Introducing Dr. Makover and Your Guide to RA

Michael Makover Health Guide
  • It starts with a little stiffness in the morning. Over time, both hands are involved and the stiffness takes hours to get better and never really goes away. You feel fatigued and don't know why. Then the middle joints on your right hand begin to be a little swollen, tender and painful. A few weeks later, the same joints on the other hand develop the same symptoms, like a mirror image.

    You do not know it yet, but you probably have rheumatoid arthritis (RA). You will join over 1.3 million other Americans who have one of the most common chronic diseases. Over two thirds of RA sufferers are women, but many men are also affected. A similar disease occurs in children and is called either juvenile rheumatoid arthritis (JRA) or juvenile idiopathic (means cause unknown) arthritis (JIA). This blog will use the term JIA. JIA has much in common with RA and in some ways is different. Millions more Americans are affected indirectly as relatives or caregivers of patients. Most who have not had contact with people with RA know little about it.

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    The cause is unknown, there is no definitive diagnostic test, the treatments are complicated and some are extremely expensive. The good news is that the newer treatments and the concept to treat very early have provided major relief for many patients.

    This blog will introduce readers to RA and explain much of what is important to understand if you have the disease, know someone who does or just want to learn about it.

    RA affects the whole body and can have many complications. For most patients, the fatigue and arthritis are the most prominent components. Future postings will cover the entire range, how to treat it and how to live with it or help those who have it.

    I also write a blog for HealthCentral on another form of arthritis, osteoarthritis. As readers of that blog know, arthritis is a general term for many different diseases. Arthritis, of which there are over 100 different kinds, means change inside a joint, marked by one or more of swelling, redness, tenderness or pain. Some kinds of arthritis affect only the joint, while others affect many other parts of the body as well. Bursitis, tendonitis and some kinds of bone and muscle problems might feel as if they are arthritic, but they are different and afflict the structures that are outside and supportive of the joint.


    The joint is a capsule that envelops the meeting place of the ends of two bones. Within the capsule are structures that provide a lubricated lining to facilitate smooth and effective movement of the two opposing cartilage surfaces that cover the outer ends of the bones for which the joint provides connection and movement. The lining tissue, called the synovium, makes the oily lubricant and has many other functions. Cartilage has been thought of as akin to bone without calcium, but is actually a substance with quite different properties. It is smooth, firm and rubbery and has a cellular structure.

    Most people think of joints as if they are fixed, mechanical devices made of immutable material like rubber and steel, but instead bone and the contents of the joint are very much living parts of your body. They are in constant flux, very much attuned to everything else that happens in your body and capable of remarkable self healing and remodeling. Like all good things, that ability has its limits. In RA, the immune system begins to inappropriately attack your own tissues. The synovium becomes very inflamed and begins to damage the inside of the joint. When your body attacks itself through the immune system, those diseases are called autoimmune; RA is one of the most common. The same process may involve other parts of the body in RA.


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    Research is progressing very rapidly. RA patients are already benefiting from important advances and can look forward to more breakthroughs in the relatively near future. We will discuss current treatments and what might be coming along within the next decade or two.


    Please feel free to post comments, suggest topics and ask questions, but I cannot respond to them directly. At times I will address a reader's question or comment within a posting. As with all such sites as this, it is not intended to give individual advice, to advise on your treatment or to substitute for your own doctors. It is intended to give you some insight and background that we hope will help you understand the disease better.

Published On: July 23, 2008