. these test are most often used in monitoring autoimmune disorders such as Rheumatoid arthritis.

ESR stands for erythrocyte sedimentation rate. this is a test that indirectly measures the level of inflammation is in the body.

normal readings are

Adults, Westergren method Women under 50 years old-- less than 20 mm/hr

Women over 50 years old---- less than 30 mm/hr

.

Seropositive Rheumatoid arthritis is RA in a person that has rheumatoid factor in the blood. As opposed to seronegative RA where there is no RF.

Rheumatoid arthritis is an autoimmune disease that exhibits itself in a certain way when it is suspected that one has RA ones blood is tested for Rheumatoid factor (a particular antibody) if it is found to be elevated then one is said to have seropositive RA.

The ESR test us useful insofar as it gives the doctor treating an inflammatory condition like rheumatoid arthritis an idea of how the treatment being used is working. The ESR indicates the degree of inflammation in the system, in the case of RA inflammation happens mainly in and around the joints of the body causing damage. by monitoring inflamation it is easier to effectively monitor dosages of controlling drugs,

No rheumatoid arthritis is not contagious. There does seem to be a genetic connection meaning that if any of your parents have it you are also more likely to suffer from it. However you would for example not get Rheumatoid artritis if you were to receive a blood donation from someone with RA. RA is a chronic Autoimmune disease where for reasons not yet understood the immune system turns on selected tissues of the body leading to their destruction.

It is not unusual for Anemia or "low blood" to accompany rheumatoid arthritis. Anemia indicates a low number of red blood cells and that these cells are low in hemoglobin, the substance that carries oxygen through the body. A low white blood cell count (leukopenia) can occur as a result of Felty's syndrome which is a complication of rheumatoid arthritis that is also characterized by enlargement of the spleen.

No. Rheumatoid arthritis is an autoimmune disease ankylosing spondilitis is not.

What are Hand Tumors?

Any abnormal lump or bump is considered a tumor. A tumor can also be referred to as a "mass". The term "tumor" does not necessarily mean it is malignant or it is a cancer. In fact, the vast majority of hand tumors are benign or non-cancerous. Any lump or bump in your hand is a tumor regardless of what causes it.

Hand tumors can occur on the skin, like a mole or a wart, or can occur underneath the skin in the soft tissue or even the bone. Because there are so many tissue types in the hand (e.g. skin, tendon, fat, ligaments, bone, etc) there are many types of tumors that can occur. However, only a few of them are seen commonly.

What types of Hand Tumors are there?

The most common tumor in the hand and wrist is a ganglion cyst. These are benign sacs of gelatinous fluid that form off of a joint or tendon sheath. They are seen frequently in the wrist but can also occur around finger joints. They form when a portion of the joint capsule or tendon sheath starts ballooning out and becomes filled with the fluid that lubricates the joint or tendon. The diagnosis and treatment options are discussed in more detail in another brochure and in a separate section on the ASSH web-site.

The 2nd most common hand tumor is a giant cell tumor of tendon sheath. Unlike the fluid-filled ganglion cyst, these tumors are solid masses. They can occur anywhere there is a nearby tendon sheath. They are benign, slow-growing masses that spread through the soft tissue underneath the skin (see Figure 1). Some believe that they may be caused by trauma that stimulates the tendon sheath to start growing abnormally. They are not cancer.

Figure 1: Giant Cell Tendon Sheath Tumor of the Thumb

Another common tumor is an epidermal inclusion cyst (see Figure 2). It is also benign and forms just underneath the skin, originating from the undersurface of the skin where there may have been a cut or puncture. Skin cells normally secrete a protective waxy substance called keratin. They also undergo a cycle in which surface skin cells die and slough off into the environment. When skin cells get trapped under the surface, they continue to make keratin and continue to reproduce and slough. The keratin and dead skin cells get trapped underneath the skin and start forming the cyst. The cyst grows as more keratin is produced and more skin cells die. Ultimately, you get a fibrous sac filled with a cheesy substance that is attached to the undersurface of the skin from where it arose.

Figure 2: Epidermal inclusion cyst of the finger

There are other less common types of tumors seen in the hand. They include lipomas

(fatty tumors), neuromas, nerve sheath tumors, fibromas, and glomus tumors among others (see Figure 3). They are practically all benign. Bone spurs can form, from arthritis or trauma, which feel like hard tumors. Foreign bodies, like a splinter, can also cause reactions that form lumps or bumps in the hand (see Figure 4).

Figure 3: Fibroma of the little finger

Figure 4: Foreign body reaction causing tumor in the palm

Typically, definitive treatment with the lowest recurrence rate involves surgical excision of the tumor. Excising the tumor also allows a pathologist to analyze it and determine exactly what type it is with reasonable certainty. Surgery can frequently be done on an outpatient basis and may not require a general anesthetic. Risks and benefits should be discussed with the surgeon. Most tumors can be cured with surgery.

If the doctor thinks the tumor is a ganglion cyst, then trying to aspirate or inject the cyst may be an option if the patient does not want surgery, though recurrence is fairly common. Needle biopsy or incisional biopsy may be considered for a solid tumor if the surgeon wants to get a tissue diagnosis before recommending definitive treatment.

Some patients may choose to do nothing and simply live with the tumor once they learn that it is probably benign. Typically, however, tumors get bigger with time and can become more of a nuisance. Patients should also consider the risks, benefits, and consequences if choosing not to have surgery. Hand surgeons can provide information and advice to allow patients to make the best decisions regarding their treatment plans.

(c) 2007 American Society for Surgery of the Hand

Developed by the ASSH Public Education Committee

View a PDF of this content.

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More Information

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National Institutes of Health

hand tumors, ganglion cyst, cyst, tendon sheath, epidermal inclusion cyst, fibroma, ASSH, American Society for Surgery of the Hand

Related Files

Hand Tumors (PDF File)

New to the world of medical coding? ICD-9-CM codes are used throughout the healthcare industry to describe diseases, injuries, symptoms and conditions. CPT codes are used to describe medical and surgical services performed by healthcare providers. ICD-9-CM codes and CPT codes are inherently related, as the diagnosis (ICD-9-CM code) must support the procedure (CPT code). All Medicaid and Medicare claims require a valid ICD-9-CM diagnosis code and a CPT procedure code in order to be reimbursed. Turn to ICD9Data.com as your free expert source for everything related to diagnosis coding.

these are the oly references that I could find to rheumatiod

ICD-9-CM Diagnosis 714.30Chronic or unspecified polyarticular juvenile rheumatoid arthritis

• rheumatoid arthritis of children occurring in three major subtypes defined by the symptoms present during the first six months following onset: systemic onset (Still's Disease, Juvenile Onset), polyarticular onset, and pauciarticular onset; adult onset cases of Still's disease (Still's Disease, adult onset) are also known; only one subtype of juvenile rheumatoid arthritis (polyarticular onset, rheumatoid factor positive) clinically resembles adult rheumatoid arthritis and is considered its childhood equivalent.

ICD-9-CM Diagnosis 714.0Rheumatoid arthritis

• chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures; etiology is unknown, but autoimmune mechanisms have been implicated.
• A chronic systemic disease, primarily of the joints, marked by inflammatory changes in the synovial membranes and articular structures, widespread fibrinoid degeneration of the collagen fibers in mesenchymal tissues, and by atrophy and rarefaction of bony structures. Etiology is unknown, but autoimmune mechanisms have been implicated.

The inflammation caused by RA results in damage to the joints as well as many other tissues and organs of the body. The main way to stop or at least reduce joint damage is by giving medications that suppresses inflammation.and Disease-Modifying Anti-Rheumatic drugs that reduce the effect that the immune system has in some situations.

