Published on Jul 03, 2019 and last reviewed on Jun 30, 2020 - 5 min read
Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation and pain in the joints throughout the body
Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation and pain in the joints throughout the body. It is a long-term and disabling disease.
This disease usually affects the joints of the hands and feet first, and if one side of the joint is affected, it is most likely to affect the joint on the other side also.
The common types of RA are:
Seropositive rheumatoid arthritis - 60 to 80 % of patients test positive for antibodies called anti-cyclic citrullinated peptides (anti-CCPs) or rheumatoid factor (RF).
Seronegative rheumatoid arthritis - Patients test negative for anti-CCPs and rheumatoid factors but still show symptoms of RA.
The immune system prevents diseases by attacking the virus or bacteria or any foreign objects that enter the body. When this immune system starts identifying the cells of the body as foreign objects, they start attacking them, which leads to autoimmune disorders or diseases.
The signs of rheumatoid arthritis are:
Pain, tenderness, stiffness, swelling, redness, and warmth on involved joints, usually in a symmetrical manner.
Walking with a limp.
Loss of joint function.
Small joints like the joints in the fingers and toes are usually affected first. In the later stages, it spreads to the wrist, knee, ankle, hips, shoulders, and elbows.
The symptoms aggravate during periods known as flares, and during the remission period, the symptoms disappear. The symptoms can be mild to severe for different patients.
When the immune system attacks the membrane lining the joints (synovium), it leads to inflammation and thickening of the synovium. This inflammation eventually affects the cartilage and bone in the joint. The tissues that hold the bones in the joint together (ligaments and tendons) stretch and weaken, making the joints lose their shape and alignment.
The three phases in which RA progresses are:
Chronic inflammatory phase.
Factors that increase the risk of an individual acquiring RA are:
Age - Its onset is highest in older adults (60 years and above), but it can begin at any age.
Sex - Women are two-to-three more prone than men.
Women who have never given birth.
Children of mothers who smoked while pregnant.
Genetics - Individuals born with the HLA (human leukocyte antigen) gene are more susceptible. This, along with exposure to environmental factors, can increase the risk of RA.
Stage 1 -Early Stage Rheumatoid Arthritis - Joint pain, stiffness, or swelling. No damage to the bones and only the tissue lining the joint (synovium) is inflamed.
Stage 2 - Moderate Stage Rheumatoid Arthritis - The joint cartilage gets damaged due to inflammation of the synovium. This results in joint pain and loss of mobility.
Stage 3 - Severe Stage Rheumatoid Arthritis - In this stage, the bone also gets damaged. This results in severe pain and swelling, more loss of mobility, and bone deformity.
Stage 4 - End-stage Rheumatoid Arthritis - The joints do not work, resulting in pain, stiffness, swelling, and loss of mobility. The bones might also fuse together (ankylosis).
It has been noted that people with RA commonly develop the following conditions:
Osteoporosis - The bone becomes porous and prone to fractures.
Rheumatoid nodules - Firm lumps under the skin near the joints that are affected by RA.
Sjogren’s syndrome - An autoimmune condition where the cells of the immune system attack the glands that produce tears and saliva.
Atherosclerosis - A condition where fat or plaque builds up inside the arteries.
Lymphoma - A type of cancer that originates in the lymphocytes.
Carpal tunnel syndrome - Otherwise called median nerve compression, results in pain and numbness in the hand and arm.
Cervical myelopathy - It is a degenerative condition that results from compression of the spinal cord.
Depression and anxiety.
Diagnosis of RA needs a lot of blood tests and imaging. If you have symptoms of RA, consult a rheumatologist. The doctor will ask you about the symptoms you are having and will conduct a few physical examinations. The doctor will look for redness, tenderness, and warmth in the affected joint. To rule out all other causes and to check the damages done to your bones, he or she might order some blood and other tests.
You might have to get the following tests done:
Blood test - A blood test is done to look for the presence of rheumatoid factor and anti-CCP antibodies. C-reactive protein and erythrocyte sedimentation rate (ESR) are also elevated in RA patients.
Imaging tests - X-rays, MRI, and ultrasound are done to see the progression of the disease.
Starting medicines early keep the disease in remission period. The treatment options include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) - Ibuprofen and Naproxen sodium to reduce pain.
