What Is Rheumatoid Arthritis?
Rheumatoid arthritis, also known as RA, is a common autoimmune disease that causes joint pain and damage throughout the body. It affects millions of people across the globe. Usually, the joint damage affects both sides of the body, which means that if the condition occurred on a joint in one of the arms or legs, it might occur on the other arm or leg as well. This is a major way how doctors differentiate it from other forms of arthritis.
Rheumatoid arthritis can start at any age but mostly affects individuals between the ages of 30 and 50. Besides, women are more susceptible to developing this condition. The treatment for rheumatoid arthritis works the best when it is diagnosed in its early stages. Therefore, awareness of arthritis is important. Here’s everything you need to know about rheumatoid arthritis, symptoms, causes, treatment and more.
What Are the Symptoms of Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic disease that leads to swelling, stiffness and pain in the joints limiting their movements. Although it commonly occurs in the small joints of the hands and feet, RA can also affect the eyes, skin or lungs.
In RA, the joint stiffness is at its worst especially in the morning and may last for a few hours or even the whole day. The period during which the symptoms of rheumatoid arthritis show up is called flares or exacerbations, and the period when the symptoms completely disappear is called remission. Prolonged joint stiffness in the morning doesn’t commonly occur in other conditions, so it is a sure symptom of rheumatoid arthritis. Other rheumatoid arthritis symptoms are –
- Loss of appetite and energy
- Low fever
- Dry eyes and mouth due to a related health issue like Sjogren’s syndrome
- Formation of firm lumps beneath the skin of the elbow and hands called rheumatoid nodules
What Causes Rheumatoid Arthritis?
Rheumatoid arthritis pathogenesis begins when the immune system of the body attacks the lining of the membranes surrounding the joints called synovium. The inflammation caused on the synovium due to the attack thickens it and gradually destroys the cartilage and bone within the joint. In RA, as the tendons and ligaments holding the joint weaken, the joint becomes misaligned and out of shape.
Although the exact cause of the condition isn’t known, some pieces of evidence point out that autoimmune conditions like rheumatoid arthritis run in families. This doesn’t mean that having certain genes causes rheumatoid arthritis, rather they increase the likelihood of developing the disease sometimes due to an infection with a virus or bacteria that may trigger it.
Some of the factors that may increase your chances of developing rheumatoid arthritis are as follows.
- Sex: RA tends to affect women more than men.
- Age: Although the condition can occur at any age, it is more likely to happen in the middle age.
- Family history: RA is known to run in families.
- Smoking: Smoking is the number one avoidable risk factor leading to several diseases, including rheumatoid arthritis.
- Environmental factors: More studies are yet to be conducted on this, but exposure to certain substances like asbestos or silica may increase the risk of developing RA.
- Obesity: Individuals who are obese or overweight and beyond the age of 55 have a higher chance of developing RA.
Rheumatoid arthritis can lead to several complications, which may include –
- Osteoporosis: It is a condition that causes the bone to become weak and brittle.
- Rheumatoid nodules: These are firm bumps of tissue that form around joints affected by RA. Rheumatoid nodules can also form in the lungs.
- Sjogren’s syndrome: Individuals with RA have a higher possibility of developing this condition which decreases the amount of moisture in the eyes and mouth.
- Infections: Rheumatoid arthritis and the medications used in the treatment of the condition may reduce the functioning of the immune system and lead to increased infections.
- Carpal tunnel syndrome: Inflammation due to RA can affect the nerves of the wrists leading to carpal tunnel syndrome.
- Heart problems: RA increases the risks of blocked and hardened arteries leading to heart problems.
- Lung disease: RA can lead to scarring and inflammation of the lung tissues.
- Lymphoma: It is a group of blood cancers that occur in the lymph system.
How Is Rheumatoid Arthritis Diagnosed?
As the symptoms of rheumatoid arthritis can be commonly seen in many other diseases, rheumatoid arthritis diagnosis is quite difficult in its early stages. Moreover, there isn’t a single blood test or physical finding that doctors could rely upon to confirm rheumatoid arthritis.
Hence, multiple lab tests are conducted to accurately diagnose rheumatoid arthritis. The first step in the diagnosis process is going through your symptoms and medical history followed by a physical examination of the joints, which can include the following:
- Looking for any visible signs of swelling and redness
- Checking the range of motion of the joints and their functionality
- Examining the joints for warmth or tenderness
- Testing the reflexes
Certain blood tests may also be conducted to test for ESR or sed rate or C-reactive protein which are indications of inflammations in the body. Other tests may include the following.
- The rheumatoid factor or RF blood test
- Anti-CCP or anti-citrullinated protein antibody test
- Antinuclear antibody test to check whether your immune system is producing antibodies
In addition to that, imaging tests like X-rays, MRI and ultrasound scans need to be performed to determine if joint damage has occurred as well as understand the severity of the damage.
How Is Rheumatoid Arthritis Treated?
If you are wondering “is rheumatoid arthritis curable?”, unfortunately, it isn’t. However, the symptoms can go into remission when treatment begins early. The treatment for rheumatoid arthritis includes the following:
Your doctor will prescribe rheumatoid arthritis medications depending on the duration you had the condition and its severity.
- Nonsteroidal anti-inflammatory drugs or NSAIDs: They work well to relieve the pain and inflammation caused due to RA. Ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve) are some over-the-counter NSAID medications.
- Steroids: Prednisone may be useful in slowing down the joint damage as well as reducing pain and inflammation.
- Disease-modifying antirheumatic drugs or DMARDs: Methotrexate (Trexall, Otrexup), sulfasalazine (Azulfidine), leflunomide (Arava), hydroxychloroquine (Plaquenil) are some DMARDs, which are prescribed to slow the progression of RA and prevent joints and tissues from permanent damage.
- Biologic response modifiers: They are a newer class of DMARDs and are also known as biologic agents. Examples include abatacept (Orencia), golimumab (Simponi), sarilumab (Kevzara), rituximab (Rituxan), anakinra (Kineret), etc.
Physical therapy may be recommended by your doctor to maintain flexibility in your joints. A physical or occupational therapist will help you plan out new ways to perform your daily tasks so that your joints don’t go through too much pressure.
Surgery may be considered if joint damage couldn’t be slowed or prevented by medications. It can not only reduce pain but also restore the functionality of the joints. Some surgical procedures include synovectomy, tendon repair, joint fusion and total joint replacement.
It’s recommended to consult a rheumatology doctor as soon as you notice any symptoms of rheumatoid arthritis and get the right treatment.
Dr. Chetan M L | Consultant Orthopedician | Arthroscopy & Joint Replacement Surgeon | Sahyadri Narayana Multispeciality Hospital Shimoga