Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation of the joints. It primarily affects the synovial joints, causing pain, stiffness, and swelling. RA is a systemic condition, meaning it can affect other parts of the body besides the joints.

Overview

Rheumatoid arthritis is a relatively common condition, affecting approximately 1% of the global population. It occurs more frequently in women than in men and can develop at any age, although it most commonly begins between the ages of 30 and 50.

Symptoms

The hallmark symptoms of rheumatoid arthritis include joint pain, swelling, and morning stiffness lasting for more than 30 minutes. The joints affected by RA are usually symmetrical, meaning if one joint on one side of the body is affected, the corresponding joint on the other side will also be affected. Commonly affected joints include the hands, wrists, elbows, knees, and ankles.

In addition to joint symptoms, individuals with RA may experience fatigue, low-grade fever, loss of appetite, and generalized malaise. Over time, untreated or poorly managed RA can lead to joint deformities, decreased joint function, and disability.

Pathophysiology

The exact cause of rheumatoid arthritis is unknown, but it is considered an autoimmune disorder. In autoimmune diseases, the immune system mistakenly attacks healthy tissues, in this case, the synovium—the membrane lining the joints. The immune response triggers inflammation, which leads to joint damage and the release of enzymes that erode cartilage and bone.

Genetic factors, environmental triggers, and abnormal immune responses play a role in the development of rheumatoid arthritis. Certain genes, such as HLA-DRB1, are associated with an increased risk of developing the condition. Environmental factors, such as smoking, hormonal changes, and certain infections, may also contribute to the development or progression of RA.

Diagnosis

Diagnosing rheumatoid arthritis involves a combination of medical history, physical examination, imaging tests, and laboratory tests. The criteria established by the American College of Rheumatology are commonly used to guide diagnosis. These criteria consider symptoms, duration of symptoms, and the presence of specific markers in the blood, such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Imaging tests, such as X-rays, ultrasounds, or magnetic resonance imaging (MRI), may be used to assess joint damage and monitor disease progression.

Treatment

The treatment of rheumatoid arthritis aims to reduce pain, inflammation, and joint damage, as well as improve joint function and quality of life. The management of RA often involves a multidisciplinary approach, including medications, physical therapy, lifestyle modifications, and regular follow-up with healthcare professionals.

Commonly used medications for RA include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These medications help reduce pain and inflammation.
• Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs, such as methotrexate, hydroxychloroquine, or sulfasalazine, are used to slow down the progression of RA and preserve joint function.
• Biologic Response Modifiers: These medications, such as tumor necrosis factor (TNF) inhibitors, target specific components of the immune system involved in RA.
• Corticosteroids: Short-term use of corticosteroids may be prescribed to reduce severe inflammation during flare-ups.

Physical therapy and exercise play a crucial role in managing rheumatoid arthritis. They help improve joint flexibility, strength, and function, and reduce pain. Assistive devices, such as splints or orthotics, may be recommended to support affected joints.

Complications and Outlook

Rheumatoid arthritis is a chronic condition that requires ongoing management. If left untreated or poorly controlled, it can lead to significant joint damage, deformities, and disability. Additionally, RA can affect other parts of the body, leading to complications such as:

• Rheumatoid Nodules: Firm lumps that develop under the skin, typically around pressure points.
• Cardiovascular Disease: Rheumatoid arthritis increases the risk of developing heart disease and stroke.
• Lung Complications: Inflammation in the lungs can lead to conditions such as interstitial lung disease or pleural effusion.
• Eye Problems: Dry eyes, inflammation of the sclera (scleritis), or damage to the cornea (keratitis) can occur in RA.

With early diagnosis, appropriate treatment, and ongoing management, individuals with rheumatoid arthritis can lead active lives with reduced pain and improved joint function.

See Also

• Autoimmune Disorders - Explore a group of conditions where the immune system mistakenly attacks healthy cells and tissues.
• Osteoarthritis - Learn about a common form of arthritis characterized by the breakdown of joint cartilage.