Introduction to Rheumatoid Arthritis
Rheumatoid arthritis is a chronic inflammatory disorder in the body that affects the bones, joints, and surrounding tissues. It is a systemic disease that can affect other organs, such as the skin, eyes, heart, and lungs. It is the most common type of inflammatory arthritis, affecting roughly 1.3 million Americans each year according to American College of Rheumatology. It is an autoimmune disease which means that the body’s immune system attacks the joints, causing inflammation and pain.
It’s a kind of auto-immune disease where one’s immune system starts attacking its own body leaving it vulnerable to infection. Rheumatoid arthritis is not curable but it can be managed by taking medications and following an exercise program. Rheumatoid arthritis is an excruciatingly painful condition that affects the joints. It’s caused by an autoimmune disorder, so it can be hard to treat sometimes.
Rheumatoid arthritis is one of the most common types of inflammatory arthritis in North America, Europe, Australia, and India. The chronic condition mainly affects the joints of the fingers, toes, wrists, elbows, and knees that are larger than usual. There are three main factors that can cause RA: genetics, environment and aging.
Inflammation associated with Rheumatoid arthritis is a chronic condition that can cause your body to attack its own tissue and joints. It is caused by the immune system attacking the tissues in the joints, like cartilage and bone, in response to an unknown trigger. In the joints, it causes swelling and stiffness over a period of time.
It is common for people with Rheumatoid arthritis to experience periods of remission, where symptoms resolve or lessen significantly. Painful flare-ups may also occur, especially if a person does not maintain their treatment routine or takes long breaks from medication. The symptoms of Rheumatoid arthritis can be quite severe and debilitating early on in the disease course. If left untreated, RA can worsen and eventually progress to physical disability and joint deformities such as joint space narrowing and bony ankylosis.
The majority of people with Rheumatoid arthritis do not need treatment for the first five years after diagnosis, but eventually need to take medication to control their symptoms.
Different types of Rheumatoid Arthritis
Generally there are 3 types of RA, namely:
- Seropositive rheumatoid arthritis is a type of chronic inflammatory arthritis, that is characterized by continuous inflammation of the joints. It is caused by a person’s immune system reacting abnormally to autoantibodies. When the blood test is positive for the protein known as rheumatoid factor. That means your body will produce an immune reaction against your normal tissues. Your chance of developing rheumatoid arthritis is four times greater if your parents, siblings, or both test positive for the disease. Having these kind of proteins in your blood doesn’t necessarily mean you have RA. However, if you do, it can help doctors identify the type & thereby recommend more effective treatment options.
- Seronegative rheumatoid arthritis -RA can affect anyone. Even if you don’t have RF and anti-CCP in your blood, you could still be affected by RA. Diagnosis isn’t based on just these tests. Your doctor will also consider your clinical symptoms, X-rays, and other lab tests in their diagnosis. People who test negative for RF/anti-CCP tend to have a milder form of RA than those who test positive.
- Juvenile rheumatoid arthritis is a form of the disease that typically occurs in childhood or adolescence. Symptoms include joint aches and swelling, skin thinning, and fatigue. Treatment for this form of arthritis includes taking anti-inflammatories and undergoing physical therapy
Symptoms of Rheumatoid Arthritis
The symptoms of Rheumatoid Arthritis vary from one person to another and there is no known cure for this disease. It often starts with joint pain in the small and medium joints in the hands and feet, which then spreads to other joints over time. Sometimes it affects the large joints, such as hips or knees, but not always.
The severity of RA can range from mild to severe, which means that it may only affect a few joints or every joint in the body. When all joints are affected by RA, it’s called polyarticular disease, whereas when only a few joints are affected, it’s called oligoarticular disease.
