Rheumatoid Arthritis: An Overview

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Rheumatoid arthritis (RA) is a chronic inflammatory disorder that affects more than just your joints. It is an autoimmune disease, which means that your immune system mistakenly attacks your own healthy tissues, causing pain, swelling, and damage. RA can also affect other parts of your body, such as your eyes, skin, lungs, heart, and blood vessels.

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What causes RA?

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The exact cause of RA is unknown, but it is likely that a combination of genetic and environmental factors triggers the disease. Some of these factors may include:

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• Age: RA usually develops in middle age, but it can occur at any age.
• Gender: RA is more common in women than in men.
• Family history: Having a close relative with RA increases your risk of developing the disease.
• Smoking: Smoking cigarettes can increase your risk of RA and make it worse.
• Obesity: Being overweight or obese can increase your risk of RA and make it harder to manage.
• Infections: Some viral or bacterial infections may trigger or worsen RA.

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What are the symptoms of RA?

The main symptom of RA is joint inflammation, which causes pain, stiffness, swelling, and reduced range of motion. The joints most commonly affected by RA are the small joints of the hands and feet, but any joint can be involved. RA usually affects the same joints on both sides of the body symmetrically.

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Other symptoms of RA may include:

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• Fatigue: Feeling tired and weak is a common symptom of RA.
• Fever: A low-grade fever may occur during flares of RA.
• Nodules: Small lumps of tissue may form under the skin over bony areas, especially on the elbows, fingers, and heels.
• Eye problems: Dryness, redness, pain, sensitivity to light, and vision problems may occur due to inflammation of the eyes or tear glands.
• Mouth problems: Dryness, gum inflammation, infection, and ulcers may occur due to inflammation of the mouth or salivary glands.
• Lung problems: Shortness of breath, coughing, chest pain, and lung disease may occur due to inflammation or scarring of the lungs or pleura (the lining around the lungs).
• Heart problems: Chest pain, irregular heartbeat, heart failure and pericarditis (inflammation of the sac around the heart) may occur due to inflammation or damage of the heart or blood vessels.
• Blood problems: Anaemia (low red blood cell count), leukopenia (low white blood cell count) and thrombocytopenia (low platelet count) may occur due to inflammation or damage of the bone marrow or spleen.
• Nerve problems: Numbness, tingling, burning or weakness may occur due to inflammation or damage of the nerves or blood vessels.

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How is RA diagnosed?

There is no single test that can diagnose RA. Your doctor will ask you about your symptoms, medical history, and family history. He or she will also examine your joints and look for signs of inflammation, such as warmth, redness, and swelling.

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Your doctor may order some tests to help confirm the diagnosis and rule out other conditions that can cause similar symptoms. These tests may include:

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• Blood tests: To check for markers of inflammation (such as erythrocyte sedimentation rate or C-reactive protein), antibodies (such as rheumatoid factor or anti-cyclic citrullinated peptide), and anaemia.
• X-rays: To look for joint damage or erosion caused by RA.
• MRI: To get a more detailed image of your joints and soft tissues.
• Ultrasound: To look for fluid accumulation or synovitis (inflammation of the joint lining) in your joints.
• Joint fluid analysis: To examine the fluid from your affected joints for signs of infection or crystals.

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How is RA treated?

There is no cure for RA, but there are treatments that can help reduce inflammation, relieve pain, prevent joint damage, and improve your quality of life. The main types of treatments for RA are:

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• Medications: There are different kinds of medications that can help treat RA, such as:

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• Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs can reduce pain and inflammation in your joints. Examples include ibuprofen, naproxen, and celecoxib.
• Corticosteroids: These drugs can quickly reduce inflammation and suppress your immune system. They are usually given as injections into your joints or as pills for short-term use. Examples include prednisone and methylprednisolone.
• Disease-modifying antirheumatic drugs (DMARDs): These drugs can slow down the progression of RA and prevent joint damage. They are usually taken as pills or injections for long-term use. Examples include methotrexate, sulfasalazine, and hydroxychloroquine.
• Biologic agents: These drugs are a newer class of DMARDs that target specific molecules involved in the immune system. They are usually given as injections or infusions for moderate to severe RA. Examples include etanercept, infliximab, and adalimumab.
• Janus kinase (JAK) inhibitors: These drugs are a newer class of oral DMARDs that block a pathway involved in the immune system. They are usually used for moderate to severe RA when other treatments have failed. Examples include tofacitinib, baricitinib and upadacitinib.

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• Surgery: If your joints are severely damaged or deformed by RA, you may need surgery to repair or replace them. The most common types of surgery for RA are:

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• Synovectomy: This is a procedure to remove the inflamed synovium from your joint.
• Tendon repair: This is a procedure to fix the tendons that have been damaged or ruptured by RA.
• Joint fusion: This is a procedure to join two bones together in your joint to provide stability and reduce pain.
• Joint replacement: This is a procedure to replace your damaged joint with an artificial one made of metal and plastic.

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• Physical therapy: This is a type of treatment that involves exercises and other techniques to improve your joint function and mobility. A physical therapist can teach you how to perform these exercises and use assistive devices, such as splints, braces, and walkers.
• Occupational therapy: This is a type of treatment that involves learning how to perform your daily activities in a way that reduces stress on your joints. An occupational therapist can teach you how to use adaptive tools, such as ergonomic keyboards, jar openers, and button hooks.
• Lifestyle changes: There are some things you can do to help manage your RA and improve your well-being, such as:

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• Exercise regularly: Physical activity can help reduce pain, stiffness, and fatigue, as well as improve your muscle strength, bone health, and mood. Choose low-impact exercises, such as walking, swimming, or cycling, and avoid high-impact exercises, such as running or jumping.
• Eat a healthy diet: A balanced diet can help provide the nutrients you need for your overall health and prevent weight gain, which can put extra stress on your joints. Include foods that are rich in omega-3 fatty acids, such as fish, flaxseeds, and walnuts, which may have anti-inflammatory effects. Avoid foods that are high in saturated fats, sugars, and salt, which may worsen inflammation.
• Quit smoking: Smoking can increase your risk of developing RA and make it worse. It can also interfere with the effectiveness of some medications and increase the risk of side effects. If you smoke, talk to your doctor about ways to quit.
• Manage stress: Stress can trigger or worsen flares of RA and affect your mental health. Find healthy ways to cope with stress, such as meditation, yoga, breathing exercises, or hobbies. Seek professional help if you feel depressed or anxious.
• Join a support group: Living with RA can be challenging and isolating. Joining a support group can help you connect with others who understand what you are going through and offer emotional support, practical advice, and coping strategies.

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Sources

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Mayo Clinic. Rheumatoid arthritis - Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

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Arthritis Foundation. Rheumatoid Arthritis: Causes, Symptoms, Treatments and More. https://www.arthritis.org/diseases/rheumatoid-arthritis

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MSN Health. What is Rheumatoid arthritis and its possible symptoms, causes, risks, and prevention methods? https://www.msn.com/en-us/health/condition/Rheumatoid-arthritis/hp-Rheumatoid-arthritis?source=conditioncdx