Rheumatoid Arthritis 

Rheumatoid Arthritis - Know It All!

Editorial

All you need to know about Rheumatic Arthritis.

Rheumatoid Arthritis 

Know your ailment well, so you can manage it better!!

Here we come with Rheumatic Arthritis today!

Overview:

RA is a chronic inflammatory disease that can affect more than just the joints. The disorder can harm a wide range of body systems in some individuals, including the skin, eyes, lungs, heart and blood vessels.

Rheumatoid arthritis, an inflammatory disease, happens when the immune system attacks the tissues of your own body erroneously.

Rheumatoid arthritis affects the lining of the joints, causing a painful swelling that can ultimately result in bone deterioration and joint deformity, unlike the wear-and-tear harm of osteoarthritis.

What may also affect other parts of the body is the inflammation associated with rheumatoid arthritis. While new types of drugs have significantly improved therapy options, extreme rheumatoid arthritis can still cause physical disabilities.

Additional features of rheumatoid arthritis can include the following.

  • It affects the lining of the joints, which damages the tissue that covers the ends of the bones in a joint.
  • RA occurs in a symmetrical pattern, meaning that if one knee or hand has the condition, the other hand or knee does, too.
  • It affects the joints in the wrist, hands, feet, spine, knees, and jaw.
  • RA may cause fatigue, occasional fevers, and a loss of appetite.
  • RA may cause medical problems outside of the joints, in areas such as the heart, lungs, blood, nerves, eyes, and skin.
Rheumatoid Arthritis 
Rheumatoid Arthritis 

What Happens in the disease:

Doctors are unaware of why joint tissues are targeted by the immune system. They do know, however, that rheumatoid arthritis can be developed when a series of events occur. Includes this sequence of events:

  • RA development begins with a combination of genes and exposure to environmental factors.
  • Years before symptoms occur, the immune system can be activated.
  • In other areas of the body, the beginning of the autoimmune phase may occur, but the effect of the immune failure remains in the joints.
  • In the inner lining of the joint, called the synovium, immune cells cause inflammation.
  • This inflammation becomes chronic, and because of an increase in cells, protein content, and other factors in the joint, the synovium thickens, which may contribute to discomfort, redness, and warmth.
  • The thickened and inflamed synovium moves deeper into the joint as RA progresses and damages the cartilage and bone within the joint.
  • The forces cause alterations within the joint structure as the joint capsule extends.
  • The muscles, ligaments, and tendons surrounding them that sustain and strengthen the joint become weak over time and do not perform as well. This can lead to more discomfort and damage to the joint and difficulty using the affected joint.

Risk Factors for RA:

To assess whether they modify the risk of developing RA, researchers have analysed a variety of genetic and environmental factors.

  • Age. RA can begin at any age, but the likelihood increases with age. The onset of RA is highest among adults in their sixties.
  • Sex. New cases of RA are typically two-to-three times higher in women than men.
  • Genetics/inherited traits. People born with specific genes are more likely to develop RA. These genes, called HLA (human leukocyte antigen) class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
  • Smoking. Multiple studies show that cigarette smoking increases a person’s risk of developing RA and can make the disease worse.
  • History of live births. Women who have never given birth may be at greater risk of developing RA.
  • Early Life Exposures. Some early life exposures may increase risk of developing RA in adulthood. For example, one study found that children whose mothers smoked had double the risk of developing RA as adults. Children of lower-income parents are at increased risk of developing RA as adults.
  • Obesity. Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.

Unlike the risk factors above which may increase the risk of developing RA, at least one characteristic may decrease the risk of developing RA.

  • Breastfeeding. Women who have breastfed their infants have a decreased risk of developing RA.
Rheumatoid Arthritis 

Symptoms:

Common symptoms of rheumatoid arthritis include:

  • Joint pain at rest and when moving, along with tenderness, swelling, and warmth of the joint.
  • Joint stiffness that lasts longer than 30 minutes, typically after waking in the morning or after resting for a long period of time.
  • Fatigue — feeling unusually tired or having low energy.
  • Occasional low-grade fever.
  • Loss of appetite.

Rheumatoid arthritis may occur in any joint; it is more prevalent in the wrist, hands, and feet, however. The signs, in a symmetrical fashion, generally appear on both sides of the body. If you have RA in your right hand, for instance, you probably have it in your left hand too.

RA impacts individuals differently. RA begins with mild to moderate inflammation in some individuals that affects only a few joints. However, RA can worsen and impact more joints if it is not treated or the treatments do not work. This can result in more harm and impairment. RA symptoms often escalate in ‘flares’ due to a cause such as stress, too much movement, or stopping medications unexpectedly.

The purpose of treatment is to manage the condition so that it is in remission or near remission, without any signs or symptoms of the disease.

Rheumatoid arthritis can cause other medical problems, such as:

  • Rheumatoid nodules that are firm lumps just below the skin.
  • Anemia due to low blood cell counts.
  • Neck pain and dry eyes and mouth.
  • Rarely, inflammation of the blood vessels, the lining of the lungs, or the sac enclosing the heart.
Rheumatoid Arthritis 

Causes:

Researchers do not understand what activates the immune system to transform against the joints and other tissues of the body. A combination of the following factors can contribute to the disease, studies show:

  • Genes:

Rheumatoid arthritis can result from certain genes that influence how the immune system works. Some individuals who have these genes, however, never develop the disease. This indicates that in the production of RA, genes are not the only factor. Moreover, who gets the disease and how serious it can become can be determined by more than one gene.

  • Environment:

In people who have particular genes that also increase their risk, researchers continue to study how environmental factors can cause rheumatoid arthritis. In addition, some factors in the production of RA may play a role, such as bacteria, viruses, and gum disease.

  • Sex Hormones:

Researchers think that when genetic and environmental variables are also involved, sex hormones can play a role in the development of rheumatoid arthritis. Studies reveal:

  1. Women have a greater risk of developing rheumatoid arthritis than men.
  2. During pregnancy, the disease can improve and flare up after pregnancy.

Complications:

Rheumatoid arthritis increases your risk of developing:

  • Osteoporosis. Rheumatoid arthritis itself will raise the risk of osteoporosis, along with certain drugs used to treat rheumatoid arthritis, a disease that weakens the bones and makes them more vulnerable to fracture.
  • Rheumatoid nodules. Around pressure points, such as the elbows, these firm bumps of tissue most commonly develop. These nodules, however, can develop anywhere in the body, including the lungs..
  • Dry eyes and mouth. People with rheumatoid arthritis are also more likely to develop Sjogren‘s syndrome, a disease that reduces the amount of moisture in the mouth and eyes.
  • Infections. The disorder itself can damage the immune system and many of the drugs used to battle rheumatoid arthritis, contributing to increased infections.
  • Abnormal body composition. In individuals who have rheumatoid arthritis, the proportion of fat to lean mass is always greater, even in individuals who have a normal body mass index (BMI).
  • Carpal tunnel syndrome. The inflammation will compress the nerve that represents most of the hand and fingers if your wrists are affected by rheumatoid arthritis.
  • Heart problems. Your risk of hardened and damaged arteries as well as inflammation of the sac that encloses your heart can be increased by rheumatoid arthritis.
  • Lung disease. There is an increased risk of inflammation and scarring of the lung tissues of people with rheumatoid arthritis, which can lead to gradual shortness of breath.
  • Lymphoma. The risk of lymphoma, a group of blood cancers that form within the lymph system, is increased by rheumatoid arthritis.

Diagnosis:

Your doctor will probably examine your joints for signs and symptoms of inflammation during a physical examination, such as swelling, warmth and tenderness, and measure the range of motion in your spine and affected joints. It is also possible for your doctor to search your eyes for inflammation and your skin for rashes.

Diagnosis of RA by physicians is done by:

  • Taking the history of the patient.
  • Conducting an examination.
  • Ordering lab tests.
  • Ordering tests in imaging, such as x-rays or ultrasound.

When it is in the early stages, it can be difficult to diagnose rheumatoid arthritis because:

  • The illness progresses over time, and in the early stages, only a few symptoms may be present.
  • The disorder is not subject to be confirmed with any single examination.
  • Symptoms vary from person to individual.
  • Symptoms may be similar to those of arthritis and joint disorders of other kinds.

As a result, a number of methods are used by physicians to diagnose the disorder and rule out other disorders.

