Rheumatoid arthritis is an autoimmune condition which is long-term, progressive and disabling. It induces inflammation, swelling , and pain inside and around the organs of the joints and other body.
Rheumatoid arthritis ( RA) usually first affects the hands and feet but can happen in any joint. Typically the same joints are involved on both sides of the body.
Common symptoms include stiff joints, particularly when you get up in the morning or when you sit down for awhile. Some people also feel tiredness, and a general sense of being unwell.
The Rheumatoid Arthritis Support Network reports that up to 1 percent of the world ‘s population and over 1.3 million people in America are affected by RA.
What is rheumatoid arthritis?
RA is an autoimmune disorder. It is also a systemic disorder , meaning it affects the whole body.
It happens when an individual’s immune system mistakes the healthy tissues of the body for foreign invaders.
Inflammation occurs in the target tissue or organ, as the immune system reacts.
In the case of RA, the joints, lungs, eyes, and heart may be these.
Symptoms of RA include:
- pain, swelling, and stiffness in more than one joint
- symmetrical joint involvement
- joint deformity
- unsteadiness when walking
- a general feeling of being unwell
- loss of function and mobility
- weight loss
The Centers for Disease Control and Prevention ( CDC) suggests that the symptoms usually involve the same joints on both sides of the body
Signs appear to come and go. They may go away during a remission, or they may be mild. They can be serious though during a flare.
No one knows what causes defects to the immune system.
Apparently some people have genetic factors that make it more likely. One hypothesis is that in people who have this genetic trait, bacteria or a virus causes RA.
In RA the antibodies of the immune system attack the synovium, which is a joint’s smooth lining. When this occurs it results in discomfort and inflammation.
Inflammation triggers thickening of the synovium. If left unchecked, it will gradually penetrate and kill cartilage — the connective tissue that cushions the ends of the bones.
It can also weaken and stretch the tendons and ligaments which hold the joint together. Ultimately the joint loses structure and shape. The damage may be serious.
The CDC states that individuals with an increased risk of developing RA can include those who:
- are aged 60 years or above
- are female
- have specific genetic traits
- have never given birth
- have obesity
- smoke tobacco or whose parents smoked when they were children
People with RA have a higher risk of some other conditions, including:
- heart disease
People with RA obesity often have a greater chance of developing diabetes and high blood pressure.
The joint damage that occurs with RA may make everyday activities difficult to perform. RA can be volatile, as well. Often, a person does not know when a flare will happen.
This uncertainty can lead to:
- depression, anxiety, and stress
- employment difficulties
There is also a greater risk that the following conditions could develop:
Carpal tunnel syndrome: This is a form of nerve damage caused by compression and a nerve irritation in the wrist. Symptoms include aching, numbness , and tingling in the fingers, thumb, and part of the hand.
Inflammation: The lungs, heart , blood vessels, eyes and other parts of the body may be affected.
Tendon rupture: Inflammation in the tendons may cause rupture, especially on the finger back.
Cervical myelopathy: Dislocation of the neck joints or cervical spine may put pressure on the spinal cord. This can result in reduced mobility and movement discomfort. Increasing the risk of cervical myelopathy as RA progresses.
Vasculitis: Blood vessel inflammation may cause them to break, thicken, tighten and scar. This may affect tissue blood flow, and can affect organ function.
Infection susceptibility: There is a higher risk of contracting colds , flu, pneumonia and other diseases, particularly if the individual is taking immunosuppressive drugs to manage RA. People with RA should ensure they are up-to – date with their vaccines, such as flu jabs.
It can be difficult for a physician to diagnose RA in its early stages, since it can mimic other disorders. Yet early diagnosis and treatment is necessary to delay disease progression.
The CDC recommends diagnosis and an appropriate treatment plan to start within 6 months of symptom onset.
A doctor will examine the clinical signs of inflammation in the person and will ask how long they have been there and how serious the symptoms are. They may also undergo a physical evaluation to check for any swelling, or functional deficiencies, or deformation.
They may recommend some tests.
Sedimentation rate of erythrocytes (ESR or sedation rate): This test assesses levels of inflammation in the body. It tests how rapidly red blood cells differentiate from blood serum in a test tube over a given time. Inflammation levels are high as the red blood cells settle quickly as sediment. This test is not RA unique and is a valuable test for other inflammatory or infectious conditions.
C-reactive protein (CRP): CRP is formed by the Liver. A higher level of CRP indicates that inflammation is present in the body. This test is not unique to RA and may occur in other inflammatory or infectious conditions.
Anemia: A lot of people with RA have anemia, too. Anemia occurs when blood is carrying too few red blood cells. Red blood cells bring oxygen to the body’s tissues and organs.
Rheumatoid factor: If there is an antibody in the blood, known as the rheumatoid factor, it may mean that there is RA. Not all with positive RA tests for this element though.
Imaging and Radiography scans
A joint X-ray or MRI may help a doctor determine what type of arthritis is present and monitor progression of RA over time.
The American College of Rheumatology proposed the following diagnostic criteria for RA in 2010:
- swelling is present in at least one joint, and it does not have another cause
- results from at least one blood test indicate the presence of RA
- symptoms have been present for at least 6 weeks
Conditions with similar symptoms
The doctor will need to distinguish RA from other conditions with similar symptoms, such as:
If a person is diagnosed with RA, they will be referred by the doctor to a specialist known as a rheumatologist, who can advise on treatment options.
There is no cure for RA at the moment but treatment can help:
- reduce inflammation to the joints
- relieve pain
- minimize any loss of function caused by pain, joint damage, or deformity
- slow down or prevent damage to the joints
Medications, physical therapy , occupational therapy, rehabilitation, and surgery are options.
Some medications can help alleviate symptoms and slow progression of the disease.
Non-steroidal anti-inflammatory drugs (NSAIDs): Pharmacies sell these over-the-counter medications. Take Advil, Motrin, and Aleve for example. Long-term use and heavy doses can lead to side effects such as swelling, stomach ulcers, high blood pressure and complications in the kidneys and liver.
Corticosteroids: These drugs alleviate pain and inflammation, and can help slow down joint damage, but they can not heal RA. If NSAIDs are not working, a doctor may inject a steroid into the joint. Usually relief is quick but the impact is variable. It can last for a few weeks or months, depending on symptom severity.
Corticosteroids may help with acute symptoms or flare-ups at short notice. Long term corticosteroid use may have significant side effects. They have cataracts, osteoporosis, glaucoma, mellitus diabetes and obesity.
Disease-modifying antirheumatic drugs (DMARDs)
By interfering with the overactive immune system, DMARDs can delay the progression of RA and prevent irreversible damage to joints and other tissues. Typically a person is taking a DMARD for life.
It is most successful when a person uses it in the early stages, but it may take 4 to 6 months to experience the benefits in full.
Some people will need to try out various DMARD styles before finding the most acceptable one.
Leflunomide (Arava), methotrexate (Rheumatrex, Trexall), sulfasalazine (Azulfidine), minocycline (Dynacine, Minocin), and hydroxychloroquine (Plaquenil) are instances.
Side effects can include liver damage and immune-related issues such as suppression of the bone marrow and a higher risk of severe lung infections.
Cyclosporine (Neoral, Sandimmune, Gengraf), azathioprine (Imuran, Azasan), and cyclophosphamide (Cytoxan) are other immunosuppressants.
Factor-alpha inhibitors of tumor necrosis (TNF-alpha inhibitors)
The human body produces factor-alpha (TNF-alpha), an inflammatory agent, causing tumor necrosis.
TNF-alpha inhibitors prevent inflammation. They can alleviate discomfort, stiffness in the morning and swell or tender joints. Typically people note a difference 2 weeks after care has begun.
Examples include (Enbrel), infliximab (Remicade) and adalimumab (Humira).
Possible side effects include:
- a higher risk of infection
- blood disorders
- congestive heart failure
- demyelinating diseases, involving an erosion of the myelin sheath that normally protects nerve fibers
An occupational therapist may help the person learn new and successful ways to handle everyday tasks. The discomfort of sore joints can be minimised.
For example , a person with painful fingers can learn to use a specially designed tool for gripping and catching.
If medication and physical therapy are not helpful, a doctor can suggest surgery to:
- repair damaged joints
- correct deformities
- reduce pain
The following procedures are possible:
- Arthroplasty: In a total joint replacement, the surgeon removes the damaged parts and inserts a metal and plastic prosthesis, or artificial joint.
- Tendon repair: If tendons have loosened or ruptured around the joint, surgery may help restore them.
- Synovectomy: This procedure involves removal of the synovium if it is inflamed and causing pain.
- Arthrodesis: The surgeon will fuse a bone or joint to decrease pain and realign or stabilize the joint.
A number of strategies can help a person to manage RA.
When a flare-up occurs, the person should rest as much as possible. Over-exerting swollen and painful joints can make the symptoms worse.
During times of remission, when symptoms are mild, the individual should exercise regularly to boost their general health and mobility and to strengthen the muscles around the joint.
The best exercises are those that do not strain the joints, such as swimming.
Following a varied diet with plenty of fresh fruits and vegetable can help a person to feel better and maintain a healthy weight.
Applying heat or cold
Tense and painful muscles may benefit from the application of heat.
- taking a 15-minute hot bath or shower
- applying a hot pack or an electric heating pad, set at the lowest setting
Cold treatment can dull pain and reduce muscle spasms, but people with poor circulation or numbness should not use cold remedies.
- cold packs or ice in a cloth, but never put ice directly on the skin
- soaking the affected joint in cold water
Some might prefer to do both:
- Place the joints in warm water for a few minutes, then dip them in cold water for 1 minute.
- Repeat for about half an hour.
- Finish up with a warm soak.
Seeking ways to psychologically alleviate tension will help reduce pain. Examples include meditation, guided visualization, deep breathing and relaxing of the muscles.
Some people with RA use the following but no scientific evidence is available to prove that they are working:
- nutritional supplements, for example, fish oil
It may not be possible to prevent RA, but the CDC suggest the following:
- avoiding or quitting smoking
- maintaining a healthy body weight
RA is a painful and persistent condition that can cause joint damage and hamper a person in performing their daily tasks.
Anyone who feels pain and swelling in two or more joints should see a doctor, because early treatment can minimize the risk of long-term issues.