What is Rheumatoid Arthritis (RA)?
Rheumatoid arthritis (RA) is categorized as an inappropriate immune system response, which normally acts to protect the body from infection and disease. The immune system attacks the membrane lining the joints (i.e. the synovium), causing inflammation, pain, stiffness, redness, swelling, and warmth in the affected joint. The joint may also lose its shape and be restricted in its movement.
RA commonly affects the small joints in the hands, feet and wrists, as well as the joints in the elbows, shoulders, hips, knees and ankles. Most often, RA affects the wrist and finger joints closest to the hand.
Unlike other types of arthritis, RA generally presents symmetrically, rarely occurring in a single knee or hand. RA is also dissimilar from other types of arthritis in that the disorder can affect the heart, lungs, blood, nerves, eyes, and skin. It can include systemic symptoms, including fatigue, fevers, and loss of appetite.
Who is affected by RA?
Roughly 0.6 percent of the adult U.S. population suffers from rheumatoid arthritis, reaching more than 1.5 million people. RA occurs in all races and ethnic groups, and is two to three times more common in women than in men.
Although statistically middle aged and older adults are more likely to be diagnosed with RA, young adults and older teenagers have also been diagnosed with RA. Children and younger teenagers who present with similar symptoms to RA can be diagnosed with juvenile idiopathic arthritis, which is thought to be related to rheumatoid arthritis.
What are the symptoms?
Morning stiffness is a prominent symptom of RA. People suffering from RA may also experience tender, warm, or swollen joints, as well as systemic symptoms like fatigue, fever, and weight loss.
Symptoms tend to progress slowly, occurring symmetrically in the same joints on both sides of the body, and have been known to vary in severity. Some people may experience alternative periods of flare-ups and relative remission, where symptoms intensify for a period of time and then may improve or resolve.
Roughly 40% of people who suffer from RA experience symptoms unrelated to the joints, affecting the skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow, and blood vessels. Although an acute onset of symptoms can occur, symptoms often occur insidiously and appear over a period of time.
What causes Rheumatoid Arthritis?
As an autoimmune disease, rheumatoid arthritis is caused when the immune system mistakes healthy tissue as a foreign invader. The immune system’s aberrant response causes inflammation in the joint synovium. The inflammation can cause the swelling, discomfort, and joint pain that is typical of RA.
While the exact cause of RA is unknown, there is evidence that autoimmune disorders can be influenced by genetic components and environmental factors. Incidents of RA have also been known to occur following vaccination. Women, people between the ages of 40 and 60, smokers, people who are overweight or obese, and emergency workers exposed to asbestos or silica may all be at increased risk of developing RA.
How is it diagnosed?
In making a clinical diagnosis of RA, medical professionals review medical history, conduct physical examinations, and often order laboratory and imaging tests. Physicians may order a variety of blood tests to support diagnosis, including tests for rheumatoid factor (RF), anti-CCP antibodies, white blood cell count, anemia, erythrocyte sedimentation rate, and c-reactive protein.
Imaging tests, such as x-rays, MRIs, and ultrasounds may also aid in providing a diagnosis for more developed cases, as they can reveal the degree to which the joints have been damaged, and can help to monitor the progression of the disease.
How is it treated?
As there currently is no cure for rheumatoid arthritis. The main goal of treatment is to improve the feel and swelling of the joints, as well as the ability to complete day-to-day activities.
Thanks to medical advancements over the past 30 years, current treatments allow most patients relief of symptoms and keep them functioning at normal levels. When symptoms are completely controlled, the disease is in “remission.” Initiating treatment as early as possible helps to prevent lasting or permanent damage to affected joints.
Many physicians may begin treatment with disease-modifying antirheumatic drugs, or DMARDs. Often prescribed in tandem with nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, DMARDs work to both relieve symptoms and slow the progression of joint damage.
Patients with more serious cases of rheumatoid arthritis may be prescribed medications known as biologic response modifiers or biological agents. These medications block the immune system response, cutting off the signals that lead to inflammation and damage of the joint tissue.
In addition to medication, routine follow-up with a rheumatologist is essential to tracking the course of the disease, as well as repeat laboratory testing and imaging. Patients may also benefit from appointments with physical and occupational therapists.
What are the complications of RA?
Patients who have been diagnosed with rheumatoid arthritis find themselves at greater risk for developing osteoporosis, rheumatoid nodules, carpal tunnel syndrome, heart problems, lung disease, and lymphoma. In addition, people suffering from RA are more prone to infections, dry eyes and mouth, and a disproportionate fat to lean mass ratio.
Living with Rheumatoid Arthritis
Rheumatoid arthritis is an ongoing disease, with active periods of pain and inflammation, known as flares, alternating with periods of remission, when pain and inflammation recede. Fortunately, research in recent years has led to a new understanding of RA, resulting in treatments allowing most people to lead active and productive lives.