These can also be described as slow acting anti rheumatic drugs (SAARDs). These drugs suppress inflammation and may also retard the development of joint erosion's The exact reason for their effectiveness is at this stage not well understood. Their effectiveness in their ability to slow the progression of erosion's is judged through the use of X-rays.

With DMARDs early diagnosis and treatment of RA is important in the aim of preventing joint deformity and disability. DMARDs take 6-8 weeks to achieve beneficial effects. Treatment with these drugs should be closely monitored. Regular blood and urine tests are often done to identify side effects and potential problems as soon as possible.

DMARDs that are used in the treatment of RA.

Methotrexate (e.g. Ledertrexate, Methoblastin) may be used in moderate to severe rheumatoid arthritis. This medication can be taken orally or by intramuscular injection. Supplements of folic acid are recommended to alleviate side effects such as nausea and mouth ulcers. Methotrexate It is potentially toxic to the liver. Methotrexate is the leading DMARD in the fight against inflammation in RA.

Sulfasalazine such as Pyralin EN and Salazopyrin EN. These drugs while less potent, have fewer adverse side effects and are used in the treatment of mild RA. These however can still cause nausea, dyspepsia, diarrhea, rash and headaches. These side effects however are reduced once the maintenance dose is reached. It can also lead to severe anemia on occasion.

Leflunomide (e.g. Arava). Used for severe active RA that does to methotrexate. Leflunomide is as effective as methotrexate in the treatment of RA.

Antimalarials such as hydroxychloroquine sulfate such as Plaquenil are also used in the treatment of mild rheumatoid arthritis. They are less toxic than some of the other treatments. Plaquenil is often used in combination with other DMARDs.

Azathioprine (e.g. Imuran) is used to treat only severe active RA that is unresponsive to other DMARDs. Because of high toxicity it is rarely used.

(NSAIDs)

Non-steroidal anti-inflammatory drugs

These drugs are prescribed as pain killers. They may also reduce inflammation inflammatory forms of arthritis, such as RA. They have no effect on the progress of the disease but may relieve symptoms. Ibuprofen such as Nurofen or Tri-Profen and naproxens such as Naprogesic are available without prescription. Drugs such as such as diclofenac, piroxicam, sulindac and indomethacin have to be prescribed by a doctor.

The use of NSAIDs is often limited because they increase the risk of upper gastrointestinal problems, such as gastric ulcer. They are not suitable for use by people who have had a peptic ulcer or gastrointestinal bleeding.

COX-2 specific inhibitors

The coxibs (e.g. celecoxib --- brand name Celebrex) These are non-steroidal anti-inflammatory agents. They are effective in reducing inflammation and relieving pain and are far gentler on the stomach than the conventional, older NSAIDs. Coxibs may be associated with an increased risk of cardiovascular events, such as heart attack and stroke, when taken in high doses. People with an increased risk of heart attack or stroke are advised not to use these medications

Corticosteroids

Corticosteroids, also known as glucocorticoids, such as prednisone and prednisolone, are medications that reduce inflammation and suppress the immune system. These agents are used in the treatment of RA, both as tablets and as injections into the joint. Prednisolone is sometimes used in moderate to severe RA where NSAIDs and DMARDs are not controlling the disease. Oral corticosteroids (those taken by mouth) are usually used at the lowest effective dose to minimize adverse effects such as weight gain, hypertension (high blood pressure) and osteoporosis.

Corticosteroids may also be injected into joints if the arthritis is not being controlled through oral therapy, however this has to be limited to 3 to 4 injections a year. Joints commonly injected are fingers, toes, knees and shoulders. Corticosteroids are also sometimes injected into the muscles.

Biologic agents

A new category of arthritis treatments called tumour necrosis factor (TNF) inhibitors has been developed. TNF inhibitors occur naturally in the body and are key players in the process of inflammation in rheumatoid arthritis. It is found in high concentration in the joint fluid of people with RA. By attaching to the TNF, these new agents can block its effect.

