Rheumatoid Arthritis:
An Outdated Name That Needs to be Changed ©
What is Rheumatism and what has it to do with RA?
How is RA like - or not like - other forms arthritis?
Isn't arthritis something old people get?
Despite the similarities of the names of Osteoarthritis (OA) and Rheumatoid Arthritis (RA), they are quite different. It is the difference that creates additional suffering for those with the more serious disease of RA.
Many patients with OA, also known as the “wear-and-tear-arthritis” which effects only the joints and comes with age, are primarily elderly, and only know that they have arthritis and are unaware of the distinctions between the many varied types of arthritis.
Unlike OA, RA effects women as much as four times more than men and though it can strike at any age, it generally strikes in the prime of life, typically adolescents or young adults between 25 and 55, and can effect infants and children, effecting approximately 2.5 million or 1-2% of the total population. Yet, it is still thought of by the average layperson as a disease of old age.
Television advertisements for products "for the relief of arthritis” making no distinction, add to the lack of clarity.
The confusion lies clearly in the fact that both OA and RA share the same name.
The word arthritis has a very simple definition: inflammation of a joint or joints resulting in pain and swelling. By this definition any injury to a joint that causes pain and swelling is arthritis. That extremely broad definition is then clarified it with the word rheumatoid, which is defined as: 1. Of, or resembling rheumatism; 2. suffering from rheumatism.
Rheumatism is defined as: 1. any of several pathological conditions of the muscles, tendons, joints, bones, or nerves, characterized by discomfort and disability; 2. rheumatoid arthritis. Thus bringing us full circle with no clearer a definition than we started with! Well-meaning friends and family are merely reacting accurately to the verbal message they are hearing when they say to someone with RA, “I have arthritis, too. Aspirin helps” leaving the RA sufferer exasperated and diminished once again.
RA has been described by medical sources as a “degenerative inflammatory disease.” While true of RA, it is in fact a more inclusive definition of OA than RA.
As an autoimmune disease - which the above does not address - RA has more in common with Lupus than it does with OA. To use the same nomenclature for OA and RA is comparable to using the same one for a brain tumor and a headache since both affect the head. Or, to use the same name for a melanoma and a pimple! Clearly more serious diseases need to be identified clearly from other ailments affecting the same body part.
The History and Confusion
Rheumatoid Arthritis, also known then as arthritis deforms, was thought to be related to rheumatism and gout, only to be found quite different from both by William Heberden, who is attributed with naming the ailment Rheumatoid arthritis in 1804. He first described the “small nodular outgrowths upon the terminal joints of the fingers,” and which are now universally referred to as Heberden's nodes.
While the etiology of RA is still unclear, we have come a long way since 1804 in understanding this disease which effects millions of Americans. Infectious and other causes have been investigated and discarded. The destruction seen in RA has been conclusively determined to be caused by the body’s immune system gone haywire and attacking healthy tissue. This creates a major distinction between RA and OA, unknown at the time the disease was named. Because it is systemic, RA causes far more than inflamed achy joints.
It is now recognized that the synovium (the lining of the joint) becomes inflamed in RA. When this occurs, it secretes more fluid and the joint becomes swollen. Later, the cartilage becomes rough and pitted as the synovium thickens. The underlying bone is eventually affected. Joint destruction may begin, often within a year or two after the appearance of the disease. Deformities result from cartilage destruction, bone erosions, and tendon inflammation and rupture, causing classic drifting of fingers and/or permanent loss of the use of fingers.
Many medical sources describe RA as “inflammation of the synovial fluid in the joints” while others call it “crippling arthritis” for the distinct deformities of joints, particularly in the hands and fingers it causes, while it damages bones and tendons in knees, hips, ankles, elbows and can also affect the neck, jaw, toes, wrists, as well as effect major organs such as heart and lungs.
One of the classic symptoms in early diagnosis calling for further testing is the often symmetrical pattern of the effected joints – both hands, or both feet, not just an isolated ache pain as with OA. Another clue is fatigue, often debilitating, loss of appetite, weakness and even fever never seen with simple OA.
What is totally unaddressed in the name RA is that this is a systemic disease of the autoimmune system, unbeknownst at the time the disease was named. The most important distinction between RA and OA, despite the similarity of their current labels, is that RA and only RA affects vital organs such as the lungs and heart ad shortens one's life span.
There is a higher rate of cardiovascular (CV) disease and CV-related deaths among people with RA compared to those without RA. Heart complications of RA commonly affect the outer lining of the heart. When inflamed, the condition is referred to as pericarditis. Inflammation of heart muscle, called myocarditis, can also develop. Both of these conditions can lead to congestive heart failure characterized by shortness of breath and fluid accumulation in the lung.
Rheumatoid vasculitis (inflammation of the blood vessels) is a serious complication of RA and can be life-threatening. It can lead to skin ulcerations (and subsequent infections), bleeding stomach ulcers (which can lead to massive hemorrhage), and neuropathies (nerve problems causing pain, numbness or tingling) which can occur in RA patients without vasculitis. Vasculitis may also affect the brain, nerves, and heart causing strokes, sensory neuropathies (numbness and tingling), heart attacks, or heart failure.
Another life-threatening joint complication can occur when the cervical spine becomes unstable as a result of RA. All of these complications, in addition to those caused by medications which stress liver function, leads to a shortened the life span expectancy of RA patients.
The name ads to misunderstanding and lessens the support of sufferers.
While the cause of the immune system running awry still eludes researchers, clearly the words “arthritis” and “rheumatoid” have well outlived their usefulness as a definition of this complicated disease and what we now know of its etiology.
Since 1804 as science has advanced its knowledge and understanding of causes of diseases names have had to be changed. This is also true in the field of mental illness, as names have been found to cause additional stress because of stigma attached to certain words and labels. Currently, those diagnosed with Chronic Fatigue Syndrome have been working for nearly a decade to change the name of that disease because they feel the word “fatigue” indicates that those who suffer are merely tried.
Rheumatoid Arthritis needs to have a name that more accurately reflects its true nature. This change is necessary in order to provide the millions who suffer the care they need and deserve from the medical professions as well as those determining benefit payments including Social Security disability, and by the population at large.
One of the issues that make life difficult for sufferers of many chronic illnesses is dealing with the inconstancies of its coming and goings; good days and bad. Patients often complain about having trouble understanding it themselves, in addition to difficulty getting support of family, co-workers and others when they may be fine one day and ill the next. It causes a great amount of stress that one might be thought of being a slacker or hypochondriac.
In addition, patients with Rheumatoid Arthritis report often having to deal with statements that clearly indicate a total misunderstanding of their disease, such as: “Your so young to have arthritis,” “My grandmother has arthritis in her knee,” “What’s RA?” “I read that eating garlic (or not eating tomatoes, or a drier climate) is good for that.” Such comments invalidate and demean the RA sufferers reality, diminishing the serious nature of the disease and its sufferers adding tot heir difficulty in dealing with an already stressful life-challenging condition.
RA is a mutlifactoral autoimmune disease and needs to be re-labeled to reflect that accurately and to address the seriousness of the disease.
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Original article. Unpublished elsewhere. Copyrighted ©.
May not be reprinted withour permission of the author. Contact RASS (at) gmail.com