Corticosteroids - Prednisone helps reduce inflammation and slows the progression of joint damage.
Disease-modifying antirheumatic drugs (DMARDs) - Methotrexate, Leflunomide, and Sulfasalazine reduces the progression of this disease.
Biologic response modifiers - Abatacept, Adalimumab, Infliximab, Rituximab, Etanercept, etc., are a new class of DMARDs.
An occupational therapist will teach exercises to make your joint more flexible and easier ways to do day-to-day activities.
In case your symptoms are not getting better with medicines and therapies, your doctor might suggest you undergo the following surgeries to repair damaged joints:
Synovectomy - The inflamed synovium is removed.
Tendon repair - The inflamed and loosened or ruptured tendons are repaired.
Joint replacement - Damaged joints are replaced by prostheses.
Joint fusion - When replacement cannot be done, the joints are fused together to reduce pain.
Perform regular gentle exercises like walking, swimming, water aerobics, etc.
Apply heat and cold compressions.
Manage stress through yoga and meditation.
Diet might not help treat RA, but some food items might cause flares, and others might help reduce inflammation.
Foods to avoid:
Fried and processed food.
Too much salt and sugar.
Food to eat:
If your symptoms are suggesting arthritis or are getting worse, consult an experienced rheumatologist online. You can ask queries or do phone or video consultation, which will help find the best treatment option for you.
If identified early and palliative care is started, rheumatoid arthritis patients can expect a normal life span. But patients who develop complications like atherosclerosis, cirrhosis, etc., the life expectancy shortens roughly by 10 to 15 years.
It is a chronic and debilitating disease. RA causes inflammation of the joints and other symptoms, which can be managed with the help of medicines and therapies. But, RA patients develop several severe complications, which can also be fatal.
The 4 stages of progression of RA are:
- Stage 1 - The immune system attacks the joint tissue.
- Stage 2 - The body starts producing antibodies, which results in inflammation of joints.
- Stage 3 - This inflammation makes the joints to bend and fingers to get crooked.
- Stage 4 - If left untreated, the joint is destroyed and bones in the joint get fused.
The first signs of RA usually begin at around 20 to 30 years of age.
If RA is not detected and treated early, it can lead to a lot of complications like:
- The cartilage and bone in the joint are damaged or destroyed, which can lead to joint deformities.
- Loss of joint function and disability.
- Coronary artery disease.
The period when there is increased disease activity, which causes severe joint pain and stiffness, is called a flare-up. RA patients suffer from flare-ups on and off throughout their lives.
The final stage or end-stage of rheumatoid arthritis is when the inflammation process destroys the bones and cartilages in the bone. It results in permanent deformation and loss of joint function.
Join pain and stiffness can increase at night. This is because joint pain interferes with sleep, which makes you stressed and depressed, which in turn makes the pain worse.
RA flare-up can result from a number of triggers like:
- Emotional stress.
- Food allergens.
- Environmental factors.
As of now, there is no medicine that can cure rheumatoid arthritis. The drugs that are used to manage this condition help ease symptoms, stop joint damage, and keep it in remission.
RA is not caused by stress, but too much stress is linked to worsening of symptoms.
There are various types of arthritis like osteoarthritis, rheumatoid arthritis, gout, psoriatic arthritis, etc., and all of them cause different types of pain. Depending on the cause and severity, all types of arthritis are painful.
Vitamins and supplements that help manage joint pain and inflammation are glucosamine, omega-3 fatty acids, and vitamin D.
Exercises that can relieve joint pain and stiffness are:
- Tai chi and Yoga.
- Swimming and water aerobics.
- Strength training.
Depending on the severity and triggers, RA progression can take months or years.
Yes, walking helps relieve pain and stiffness. It is a low-impact form of exercise, which helps maintain the heart and joint health.
Query: Hi doctor, Six months back, I had an echocardiogram and a CT angiogram. My initial troponin T level was 0.44. After six hours it dropped back down to below 0.10. My test results from the CT angiogram were normal and the calcium level was 0. My echo was also normal. I wore a monitor for seven days an... Read Full »
Query: Hello doctor, My primary care physician said that I may have RA. My ESR rate was 27, my CRP was 14.1 and my CCP antibody IgG was 500. What does this mean? I have heard a high CCP result could indicate more aggression in my RA, if that is what I have. Read Full »
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