Rheumatoid Arthritis (RA)

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is an autoimmune disease which results in chronic inflammation of joints. The characteristic features of rheumatoid arthritis include inflammation of tissue around the joints, inflammatory arthritis and injury of other organs of the body. As this is an autoimmune disease, the patient will have antibodies circulating in their blood that will target and attack his or her own body tissues which can result in inflammation. Rheumatoid Arthritis is a systemic illness that has the ability to affect multiple organs in the body.

Although, RA is a chronic illness that can last for years, patients may show no signs of symptoms for a long period of time. Nevertheless, RA which is referred to as rheumatoid disease is a progressive condition which can result in joint and functional impairment. A part of the body where two bones meet in order to facilitate movement is called a joint. Inflammation of the joints is known as arthritis. Thus, inflammation of the joints in RA can cause swelling, pain, stiffness and redness. The inflammation is not restricted to this area only; it can also occur in tissues close to the joints (tendons, ligaments and muscles).  In some individuals, chronic inflammation can lead to the deformity of joints due to destruction of cartilage, bone and ligaments.

  • Statistics
  • Causes and Risk Factors
  • Signs and Symptoms of RA
  • Complications of RA
  • Diagnosis of RA
  • Available Treatment for RA
  • Prognosis and Prevention
  • Conclusion

RA

Statistics

RA is a common rheumatic disease that is said to affect approximately 1.3 million people in the United States alone, according to current data. Statistically, women are said to be more affected than men where RA prevalence in women are three times more compared to men. In addition  the disease can start off at any age although previous cases show that it is more common in people after 40 years of age and before 60 years. Juvenile rheumatoid arthritis affects children. Moreover, some individuals report that multiple members of the family have been affected by RA showing a genetic factor for the disorder.

Causes and Risk Factors

The exact cause that gives rise to RA is still not known.  Viruses,bacteria and fungi have been suspected as the cause for a long time but has not been proven as of yet. RA research is an active field of worldwide research. Scientists have suggested that RA might be hereditary (genetical) as they have identified certain genes which increase the risk of one attaining RA. It is also presumed that certain environmental factors and infections may elicit an immune response in people who are vulnerable to RA. Therefore, it triggers an autoimmune reaction which results in one’s immune system attacking one’s normal tissue. This concurrently lead to the inflammation of the joints and some organs (lungs, eyes). Immune cells such as the lymphocytes are activated and the chemical messengers (cytokines, TNFs) manifest in the area of inflammation.

Environmental factors are believed to be a cause of RA. These factors can be tobacco smoking, silica exposure, chronic periodontal  disease; which can all be risk factors of developing RA.

 Signs and Symptoms of RA

The symptoms of RA is dependant on the degree of the inflammation incurred. The active stage of the disease is during inflammation and the inactive stage when inflammation go down, that is in remission. These remissions are sometimes spontaneous or when treatment is prescribed it can last for years, months or weeks. During this phase symptoms of the disease disappear making the patient feel better. When the disease is once again active (called a flare) the symptoms comes along with it.

Symptoms of RA include fatigue, energy loss, loss of appetite, fever (low grade), aches of muscles and joints and rigidity or stiffness. Rigidity or stiffness of muscles and joints can be experienced in the morning or after being inactive for a period of time. During disease flares arthritis is common and joints become red frequently as well as swollen, painful and tender. This occurrence is due to the result in inflammation of the joint (synovium) which will produce excess joint fluid called synovial fluid as a result. During inflammation the synovium is said to thicken causing synovitis.

RA generally affects many joints affecting both sides of the body. Early symptoms of RA can be stiffness and pain of joints which are more commonly experienced in the morning. RA of the hands will result in difficulty of performing simple tasks such as turning door knobs, opening jars and containers, etc. The tiny joints of the feet are also affected which will result in pain while walking (particularly in the morning).  Periodically only one joint is inflamed. In this case, the arthritis may resemble other forms of arthritis like gout, infection of the joint, etc. Damage to body tissues like cartilage and bone is sustained due to chronic inflammation. Chronic inflammation will thus lead to cartilage loss, erosion and weak bones and muscles which will lead to deformity of joints resulting in loss of function.

 Complications of RA 

Inflammation of RA can affect other organs and joints. Sjogren’s syndrome is a complication of RA which arise due to the inflammation of glands of the eyes and mouth. Inflammation of the lining of the lung called pleuritis can cause chest pains with deep breaths and coughing. Inflammation of the pericardium tissue which surround the heart can cause pericarditis; characterised by chest pain. Increased risk of heart attacks are linked to RA. Anaemia is another complication where the number of erythrocytes or red blood cells and white blood cells are reduced. Felty’s syndrome is portrayed by the decrease in WBCs which increase the risk of attaining infections. Also, lymphomas, cancers of the lymph glands, is also another complication of RA. Carpal tunnel syndrome can arise due to the nerves in the wrists becoming ‘pinched’.

Diagnosis of RA

RA is diagnosed on the basis of the joints involved, joint stiffness in the morning, appearance of rheumatoid factors and citrulline antibody. In addition, rheumatoid nodules and X-rays findings are evaluated. Primarily, a health care professional will look into the history of the symptoms, examine the joints in order to look for inflammation,tenderness, swelling, and any deformity. He/She will examine the skin for any rheumatoid nodules, which are firm bumps found under the skin, elbows or fingers,  and other areas of the body for inflammation.

Joint inflammation distribution is important to a medical doctor for diagnosis purposes. Joint inflammation in RA occur in a symmetrical fashion i.e. affecting both sides of the body. Joints susceptible to such inflammation include the knees, feet, wrist, hands,etc. When only one of the joints are inflamed (unsymmetrical), the diagnosis becomes quite cumbersome. A medical doctor will have to do other tests to rule out arthritis (due to gout or infection). Rheumatoid nodules arising in elbows and fingers indicate RA, making diagnosis easier.

