What is rheumatoid arthritis (RA)?
Rheumatoid arthritis is a chronic inflammatory disorder that can impact more than just your joints. In some people, the precondition can harm a variety of body systems, including the skin, eyes, lungs, and heart, and blood vessels. An immune system issue, rheumatoid arthritis inflammation happen when your invulnerable framework erroneously assaults your body’s tissues.
In contrast to the mileage from osteoporosis, rheumatoid arthritis inflammation impacts the covering of your joints, causing agonizing expansion that can at long last prompt bone erosion and joint deformation.
The aggravation related to rheumatoid arthritis inflammation is the thing that can harm different pieces of the body too. While new kinds of drugs have greatly improved treatment options, acute rheumatoid arthritis can cause physical disabilities.
Symptoms of rheumatoid arthritis
Rheumatoid arthritis is a chronic disease characterized by symptoms of inflammation and pain in the joints. These indications and signs happen during periods known as flares or intensifications. Other times are known as periods of remission when symptoms completely disappear.
While symptoms of rheumatoid arthritis can affect several organs in the body, symptoms of rheumatoid arthritis include:
- Joint pain
- Joint swelling
- Joint stiffness
- Loss of joint function and deformities
Symptoms can vary from mild to severe. It’s significant not to disregard your manifestations, regardless of whether they travel every which way. Knowing the early signs of rheumatoid arthritis will help you and your healthcare provider better treat and manage it.
Causes of rheumatoid arthritis
RA is an autoimmune disease. Your immune system, like bacteria and viruses, is supposed to attack foreign bodies in your body by causing inflammation. In autoimmune disease, the immune system mistakenly sends inflammation to healthy tissues. The immune system causes a lot of inflammation to be sent to your joints causing joint pain and swelling.
If the inflammation persists for an extended period of time, it can damage the joint. Usually, this damage cannot be reversed once it has occurred. The cause of rheumatoid arthritis is unknown. There is evidence that autoimmune diseases run in families. For example, some of the genes you were born with may make you more likely to develop rheumatoid arthritis.
Risk factors of rheumatoid arthritis
According to the Arthritis Foundation, women get rheumatoid arthritis two to three times more often than men. In women, symptoms tend to appear between the ages of 30 and 60, while men often develop symptoms later in life. There may also be a genetic basis for the disease. Cigarette smoking and periodontitis are also risk factors.
Diagnosis of rheumatoid arthritis
In its early stages, rheumatoid arthritis can be difficult for a doctor to diagnose because it can resemble other conditions. However, early diagnosis and treatment are essential to slow disease progression. The CDC recommends an effective diagnosis and treatment strategy to begin within 6 months of symptoms appearing.
The doctor will look at the person’s clinical signs of inflammation and ask how long they have been there and how severe the symptoms are. They will also perform a physical examination to check for any swelling, functional limitations, or deformity. They might recommend some tests.
- Erythrocyte sedimentation rate (ESR or sed rate): This test measures levels of inflammation in the body. It measures how quickly red blood cells in a test tube separate from blood serum over a specified period. If the red blood cells rapidly settle into deposits, levels of inflammation are elevated. This test is not specific to RA and is a useful test for inflammatory conditions or other infections.
- C-reactive protein (CRP): The liver produces C-reactive protein. A high CRP level indicates inflammation in the body. This test is not specific to RA and CRP can occur in inflammatory conditions or other infections.
- