Rheumatoid arthritis

Published: 9 Oct 2024, 21:08 PM

Medically Reviewed by

Dr Aashish Chaudhry

What is Rheumatoid arthritis?

Causes of Rheumatoid arthritis

The exact cause of rheumatoid arthritis (RA) remains unclear. Researchers believe it results from a combination of genetics, hormones, and environmental factors. Normally, the immune system safeguards the body against infections and diseases by producing antibodies. However, in RA, the immune system mistakenly attacks the thin membrane that lines the joints. This attack can lead to inflammation, resulting in pain and stiffness. If not treated, the inflammation can damage cartilage—the connective tissue that cushions the ends of bones. Over time, this can alter the joint’s shape and structure, potentially causing significant damage.

Risk factors of rheumatoid arthritis

While the exact cause of rheumatoid arthritis is not known, there are several factors that can increase your risk of developing this disease:

1. Genetic factors: If you have family members with RA, you may be more likely to develop this disease.
2. Age: While RA can occur at any age, it is most commonly seen in middle-aged adults, typically between 30 and 60 years old.
3. Sex: Women are more likely to get RA than men. This is due to the difference in hormones between males and females, which makes women more prone to RA.
4. Obesity: If you are obese or overweight, it can put extra pressure on your joints, which may raise your risk of developing RA.
5. High birth weight: Some research suggests that babies born with a higher birth weight may have a greater chance of developing RA as adults.
6. Smoking: Using tobacco is a significant risk factor for RA. Not only does it increase the likelihood of developing the disease, but it can also make symptoms worse.
7. Diet: Eating a diet rich in red meat and vitamin D deficiency has been found to increase the risk of RA. Plus, excessive salt and coffee consumption is also linked to joint problems.
8. Infections: Certain viral or bacterial infections, such as microbes like mycoplasma and enteric bacteria, could trigger RA in people who are already at risk for the disease.
9. Periodontitis: It is a chronic gum disease, or periodontitis, that has been linked to a higher risk of RA. This might be due to the inflammation that affects the body overall.

Complications of rheumatoid arthritis

Rheumatoid arthritis not only affects your joints, but it can even increase the risk of these complications:

1. Osteoporosis: RA and its treatments can weaken bones, making them prone to fractures.
2. Rheumatoid nodules: These firm lumps can develop under the skin, often near joints.
3. Dry eyes and mouth: Inflammation in RA can affect moisture-producing glands, leading to dryness.
4. Infections: RA and its medications can weaken the immune system, increasing susceptibility to infections.
5. Abnormal body composition: Muscle loss and fat gain are common in people with RA.
6. Carpal tunnel syndrome: Inflammation can compress nerves in the wrist, causing pain and numbness.
7. Heart problems: RA causes inflammation that increases the risk of cardiovascular disease, including heart attacks.
8. Lung disease: Inflammation can affect lung tissues, leading to scarring and breathing issues.
9. Lymphoma: RA patients have a higher risk of developing lymphoma, a type of blood cancer.

Key Facts About Rheumatoid arthritis

Major Symptoms	Joint pain and stiffness Swelling and inflammation Fever Fatigue Weight loss
Necessary Health Tests	Blood tests -Rheumatoid factor (RF) -C-reactive protein (CRP) -Antinuclear antibody -Erythrocyte sedimentation rate (ESR) -Anti cyclic citrullinated peptide (Anti-CCP) Human leukocyte antigen tissue typing (HLA) Imaging techniques -X-rays -MRI
Treatment	Medication -NSAIDs -DMARDs -Steroids -Biological DMRADs -Anti TNF drugs -Targeted synthetic DMRADs Therapy Surgery

Symptoms of Rheumatoid arthritis

Rheumatoid arthritis (RA) often starts with joint pain and stiffness, especially in the knees, ankles, feet, and hands. Usually, symptoms occur in the same joints on both sides of the body. While pain and stiffness often increase after periods of inactivity, they tend to be usually worse in the morning or following extended rest. Other symptoms of RA include:

• Inflammation can cause swelling and warmth around the joints.
• Fatigue that may leave you feeling exhausted without much physical activity.
  Fever and unintended weight loss can also be the symptoms, leaving you feeling unwell.

According to the Centers for Disease Control and Prevention (CDC), rheumatoid arthritis (RA) typically begins in people in their 60s, with symptoms often starting slowly and progressively worsening over time. Additionally, around 40 percent of those with RA experience symptoms that extend beyond the joints. Areas that may be affected include:

• Skin, which may develop painful nodules or rashes
• Eyes, leading to dryness or vision issues
• Lungs, where inflammation can cause difficulty breathing or chest pain
• The heart, which may face an increased risk of diseases
• Kidneys, potentially experiencing inflammation
• Salivary glands, which may swell and cause dry mouth
• Nerve tissue, where damage can result in numbness or tingling
• Bone marrow, affecting its ability to produce healthy blood cells
• Blood vessels, where inflammation may lead to organ damage

It is important to note that RA is a complex condition, and symptoms can vary from person to person and may even come and go. Patients typically experience flare-ups, when symptoms worsen, followed by periods of relative remission, during which swelling and pain may diminish or disappear. Over time, RA can lead to joint deformities and misalignment.

Diagnosis of Rheumatoid arthritis

Diagnosing rheumatoid arthritis (RA) in its early stages can be challenging for doctors, as its symptoms can mimic those of other conditions like lupus (SLE) or psoriatic arthritis (PsA). The CDC advises that individuals seek a diagnosis within six months of noticing symptoms to ensure treatment can start promptly. During the diagnosis process, a doctor will evaluate signs of inflammation and ask you about how long the symptoms have been present and their severity. A physical examination will be conducted to check for swelling, difficulties in moving joints, or other unusual signs. In addition to the physical examination, diagnosing RA typically requires several tests. These may include blood tests to look for specific antibodies and imaging scans, such as X-rays, to assess joint damage and inflammation.

Blood tests

1. Rheumatoid factor (RF): This checks for an antibody often found in people with RA, though not always.
2. C-reactive protein (CRP): High levels of CRP suggest inflammation, which is common in RA.
3. Antinuclear antibody: This test looks for antibodies that may indicate an autoimmune condition like RA.
4. Erythrocyte sedimentation rate (ESR): This test measures how quickly red blood cells settle. Faster rates indicate inflammation.
5. Anti-cyclic citrullinated peptide (Anti-CCP): Anti-CCP antibodies are strongly associated with RA, helping in early diagnosis.
6. Human leukocyte antigen tissue typing (HLA): This looks for certain genetic markers that may increase the risk of RA.

Imaging techniques

1. X-rays: X-rays show bone damage and joint changes caused by RA but are often more useful in advanced stages.
2. MRI: Magnetic resonance imaging (MRI) provides detailed images of joints, allowing doctors to detect early damage, swelling, or inflammation.

Together, these tests help doctors diagnose RA early and can help with early treatment to prevent further joint damage.

Treatment of Rheumatoid arthritis

While there is no cure for rheumatoid arthritis, an early diagnosis can help with timely treatment, helping to control symptoms. This can prevent flares, reduce inflammation, alleviate pain, minimise loss of function, and slow or prevent damage to joints and organs. Some medications commonly used to manage symptoms include:

1. NSAIDs (nonsteroidal anti-inflammatory drugs): These medications, like ibuprofen, are used to reduce pain and inflammation but they do not slow disease progression.
2. DMARDs (disease-modifying antirheumatic drugs): These drugs, like methotrexate, slow the progression of RA and help prevent joint damage.
3. Steroids: Corticosteroids like prednisone quickly reduce inflammation and pain but are used short-term due to side effects.
4. Biological DMARDs: These are prescribed to reduce swelling and redness. Examples include abatacept and rituximab.
5. Anti-TNF drugs: These block tumor necrosis factor (TNF), a substance in the body that causes inflammation. Popular options include Infliximab and Adalimumab.
6. Targeted synthetic DMARDs: In cases where conventional DMARDs and the biological agents do not provide relief, targeted synthetic DMARDs are prescribed. It includes Bariticinib, Tofacitinib, and Upacitinib.

Apart from medications, treating rheumatoid arthritis (RA) involves a combination of therapy and sometimes surgery to manage symptoms and prevent joint damage.

• Therapy: Physical and occupational therapy help strengthen muscles, improve joint flexibility, and teach ways to protect joints during daily activities.
• Surgery: In severe cases, surgery may be needed to repair or replace damaged joints. Common procedures include joint replacement, tendon repair, and synovectomy (removal of inflamed joint tissue).

How to prevent it?

While preventing the development of rheumatoid arthritis (RA) is not always possible, certain lifestyle changes can reduce the risk or manage symptoms if you already have the condition.

1. Quit smoking: Smoking is a major risk factor for RA. Quitting can lower the chance of developing RA and reduce symptoms if you have it.
2. Manage weight: Maintaining a healthy weight reduces stress on joints and lowers inflammation levels.
3. Eat healthy: Focus on anti-inflammatory foods like leafy greens, fish rich in omega-3s, and whole grains. Avoid processed foods, sugar, and excessive red meat, which can worsen inflammation.
4. Vitamins and supplements: Ensure adequate intake of vitamins like D and calcium to support joint and bone health.
5. Take proper sleep: Rest is crucial for reducing fatigue and managing inflammation.
6. Massage: Gentle massage can relieve joint stiffness and improve circulation, reducing discomfort.
7. Heat and cold compress: Heat relaxes stiff joints, while cold compresses reduce swelling and pain.
8. Dental health: Good oral hygiene is important since gum disease is linked to RA inflammation.
9. Relax: Stress can worsen RA symptoms. Practicing relaxation techniques like meditation helps manage stress levels.
10. Seek medical help: Early diagnosis and treatment are key to slowing RA’s progression and reducing joint damage.

Home remedies

Home remedies for rheumatoid arthritis include turmeric, known for its anti-inflammatory curcumin and ginger, and cinnamon, both helping to reduce joint pain. Garlic and black pepper are also suggested, as they are known to boost immunity and fight inflammation. Green tea contains antioxidants that ease symptoms, and ashwagandha is believed to lower inflammation and support joint health. These natural remedies may help reduce the symptoms of RA along with medical treatments.

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