Rheumatoid arthritis is an autoimmune disorder which presents with chronic joint pain, swelling and significant stiffness of predominantly small joints in your hands and feet.
In the early phase of the disease, the condition affects joints in the hand and feet, but as it progresses, joints in the knees, ankles, wrists, and shoulders may be affected. Aside from joints, RA can also affect other organs in the body like the lungs, heart and the skin. Uncontrolled rheumatoid arthritis could increase the risk of heart disease.
Causes
Rheumatoid arthritis is an autoimmune condition. In autoimmune disorders, your immune system attacks healthy tissues in your body. In case of rheumatoid arthritis, your immune system attacks the joint tissue leading to inflammation in the joints.
Risk Factors
The cause of rheumatoid arthritis is complex with interaction between genetic risk factors and various environmental exposure. Having a family member with rheumatoid arthritis increases the odds of developing it. If you have a family member who has RA, your risk is slightly increased.
There are multiple other environmental risk factors that further increase your risk for the disease. The most well known environmental risk for rheumatoid arthritis is smoking. Smoking changes the structure of the proteins in our body leading to activation of the immune system. Silica exposure is another known environmental risk factor. Poor gingival health is also associated with increased risk of rheumatoid arthritis.
Other risk factors for rheumatoid arthritis are not well understood. Females are more likely to have RA. There is a small increase in the risk of RA if you have obesity. In summary, RA is due to a combination of genetic risk factors with exposure to various environmental triggers, both of which are needed to cause the disease.
Symptoms
Rheumatoid arthritis presents with chronic inflammation in the small joints in the hand and the feet. Symptoms of the condition may include:
- Multiple joint pain
- Morning stiffness of joints (lasting more than 1 hour)
- Multiple joint swelling
- Tenderness over the joints
- Fatigue
- Mild fever
Rheumatoid arthritis can also affect other areas of your body including the eyes, lungs, heart, and skin. The symptoms of RA often fluctuate with waxing and waning patterns of joint symptoms. A period where symptoms are more severe is called a “flare”. In case of long term untreated arthritis, you could get multiple joint deformities leading to significant limitation of the joint movements.
Diagnosis
Rheumatoid arthritis is typically diagnosed based on the typical symptoms of joint inflammation. This is through a patient’s medical history and a physical examination by a clinician. The diagnosis is further supported by laboratory testing for signs of auto-immune markers and markers of inflammation in the blood tests. Your doctor could also do X-rays of the joints to look for any signs of joint damage, which could happen in some cases of long standing RA.
Treatment
Early diagnosis and early treatment is important in the treatment plan for rheumatoid arthritis. There has been a major advancement in the treatment of RA in the last three decades with discovery of many safe and effective therapies. The group of medications that are used to treat RA is referred to as disease modifying anuti-rheumatic drugs (DMARDs). These medications help control the inflammation and decrease the progression of the disease. In case you have continued inflammation, a combination of medications is also needed. The most commonly used DMARDs include: methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine. There are newer biologic DMARDs which are very effective in helping with the symptoms of RA, significantly improving the quality of life. These are relatively safe medications but require close monitoring by a rheumatologist for any unwanted side effects. Steroids (also known as glucocorticosteroids) are also used for a short period of time when your disease is severe leading to significant joint pain.
Alternative treatments
Better understanding of rheumatoid arthritis as a chronic disease helps in the overall long term better care. It helps improve your overall quality of life. You, as a patient, need to actively participate in the care and decision making process.
Physical and occupational therapy is sometimes used to help improve the functioning of the joints. A physical therapist and an occupational therapist can help you build strength and flexibility in your joints.
As a last-resort option, surgery can be used to reduce pain and repair joint damage. Surgery is not often performed, as conventional treatments usually provide a sufficient degree of symptom relief. Techniques such as synovectomy are used to remove inflamed joint lining, while joint replacement surgery removes the damaged joint and replaces it with a prosthetic one.
Living with RA
If you’ve been diagnosed with rheumatoid arthritis, remember that you’re not alone. Living with the condition can be difficult, but by following a treatment plan recommended by your doctor and making healthy lifestyle choices, you can be in control of your rheumatoid arthritis. One of the most important aspects in RA care is early diagnosis and initiation of early treatment to prevent long term joint damage.
Some healthy lifestyle choices that may help with RA include:
- Exercising. Low-impact exercises such as bike-riding, swimming, and yoga have been proven to reduce symptoms of rheumatoid arthritis.
- Eating well. Eating a healthy diet can reduce inflammation and possibly ease symptoms. In addition, eating well prevents obesity, which can make rheumatoid arthritis much worse.
- Avoiding stress. Living with the symptoms of rheumatoid arthritis can be mentally taxing, so consider stress reduction techniques like yoga and meditation.
Prognosis and Complications
The prognosis of rheumatoid arthritis depends on how your disease is managed with effective therapies. Someone who takes their medications as instructed, exercises regularly, eats a healthy diet, and avoids tobacco could have a good quality of life. With the significant improvement in the medical treatment, there has been a significant progress in the care of rheumatoid arthritis. This has significantly reduced the long term complications associated with RA.
Even so, rheumatoid arthritis can lead to long term complications in some of the patients. The most significant is the joint damage leading to deformities and reduced joint function. Patients with RA which is poorly controlled are at increased risk of heart diseases leading to decreased life expectancy. Many of the complications are due to medications related side-effects which require regular monitoring.
Prevention
As rheumatoid arthritis is a chronic autoimmune condition, it cannot be prevented or cured. However, making wise lifestyle choices like quitting tobacco and losing weight can decrease your risk of developing RA. Adequate control of the disease by taking the DMARDs could slow the progression of the disease and prevent permanent joint damage.
Facts / Statistics
1.5 million people in the US have the diagnosis of rheumatoid arthritis. Women develop the disease three times more likely than men. It is less common than the common form of arthritis called osteoarthritis, which over 32 million Americans live with.
Summary
Rheumatoid arthritis is a chronic autoimmune disease that affects 1.3 million American adults. It causes chronic inflammation in the small joints in the hand and the feet leading to joint pain, swelling and significant morning stiffness. Rheumatoid arthritis has no cure, but it can be managed effectively with medications, which significantly improves the quality of life. Early treatment with effective therapies prevents long term joint damage. A regular follow up with a rheumatologist is essential to find the appropriate treatment and early detection of side effects from the medications.
Written by Natan Rosenfeld
