Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease—a type of illness where the immune system attacks healthy cells by mistake, potentially inducing infection. If you have RA, your immune system can target and destroy the healthy tissues that cover your joints, with bones of your hands and feet often being the most affected areas.

RA is a type of arthritis that can cause inflammation of the lining of your joints, also known as synovitis. Specifically, antibodies (called autoantibodies because they are targeting your own cells) infiltrate the joint. These antibodies attract other immune cells that together cause inflammation, as if your immune system is fighting something within the joint. When the coverings of your joints are inflamed, you may feel pain, swelling, redness, or warmth to the touch in various areas of your body. Fever may also occur as your body fights the inflammation. If not treated, this inflammation may lead to joint damage and arthritis, causing changes in the joints' appearance and functionality.

Joints are the main target of RA. However, other organs such as the eyes, heart, lungs, skin, tendons, and blood vessels can also be affected. This may occur if the body’s immune system attacks these organs in the same way it attacks joints, causing comparable changes. Researchers in the field continually stress the importance of treating RA to reduce your symptoms and prevent long-term damage to your joints and other organs.

What are the symptoms of rheumatoid arthritis?

People with RA have painful, stiff, and swollen joints, impacting both sides of their body equally. Your joints become inflamed and larger, and they may begin to feel what doctors describe as boggy, which means your joints feel mushy when you touch them.

The disease can involve just a few joints or many. Hands (fingers) are usually the most affected. But just about any joint can be damaged by RA, including the knee, ankle, foot, wrist, elbow, shoulder, and back. This implies that diseases like RA are not bound by location.

Symptoms can differ from one person to the next. Some people may live with constant symptoms. But for others, symptoms may come and go depending on several factors, including infection, stress, and general health.

Main symptoms

• Pain and swelling in the joints
• Joint stiffness - joint stiffness worse in the morning is also a hallmark of osteoarthritis, which is a non-inflammatory cause for joint dysfunction. However, whereas osteoarthritis morning stiffness goes away after 30 min to an hour of being awake, RA-related stiffness lasts much longer
• Warmth and redness of the joints
• Deformed joints (in severe, untreated cases) (e.g. ulnar deviation)

Other symptoms you may have

• Low energy
• Muscle aches
• Weakness
• Depression
• Loss of appetite

How is rheumatoid arthritis diagnosed?

Given the complex nature of this disease, your doctor may refer you to a rheumatologist (an arthritis specialist). The diagnosis process involves multiple tests, as RA symptoms can be very different for each person and blood tests for the disease can be inconclusive.

There is no one blood test that confirms RA. However, blood tests can rule out other conditions. Since RA is an inflammatory disease, a test can find higher levels of markers such as C-reactive protein (CRP), erythrocyte sedimentation rate, etc in your blood that may indicate inflammation. A rheumatoid factor (RF) blood test can also help confirm the diagnosis. X-rays may be helpful to see how much joint damage there is. Magnetic resonance imaging (MRI) is uncommon and not necessary for diagnosis.

If RA is not treated, you may have permanent damage and disability in your joints, especially your fingers, wrists, ankles, shoulders, elbows, and knees. Hence, it becomes crucial to seek professional help at the earliest.

Treating joint pain and swelling starts by resting your joints, applying ice, and taking anti-inflammatory medication. Despite these treatments, if joint pain and swelling last for more than a few weeks, it's crucial to call your doctor.

How is rheumatoid arthritis treated?

There is no known cure for RA. But there are many effective treatments to ease your pain, maintain your function, and mitigate flares (periods of intense inflammation and rheumatoid arthritis symptoms), placing you in a state of "remission". The decision on when to start medications and which medications are most appropriate will depend on discussions with your doctor and how bad your symptoms are. When severe joint deformity occurs, replacement surgery may become necessary.

• NSAIDs: Over-the-counter medications such as ibuprofen (Motrin, Advil) and naproxen (Aleve) can relieve pain by reducing joint inflammation. NSAIDs work best if taken consistently. But they can cause stomach irritation, and liver, or kidney problems so you should talk with your doctor about your risks before starting.
• Disease-modifying antirheumatic drugs (DMARDs): These prescription medications work by reducing the damage done to the joints by rheumatoid arthritis. Common DMARDs include methotrexate, hydroxychloroquine (Plaquenil), and sulfasalazine. Potential side effects include liver damage and bone marrow suppression.
• Biologic agents: These are a newer class of therapies that limit the immune system’s ability to damage the joints. Many biologic agents have become available in recent years, including adalimumab (Humira), infliximab (Remicade), tofacitinib (Xeljanz), and etanercept (Enbrel). Because these drugs alter your immune system, they can increase the risk of infections.
• Cortisone injections: Cortisone is a type of anti-inflammatory medication called a corticosteroid that acts within the joint. These injections are typically performed in the doctor’s office by a rheumatologist or orthopedic surgeon as part of a more conservative approach to your joint health.
• Joint replacement surgery: In cases where damage is severe, joint replacement surgery may be required. Damaged cartilage and bone are removed and replaced with metal and plastic parts. However, RA patients may be at increased risk of surgical complications given the use of immune-modulating medications and the dysregulated immune system itself.

What is the main cause of rheumatoid arthritis?

Rheumatoid arthritis occurs when the body’s immune system attacks the joints. For reasons that are not well understood, the body sends a signal to the immune system to attack the lining of the joints (synovium). That makes the lining inflamed and thickened. This inflammation and thickening causes the joints to become stiff, warm, painful, and swollen.

The exact cause of rheumatoid arthritis is not known, but scientists believe it is a result of a combination of genetic and environmental factors. Research suggests that certain genes may increase the risk of developing rheumatoid arthritis, and exposure to certain bacteria or viruses may trigger the onset of the disease. Some environmental factors that may contribute to the development of rheumatoid arthritis include smoking, obesity, and a high-meat diet.

If RA is not treated, you can have permanent damage to the joints and the cartilage can break down.

What makes you more likely to have rheumatoid arthritis?

No one knows what causes rheumatoid arthritis. However, it may have to do with genetics, exposure to certain types of infections, or other environmental factors.

• Having a family history of rheumatoid arthritis or exposure to certain viruses or bacteria can be risk factors.
• Smokers are more likely to develop RA than non-smokers.
• Gender may also play a role. Studies show that women are 2 to 3 times more likely than men to have RA. Also, the diagnosis tends to occur in middle age—the period between early adulthood and old age.

What is the follow-up care for rheumatoid arthritis?

If you don’t treat your RA, your joints and cartilage (the connective tissue between your joints) can be permanently damaged. If your symptoms are mild, you only need to follow up with your doctor if pain gets worse or your joints become severely swollen and stiff.

If RA has begun to damage your joints or the disease is affecting other parts of your body, you may require more care from your doctor.

Can rheumatoid arthritis be prevented?

No one knows the exact causes of RA. So there isn’t any way to prevent it. The goal is to get treatment to minimize symptoms.

Taking medications can help make flare-ups shorter and less painful. Follow up with your primary doctor or rheumatologist to manage the disease and keep symptoms under control.