Rheumatoid Arthritis – Causes, Symptoms, Diagnosis, Treatment

Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis and affects 1% of the world population. RA is characterized by pain, stiffness, and swelling of the joints, especially the small joints in the hands and feet. It can also affect organs such as the lungs, eyes, or skin. Left untreated, joints can suffer permanent damage, sometimes necessitating replacement.  (Check out our blog: “What is Arthritis: Types, Symptoms, Diagnosis, Treatment“)

Causes of Rheumatoid Arthritis

The cause of RA is not known. It is an autoimmune disease that triggers the immune system to mistakenly direct inflammation to healthy joints. Several factors which play role in the development of RA include age, race, sex, genetic factors:

• Sex: Women are more at risk of developing RA. According to the American College of Rheumatology, 75% of RA patients are women and 1-3% of women may develop RA in their lifetime.
• Age: The disease starts mostly between 20-40 years of age, but it can begin as early as 18 years, and the risk increases with age until the age of 70.
• Race: Highest risk in Native Americans, the low prevalence in the Asian population, and lowest in African countries.
• Family History: Risk in siblings increases to 5% and in identical twins’ risk is up to 15%.

Symptoms Of Rheumatoid Arthritis

The small joints of the hands and feet are most susceptible. Symptoms include:

• Pain
• Swelling
• Stiffness (worst in the morning or after inactivity and improves with activity)
• Restricted movement

  May be accompanied by:

• Loss of energy
• Low fever
• Firm lumps or nodules growing underneath the skin on the hand or elbow

Complications of Rheumatoid Arthritis

RA can affect other organs of the body besides joints in approximately half of the patients. Patients may also suffer side effects from drugs used to treat RA.

• Heart: There can be inflammation of heart arteries increasing the risk of a heart attack.
• Pulmonary Hypertension: There can be inflammation of lung arteries leading to high pressure in the lungs causing shortness of breath.
• Lymphoma: RA increases the risk of certain blood cancers like lymphoma
• Infections: RA and drugs used to treat RA can weaken the immune system, making patients prone to more infections.
• Osteoporosis: The bones may become weak and brittle due to RA, leading to fracture.

Diagnosis Of Rheumatoid Arthritis

Due to its chronic nature, a diagnosis of RA is usually not considered until the symptoms have been present for at least 3 months. No single test can confirm the presence of RA. Instead, a combination of the following can help confirm a diagnosis:

• Physical examination of joints and organs
• X-ray, ultrasound, or MRI
• Blood tests

The common blood tests done in suspected RA include blood count to check for anemia, ESR (erythrocyte sedimentation rate), Rheumatoid Factor, anti-CCP antibodies.

Treatment Of Rheumatoid Arthritis

Treatment is focused on easing joint pain and swelling, as there is no cure for RA. Lasting or permanent damage can best be prevented by starting medication as soon as possible. Unfortunately, not all patients respond to the same medications, and many must change their treatment plans at least once during their lifetimes.

Treatment typically consists of:

• Medications (often prescribed in combination)
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): prescribed to reduce pain and swelling (examples include aspirin and ibuprofen)
  • Low-Dose Corticosteroids: periodic injection administered to reduce pain and inflammation (also known as cortisone)
  • Disease-Modifying Antirheumatic Drugs (DMARDs): prescribed to slow the progression of joint damage and to relieve symptoms (examples include methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, azathioprine)
  • Biologic Response Modifiers (“biologic agents”): prescribed to intercept the immune system’s (faulty) signal to inflame healthy joints (examples include Remicade, Enbrel, Humira, and Orencia)
• Patient Education (to learn to cope with RA)
• Physical /Occupational Therapy
• Walking and other low-impact exercises

Prognosis Of Rheumatoid Arthritis

Patients receiving proper treatment can expect to lead relatively normal and active lives. When somebody has joint pain and stiffness for more than a few days they should seek care from a Rheumatologist.

References:

• www.orthoinfo.aaos.org
• www.rheumatology.org
• www.who.org
• The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014 Jul;73(7):1316-22. DOI: 10.1136/annrheumdis-2013-204627. Epub 2014 Feb 18
• Characterizing the quantitative genetic contribution to rheumatoid arthritis using data from twins. Arthritis Rheum 2000;43:30-7.