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This booklet is for people who have rheumatoid arthritis,
as well as for their family members, friends, and others who want to find
out more about this disease. The booklet describes how rheumatoid arthritis
develops, how it is diagnosed, and how it is treated, including what patients
can do to help manage their disease. It also highlights current research
efforts supported by the National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) and other components of the National Institutes
of Health (NIH). If you have further questions after reading this booklet,
you may wish to discuss them with your doctor.
Features of Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory disease that causes
pain, swelling, stiffness, and loss of function in the joints. It has
several special features that make it different from other kinds of arthritis
(see information box below). For example, rheumatoid arthritis generally
occurs in a symmetrical pattern. This means that if one knee or hand is
involved, the other one is also. The disease often affects the wrist joints
and the finger joints closest to the hand. It can also affect other parts
of the body besides the joints (see illustrations below). In addition,
people with the disease may have fatigue, occasional fever, and a general
sense of not feeling well (malaise).
Another feature of rheumatoid arthritis is that it varies
a lot from person to person. For some people, it lasts only a few months
or a year or two and goes away without causing any noticeable damage.
Other people have mild or moderate disease, with periods of worsening
symptoms, called flares, and periods in which they feel better, called
remissions. Still others have severe disease that is active most of the
time, lasts for many years, and leads to serious joint damage and disability.
Although rheumatoid arthritis can have serious effects
on a person's life and well-being, current treatment strategies--including
pain relief and other medications, a balance between rest and exercise,
and patient education and support programs--allow most people with the
disease to lead active and productive lives. In recent years, research
has led to a new understanding of rheumatoid arthritis and has increased
the likelihood that, in time, researchers can find ways to greatly reduce
the impact of this disease.
Features of Rheumatoid Arthritis
- Tender, warm,
pattern. For example, if one knee is
affected, the other one is also.
inflammation often affecting the wrist
and finger joints closest to the hand;
other affected joints can include those
of the neck, shoulders, elbows, hips,
knees, ankles, and feet.
occasional fever, a general sense of not
feeling well (malaise).
- Pain and
stiffness lasting for more than 30
minutes in the morning or after a long
- Symptoms that
can last for many years.
- Symptoms in
other parts of the body besides the
of symptoms among people with the
How Rheumatoid Arthritis Develops and Progresses
A normal joint (the place where two bones meet) is surrounded
by a joint capsule that protects and supports it (see illustration). Cartilage
covers and cushions the ends of the two bones. The joint capsule is lined
with a type of tissue called synovium, which produces synovial fluid.
This clear fluid lubricates and nourishes the cartilage and bones inside
the joint capsule.
In rheumatoid arthritis, the immune system, for unknown
reasons, attacks a person's own cells inside the joint capsule. White
blood cells that are part of the normal immune system travel to the synovium
and cause a reaction. This reaction, or inflammation, is called synovitis,
and it results in the warmth, redness, swelling, and pain that are typical
symptoms of rheumatoid arthritis. During the inflammation process, the
cells of the synovium grow and divide abnormally, making the normally
thin synovium thick and resulting in a joint that is swollen and puffy
to the touch (see illustration).
As rheumatoid arthritis progresses, these abnormal synovial
cells begin to invade and destroy the cartilage and bone within the joint.
The surrounding muscles, ligaments, and tendons that support and stabilize
the joint become weak and unable to work normally. All of these effects
lead to the pain and deformities often seen in rheumatoid arthritis. Doctors
studying rheumatoid arthritis now believe that damage to bones begins
during the first year or two that a person has the disease. This is one
reason early diagnosis and treatment are so important in the management
of rheumatoid arthritis.
A joint (the place where two bones meet) is surronded by
a capsule that protects and supports it. The joint capsule is lined with
a type of tissue called synovium, which produces synovial fluid that lubricates
and nourishes joint tissues. In rheumatoid arthritis, the synovium becomes
inflmaed, causing warmth, redness, swelling, and pain. As the disease
progresses, abnormal synovial cells invade and erode, or destroy, cartilage
and bone within the joint. Surronding muscels, ligaments, and tendons
become weakened. Rheumatoid arthritis can also cause more generalized
bone loss that may lead to osteoporosis (fragile bones that are prone
Other Parts of the Body
Some people also experience the effects of rheumatoid arthritis
in places other than the joints. About one-quarter develop rheumatoid
nodules. These are bumps under the skin that often form close to the joints.
Many people with rheumatoid arthritis develop anemia, or a decrease in
the normal number of red blood cells. Other effects, which occur less
often, include neck pain and dry eyes and mouth. Very rarely, people may
have inflammation of the blood vessels, the lining of the lungs, or the
sac enclosing the heart.
Occurrence and Impact of Rheumatoid Arthritis
Scientists estimate that about 2.1 million people, or 1
percent of the U.S. adult population, have rheumatoid arthritis. Interestingly,
some recent studies have suggested that the overall number of new cases
of rheumatoid arthritis may actually be going down. Scientists are now
investigating why this may be happening.
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 millions of dollars. Daily
joint pain is an inevitable consequence of the disease, and most patients
also experience some degree of depression, anxiety, and feelings of helplessness.
In some cases, rheumatoid arthritis can interfere with a person's ability
to carry out 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.
These programs are described later in the section Diagnosing and Treating
Searching for the Cause of Rheumatoid Arthritis
Rheumatoid arthritis is one of several "autoimmune" diseases
("auto" means self), so-called because a person's immune system attacks
his or her own body tissues. Scientists still do not know exactly what
causes this to happen, but research over the last few years has begun
to unravel the factors involved.
Genetic (inherited) factors:Scientists have found
that certain genes that play a role in the immune system are associated
with a tendency to develop rheumatoid arthritis. At the same time, some
people with rheumatoid arthritis do not have these particular genes, and
other people have these genes but never develop the disease. This suggests
that a person's genetic makeup is an important part of the story but not
the whole answer. It is clear, however, that more than one gene is involved
in determining whether a person develops rheumatoid arthritis and, if
so, 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. An infectious agent
such as a virus or bacterium appears likely, but the exact agent is not
yet known. Note, however, that rheumatoid arthritis is not contagious:
A person cannot "catch" it from someone else.
Other factors: Some scientists also think that a
variety of hormonal factors may be involved. 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 aren't known, one thing is
certain: Rheumatoid arthritis develops as a result of an interaction of
many factors. Much research is going on now to understand these factors
and how they work together (see the Current Research section).
Diagnosing and Treating Rheumatoid Arthritis
Diagnosing and treating rheumatoid arthritis is a team effort
between the patient and several types of health care professionals. A
person can go to his or her family doctor or internist or to a rheumatologist.
A rheumatologist is a doctor who specializes in arthritis and other diseases
of the joints, bones, and muscles. As treatment progresses, other professionals
often help. These may include nurses, physical or occupational therapists,
orthopedic surgeons, psychologists, and social workers.
Studies have shown that people who are well informed and
participate actively in their own care experience less pain and make fewer
visits to the doctor than do other people with rheumatoid arthritis.
Patient education and arthritis self-management programs,
as well as support groups, help people to become better informed and to
participate in their own care. An example of a self-management program
is the arthritis self-help course offered by the Arthritis Foundation
and developed at one of the NIAMS-supported Multipurpose Arthritis and
Musculoskeletal Diseases Centers. Self-management programs teach about
rheumatoid arthritis and its treatments, exercise and relaxation approaches,
patient/health care provider communication, and problem solving. Research
on these programs has shown that they have the following clear and long-lasting
- They help people
understand the disease.
- They help people
reduce their pain while remaining active.
- They help people cope
physically, emotionally, and mentally.
- They help people feel
greater control over their disease and help build
a sense of confidence in the ability to function
and lead a full, active, and independent life.
Rheumatoid arthritis can be difficult to diagnose in its
early stages for several reasons. First, there is no single test for the
disease. In addition, symptoms differ from person to person and can be
more severe in some people than in others. Also, symptoms can be similar
to those of other types of arthritis and joint conditions, and it may
take some time for other conditions to be ruled out as possible diagnoses.
Finally, the full range of symptoms develops over time, and only a few
symptoms may be present in the early stages. As a result, doctors use
a variety of tools to diagnose the disease and to rule out other conditions.
Medical history: This is the patient's description
of symptoms and when and how they began. Good communication between patient
and doctor is especially important here. For example, the patient's description
of pain, stiffness, and joint function and how these change over time
is critical to the doctor's initial assessment of the disease and his
or her assessment of how the disease changes.