RA commonly affects your hands and feet but may also occur in other parts of your body such as your elbows, knees, ankles, neck or shoulders. Rheumatoid arthritis symptoms may also occur at different times. For example, you may experience morning stiffness followed by periods of less pain and a greater range of motion as the day goes on. Also, symptoms can come and go for a short period of time before becoming more constant over time. Rheumatoid arthritis symptoms include:
Some common symptoms of RA include:
- Morning stiffness in your joints lasting longer than 30 minutes
- Joint pain or stiffness that worsens with activity
- Swelling from inflammation in your body’s tissues
- Weakness or fatigue because RA interferes with sleep patterns and restful slumber
- Tenderness, swelling or warmth in joints
What are the Causes of Rheumatoid Arthritis?
When your own immune system attacks your joints, you have rheumatoid arthritis. This leads to inflammation and pain in the affected areas, but it can also affect other areas of the body because it affects the entire immune system. The most common type of arthritis, rheumatoid arthritis typically develops when a person is between 40 and 60 years old.
RA starts when white blood cells attack not only your joints, but also various organs throughout your body. It might initially cause fatigue, decreased appetite or weight loss, stiffness in one or more joints, or swelling in one area of the body. For example, you may feel pain in your toes before anywhere else.
Though the causes for Rheumatoid arthritis are unknown. There are many theories as to what causes RA, each with their own validity and shortcomings. Some of the main conjectures include genetics, viruses, bacteria, environmental factors, and stress.
Rheumatoid arthritis has no known cure, but there are medications to help relieve symptoms such as pain killers. Rheumatoid arthritis is more common in older adults, women than men, people with family history, and people who have another autoimmune disorder
How autoimmune disorder causes RA?
RA can be caused by an autoimmune disorder where the body’s immune system attacks its own tissues. The body is not able to differentiate between healthy cells and abnormal ones, so it often will attack itself in the case of autoimmune diseases. This means that the inflammation response of the immune system begins to target healthy joints, tendons, muscle tissue, blood vessels, skin and other surrounding soft tissues.
The reason or trigger for this change is still unknown or uncertain; however some research suggests that environmental factors (such as sun exposure) may cause chronic inflammation of the synovial membrane within a joint to begin. Once this chronic inflammatory process begins it causes local tissue damage which results in further problems with pain, swelling and decreased range of motion (RoM).
There is also a possible link between Rheumatoid Arthritis and autoimmune disorders such as Multiple Sclerosis (MS) and Lupus (SLE). This might be explained by an immune system malfunction that causes it to incorrectly identify the body’s healthy tissues as harmful substances; this causes the immune system to attack these tissues (autoimmunity). It is thought that having certain genes can predispose someone to developing an autoimmune disorder like Rheumatoid Arthritis or MS.
Treatment Options for Rheumatoid Arthritis Patients
Rheumatologists treat RA with medications, sometimes in combination with other treatments such as physical therapy.
The four main goals of medication treatments for Rheumatoid Arthritis are to reduce inflammation, prevent or minimize joint damage, improve function and relieve symptoms. Rheumatoid arthritis can be treated with many medications including non-steroidal anti-inflammatory drugs (NSAIDS), steroids, biologic agents and Methotrexate (MTX). These agents do not cure the disease however they help people cope better with their symptoms.
Medication as a treatment of RA is indicated for Rheumatoid Arthritis (RA) patients with increased inflammation or increased joint damage. It is important to note that RA is a chronic disease, and the decisions on what drug to use are usually made, not in isolation, but after consideration of several factors including pharmacological efficacy, dose-related toxicity, patient preference, and costs. Biologics are manufactured proteins which would work more directly on the immune system than other drugs like methotrexate sulfasalazine.
The currently available medications can be divided into four main categories:
- Disease modifying anti-rheumatic drugs (DMARDs) and Biologic agents: This category includes Rituxan and Imuran – two drugs which inhibit an enzyme called calcineurin;
- Methotrexate – a DMARDs drug that inhibits DNA synthesis;
- Enbrel – a Tumor necrosis factor (TNF) blocker;
- Rituxan– Rituximab therapy – Rituximab is an anti-CD20 monoclonal antibody that binds to B cells and causes cell death. Rituximab has been approved by the U.S. Food and Drug Administration (FDA) for treatment of Rheumatoid Arthritis in 1997, infliximab (Remicade) was developed as a chimeric IgG1 monoclonal antibody against tumor necrosis factor alpha (TNFα).
