Diseases & Conditions

 

Rheumatoid Arthritis

Diseases & Conditions

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic inflammatory, autoimmune disease causing joint inflammation. It affects the lining of the joints in the hands and feet causing swelling, pain, functional impairment and muscle wasting and is associated with increased risk of cardiovascular disease and osteoporosis.1

Among the inflammatory rheumatic diseases, rheumatoid arthritis is the most common type affecting about 1% of the world population. With people living longer, the prevalence of this disease is expected to increase by ∼22% between 2005 and 2025.2

At early stages, patients with rheumatoid arthritis may have general complaints such as fatigue, weakness, and tingling in the hands and feet. As the disease progresses, symptoms progress to the joints of the wrists, knees, ankles, elbows and toes.3 In this disease, joints on the both side of the body are affected, such as both hands, both wrists, and both knees. This symmetry helps to set it apart from other types of arthritis.

What causes rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease meaning that that the body's natural defence system attacks the joints. Despite intensive research, no one knows for sure why the immune system goes awry and the precise cause of rheumatoid arthritis remains unknown.

However, researchers believe that some genes that affect the immune system could make some people more prone to getting rheumatoid arthritis. It is also suspected that the immune system of these individuals susceptible to getting the disease might be triggered by certain infections or factors in the environment. These environmental factors include smoking tobacco, exposure to silica mineral and chronic periodontal disease, which all increase the risk of developing rheumatoid arthritis.4 However, the exact cause or causes of the disease are still unknown.5

What are the risk factors for rheumatoid arthritis?

The following risk factors may raise the risk of developing rheumatoid arthritis:6

  • Gender: Women are affected two to three times more commonly than men7
  • Age: Rheumatoid arthritis can occur at any age, but its onset, in both women and men, is highest among those in their sixties
  • Family history: People who have a close family member with rheumatoid arthritis may have a higher risk of developing it themselves
  • Smoking: Regular smokers have a significantly higher risk of developing rheumatoid arthritis than non-smokers
  • Obesity

 

What are the symptoms of rheumatoid arthritis?

The following symptoms are warning signs of rheumatoid arthritis:8

  • Joint pain and swelling
  • Morning stiffness for 30 minutes or longer
  • Fatigue
  • Loss of appetite and weight loss
  • Fever

 

The typical case of rheumatoid arthritis begins with the slow development of signs and symptoms over weeks to months. Often the patient first notices stiffness in one or more joints, usually accompanied by pain on movement and by tenderness in the joint. The number of joints involved is highly variable, but the process usually involves five or more joints. The joints most often involved are the joints of the hands, the wrists, shoulders, elbows, knees, and ankles. The disease usually affects both sides of the body at the same time. In rare but severe cases, it may affect the eyes, lungs, heart, nerves, or blood vessels.8

 

How is rheumatoid arthritis diagnosed?

Rheumatoid arthritis can be hard to diagnose in its early stages because of the subtle symptoms such as painful joints and slight morning stiffness. There is no singular test for diagnosing rheumatoid arthritis and the diagnosis is based on the clinical presentation. Ultimately, rheumatoid arthritis is diagnosed based on a combination of the following criteria:9

  • Joints stiffness in the morning lasting at least one hour before improvement
  • At least three joint areas simultaneously have had soft tissue swelling or fluid observed by a physician. The possible areas are right or left hands, wrist, elbow, knee, ankle, and neck
  • Symmetry of painful joints
  • The presence of bumps and nodules under the skin observed by a physician (rheumatoid nodules)
  • Blood test showing abnormal amounts of serum rheumatoid factor
  • X-ray showing radiographic changes typical of rheumatoid arthritis such as decalcification localized on the hand and wrist


How is rheumatoid arthritis treated?

The goals of rheumatoid arthritis treatment are to reduce inflammation and pain, slow the disease process, improve function, and maintain quality of life. Early diagnosis and management are very important to alter the course of this progressive disease. Getting treatment early may control the condition or keep it from getting worse. Treatment for rheumatoid arthritis may involve medications, therapy, surgery, and lifestyle changes.10

  • Medications:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation
    • Steroids can reduce inflammation and pain and slow joint damage
    • Disease-modifying antirheumatic drugs (DMARDs) can slow the progression of the disease and save the joints from permanent damage
    • Biologic agents is a newer class of DMARDs that should be paired with nonbiologic DMARD such as methotrexate according to the 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis recommendations.11
  • Therapy:
  • A therapist will be able to teach the patients how to keep their joints flexible
  • Surgery: (if medications and therapy fail to slow joint damage)
    • Total joint replacement by inserting a metal or plastic prosthesis to replace the damaged joints
    • Tendon repair
    • Joint fusion to stabilize the joints
  • Lifestyle changes:
    • Exercise regularly to strengthen the muscles around the joints
    • Apply heat and cold to ease the pain
    • Relax to reduce pain and stress

 

Treatment for rheumatoid arthritis is life-long. Many of the medicines used to treat rheumatoid arthritis have side effects. Therefore, it is important to have regular check-ups and talk with the doctor about any problems. This will help the doctor find a treatment that works best for the individual.

  References:

  1. Rennie, K. L., et al. "Nutritional management of rheumatoid arthritis: a review of the evidence." Journal of Human Nutrition and Dietetics 16.2 (2003): 97-109.
  2. Stark, S. (2004). Rheumatoid Arthritis.  In Magill’s medical guide (3rd ed.) (pp. 2233-2236).  Pasadena, CA: Salem Press.
  3. Crowson, Cynthia S., et al. "Rheumatoid arthritis and cardiovascular disease." American heart journal 166.4 (2013): 622-628.
  4. http://www.medicinenet.com/rheumatoid_arthritis/page2.htm
  5. Edwards, C. J., and C. Cooper. "Early environmental factors and rheumatoid arthritis." Clinical & Experimental Immunology 143.1 (2006): 1-5.
  6. Wasserman, Amy M. "Diagnosis and management of rheumatoid arthritis." American family physician 84.11 (2011): 1245.
  7. Cojocaru, Manole, et al. "Extra-articular manifestations in rheumatoid arthritis." Maedica 5.4 (2010): 286.
  8. Bergström, Ulf. "Clinical and epidemiologic aspects of Rheumatoid Arthritis. Special emphasis on cardiovascular outcome and risk factors." Lund University Faculty of Medicine Doctoral Disseration Series 2011.42 (2011).
  9. Arnett, Frank C., et al. "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis." Arthritis & Rheumatism 31.3 (1988): 315-324.
  10. Royal College of General Practitioners. "Clinical guideline for the diagnosis and management of early rheumatoid arthritis." Melbourne: The Royal College of General Practitioners (2009).
  11. Singh, J.A., et al. “2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.” Arthritis Rheumatol. 2015 Nov 6 doi: 10.1002/art.39480. [Epub ahead of print]