Infliximab (e.g. Remicade) is a TNF inhibitor available for the treatment of RA in selected patients. It slows the progression of RA and reduces joint damage. Inflixmab is given by infusion via a drip into a vein. Each treatment takes approximately 2 hours. It is given along with methotrexate. There are very tight Government restrictions In Australia on which patients with RA can obtain access to Remicade because of the expense involved.

Etanercept (e.g. Enbrel)

Humira (adalimumab),

There are also promising experiments going on that have now reached testing in humans where stem cell technology is being employed to replace damage cartilage bone and muscle.

National Rheumatoid Arthritis Society booklet 'A self-help guide to claiming Disability Living Allowance for adults with rheumatoid arthritis'. Go to the link below (Disability living allowance)

The exact cause of RA is at present not known Rheumatoid arthritis (RA) is an autoimmune disorder. That is a disorder where the immune system of the body mistakenly destroys the bodies own tissue. In the case of RA, joints and other tissues of the body are attacked by the immune system. Most commonly the immune system attacks synovia, the fluid around joints, causing swelling and discomfort

We are unsure of the exact mechanisms that brings about RA. However researchers feel these factors are involved. Chemicals called cytokines are used by the immune system cells to communicate. It is thought that people with RA have too much of certain types of cytokines, including interleukin (IL) and tumour necrosis factor alpha (TNF-α), which may be sending the messages that cause the joints to be attacked. There is a greater risk of having RA if there is a member of the family with the disease or if you are female. Some family's are genetically predisposed to RA making them more prone to the disease. Biological factors such as hormone changes, or factors such as an infection, are believed to trigger the immune system to attack the joints in people prone to RA.

Results are usually reported in one of two ways:

• Less than 40-60 u/mL
• Less than 1:80 (1 to 80) titer

A low number (normal result) generally means you do not have rheumatoid arthritis or Sjogren syndrome. However, these conditions still can still occur in some people who have have a "normal" or low rheumatoid factor (RF).

Normal value ranges may vary slightly among different laboratories.

Rheumatoid factor (RF) blood tests measures the amount of the RF antibody in the blood.

The results of the rheumatoid factor (RF) test may be reported in titers or units:

A titer is a measure of how much the blood sample can be diluted before RF can no longer be detected. A titer of 1 to 20 (1:20) means that RF can be detected when 1 part of the blood sample is diluted by up to 20 parts of a salt solution (saline). A larger second number means there is more RF in the blood. Therefore, a titer of 1 to 80 shows more RF in the blood than a titer of 1 to 20.

Nephelometry units indicate how much light is blocked by the blood sample in the tube. A high level of RF causes the sample to be cloudy, so less light passes through the tube than when the RF level is low. So an RF level of 100 units is higher than one of 40 units.

Normal

Normal values vary from lab to lab. Results are usually available in a day or two.

Rheumatoid factor (RF) Titers

1:20 to 1:80 Units

14 units/mL to 60 units/mL

Patients should check with their heath profesional to see what the normal range is for the lab that tested your blood.

Rheumatoid factor is an immunoglobulin (antibody) which is able to bind to other antibodies. Rheumatoid factor is usually not found in the general population. it is only found in about 1-2% of healthy people. Rheumatoid factor increases with age and about 20% of people over 65 years old have an elevated rheumatoid factor.

A blood test is done to detect the presence of rheumatoid factor. This is normally ordered to diagnose rheumatoid arthritis. Rheumatoid factor is present in 80% of adults who have rheumatoid arthritis The incidence of rheumatoid factor increases with duration time: at 3 months the incidence is 33%, at one year it is 75%. Up to 20% of rheumatoid arthritis sufferers remain negative for rheumatoid factor (also known as "seronegative rheumatoid arthritis") throughout their disease.

Results are usually reported in one of two ways:

Normal values are LESS than 60 U/ml.

A low number (normal result) usually means you do not have rheumatoid arthritis or Sjogren syndrome. However, some people who do have these conditions still have a "normal" or low rheumatoid factor (RF).