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Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic inflammatory disease that can affect more than one joint. This disease can damage a wide range of body systems, including the skin, eyes, lungs, heart, and blood vessels.

Rheumatoid arthritis disorder, which is considered an autoimmune disease, occurs when the immune system mistakenly attacks your body’s tissues.

Unlike the wear and tear from osteoporosis, rheumatoid arthritis affects the lining of your joints, causing painful swelling and can ultimately lead to bone erosion and joint deformity.

The inflammation caused by rheumatoid arthritis can also damage other parts of the body. While new types of drugs have greatly improved treatment options, acute rheumatoid arthritis continues to cause physical disability.

What are the symptoms of rheumatoid arthritis?

  • Pain, stiffness, and swelling in more than one joint
  • Fatigue, fever, and weight loss
  • Loss of function and mobility
  • Joint deformity

Rheumatoid arthritis tends to affect small joints first, especially the joints that connect the fingers and toes. As the disease progresses, symptoms may spread to the wrist, knee, ankle, elbow, groin, and shoulder joints.

Many people with rheumatoid arthritis also experience signs and symptoms unrelated to the joints. Rheumatoid arthritis may affect many other organs, including:

  • Skin
  • Eyes
  • Heart
  • Lungs
  • Kidneys
  • Nerves

Rheumatoid arthritis signs and symptoms vary in severity and may come and go. Periods of increased disease activity, called flare-ups, alternate with relative recovery periods when the swelling and pain improve or disappear. Over time, rheumatoid arthritis may cause joints deformity.

What are the causes of rheumatoid arthritis?

Rheumatoid arthritis occurs when the immune system attacks the synovium – the lining of the membranes surrounding joints. The resulting inflammation thickens the synovium, which can destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

 

The factor causing this process is still unknown, although the genetic component seems likely. Although genes do not cause rheumatoid arthritis, they can make you more vulnerable to environmental factors, such as infections that may cause the disease.

What are the risk factors of rheumatoid arthritis?

  • Gender. Women are more likely than men to develop rheumatoid arthritis.
  • Age. Rheumatoid arthritis occurs at any age, but it commonly begins in middle age.
  • Family history. The risk of developing rheumatoid arthritis increases if someone in your family has it.
  • Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, especially if you are genetically predisposed to developing the disease. Smoking also appears to be related to increased disease severity.
  • Obesity. Overweight or obese people seem to have a higher risk of developing rheumatoid arthritis.

What are the complications of rheumatoid arthritis?

  • Osteoporosis. Rheumatoid arthritis itself, along with some of the medications used to treat rheumatoid arthritis, can increase your risk of developing osteoporosis.
  • Rheumatoid nodes. These stiff bumps of tissue often form around pressure points, such as the elbows. Despite this, these nodules can form anywhere in the body, including the lungs.
  • Dry eyes and mouth. People with rheumatoid arthritis are more likely to develop Sjogren’s syndrome, a disorder that reduces the amount of moisture in your eyes and mouth.
  • Abnormal body composition. The ratio of fat to muscle mass is often higher in people with rheumatoid arthritis and even in people with a normal body mass index (BMI).
  • Carpal tunnel syndrome. If rheumatoid arthritis affects the wrists, the inflammation may compress the nerve responsible for the functions of your hands and fingers.
  • Heart problems. Rheumatoid arthritis can increase the risk of hardened and blocked arteries, including inflammation of the sac surrounding your heart.
  • Lung diseases. People with rheumatoid arthritis are at increased risk of inflammation and scarring in the tissues of the lungs, which can lead to progressive shortness of breath.
  • Lymphoma. Rheumatoid arthritis increases the risk of developing lymphoma, which is a group of blood cancers that develop in the lymphatic system.

How is rheumatoid arthritis diagnosed?

Rheumatoid arthritis is difficult to diagnose in its early stages. Because the primary signs and symptoms are similar to those of many other diseases, there is no single blood test or physical symptom to confirm the diagnosis.

 

    • Physical exam. During the physical exam, your doctor will check your joints for swelling, redness, and warmth. They may also check your reflexes and muscle strength, and joints function, and range of motion.
    • Blood tests. People with rheumatoid arthritis often have an increased erythrocyte sedimentation rate and C-reactive protein, which indicates the presence of an inflammatory process in the body. Other tests detect antibodies to rheumatoid factor and anti-ring citrulline peptide.
  • Screening tests. Your doctor may request an X-ray to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor determine the severity of the disease in your body.

How is rheumatoid arthritis treated?

There is no cure for rheumatoid arthritis. But clinical studies indicate that symptom relief occurs better when treatment is started early with drugs known as disease-modifying antirheumatic drugs (DMARDs).

Medical treatment

The types of medications your doctor recommends will depend on the severity of your symptoms.

  • Non-steroidal anti-inflammatory drugs. Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation.
  • Steroids. Corticosteroid medications reduce inflammation and pain and slow joint damage.
  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs). These medications can slow the progression of rheumatoid arthritis and keep joints and other tissues from permanent damage.
  • Biologics. These drugs can target parts of the immune system that stimulate inflammation that causes joint and tissue damage.
Surgical treatment

If medications fail to prevent or slow joint damage, your doctor may suggest surgery to repair damaged joints. Surgery may help you regain your ability to use the joint. It can also reduce pain and improve function.

Rheumatoid arthritis surgery may include one or more of the following procedures:

  • Synovial removal. It is a surgical procedure to remove the inflamed lining of the joint (synovium), and it can be performed on the knees, elbows, wrists, fingers, and hips.
  • Tendon repair. Inflammation and joint damage may cause tendons around a joint to become loose or torn. Your surgeon may be able to repair tendons around your joint.
  • Joint fusion. Surgical fusion may be recommended to stabilize or realign the joint and to relieve pain when joint replacement is not an option.
Total joint replacement. In this procedure, the surgeon removes the damaged parts of the joint while inserting a prosthesis made of metal and plastic.
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