Rheumatoid Arthritis | Rheumatoid Disease

Rheumatoid Arthritis: Symptoms, Causes, Diagnosis, Treatment, and Prevention

What is Rheumatoid Arthritis?

Rheumatoid disease (RA) is a chronic, autoimmune condition that causes inflammation in the joints, the surrounding tissues and in the other organs of the body.

Autoimmune diseases, as the name suggests, are a group of diseases in which the immune system identifies one’s own body organs as foreign objects and begins to attack them.

Rheumatoid disease is referred to as a systemic illness as it affects different body organs. The disease is long-lasting but may exist for long periods of time without any symptoms.

What is Arthritis?

The most significant feature of this illness is rheumatoid arthritis or joint inflammation  which can occur early in the disease.This disease has the potential to totally destroy the joints and bring about functional disability. The inflammation can also occur in tissues adjoining the joints, such as the muscles, tendons and ligaments.

Rheumatoid arthritis, a common rheumatic disease, is three times more common in women than in men, of all races equally. Although the disease can begin at any age (as seen in juvenile rheumatoid arthritis), it most often occurs between the ages of 40 and 60 . It some families it has a familial pattern of inheritance.

When the disease is active the inflammation is severe; it subsides when the disease is inactive or in remission. When the symptoms return it is called a “flare.” Periods of remission and flares are common in affected individuals.

What Causes Rheumatoid Arthritis?

Various factors causing rheumatoid diseases have been cited. They include viruses, bacteria and fungi although none have been conclusively proven. Even environmental factors, such as tobacco usage, are likely to play a role in triggering the disease. Research has also indicated that the reason could be gene-linked.

During the active stage of the disease, symptoms may include fatigue, low-grade fever, lack of appetite, muscle and joint aches, and stiffness. Joint inflammation mostly occurs in a symmetrical fashion.

Muscle and joint stiffness are prominent after periods of inactivity or in the mornings.  Joints become red, swollen, painful, tender and sometimes fluid –filled. The small joints of the wrists and feet are mostly involved. Daily tasks such as opening door  knobs, or bottles, become a problem. Walking in the morning after getting up from bed becomes laborious.

How to Diagnose Rheumatoid Arthritis?

Rheumatoid disease cannot be diagnosed through a single test but by a combination of symptoms presentation. Classic diagnostic features include –

  • Joint stiffness, inflammation (arthritis) typically present in a symmetrical fashion
  • Rheumatoid nodules
  • Blood rheumatoid factor – an antibody present in 80% of the affected people
  • Citrulline antibody
  • Radiographic changes (X-ray testing)
  • C-reactive protein levels to assess the level of inflammation.

Treatment for Rheumatoid Arthritis

The specialist who treats arthritis and associated diseases is known as rheumatologist

Up until now, there is no known cure for rheumatoid arthritis. Aggressive early treatment is required to reduce joint inflammation and pain, prevent joint deformity and improve joint movement. 

Two types of medications are employed in treating rheumatoid arthritis. They are “first-line drugs,” such as aspirin and cortisone which are fast acting, and  the “second-line drugs” (disease-modifying anti-rheumatic drugs or DMARDs)  such as  methotrexate and hydrochloroquinine which are slow-acting. The first-line drugs help to  reduce pain and inflammation while the  second-line drugs prevent progressive joint destruction and promote disease remission.

Rheumatoid Disease – A Systemic Disease

  • Chronic inflammation can erode body tissues and cause weakness of the bones, cartilage and muscles. This can lead to joint deformities
  • There can be tightening of the vocal cords due to inflammation of the cricoarytenoid joint causing hoarseness of voice,
  • Inflammation of the eye glands or the mouth can cause dryness in these areas and this is referred to as Sjogren’s syndrome
  • Inflammation of the lung lining (pleuritis) causes chest pain, breathlesness, or coughing.
  • Inflammation of the external covering of the heart (pericardium) can occur
  • Rheumatoid disease can cause anemia and leucopenia
  • Lumps under the skin (rheumatoid nodules) can occur when there is frequent pressure such as in areas around the elbows or fingers. Sometimes the nodules become infecte
  • Even though these nodules usually do not cause symptoms, occasionally they can become infected.
  • Nerve deformity in the wrists causing carpel-tunnel syndrome
  • Blood vessel inflammation (Vasculitis) which can affect blood supply and lead to tissue death (necrosis).

 Tips to Manage Rheumatoid Arthritis

  • Tip 1: Regular exercise to promote joint mobility and improving muscle strength is necessary. Swimming is particularly useful as it is easy on the joints
  • Tip 2: Wrists and finger splints are required in most cases
  • Tip 3: Devices that help in daily activity such as toilet seat raisers, jar grippers and canes can help
  • Tip 4: Heat /cold applications after exercise can provide relief
  • Tip 5: Surgery to help joint mobility
  • Tip 6: Stress management can ease arthritic symptoms to some extent.

References:

  • Rheumatoid Arthritis (https://www.arthritis.org/diseases/rheumatoid-arthritis)
  • Diseases and Conditions Rheumatoid Arthritis (https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis)