Rheumatoid Arthritis

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Rheumatoid Arthritis

Overview

Tips and Extra Resources

OverviewOverview

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that primarily affects the joints. Unlike the wear-and-tear damage of osteoarthritis, RA affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity. It can affect more than just your joints, potentially causing numerous medical issues in various parts of the body.

The most common areas impacted by RA include the hands, wrists, and knees. The inflammation caused by RA can damage other parts of the body as well. Early and aggressive treatment is recommended to ultimately control the disease and to prevent complications associated with RA.

Risk Factors

Several risk factors are associated with the development of RA. Understanding these can help individuals assess their risk and seek medical advice if necessary.

Gender: Women are more likely than men to develop rheumatoid arthritis.
Age: While rheumatoid arthritis can occur at any age, its most common onset is between the ages of 40 and 60.
Family History: If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
Smoking: Cigarette smoking increases the risk of developing RA, especially if you have a genetic predisposition to the disease.
Obesity: Being overweight or obese can increase the risk of developing RA, particularly in women aged 55 and younger.

Causes

The exact cause of RA is not known, but several factors may contribute to the development of the disease. It's believed that rheumatoid arthritis occurs as a result ofan immune system dysfunction, where the immune system attacks the synovium—the lining of the membranes that surround the joints.

Several factors contribute to this malfunction, including:

Genetic factors: Certain genes, such as HLA-DR4, have been linked to an increased risk of developing rheumatoid arthritis.
Environmental triggers: Certain environmental factors like infections may trigger the disease in people who have a genetic predisposition.
Hormonal factors: Hormones that control and regulate the immune system may also be involved.

Signs and Symptoms

RA often starts subtly and gradually; however, as the disease progresses, the signs and symptoms can become more pronounced. The following are the most common signs and symptoms associated with RA:

Joint pain, tenderness, swelling, or stiffness that lasts for six weeks or longer
Morning stiffness that lasts for 30 minutes or longer
More than one joint is affected
Small joints (wrists, certain joints in the hands and feet) are typically affected first
Same joints on both sides of the body are affected (symmetrical pattern)
Fatigue, loss of appetite, and low-grade fever

Diagnosis and Tests

Early diagnosis and treatment are crucial for managing RA effectively. Physicians use a combination of methods to diagnose the disease, including:

Medical History and Physical Examination: A comprehensive medical history and thorough physical examination to evaluate symptoms and joints.
Blood Tests: Blood tests to check for inflammation markers (like ESR or CRP) and the presence of antibodies such as rheumatoid factor (RF) and anti-CCP.
Imaging Tests: X-rays, MRI, or ultrasound to detect joint damage and inflammation.

Treatments

Although there is no cure for RA, various treatments can help manage symptoms and improve the quality of life. The treatment plan usually involves a combination of medication, lifestyle changes, and other supportive measures.

Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, disease-modifying antirheumatic drugs (DMARDs), and biologic agents. These include methotrexate, hydroxychloroquine, anakinra, sulfasalazine, abatacept, tocilizumab, and rituximab. Approved tumor necrosis factor (TNF) inhibitors include etanercept, adalimumab, infliximab, certolizumab pegol, and golimumab.
Physical Therapy: Exercise programs designed by a physical therapist to improve and maintain joint flexibility and strength.
Surgery: When joint damage is severe, surgical options such as joint replacement, joint fusion, and synovectomy may be considered.
Lifestyle Changes: Adopting a healthy diet, maintaining a balanced weight, and avoiding activities that strain the joints.

The American College of Rheumatology guideline for the treatment of RA strongly recommends the use of methotrexate as an initial treatment for patients who previously did not receive a disease-modifying therapy and who have moderate to high disease activity, over options including DMARDs and biologic therapies.

Tips and Extra Resources

Living with RA can be challenging, but several strategies can help manage the condition and enhance your daily life. Consider these tips:

For more information, consider the following resources:

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