Physical examination: This includes the doctor's
examination of the joints, skin, reflexes, and muscle strength.
Laboratory tests: One common test is for rheumatoid
factor, an antibody that is eventually present in the blood of most rheumatoid
arthritis patients. (An antibody is a special protein made by the immune
system that normally helps fight foreign substances in the body.) Not
all people with rheumatoid arthritis test positive for rheumatoid factor,
however, especially early in the disease. And, some others who do test
positive never develop the disease. Other common tests include one that
indicates the presence of inflammation in the body (the erythrocyte sedimentation
rate), a white blood cell count, and a blood test for anemia.
X rays: X rays are used to determine the degree of
joint destruction. They are not useful in the early stages of rheumatoid
arthritis before bone damage is evident, but they can be used later to
monitor the progression of the disease.
Doctors use a variety of approaches to treat rheumatoid
arthritis. These are used in different combinations and at different times
during the course of the disease and are chosen according to the patient's
individual situation. No matter what treatment the doctor and patient
choose, however, the goals are the same: relieve pain, reduce inflammation,
slow down or stop joint damage, and improve the person's sense of well-being
and ability to function.
Treatment is another key area for communication between
patient and doctor. Talking to the doctor can help ensure that exercise
and pain management programs are provided as needed and that drugs are
prescribed appropriately. Talking can also help in making decisions about
Goals of Treatment
- Relieve pain
- Slow down or
stop joint damage
- Improve a
person's sense of well-being and ability
Current Treatment Approaches
monitoring and ongoing care
This approach includes several activities that help improve
a person's ability to function independently and maintain a positive outlook.
Rest and exercise: Both rest and exercise help in
important ways. People with rheumatoid arthritis need a good balance between
the two, with more rest when the disease is active and more exercise when
it is not. Rest helps to reduce active joint inflammation and pain and
to fight fatigue. The length of time needed for rest will vary from person
to person, but in general, shorter rest breaks every now and then are
more helpful than long times spent in bed.
Exercise is important for maintaining healthy and strong
muscles, preserving joint mobility, and maintaining flexibility. Exercise
can also help people sleep well, reduce pain, maintain a positive attitude,
and lose weight. Exercise programs should be planned and carried out to
take into account the person's physical abilities, limitations, and changing
Care of joints: Some people find that using a splint
for a short time around a painful joint reduces pain and swelling by supporting
the joint and letting it rest. Splints are used mostly on wrists and hands,
but also on ankles and feet. A doctor or a physical or occupational therapist
can help a patient get a splint and ensure that it fits properly. Other
ways to reduce stress on joints include self-help devices (for example,
zipper pullers, long-handled shoe horns); devices to help with getting
on and off chairs, toilet seats, and beds; and changes in the ways that
a person carries out daily activities.
Stress reduction: People with rheumatoid arthritis
face emotional challenges as well as physical ones. The emotions they
feel because of the disease--fear, anger, frustration--combined with any
pain and physical limitations can increase their stress level. Although
there is no evidence that stress plays a role in causing rheumatoid arthritis,
it can make living with the disease difficult at times. Stress may also
affect the amount of pain a person feels. There are a number of successful
techniques for coping with stress. Regular rest periods can help, as can
relaxation, distraction, or visualization exercises. Exercise programs,
participation in support groups, and good communication with the health
care team are other ways to reduce stress.
Healthful diet: With the exception of several specific
types of oils (mentioned in the Current Research section), there is no
scientific evidence that any specific food or nutrient helps or harms
most people with rheumatoid arthritis. However, an overall nutritious
diet with enough--but not an excess of--calories, protein, and calcium
is important. Some people may need to be careful about drinking alcoholic
beverages because of the medications they take for rheumatoid arthritis.
Those taking methotrexate may need to avoid alcohol altogether. Patients
should ask their doctors for guidance on this issue.
Climate: Some people notice that their arthritis
gets worse when there is a sudden change in the weather. However, there
is no evidence that a specific climate can prevent or reduce the effects
of rheumatoid arthritis. Moving to a new place with a different climate
usually does not make a long-term difference in a person's rheumatoid
Most people who have rheumatoid arthritis take medications.
