What is rheumatoid arthritis?
RA is an autoimmune disorder, a condition where the body’s immune system attacks its own tissues.
Osteoarthritis occurs as a result of wear and tear of the joints. RA affects the lining of the joints, leading to inflammation, pain and swelling that eventually cause bone erosion and joint deformities. RA causes inflammation and damage in other parts of the body as well. Although new types of medications have improved treatment options dramatically, severe RA can still cause physical disabilities.
How serious is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic disease where patients suffer from frequent flare-ups of signs and symptoms and periods of remission (asymptomatic periods). Initially, the small joints are affected, especially the joints of the fingers and toes. As the disease progresses, other joints may be affected, like the wrists, knees, ankles, elbows, hips and shoulders. RA also presents with systemic signs and symptoms and other body systems may be affected in 40% of cases. If not diagnosed early and appropriately treated, RA can lead to permanent deformities, disabilities and serious systemic complications.
Signs and symptoms of RA in the joints include
- Tender, warm and swollen joints
- Joint stiffness that is usually worse in the mornings and after inactivity
- Loss of joint function
- Joint deformities
Systemic signs and symptoms
- Loss of appetite
- Weight loss
- Blue fingertips due to vasculitis (inflammation of the blood vessels)
- Muscle wasting
- Scleritis: Inflammation of the sclera of the eyes.
- Pericarditis: Inflammation of the outer covering of the heart.
- Myocarditis: Inflammation of the heart.
- Inflammation of the nerves
Complications of RA
- Osteoporosis: Weakening of the bones, making them more prone to fractures.
- Rheumatoid nodules: Firm bumps of tissue around the pressure points of joints, lungs, etc.
- Sjögren's syndrome: A disorder that causes dryness in the eyes and mouth.
- Infections: Systemic infections can occur because of the disease or medications.
- Weight gain can occur.
- Carpal tunnel syndrome: Inflammation can compress the median nerve that runs from the forearm into the hand and fingers.
- Cardiac (heart) complications: Pericarditis (inflammation of the outer covering of the heart) and myocarditis (inflammation of the heart) can occur.
- Lung complications: Scarring of the lungs (fibrosis) causing breathing difficulty.
- Lymphoma: RA increases the risk of lymphoma (blood cancers that develop in the lymph system).
What are the causes of rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune disorder. Certain factors increase the risk of RA. The common risk factors are
- Sex: Women are at an increased risk compared to men.
- Age: RA most commonly begins during middle age.
- Family history: A positive family history increases the risk of the disease.
- Smoking and other environmental exposures to asbestos or silica increase disease risk.
- Obesity: Excess weight, especially in women younger than55, increases disease risk.
How is rheumatoid arthritis treated?
There is no cure for rheumatoid arthritis (RA). It is a lifelong disease with multiple flare-ups and periods of remission (asymptomatic periods). There are various treatment options available to control the progression of the disease and prevent complications. Treatment usually involves a combination of more than one treatment modality. The treatment options are
- Steroids: Corticosteroid medications suppress the immune system. They reduce inflammation and pain and delay joint damage.
- Disease-modifying antirheumatic drugs (DMARDs): These drugs are effective in the treatment of RA. They suppress inflammation and relieve symptoms. They can slow the progression and prevent joint deformities and systemic complications. Some commonly prescribed DMARDs are methotrexate, hydroxychloroquine, sulfasalazine and leflunomide (Arava).
- Biological modifiers: These are a newer generation of DMARDs and they are usually taken with DMARDs. They suppress inflammation. Some commonly used biological agents are infliximab, rituximab, sarilumab, etc.
Patients are usually referred for physical or occupational therapy to learn exercises for improving and maintaining joint flexibility and rehabilitation of joints.
Surgical procedures may be performed to help restore joint function and anatomy and reduce pain.