It is an autoimmune disorder which is characterized by the self attack of immune system to the body cells.

What is rheumatoid arthritis? (1)

Certain triggers stimulate immune system of the body. Due to some reasons, the immune system starts attacking body’s tissue of certain areas such as joints of knees, wrists and hands. This results in the inflammation of joint tissues leading to deformity, unsteadiness, and chronic pain. Rheumatoid arthritis does not specifically target joint areas but can also damage some other parts such as eyes, heart, and lungs.

Signs and symptom

At the onset of disorder, many people do not see any swelling or redness but feel pain and tenderness. Some symptoms of RA are:

  • Stiffness, swelling, tenderness or joint pain that continues for at least 6 weeks or more.
  • Stiffness in the morning for up to 30 minutes.
  • One or more joints are affected
  • Small joints such as joints of feet, hands and wrists are affected more
  • Two same joints of different sides of body are affected.
  • Low-grade fever
  • Fatigue

Effects on health

  • Eyes: trouble in seeing, light sensitivity, redness, inflammation, pain, and dryness
  • Mouth: gum infection, irritation or inflammation and mouth dryness
  • Skin: formation of small lumps beneath the skin at the site of inflammation, which are called rheumatoid nodules.
  • Lungs: scarring and inflammation that results in lung disease or breath shortness.
  • Blood vessels: blood vessels get inflamed causing damage to skin, nerves and other organs.
  • Blood: low count of red blood cells.
  • Heart: inflammation can cause damage to the coronary muscles and surrounding tissues.

Causes

In normal body, the immune system targets and attacks invaders like viruses and bacteria. In abnormal conditions such as Rheumatoid arthritis, the immune system mistakenly kills body’s cells at joints. The exact cause behind the abnormal functioning of immune system is yet not identified. Some environmental factors and genes are considered as triggering agents of immune system.

Risk factors of rheumatoid arthritis (2)

Several factors are thought to increase the risk of an individual getting rheumatoid arthritis. Some of them are as follows:

Age

Onset of rheumatoid arthritis is not age dependent. But its chances get increased multiple times in adults. So individuals above 60 are at higher risk of developing RA.

Sex

RA is not gender-specific. However, women are 2 to 3 times more at the risk of getting RA than men.

Inherited traits or genetics

A specific gene known as “Human leukocyte antigen” is associated with RA. This gene worsen the severity of RA. Individuals with this gene can develop RA more quickly when they face an environmental trigger such as obesity or smoking.

Smoking

Several pieces of evidence have shown that smoking enhances the RA development and makes the condition more severe.

Live birth history

Women who never delivered a baby are more prone to RA.

Life exposures

Several early life exposures are considered to enhance RA development. For instance, if a child’s mother smoked during pregnancy than the child is having more chances of developing RA. Moreover, people with low income or malnutrition can also get RA in their adulthood.

Obesity

Obesity means weight more than needed. If a person is obese then he or she is more vulnerable to RA.

Factor that decreases the risk of RA

Unlike risk factors, there may be one factor that decreases the onset chances of RA and that is “Breastfeeding”. Women who breastfeed their babies are at lower risk of developing RA.

Diagnosis of rheumatoid arthritis

The first step towards effective treatment of RA is its quick and appropriate diagnosis. Correct diagnosis is done by the doctor specialized in the disorder (known as rheumatologist). He made diagnosis through physical examination, lab tests and medical history.

Medical history

The doctor mostly asks following questions:

  • Joint symptoms (inflammation, tenderness, stiffness, pain)
  • The time when symptoms appeared
  • Frequency of symptoms
  • Severity of symptoms
  • Activities that make symptoms severe or better
  • Existence of RA in family members
  • Existence of any autoimmune disease in family members

 

Physical examination

The rheumatologist will examine joint swelling, tenderness, warmth, limited or painful movement, rheumatoid nodules and low-grade fever.

Lab tests

After medical history and physical examination, the doctor asks the patient for different lab tests. These are:

Blood tests

Several blood tests are done to determine the presence of RA associated antibodies and inflammation.

  • CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) marks the presence of inflammation. High values of CRP and ESR along with some other clues help to diagnose RA.
  • Rheumatoid factor RF is seen in 80% of RA patients. Antibodies to CCP (Cyclic citrullinated peptide) are also seen in almost 70% RA patients. These two markers are determine to check the onset of RA.

Imaging test

RA gradually causes the erosion of joint terminals. MRI (magnetic resonance imaging), ultrasound, or X-ray reveals the inner image of joint erosion. But this erosion cannot be seen in early RA. Imaging tests also tells the efficiency of treatment.

 

Treatment

The treatment goals of RA are:

  • Eradication or reduction of inflammation to possible lowest level.
  • Relief from symptoms
  • Prevention of organ and joint damage
  • Function improvement
  • Reduction of long-term complications

Following strategies are performed to achieve the above goal.

Early, quick treatment; to reduce or seize the inflammation as fast as possible

Targeting remission; work toward no or little signs of active inflammation

Target control; keep swelling and pain at lowest grade possible

Different drugs are used to treat RA that slows down the diseases or treat joint deformity. These drugs are called DMARDs- Drug modifying antirheumatic Drugs. These are first line of treatment. The second choice is biologicals. These are used when patient does not respond to DMARDs. Self-management approach also reduce the pain and immobility. This allows the patient to pursue his daily physical activities. NSAIDs (Non-steroidal Anti-inflammatory Drugs) reduce the pain associated with RA. These include ibuprofen, meloxicam, diclofenac sodium/ potassium, piroxicam.

The treatment of RA should be start as soon as possible to avoid any other health problems such as obesity, premature heart problems, and more.

 

References

  1. https://www.arthritis.org/diseases/rheumatoid-arthritis
  2. https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html