Rheumatoid Arthritis-related nerve damage
Rheumatoid arthritis is an autoimmune disorder that is characterized by inflammation, pain, and loss of function in the joints. It most often affects the wrist and hand, but sometimes it affects the elbows, shoulders, neck, knees, hips or ankles. The swelling, inflammation and damage to the joints occur when the body’s immune system attacks the tissue around the joints. Although not as common, rheumatoid arthritis may affect other parts of the body besides the joints. Rheumatoid arthritis may flare up and suddenly go into remission, or it can be a constant debilitating and painful condition.
1%
Rheumatoid arthritis affects roughly 1% of the population worldwide,
2x
Women are two to three times more likely to develop Rheumatoid Arthritis than men
Some rheumatoid arthritis patients will develop carpal tunnel syndrome or other mild forms of peripheral neuropathy. Symptoms tend to appear bilaterally, meaning that both sides of the body (i.e. both hands or both knees) are impacted in a similar way.
The cause of rheumatoid arthritis is unknown, but researchers believe that there are genetic, environmental and other factors that trigger the disease. Onset usually occurs in middle age, and is more likely to develop in women. Approximately 10 to 15 percent of patients suffering from rheumatoid arthritis will also develop Sjögren’s syndrome, an inflammatory disorder characterized by dryness in the eyes and mouth.
Early detection of rheumatoid arthritis positively impacts the ability to treat this disease and its symptoms. Early treatment may reduce the potentially crippling damage caused to bones. Unfortunately, rheumatoid arthritis is sometimes difficult to detect and diagnose because the symptoms vary from person to person and there is no one definitive test for the disease.
Symptoms & Signs
(Not all symptoms and signs may be present)
- Anemia
- Fatigue, at times accompanied by fever
- Loss of appetite
- Tender, warm or swollen joints
- Difficulty moving affected joints
- Pain and stiffness
- Stiffness
- Rheumatoid nodules (lumps under the skin)
Evaluation & Tests
(Not all evaluation and tests may be necessary)
- Neurological exam
- Electromyography
- Nerve conduction velocity test
- X-ray to determine joint damage
- Blood tests (for presence of rheumatoid factor antibody, anemia and to measure white blood cell count)
Treatment & Therapy
(Not all treatments and therapies may be indicated)
Treatment focuses on relieving pain by reducing inflammation, slowing joint and bone damage and improving the ability to function with the disease.
- Rest and exercise programs
- NSAIDs (aspirin, ibuprofen and Aleve®) to reduce joint inflammation and pain
- Disease modifying anti-rheumatic drugs (DMARDs) to suppress the immune system and slow the onset of the disease (hydroxychloroquine (Plaquenil®), methotrexate (Rheumatrex®, Trexall®), leflunomide (Aravara®)
- Surgery may be considered to replace or repair severely damaged joints and tendons
- Take safety measures to compensate for loss of sensation
- Ask your doctor about special therapeutic shoes (which may be covered by Medicare and other insurance)
Today, doctors are exploring a link between pre-diabetes (also known as impaired glucose tolerance or IGT) and peripheral neuropathy. Approximately 10% of adults in America have what is being called “pre-diabetes” or “borderline diabetes”—a condition where the body has higher than normal blood sugar levels, but not high enough to be diagnosed as true diabetes. If left untreated, people with pre-diabetes are at risk of developing type 2 diabetes, heart disease, and nerve damage (which could result in peripheral neuropathy.)
People with pre-diabetes or IGT can significantly reduce their risk of developing type 2 diabetes through diet, exercise and learning to control their blood sugar levels.
Symptoms
(Not all symptoms and signs may be present)
People with IGT often have no symptoms. People who actually have diabetes—and who therefore are at greater risk of developing peripheral neuropathy—often don’t realize it because the symptoms of diabetes come on so gradually. Pre Diabetic symptoms and its complications include:
- Frequent urination
- Blurred vision
- Constant thirst
- Fatigue
- Frequent infections
- Cuts and bruises that heal slowly
- Tingling or numbness in the hands or feet
Tests
(Not all evaluation and tests may be necessary)
To test for pre-diabetes:
- Blood test
- Oral glucose tolerance test
Treatments
(Not all treatments and therapies may be indicated)
- Over-the-counter pain medication for mild pain
- Take safety measures to compensate for loss of sensation.
- Ask your doctor about special therapeutic shoes (which may be covered by Medicare and other insurance).
The first sign of diabetic neuropathy is usually numbness, tingling or pain in the feet, legs or hands.
Over a period of several years, the neuropathy may lead to muscle weakness in the feet and a loss of reflexes, especially around the ankle.
As the nerve damage increases, the loss of sensation in the feet can reduce a person’s ability to detect temperature or to notice pain. Because the person can no longer notice when his/her feet become injured, people with diabetic neuropathy are more likely to develop foot problems such as skin lesions and ulcers that may become infected.
Diabetic neuropathy may suddenly flare up and affect a specific nerve or group of nerves. When this occurs, the result may be weakness and muscle atrophy in various parts of the body, such as involvement of the eye muscles or eyelid (e.g., causing double vision or a drooping eyelid) or thigh muscles. Alternatively, neuropathy caused by diabetes may slowly progress over time. It also can interfere with the normal functioning of the digestive system and sexual organs.
Symptoms
(Not all symptoms and signs may be present)
- Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
- Indigestion, nausea, or vomiting
- Diarrhea or constipation
- Dizziness or faintness due to a drop in blood pressure especially when rising to a standing position
- Problems with urination
- Erectile dysfunction (impotence) or vaginal dryness
Tests
(Not all evaluation and tests may be necessary)
- Comprehensive foot exam
- Physical examination
- Neurological exam
- Electromyography
- Nerve conduction velocity test
- Quantitive sensory testing (QST)
- Nerve or skin biopsy
- Blood studies (to verify diabetes (e.g., HbA1C) and to rule out other potential causes)
Treatments
(Not all treatments and therapies may be indicated)
The goal of treatment for diabetic neuropathy is to relieve discomfort and to prevent further tissue damage. The first step is to bring blood sugar levels under control by diet and medication. Another important part of treatment involves taking special care of the feet.
- Over-the-counter pain medication for mild pain
- For severe pain, take over-the-counter pain medication or prescription drugs used for peripheral neuropathy, on a regular basis—rather than waiting until nighttime when symptoms can become more severe
- Keep blood sugar levels in normal range
- Get regular exercise
- Maintain a healthy weight
- Antidepressants (for pain relief)
- Foot care: inspect your feet daily for injuries
- Special Therapeutic shoes (which may be covered by Medicare and other insurance)
- Take safety measures to compensate for loss of sensation
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