Steroids are used to treat Rheumatoid Arthritis. Steroids such as methylprednisolone are useful because they lower inflammation, they work quickly and there are few side effects. However, if steroids are stopped too early then Rheumatism can return or flare up again.
Biologics are available as either an injectable or a tablet, and biological DMARDs are most effective when combined with a traditional DMARD like methotrexate. This drug is also associated with an increased risk of infections.
Targeted synthetic DMARDs
If traditional DMARDs and biologics haven’t worked, the medications baricitinib (Olumiant), tofacitinib (Xeljanz), and upadacitinib (Rinvoq) can be used. There is a risk of blood clots in the lungs, major heart-related problems, and cancer with higher doses of tofacitinib.
Therapy for Rheumatoid arthritis
If you have rheumatoid arthritis, your doctor may recommend you to a physical or occupational therapist who can teach you stretching and strengthening exercises to help keep your joints flexible while also stretching and strengthening your muscles. In addition, the therapist will also most likely provide you with suggestions on how to modify certain activities that exacerbate Rheumatoid arthritis symptoms, such as avoiding repetitive work with your wrists and elbows.
Surgery in case of severe Rheumatoid arthritis
If non-steroidal anti-inflammatory drugs fail to alleviate Rheumatoid Arthritis damage to the joints, surgical treatment may be recommended.. Some examples of Rheumatoid arthritis surgery include: Synovectomy, Joint replacement for severe Rheumatoid arthritis, Rheumatoid Arthritis drainage and Rheumatoid Arthritis fusions.
Rheumatology doctors recommend Rheumatoid arthritis surgery only when the damage caused by Rheumatoid Arthritis is severe enough that it cannot be treated with medication alone. Before joint replacement is considered, you should try intensive treatment with at least two disease-modifying anti-rheumatic drugs (DMARDs) with or without biologics , even though this will often result in significant side effects.
Risks Associated with Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a condition that can lead to joint pain, stiffness, swelling, and loss of function. This debilitating autoimmune disease affects the entire body, but it can also have serious effects on other parts of your health. Risks associated with Rheumatoid arthritis range from minor inconveniences to life-threatening complications.
An estimated one in five people with rheumatoid arthritis also has kidney disease. Rheumatoid medications that suppress the immune system, such as methotrexate and drugs like prednisone, can lead to increased odds for developing this type of kidney damage. The inflammation associated with Rheumatoid arthritis can result in tiny deposits of calcium called renal calcinosis developing in your kidneys or elsewhere in your body. Rheumatoid medications may also increase your risk for the development of bacterial infections, anemia and gastrointestinal perforations (holes). If you have early stage kidney disease and high blood pressure , Rheumatoid arthritis medication could make it worse.
Rheumatic heart disease involves heart damage resulting from earlier inflammation due to rheumatoid arthritis or another form of inflammatory arthritis. At least one episode of rheumatic fever, repeated attacks of rheumatic fever, poor nutrition, alcoholism and the use of oral contraceptives while taking steroids. Rheumatoid arthritis also increases your risk of developing serious blood clots that can lead to a life-threatening pulmonary embolism or stroke.
Effects on the Skin
Rheumatoid nodules are firm red or yellowish bumps that usually appear over your bony areas, such as the knuckles and elbows. These usually do not cause pain, but they can become very large and might interfere with your ability to use your hands. Rheumatoid nodules sometimes look like raised warts. Rheumatoid nodules sometimes go away without treatment; however, some people may need medication for this problem and others who don’t improve may need surgery (rheumatoid nodule). If you want to read article related to treatment of Cold Sore, please click on the link to read more.
There is a risk of cataracts when you have Rheumatoid arthritis . You will need to see a doctor about what else might be going wrong.
The following are some ways Rheumatoid Arthritis may affect your eyes:
- Rheumatoid Eye Disease
- Dry Eyes
- Iritis (inflammation of iris and ciliary body )
- Uveitis (inflammation of uvea – middle layer of eye
- Ectropion (outward turning eyelid that causes inability to close eye properly)
- Scleritis (inflammation there is a risk of cataracts when you have RA.
You will need to see a doctor about what else might be going wrong.
Rheumatoid arthritis or some of the medications used to treat it might reduce the amount of healthy red blood cells in your circulation, you may suffer from anemia. Many Rheumatoid Arthritis patients are at risk for blood clots in their leg veins, termed venous thromboembolism (VTE) . This includes DVT , PE , and stroke from a clot that is dislodged from the legs and goes to the lungs. In order to prevent these potentially life-threatening conditions, Rheumatologists recommend taking all necessary precautions to prevent VTEs while taking DMARDs.
Rheumatoid arthritis (RA) can also lead to pneumonitis, an inflammation of the lung tissue that causes shortness of breath. Rheumatism deformans is another possible result of RA, which is characterized by formation of hard nodules in the lungs. If you have RA, your risk for developing any one or more of these lung problems is increased.
According to the National Osteoporosis Foundation (NOF), people with Rheumatoid Arthritis are at increased risk for both osteoporosis and fractures because of high levels of inflammation that interfere with calcium absorption. They say, people who take medications called disease-modifying antirheumatic drugs (DMARDs), such as methotrexate or sulfasalazine, may also be at increased risk for osteoporosis. Osteoporosis is a disease which makes the bones fragile and thin. For this reason, it is important to get enough Vitamin D and to exercise regularly if you have RA.
Emotional effect like depression
Rheumatoid arthritis can cause emotional effects like depression. RA affects up to 1% of the world’s population, and women are three times more likely than men to develop rheumatoid arthritis. Rheumatism, closely related but less severe, occurs in about 10-15% of people with RA. Rheumatism causes milder symptoms than Rheumatoid Arthritis.
Facts You Need For Managing Your Rheumatoid Arthritis
Sometimes, your Rheumatoid Arthritis symptoms get worse and other times they get better. Your doctor will work with you to help reduce your symptoms. They will give you medicine. But always remember that you have the power to help yourself every day. Here are some ways to do it:
When you have joint pain, sometimes you don’t want to move. But if you are active, then it will help your symptoms. Exercise is usually what people with rheumatoid arthritis do. It helps the pain go away and prevents future problems.
- Performing yoga
- Eat fruit and vegetables to complete your micro nutrients
- Aerobic exercise
Take care of your well being
Taking care of yourself and monitoring the disease is an important aspect of RA therapy. Take your medicine as per the prescription and recommendation by the doctor. Don’t skip a dose. Any undesirable effects should be reported to your doctor. If you have any queries, consult with them or your pharmacist.
If you do not already have a doctor on your list that is a rheumatologist, ask for one. This kind of doctor helps people with arthritis. They will examine your treatment plan to ensure that nothing has been missed. According to researchers, people with RA who see a rheumatologist at least once a year do better in studies.
Visit a Physical or Occupational Therapist for an examination.
Therapists can show you how to move your body in the safest ways for common activities like lifting a box to help safeguard your joints. They can teach you exercises to do at home. This will help you get stronger without hurting yourself and triggering a flare. An occupational therapist helps you learn how to perform particular activities at home or at work. A physical therapist aids in your mobility. It is best to see a doctor who has experience working with people who have arthritis.
If you or someone you know is suffering from Rheumatoid Arthritis, it’s important to understand the symptoms and find a treatment that works for them. While there may not be a cure, we’re here to help! You can get started by reading our blog post about what RA is and how people often respond differently to treatments. We also recommend talking with your doctor if these symptoms sound like they might apply to you. And don’t forget – while this disorder has no known cure, there are lots of ways we can all live well despite having arthritis. Let us know in the comments section below which types of symptoms you face so we can start thinking together about how best to manage those challenges.
Disclaimer: Please note that this is only to be used for educational purposes and not to be treated as a medical prescription. Consult your doctor in case you experience any of the above-mentioned symptoms of Rheumatoid Arthritis.