Friday, October 7, 2011

The Idiot's Guide to RA - no I'm not calling you an idiot!

It occurred to me that I haven't really explained what rheumatoid arthritis is and why it's so dangerous. If you are reading this and you have RA please keep reading because I think this might put a different twist on things.

In summary RA is an autoimmune disease where the immune system attacks your joints mainly but can move on to other tissues and major organs through out the body. This can cause inflammation, swelling, pain, and over all fatigue. Now here is where we get to the good stuff! I know you can hardly contain yourself!


Now look at the above diagram. This is your basic weight bearing joint. Most joints have a synovial membrane (shown as synovium above) and those particular joints are constructed so no rough surfaces ever touch. If only they would stay that way right? Inside this cavity you have synovial fluid to ensure this does not happen. The fluid is made up of water and chondroitin sulfate. The cartilage that you see at the tops of each bone have collagen fibers that catch the fluid to allow the ease of use of the joints. Think of the fluid as food for that cartilage to survive. Having RA means that your immune system is trying to kill off your synovium and/or fluid. Compromising that area will lead to unhealthy cartilage, deterioration of, then bone rubbing on bone, which will lead to being curled up in a fetal position crying from the pain. Interesting huh? It gets better.

Lets go over why your immune system even starts to be so nasty and mean in most cases of RA. We start with a healthy body invaded by a pathogen (a virus or a microorganism). Your body produces T-cells, B-cells, and antibodies to fight this pathogen. You win the fight! Yay! The pathogen is gone! Would have been nice if your immune system got the memo because now you have memory cells made up of these antibodies searching for remnants of the pathogen. These antibodies get confused because the proteins in your synovium mimic the makeup of the pathogen. A pathogen's protein coat has a bunch of amino acids. Amino acids are also found in normal healthy parts of the body. All you need is for your synovium to mimic 5 amino acids in a row as the pathogen and BAM those antibodies get to work and start destroying the good stuff. You also might be genetically predisposed to these antibodies too. Now in defense the synovial membrane swells and thickens. This causes the fluid to accumulate and that's when you feel pressure and pain. The inflamed tissue releases an enzyme that will erode the cartilage right down to the bone. Remember we said the fluid was like food for the cartilage? Well imagine those enzymes being released into the fluid and them being nothing but unhealthy fatty fast food. We all know how our body reacts to that. So with no cartilage, and a sub par synovium, the joint starts to deform. A fibrous scar tissue will accumulate and then the joint bones are fused together. Can we say OUCH?

Now seeing how confused the antibodies get we understand why we can get complications secondary to the the joint issue. Every tissue in our body is in danger. That includes lungs, heart, blood vessels, the list goes on and on. This is why you NEVER say to someone with RA "...but you look great". Yeah I look like a super model I'm sure but my insides are at war! What makes this even more serious is that the drugs used to treat RA are also used to fight MS and Cancer. Yes cancer folks! Did you know that the when the chemo, that we put in our body, is prepared the person has to wear protective gear as not to hurt themselves. But hell, at least you look ok right?

photo credits

The information in the post is based on A Massage Therapist's Guide to Pathology Third Edition by Ruth Werner


  1. A very interesting perspective on ra :-) Couldn't agree with you more and loved the truth about the pain part too! Keep up the great work of getting the word out there!

  2. I'm going to print this out and laminate it. And force everyone in my life to read it. So they GET IT.

    Thank you for this.

  3. I loved how you explained RA and our bodies at war, awesome!

  4. I really believe that having a good understanding of what you really want will make a change for a lifetime. This post has exactly a diagnosed person should know about rheumatoid arthritis.

  5. I am constantly being told ' but you look great' I am struggling daily with pain and fatigue, meds don't last long for me, had most of them now. RA also caused lung problems and I have just had the lower portion of my LT lung removed

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