Rheumatoid Arthritis
Disease Information
What is Rheumatoid Arthritis (RA)
- Rheumatoid Arthritis is a form of inflammatory arthritis and an autoimmune disease of the joints. RA occurs when the body’s immune system attacks the Synovium, the thin membrane that lines the joints, causing joint damage, pain, inflammation, stiffness, swelling, warmth, redness, loss of function and disability.
- The joints RA affects the most are the hands, wrists, elbows, knees, ankles, and feet. Usually both sides of the body are affected equally, meaning if one joint on one side of the body is affected, the same joint on the opposite side will also be affected. In some cases, RA can affect body parts aside from joints, including blood, lungs, eyes, and the heart.
- RA is a chronic disease which cannot be cured, however, with early diagnosis and continuous treatments the disease can be controlled. Proper treatment helps prevent joint destruction, organ damage and disability, and assist with managing the side effects of the disease.
Signs and Symptoms
The severity and duration of the symptoms varies depending on the person and may come and go without any warning. With RA there are periods of increased disease activity, referred to as flare-ups or flares, alternating with periods when the symptoms fade or disappear, called remission.
Symptoms of RA
- Pain and stiffness lasting for more than 1 hour in the morning or after a long rest. Joints may feel warm, tender, and stiff if not used for an hour.
- Joint inflammation in the joints closest to the hand as well as the neck, shoulders, elbows, hips, knees, ankles and feet. Affects the ability to go about daily activities.
- Symmetrical pattern of inflammation, meaning both sides of the body are affected equally.
- Chest pain when breathing.
- Eye burning, itching, and discharge.
- Loss of energy and appetite.
- Dry eyes and mouth from an associated condition known as Sjogren’s syndrome.
- Small, round Firm bumps, called Rheumatoid nodules, which grow beneath the skin on the elbow and hands. They can be felt, but are not painless.
- Fatigue, an occasional fever, and a sense of not feeling well.
Risk Factors
- Age – Can occur at any age however RA usually starts between the ages of 25 and 55
- Gender – Women get RA two and half times more than men and are more likely to have severe symptoms. RA affects more than one million Americans and of these 75% are women
- Family History – Having relatives with RA will increase the risk of getting the disease
- Genetics – For some people, genetic factors may be involved in determining whether they will develop RA
- Environmental – In people who have inherited a genetic tendency for the disease, RA can be triggered by an infection
Causes
Despite extensive research, the cause of Rheumatoid Arthritis is unknown. Many doctors, however, have concluded that a combination of genetic and environmental factors are responsible. Researchers have identified genetic markers that cause a greater probability of developing rheumatoid arthritis. These genes are associated with the immune system, chronic inflammation or the development and progression of RA. Still, not all people with these genes develop rheumatoid arthritis and not all people with the disease have these genes.
Researchers are also investigating infectious agents, such as bacteria or viruses, which may trigger the disease in someone with a genetic propensity for it. Other suspects include female hormones (70 percent of people with RA are women) and the body’s response to stressful events such as physical or emotional trauma. Smoking may also play a role – it not only boosts the risk of developing RA among people with a specific gene, it can also increase the disease’s severity and reduce the effectiveness of treatment.
Effects
Rheumatoid Arthritis can affect almost every part of the body and if left untreated it can worsen and destroy joints. After the onset of the disease, some of the effects are:
- Tendons becoming inflamed and tearing apart
- Swelling; which can damage or destroy ligaments that hold joints together
- Erosion of the bones of the joint
- Damage to lung tissue
- Spinal injury when the neck bones become damaged
- Inflammation of the blood vessels, which can lead to skin, nerve, heart, and brain problems
Diagnosis
Rheumatoid Arthritis can be difficult to diagnose in its early stages because only subtle symptoms may be present at the time; such as joint pain or some stiffness in the morning. Also, symptoms can be similar to other types of arthritis, joint conditions, or diseases and for this reason, patients should be evaluated by a Rheumatologist, a physician with the necessary skill and experience to reach a precise diagnosis and develop the most appropriate plan for managing care.
Doctors use a variety of tools to diagnose the disease and to rule out other conditions:
- Medical History – The doctor will ask about what symptoms the patient has been experiencing, when and how the symptoms started, and if the symptoms have changed over time. The doctor will also ask about any other medical problems the patient and family members have and any medications the patient is taking.
- Physical Examination – The doctor will complete a full physical examination of the patient checking reflexes, the skin for rashes, general health, and muscle strength. The doctor also examines bothersome joints and observes the patient’s ability to walk, bend, and carry out daily living activities.
- Laboratory Tests – Numerous lab tests are completed and may be useful in diagnosing Rheumatoid Arthritis including:
- Rheumatoid Factor (RF) - Testing for an antibody called the Rheumatoid Factor that is normally present in the blood of 70% - 90% of people with RA. Not everyone who has RA will test positive for this antibody or ever develop the disease and vice versa.
- Anti-CCP Antibodies – This test detects antibodies to Cyclic Citrullinated Peptide (Anti-CCP) and is positive in most people with RA. When used in conjunction with the RF test, its results are useful in confirming an RA diagnosis.
- Erythrocyte Sedimentation – This test measures the presence of inflammation in the body and people with RA normally have abnormally high rates of Erythrocyte Sedimentation.
- X-rays – X-rays are useful in determining the severity of the joint destruction, possibly ruling out other causes of joint pain, and may be used in monitoring the progression of the disease. However, X-rays are not useful in the early stages (3 to 6 months) of arthritis and may not show any abnormalities during this period. MRI’s and ultrasounds are also being used to help detect RA.
Treatment
It is important to get diagnosed early and to start treatment to prevent the disease from worsening. Doctors use a variety of approaches when treating Rheumatoid Arthritis, which, depending upon the patient, are used in different combinations and at various times during the course of the disease. RA usually requires lifelong treatment, including medications, physical therapy, education, routine monitoring and ongoing care, and possibly surgery. Talking to a doctor can help ensure that the necessary and proper treatments are administered and that the goals of the treatments are being reached.
References
1Arthritis Foundation. “Rheumatoid Arthritis Fact Sheet.”
2Arthritis Today Online Magazine. “Focus on Rheumatoid Arthritis.”
3Arthritis.com. “What is Rheumatoid Arthritis?”
4University of Maryland Medical Center. “Rheumatoid Arthritis.”
5Medline Plus Medical Encyclopedia. “Rheumatoid Arthritis.”
6American College of Rheumatology. “Rheumatoid Arthritis Fact Sheet.”
7National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Handout on Health: Rheumatoid Arthritis.”