Laboratory Tests:

  • Rheumatoid Factor(RF): This blood test tests for RF, an antibody that can ultimately be found in the blood of many people with rheumatoid arthritis. An antibody is a specific protein formed by the immune system that usually helps combat the body’s invaders. Not all individuals with RA test positive for RF; some individuals test positive for RF, but the disease never develops; and some individuals test positive but have another illness. However, to diagnose rheumatoid arthritis, doctors will use this test, along with other test results and assessments.
  • Anti-cyclic citrullinated peptide antibody (anti-CCP): This blood test tests the existence of anti-CCP antibodies that occur in many individuals with rheumatoid arthritis. Furthermore, before RA symptoms emerge, anti-CCP can appear, which may help physicians diagnose the disease early. The results of this examination, along with the results of RF blood tests, are very helpful for confirming a diagnosis of rheumatoid arthritis.
  • Complete Blood Count: This blood test tests various counts of blood cells and can help diagnose anaemia, which is prevalent in people with RA.
  • Erythrocyte sedimentation rate
  • C-reactive protein: This is another popular inflammation test that can help diagnose rheumatoid arthritis and track the activity of the disease and treatment response.

Imaging Tests:

X-rays help screen for RA, but before a joint injury occurs, they are not effective in the early stages of rheumatoid arthritis. Doctors may use x-rays to track disease progression or to rule out other causes of pain in the joints.

In the early stages of the disorder, magnetic resonance imaging ( MRI) and ultrasound may help diagnose rheumatoid arthritis. Furthermore, these imaging tests can help to determine the amount of joint damage and the seriousness of the disease.

Treatment Options:

Your doctor’s suggested types of drugs would depend on the severity of your symptoms and how long you have had rheumatoid arthritis.

Rheumatoid Arthritis 
  • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can alleviate discomfort and decrease inflammation. Ibuprofen and naproxen sodium provide over-the-counter NSAIDs. By prescription, stronger NSAIDs are available. Stomach discomfort, heart attacks and kidney damage can be side effects.
  • Steroids. Inflammation and discomfort and slow joint deterioration are minimised by corticosteroid drugs, such as prednisone. Thinning of bones, weight gain and diabetes can be side effects. To alleviate acute symptoms, doctors frequently prescribe a corticosteroid, with the aim of eventually tapering off the drug.
  • Disease-modifying antirheumatic drugs (DMARDs). These medications can delay the progression of rheumatoid arthritis and prevent permanent damage to the joints and other tissues. Methotrexate, leflunomide, hydroxychloroquine and sulfasalazine are all popular DMARDs. Side effects vary, but they can include liver damage, suppression of the bone marrow and serious lung infections.
  • Biologic agents. Abatacept, adalimumab, anakinra, baricitinib, certolizumab, etanercept, golimumab, infliximab, rituximab (Rituxan), sarilumab, tocilizumab, and tofacitinib are also classified as biologic reaction modifiers in this newer class of DMARDs.
  • These drugs can target parts of the immune system that cause joint and tissue damage-causing inflammation. The risk of infections also rises with these types of medications. A higher dose of tofacitinib can increase the risk of blood clots in the lungs in people with rheumatoid arthritis. Typically, when combined with a non-biological DMARD, such as methotrexate, biologic DMARDs are most successful.

Therapy

In order to help keep your joints stable, your doctor can send you to a physical or occupational therapist who can teach you exercises. Fresh approaches to do everyday activities can also be recommended by the doctor, which would be easier on the joints. You may want to pick up an object using your forearms, for instance.

Assistive devices will make it easier to keep your sore joints from being strained. A kitchen knife fitted with a handgrip, for example, helps protect the finger and wrist joints. Other tools can make it easier to get dressed, such as buttonhooks. Healthy places to look for ideas are catalogues and medical supply stores.

Surgery

You and your doctor can recommend surgery to fix damaged joints if medications fail to prevent or delay joint damage. Surgery will help to regain the ability to use the joint. It can also decrease pain and enhance function.

One or more of the following procedures may require rheumatoid arthritis surgery:

  • Synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can be performed on knees, elbows, wrists, fingers and hips.
  • Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
  • Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn’t an option.
  • Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.

Surgery carries a risk of discomfort, infection and bleeding. Discuss with your doctor the advantages and risks.

How to cope up:

  • Research indicates that less discomfort and fewer hospital visits are recorded by individuals who invest in their own treatment. They have a better quality of life as well.
  • In controlling your RA and improving your health, self-care will help you play a part. You could:
  • More about, and therapies for, rheumatoid arthritis.
  • Use calming strategies and exercises to reduce the discomfort and keep you involved.
  • To have more influence over your condition, connect well with your health care team.
  • Reach out for assistance to deal with the physical, mental and emotional effects of rheumatoid arthritis.
  • Participating in your treatment will help create faith in your abilities to conduct everyday tasks, helping you to lead a life that is full, healthy and independent.

 

References:

https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html

https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis

https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653

https://www.niams.nih.gov/health-topics/rheumatoid-arthritis/

 

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.