Some medications are used only for pain relief; others are used to reduce
inflammation. Still others--often called disease-modifying antirheumatic
drugs, or DMARDs--are used to try to slow the course of the disease. The
person's general condition, the current and predicted severity of the
illness, the length of time he or she will take the drug, and the drug's
effectiveness and potential side effects are important considerations
in prescribing drugs for rheumatoid arthritis. The table below about "Medications
Commonly Used To Treat Rheumatoid Arthritis" shows currently used rheumatoid
arthritis medications, along with their effects, side effects, and monitoring
Traditionally, rheumatoid arthritis therapy has involved
an approach in which doctors prescribed aspirin or similar drugs, rest,
and physical therapy first, and prescribed more powerful drugs later only
if the disease became much worse. Recently, many doctors have changed
their approach, especially for patients with severe, rapidly progressing
rheumatoid arthritis. This change is based on the belief that early treatment
with more powerful drugs, and the use of drug combinations in place of
single drugs, may be more effective ways to halt the progression of the
disease and reduce or prevent joint damage.
Used To Treat Rheumatoid Arthritis
* Brand names included in this booklet are provided as
examples only, and their inclusion does not mean that these products are
endorsed by the National Institutes of Health or any other Government
agency. Also, if a particular brand name is not mentioned, this does not
mean or imply that the product is unsatisfactory.
Several types of surgery are available to patients with
severe joint damage. The primary purpose of these procedures is to reduce
pain, improve the affected joint's function, and improve the patient's
ability to perform daily activities. Surgery is not for everyone, however,
and the decision should be made only after careful consideration by patient
and doctor. Together they should discuss the patient's overall health,
the condition of the joint or tendon that will be operated on, and the
reason for and the risks and benefits of, the surgical procedure. Cost
may be another factor. Commonly performed surgical procedures include
joint replacement, tendon reconstruction, and synovectomy.
Joint replacement: This is the most frequently performed
surgery for rheumatoid arthritis, and it is done primarily to relieve
pain and improve or preserve joint function. Artificial joints are not
always permanent and may eventually have to be replaced. This may be an
issue for younger people.
Tendon reconstruction: Rheumatoid arthritis can damage
and even rupture tendons, the tissues that attach muscle to bone. This
surgery, which is used most frequently on the hands, reconstructs the
damaged tendon by attaching an intact tendon to it. This procedure can
help to restore hand function, especially if the tendon is completely
Synovectomy: In this surgery, the doctor actually
removes the inflamed synovial tissue. Synovectomy by itself is seldom
performed now because not all of the tissue can be removed, and it eventually
grows back. Synovectomy is done as part of reconstructive surgery, especially
Routine Monitoring and Ongoing Care
Regular medical care is important to monitor the course
of the disease, determine the effectiveness and any negative effects of
medications, and change therapies as needed. Monitoring typically includes
regular visits to the doctor. It may also include blood, urine, and other
laboratory tests and x rays.
Osteoporosis prevention is one issue that patients may
want to discuss with their doctors as part of their long-term, ongoing
care. Osteoporosis is a condition in which bones lose calcium and become
weakened and fragile. Many older women are at increased risk for osteoporosis,
and their rheumatoid arthritis increases the risk further, particularly
if they are taking corticosteroids such as prednisone. These patients
may want to discuss with their doctors the potential benefits of calcium
and vitamin D supplements, hormone replacement therapy, or other treatments
Alternative and Complementary Therapies
Special diets, vitamin supplements, and other alternative
approaches have been suggested for the treatment of rheumatoid arthritis.
Although many of these approaches may not be harmful in and of themselves,
controlled scientific studies either have not been conducted or have found
no definite benefit to these therapies. Some alternative or complementary
approaches may help the patient cope or reduce some of the stress associated
with living with a chronic illness. As with any therapy, patients should
discuss the benefits and drawbacks with their doctors before beginning
an alternative or new type of therapy. If the doctor feels the approach
has value and will not be harmful, it can be incorporated into a patient's
treatment plan. However, it is important not to neglect regular health
care. The Arthritis Foundation publishes material on alternative therapies
as well as established therapies, and patients may want to contact this
organization for information. (See the For More Information section.)