Abnormal antibodies arise with RA. Rheumatoid factor (RF) is such an antibody which is found in approximately 80% of RA patients. ‘Seronegative rheumatoid arthritis’ is a term given to a condition where RA patient’s test does not render positive results for the antibody. Citrulline antibody is another type of antibody used to diagnose RA when evaluating unexplained inflammation of joints. These antibodies represent early stages of RA and have been linked to aggressive cases of RA. ANA is another type of antibody which can be found in RA patients.

Sedimentation rate (sed rate) is a blood test which will measure the joint inflammation crudely. This test will measure the speed at which RBCs fall or settle at the bottom of a test tube and are said to be faster in disease flare states and slower in remissions. C-reactive protein is used to measure the degree or the extent of RA. Blood test can indicate anaemia too, which is one of the complications of RA.

X-rays of joints may be normal or sometimes indicate swelling of soft tissues (early stages). Later on, X-rays will show the erosion of the bones which indicates RA. These X-rays is useful to follow disease progression and damage incurred to the bone over a period of time.  Inflammation of the bones can also be found out using bones scans, a procedure that uses radioactive substance (small amounts). MRIs can also indicate and show joint damage.

The American College of Rheumatology has invented a system which can classify RA. This is based on X-rays of joints. The stages are as follows:-

Stage I – X-rays show no damage, signs of bone thinning may be seen. 

Stage II- bone thinning seen around a joint with or without presence of damage to bone. Possibility of Cartilage damage (not severe). Mobility of joint limited where deformities are not seen. Atrophy of muscles adjacent to site. Possibility of soft tissue (around joint) abnormalities.

Stage III-Cartilage, bone damage and bone thinning around a joint is observed. Joint deformity (absence of permanent stiffness or fixation of joint). Considerable atrophy muscles. Possibility of soft tissue (around joint) abnormalities.

Stage IV- Damage to cartilage and bone. Osteoporosis around joint. Ankylosis. Considerable atrophy of muscles. Possibility of soft tissue (around joint) abnormalities.

 

Video of  Rheumatoid Arthritis

The functional status of such patients are classified by Rheumatologists:

  • Class I- Ability to execute daily day to day activities.
  • Class II-Ability to execute self and work activities but cannot perform other activities (sports, household chores)
  • Class III- Ability to execute self care activities but cannot perform or limited in work and other activities.
  • Class IV- Cannot or limited in performing self care, work related and other activities.

 Available Treatment for RA

Unfortunately, there is no cure for RA. Treatment for RA involves reducing pain and inflammation of the joints, restore joint function, avoid destruction and deformity of the joint. Medications, rest, exercises, joint protection, education of patient and family are some of the procedures used in a treatment plan for RA. Treatment takes into consideration ones disease activity, kind of joint involved, general health, age and the occupation of the patient.

Two categories of medications are used to treat RA. The first one is the fast acting ‘first-line drugs’ and other is the slow acting ‘second-line drugs”. The fast acting drugs are prescribed in order to decrease pain and inflammation. The slow acting drugs are prescribed to stimulate disease remission and to avoid the continuing joint destruction. Many newer and useful medications for different conditions of RA are available today.

There is no special diet that can cure RA which in fact is believed by some. Studies have shown that fish oil can be beneficial and curcumin (yellow pigment in curry) provides anti inflammatory effects which have the ability to reduce some of the symptoms of RA.

Topical creams can releive pain when rubbed into skin. Clinical trials of antibiotics have shown mild to moderate betterment of the symptoms. Regular exercises can help in joint mobility and in making muscles around the joint area more stronger. Swimming is the most beneficial form of exercise as it exerts less stress on the joints. Therapists will provide exercise routines specific to your needs. They can provide splinting supports, for say, your wrist and fingers which can be very useful in inflammation reduction and maintaining the proper position of the joint. Heat and cold therapies can help with the symptoms too.

To re-establish joint mobility and to repair joints that are damaged, surgery may be recommended by your doctor. Joint surgery include arthroscopy to part of or complete replacement of the joint. Arthroscopy is a surgical procedure where the surgeon will insert a tube like equipment into the joint. In  replacement surgeries, artificial materials are utilised to replace a destroyed joint. Large joints are replaced with metals in the case of hip or knee joints. Plastic material can be used to replace the small joints of the hand.

 Prognosis and Prevention

The prognosis for RA can be very good if early and aggressive treatment can be administered. Health care professionals try to get rid of any signs of active stages of the disease. Optimal health can be reached in a relatively short period of time owing to the cooperation of the doctor and the patient and the effective control of the disease.

The prognosis is poor for patients who have deformity, disability or progressive joint inflammation which cannot be controlled or RA which affects other organs. It has been demonstrated that RA can have severe damaging effects when rheumatoid factor or citrulline appears in the blood test.

As of yet, no specific prevention plan is available for RA. Certain factors and conditions which are risk factors for RA should be avoided; these include smoking cigarettes, silica mineral exposure, chronic periodontal disease,etc.

Conclusion

Rheumatoid Arthritis (RA) is an autoimmune disease which results in chronic inflammation of joints or other areas of the body. It can affect people of all ages and the cause of RA is still not known. It is a chronic disease which is portrayed by the flares and remission phases of the disease. In RA inflammation of the joints, most of the time, occur in a symmetrical fashion involving multiple joints. Chronic inflammation has the tendency to lead to destruction of joints and deformity. Treatment for RA involves a combination of education of patient and family, rest, exercise, joint protection procedures, medications and sometimes surgery. For optimal outcome, early detection and treatment is advised.

 

 

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

 

 

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