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Occurrence And Impact Of Rheumatoid Arthritis
Scientists estimate that about 1.3 million people, or about 0.6 percent of the U.S. adult population, have rheumatoid arthritis.
- Interestingly, some recent studies have suggested that although the number of new cases of rheumatoid arthritis for older people is increasing, the overall number of new cases may actually be going down.
Rheumatoid arthritis
occurs in all races and ethnic groups. Although the disease often
begins in middle age and occurs with increased frequency in older
people, children and young adults also develop it. Like some other
forms of arthritis, rheumatoid arthritis occurs much more frequently in women than in men. About two to three times as many women as men have the disease.
By all measures, the financial and social impact of all types of arthritis, including rheumatoid arthritis,
is substantial, both for the Nation and for individuals. From an
economic standpoint, the medical and surgical treatment for rheumatoid arthritis
and the wages lost because of disability caused by the disease add up
to billions of dollars annually. Daily joint pain is an inevitable
consequence of the disease, and most patients also experience some
degree of depression, anxiety, and feelings of helplessness. For some
people, rheumatoid arthritis
can interfere with normal daily activities, limit job opportunities, or
disrupt the joys and responsibilities of family life. However, there
are arthritis
self-management programs that help people cope with the pain and other
effects of the disease and help them lead independent and productive
lives. (See Diagnosing and Treating Rheumatoid Arthritis.)
- According to the National Arthritis Data Workgroup, the actual number of new cases of rheumatoid arthritis is lower than previous estimates due to changes in the classification for the condition, as cited in "Estimates of the Prevalence of Arthritis and Other Rheumatic Conditions in the United States," Arthritis and Rheumatism, 58(1):15-25, January 2008.
Searching for the Causes of Rheumatoid Arthritis
Scientists still do not know exactly what causes the immune system to turn against itself in rheumatoid arthritis, but research over the last few years has begun to piece together the factors involved.
Genetic (inherited) factors: Scientists have discovered that certain
genes known to play a role in the immune system are associated with a
tendency to develop rheumatoid arthritis. Some people with rheumatoid arthritis
do not have these particular genes; still others have these genes but
never develop the disease. These somewhat contradictory data suggest
that a person's genetic makeup plays an important role in determining
if he or she will develop rheumatoid arthritis,
but it is not the only factor. What is clear, however, is that more
than one gene is involved in determining whether a person develops
rheumatoid arthritis and how severe the disease will become.
Environmental factors: Many scientists think that something must occur
to trigger the disease process in people whose genetic makeup makes
them susceptible to rheumatoid arthritis. A viral or bacterial infection appears likely, but the exact agent is not yet known. This does not mean that rheumatoid arthritis is contagious: a person cannot catch it from someone else.
Other factors: Some scientists also think that a variety of hormonal
factors may be involved. Women are more likely to develop rheumatoid arthritis than men, pregnancy may improve the disease, and the disease may flare after a pregnancy. Breastfeeding may also aggravate the disease. Contraceptive use may alter a person's likelihood of developing rheumatoid arthritis.
Scientists think that levels of the immune system molecules interleukin
12 (IL-12) and tumor necrosis factor-alpha (TNF-a) may change along
with the changing hormone levels seen in pregnant women. This change
may contribute to the swelling and tissue destruction seen in
rheumatoid arthritis. These hormones, or possibly deficiencies or changes in certain hormones, may promote the development of rheumatoid arthritis in a genetically susceptible person who has been exposed to a triggering agent from the environment.
Even though all the answers are not known, one thing is certain: rheumatoid arthritis
develops as a result of an interaction of many factors. Researchers are
trying to understand these factors and how they work together.
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