Over the last several decades, research has greatly increased
our understanding of immunology, genetics, and cellular and molecular
biology. This foundation in basic science is now showing results in several
areas important to rheumatoid arthritis. Scientists are thinking about
rheumatoid arthritis in exciting ways that were not possible even 10 years
The National Institutes of Health funds a wide variety
of medical research at its headquarters in Bethesda, Maryland, and at
universities and medical centers across the United States. One of the
NIH institutes, the National Institute of Arthritis and Musculoskeletal
and Skin Diseases, is a major supporter of research and research training
in rheumatoid arthritis through grants to individual scientists, Specialized
Centers of Research, and Multipurpose Arthritis and Musculoskeletal Diseases
Following are examples of current research directions in
rheumatoid arthritis supported by the Federal Government through the NIAMS
and other parts of the NIH.
Scientists are looking at basic abnormalities in the immune
systems of people with rheumatoid arthritis and in some animal models
of the disease to understand why and how the disease develops. Findings
from these studies may lead to precise, targeted therapies that could
stop the inflammatory process in its earliest stages. They may even lead
to a vaccine that could prevent rheumatoid arthritis.
Researchers are studying genetic factors that predispose
some people to developing rheumatoid arthritis, as well as factors connected
with disease severity. Findings from these studies should increase our
understanding of the disease and will help develop new therapies as well
as guide treatment decisions. In a major effort aimed at identifying genes
involved in rheumatoid arthritis, the NIH and the Arthritis Foundation
have joined together to support the North American Rheumatoid Arthritis
Consortium. This group of 12 research centers around the United States
is collecting medical information and genetic material from 1,000 families
in which two or more siblings have rheumatoid arthritis. It will serve
as a national resource for genetic studies of this disease.
Scientists are also gaining insights into the genetic basis
of rheumatoid arthritis by studying rats with autoimmune inflammatory
arthritis that resembles human disease. NIAMS researchers have identified
several genetic regions that affect arthritis susceptibility and severity
in these animal models of the disease, and found some striking similarities
between rats and humans. Identifying disease genes in rats should provide
important new information that may yield clues to the causes of rheumatoid
arthritis in humans.
Scientists are studying the complex relationships among
the hormonal, nervous, and immune systems in rheumatoid arthritis. For
example, they are exploring whether and how the normal changes in the
levels of steroid hormones (such as estrogen and testosterone) during
a person's lifetime may be related to the development, improvement, or
flares of the disease. Scientists are also looking at how these systems
interact with environmental and genetic factors. Results from these studies
may suggest new treatment strategies.
Researchers are exploring why so many more women than men
develop rheumatoid arthritis. In hopes of finding clues, they are studying
female and male hormones and other elements that differ between women
and men, such as possible differences in their immune responses.
To find clues to new treatments, researchers are examining
why rheumatoid arthritis often improves during pregnancy. Results of one
study suggest that the explanation may be related to differences in certain
special proteins between a mother and her unborn child. These proteins
help the immune system distinguish between the body's own cells and foreign
cells. Such differences, the scientists speculate, may change the activity
of the mother's immune system during pregnancy.
A growing body of evidence indicates that infectious agents,
such as viruses and bacteria, may trigger rheumatoid arthritis in people
who have an inherited predisposition to the disease. Investigators are
trying to discover which infectious agents may be responsible. More broadly,
they are also working to understand the basic mechanisms by which these
agents might trigger the development of rheumatoid arthritis. Identifying
the agents and understanding how they work could lead to new therapies.
Scientists are searching for new drugs or combinations
of drugs that can reduce inflammation, can slow or stop the progression
of rheumatoid arthritis, and also have few side effects. Studies in humans
have shown that a number of compounds have such potential. For example,
some studies are breaking new ground in the area of "biopharmaceuticals",
or "biologics". These new drugs are based on compounds occurring naturally
in the body, and are designed to target specific aspects of the inflammatory
Investigators have also shown that treatment of rheumatoid
arthritis with minocycline, a drug in the tetracycline family, has a modest
benefit. The effects of a related tetracycline called doxycycline are
under investigation. Other studies have shown that the omega-3 fatty acids
in certain fish or plant seed oils also may reduce rheumatoid arthritis
inflammation. However, many people are not able to tolerate the large
amounts of oil necessary for any benefit.
Investigators are examining many issues related to quality
of life for rheumatoid arthritis patients and quality, cost, and effectiveness
of health care services for these patients. Scientists have found that
even a small improvement in a patient's sense of physical and mental well-being
can have an impact on his or her quality of life and use of health care
services. Results from studies like these will help health care providers
design integrated treatment strategies that cover all of a patient's needs--emotional
as well as physical.
