The autoimmune disease rheumatoid arthritis (RA) is caused by the body's immune system mistakenly attacking its own tissues, causing chronic inflammatory disease to affect the joints and other parts. As well as causing joint pain, swelling, stiffness, and deformity, RA can damage skin, eyes, the lungs, the heart, and blood vessels. It can reduce quality of life as well as increase complications and death risks.
There is no known cause for RA, but genetics and environment may be involved. People with certain genes may be more likely to develop RA, and some triggers, such as infections, stress, or smoking, may cause their immune system to attack their joints. This attack can result in inflammation that damages the synovium, which lines and lubricates the joints. It is possible for the damaged synovium to produce too much fluid, causing swelling and pain in the joints. The inflammation can also spread to other tissues and organs, resulting in further damage.
The symptoms of RA may vary from person to person, and may change over time. Some common symptoms include:
Joint pain, tenderness, swelling, and stiffness, especially in the morning or after a period of inactivity
Reduced range of motion and function of the affected joints
Fatigue, fever, and loss of appetite
Rheumatoid nodules, which are small lumps under the skin over bony areas
Dryness, redness, and inflammation of the eyes and mouth
Shortness of breath, chest pain, and coughing due to lung involvement
Anemia, which is a low number of red blood cells
Increased risk of infections, cardiovascular disease, and osteoporosis
RA usually affects the small joints of the hands and feet first, and then the larger joints, such as the wrists, elbows, shoulders, hips, knees, and ankles. RA usually affects the same joints on both sides of the body symmetrically, but it can also affect only one side or be asymmetrical.
Flares are episodes of increased disease activity and inflammation associated with RA that can last for days, weeks, or months. They may result from stress, infection, or other factors. Flares can be followed by periods of remission, in which symptoms are reduced or absent.
Physical examinations, medical histories, blood tests, and imaging tests can be used to confirm the diagnosis of RA and rule out other conditions. These tests may include:
Doctors will examine the joints for signs of inflammation, such as swelling, warmth, redness, and tenderness. They will also check for rheumatoid nodules and other skin changes.
The doctor will ask about the onset, duration, frequency, and severity of the symptoms, as well as if there are any family members with RA or other autoimmune diseases. Additionally, the doctor will ask about any medications, supplements, or lifestyle factors that may affect the condition.
A doctor will order blood tests to measure the levels of inflammation markers, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). As part of the RA diagnosis, the doctor will also examine the patient for antibodies such as rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP), which are produced by the immune system. These tests are not definitive, because not all people with RA have these antibodies, and some without RA may have them as well.
To visualize the joints and check for signs of damage, such as erosion, narrowing, or deformity, the doctor may order X-rays, ultrasound, or magnetic resonance imaging (MRI). Also, these tests can be used to monitor the progress and response to the treatment of the disease.
The goal of treatment is to reduce inflammation, relieve symptoms, prevent or slow down joint damage, and improve quality of life, but there is no cure for RA. There are a number of treatment options for RA, including medications, physical therapy, surgery, and lifestyle changes.
Medications: There are different types of medications that can be used to treat RA, depending on the severity and stage of the disease. Some of the common medications include:
The use of nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help reduce joint pain and inflammation. However, long-term use can cause stomach ulcers, bleeding, and kidney damage.
Inflammatory drugs such as corticosteroids, such as prednisone, can quickly alleviate the symptoms and prevent further damage to the joints. With long-term use, corticosteroids may cause weight gain, diabetes, osteoporosis, and infection risk.
It is possible to slow down the progression of the disease and prevent or reduce joint damage with disease-modifying antirheumatic drugs (DMARDs), such as methotrexate and sulfasalazine. Even so, DMARDs can have side effects, including liver damage, bone marrow suppression, and an increased risk of infection, and they may take weeks or months to work.
The newer types of DMARDs are biologics such as anakinra and tocilizumab, which target specific molecules involved in inflammation and the immune system. Although biologics are more effective and may have fewer side effects than traditional DMARDs, they can also be more expensive and may increase the risk of serious infections and allergies.
The goal of physical therapy is to improve the strength, flexibility, and function of the joints and muscles through an exercise program designed by a physical therapist. In addition to reducing pain, stiffness, and fatigue, exercise can improve mood and overall health. Assistive devices such as splints, braces, and canes can also be recommended by the physical therapist to reduce stress on the joints.
If the medications and physical therapy do not control the symptoms and prevent joint damage, surgery may be an option. A common surgical procedure for RA involves repairing or replacing damaged joints, tendons, or synovium, as well as restoring function and appearance. These procedures include:
Synovectomy, which is the removal of the inflamed synovium from the joint.
Tendon repair, which is the repair of the torn or ruptured tendons around the joint.
Joint replacement, which is the replacement of the damaged joint with an artificial one, usually made of metal and plastic.
Joint fusion, which is the joining of two bones in the joint to make it more stable and reduce the pain.
Lifestyle changes: There are some lifestyle changes that can help to manage RA and improve the quality of life. Some of the lifestyle changes include:
Eating a healthy and balanced diet that is rich in fruits, vegetables, whole grains, lean proteins, and healthy fats, and low in saturated fats, salt, sugar, and processed foods. A healthy diet can help to provide the nutrients and antioxidants that can support the immune system and reduce the inflammation. Some foods that may have anti-inflammatory properties include fish oils, olive oil, nuts, seeds, leafy greens, berries, ginger, and turmeric.
Avoiding smoking and excessive alcohol consumption, which can worsen the inflammation and increase the risk of complications, such as cardiovascular disease and osteoporosis.
Managing stress, which can trigger or aggravate the flares and affect the mood and well-being. Some ways to cope with stress include relaxation techniques, such as meditation, yoga, breathing exercises, or massage, hobbies, such as reading, gardening, or music, or support groups, such as online forums, counseling, or therapy.
Getting enough sleep, which can help to restore the energy and mood, and reduce the pain and inflammation. Some tips to improve the sleep quality include having a regular bedtime and wake-up time, avoiding caffeine, alcohol, and nicotine before bed, keeping the bedroom dark, quiet, and comfortable, and avoiding naps during the day.
It is possible to prevent or reduce damage and pain by protecting the joints. Using the stronger, larger joints to perform tasks, such as carrying a bag on the shoulder rather than your hands, using assistive devices, such as jar openers, electric can openers, or long-handled tools, to simplify daily activities, and avoiding repetitive or strenuous movements that can strain the joints are some ways to protect the joints.
There is no known way to prevent RA, but there are some steps that can help to reduce the risk or delay the onset of the disease. Some of the preventive measures include:
Avoiding or quitting smoking, which can increase the risk of developing RA, especially in people who have a genetic predisposition.
Maintaining a healthy weight, which can reduce the stress on the joints and lower the inflammation levels in the body.
Exercising regularly, which can help to keep the joints and muscles strong and flexible, and improve the blood circulation and immune function.
Getting regular check-ups and screenings.