Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, causing inflammation, pain, stiffness, and eventually joint damage. Unlike osteoarthritis, which is caused by wear and tear on the joints, rheumatoid arthritis is an autoimmune disorder where the body's immune system mistakenly attacks its own tissues, particularly the synovium (the lining of the joints). Over time, this chronic inflammation can damage cartilage, bones, and other structures around the affected joints.
Key Features of Rheumatoid Arthritis:
- Cause: The exact cause of RA is unknown, but it is believed to involve a combination of genetic and environmental factors. In RA, the immune system mistakenly targets the synovium, leading to inflammation and damage. Common triggers may include infections, smoking, or hormonal changes, but the precise factors that initiate the immune response remain unclear.
- Symptoms:
- Joint Pain and Swelling: RA often causes pain, swelling, and warmth in multiple joints, especially in the hands, wrists, knees, and feet. Joints on both sides of the body are typically affected symmetrically.
- Morning Stiffness: One of the hallmark symptoms of RA is prolonged morning stiffness, lasting for at least 30 minutes or more, which may improve throughout the day.
- Fatigue: People with RA often experience chronic fatigue, feeling unusually tired or weak even after rest.
- Joint Deformities: Over time, untreated RA can lead to joint deformities, including dislocation, misalignment, and a loss of function in the affected joints.
- Fever: Some people may experience low-grade fever during flare-ups.
- Loss of Range of Motion: As the disease progresses, joint damage can reduce the ability to move the joints fully.
- Rheumatoid Nodules: Firm, non-painful lumps can develop under the skin, usually around the elbows, hands, or other pressure points.
- Affected Joints: RA usually affects joints in the:
- Hands: Often the small joints of the fingers and wrists.
- Feet: Particularly the joints in the toes.
- Knees, elbows, and shoulders: These larger joints may also be involved.
- It can affect joints on both sides of the body symmetrically, which helps differentiate RA from other forms of arthritis.
- Diagnosis:Diagnosis of RA is based on:
- Medical History: The doctor will ask about symptoms, family history, and risk factors.
- Physical Examination: The doctor will assess the joints for signs of inflammation, tenderness, and swelling.
- Blood Tests:
- Rheumatoid Factor (RF): A blood test that checks for the presence of rheumatoid factor, an antibody often found in RA patients, though it’s not specific to the disease.
- Anti-Cyclic Citrullinated Peptide (anti-CCP): This test is more specific to RA and can help in early diagnosis.
- Inflammatory Markers: Elevated levels of markers such as C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) suggest inflammation in the body.
- Imaging Tests: X-rays, ultrasound, or MRI scans are used to assess joint damage, inflammation, and any changes in the bones.
- Treatment:While there is no cure for RA, the goal of treatment is to control inflammation, reduce symptoms, prevent joint damage, and improve quality of life. Treatments include:
- A. Medications
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter or prescription NSAIDs (e.g., ibuprofen, naproxen) can reduce pain and inflammation but do not stop the disease from progressing.
- Corticosteroids: Prednisone and other steroids can help control inflammation quickly during flare-ups.
- Disease-Modifying Antirheumatic Drugs (DMARDs): These drugs are essential in treating RA by slowing disease progression and preventing joint damage. Methotrexate is a commonly used DMARD.
- Biologic DMARDs: Biologics are a newer class of medications that target specific parts of the immune system to stop the inflammatory process. Examples include tumor necrosis factor (TNF) inhibitors (e.g., adalimumab, etanercept) and interleukin inhibitors (e.g., tocilizumab).
- Janus Kinase Inhibitors (JAK inhibitors): These oral medications work by targeting specific enzymes involved in the immune response and inflammation.
- B. Physical Therapy:
- A physical therapist can design an exercise program to maintain joint function, increase strength, and improve range of motion.
- Occupational Therapy: An occupational therapist can help patients adjust their daily activities and use devices or tools that make tasks easier.
- C. Surgery:
- Joint Replacement: If a joint becomes severely damaged, joint replacement surgery (e.g., hip or knee replacement) may be necessary.
- Synovectomy: In cases where inflammation is confined to specific joints, a surgeon may remove the inflamed synovium to reduce pain and swelling.
- Arthrodesis: Fusion of joints may be done when joint replacement is not an option.
- Prognosis:
- The course of RA varies widely from person to person. In some people, the disease progresses slowly with periods of remission, while others may experience rapid deterioration.
- With early diagnosis and appropriate treatment, most people with RA can lead active lives and prevent severe disability.
- However, if left untreated or inadequately treated, RA can lead to permanent joint damage, loss of mobility, and reduced quality of life.
- Complications:
- Joint Damage: Over time, inflammation can cause cartilage and bone damage, leading to joint deformities and loss of function.
- Cardiovascular Disease: People with RA are at an increased risk of heart disease, possibly due to chronic inflammation.
- Osteoporosis: RA and its treatments (especially corticosteroids) can increase the risk of brittle bones.
- Lung Disease: Some individuals with RA may develop lung issues such as pulmonary fibrosis or inflammation of the lungs.
- Eye Problems: RA can lead to inflammation in the eyes, which can cause discomfort or more serious vision problems.
- Prevention:
- While RA cannot be prevented, early diagnosis and aggressive treatment can help prevent joint damage and improve long-term outcomes.
- Lifestyle Modifications: Maintaining a healthy diet, exercising regularly, and avoiding smoking can help reduce inflammation and manage the disease more effectively.