Hope for the Future
Scientists are making rapid progress in understanding the
complexities of rheumatoid arthritis--how and why it develops, why some
people get it and others do not, why some people get it more severely
than others. Results from research are having an impact today, enabling
people with rheumatoid arthritis to remain active in life, family, and
work far longer than was possible 20 years ago. There is also hope for
tomorrow, as researchers continue to explore ways of stopping the disease
process early, before it becomes destructive, or even preventing rheumatoid
For More Information
National Institute of Arthritis and Musculoskeletal and
NIAMS/National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
TTY: (301) 565-2966
Fax: (301) 718-6366
World Wide Web address: http://www.niams.nih.gov/
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases Information Clearinghouse is a public service sponsored
by the NIAMS that provides health information and information sources.
The clearinghouse provides information on rheumatoid arthritis, including
a fact sheet on arthritis and exercise. Fact sheets, additional information,
and research updates can also be found on the NIAMS Web site at http://www.niams.nih.gov/.
American College of Rheumatology
1800 Century Place, Suite 250
Atlanta, GA 30345
World Wide Web address: http://www.rheumatology.org
The association provides referrals to rheumatologists and
physical and occupational therapists who have experience working with
people who have rheumatoid arthritis. The organization also provides educational
materials and guidelines.
American Academy of Orthopaedic Surgeons
P.O. Box 2058
Des Plaines, IL 60017
Phone: 800-824-BONE (2663) (free of charge)
World Wide Web address: http://www.aaos.org
The academy provides education and practice management services for orthopaedic surgeons and allied health professionals. It also serves as an advocate for improved patient care and informs the public about the science of orthopaedics. The orthopaedist's scope of practice includes disorders of the body's bones, joints, ligaments, muscles, and tendons. For a single copy of an AAOS brochure, send a self-addressed stamped envelope to the address above or visit the AAOS Web site.
The NIAMS gratefully acknowledges the assistance of the
following people in the preparation and review of this publication: John
H. Klippel, M.D., NIAMS, NIH; Reva Lawrence, M.P.H., NIAMS, NIH; Amye
L. Leong, San Pedro Peninsula, California; Michael D. Lockshin, M.D.,
Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special
Surgery, New York, New York; Kate Lorig, R.N., Dr.P.H., Stanford University,
Stanford, California; J. Lee Nelson, M.D., Fred Hutchinson Cancer Research
Center, Seattle, Washington; Stanley R. Pillemer, M.D., NIH; Paul H. Plotz,
M.D., NIAMS, NIH; Paul G. Rochmis, M.D., Fairfax, Virginia; and Ronald
L. Wilder, M.D., Ph.D., NIAMS, NIH. Special thanks also go to Cheryl Yarboro,
R.N., B.S.P.A., NIAMS, NIH, and to the patients who reviewed this publication
and provided valuable input. This booklet was written by Anne Brown Rodgers
of Cygnus Corporation.
About NIAMS and NAMSIC
The NIAMS, a part of the National Institutes of Health
(NIH), leads the Federal medical research effort in arthritis and musculoskeletal
and skin diseases. The NIAMS supports research and research training
throughout the United States as well as on the NIH campus in Bethesda,
Maryland, and disseminates health and research information. The National
Institute of Arthritis and Musculoskeletal and Skin Diseases Information
Clearinghouse is a public service sponsored by the NIAMS that provides
health information and information sources. Additional information and
research updates can be found on the NIAMS Web site at http://www.niams.nih.gov/.
Information provided by:
1330 West Peachtree Street
Atlanta, GA 30309
or your local chapter,
listed in the telephone directory
World Wide Web address: http://www.arthritis.org
The Arthritis Foundation is the major voluntary organization
devoted to supporting arthritis research and providing educational and
other services to individuals with arthritis. The foundation publishes
a free pamphlet on rheumatoid arthritis and a magazine for members on
all types of arthritis. It also provides up-to-date information on research
and treatment, nutrition, alternative therapies, and self-management strategies.
Chapters nationwide offer exercise programs, classes, support groups,
physician referral services, and free literature.
Publication Date: January 1998
Revised November 1999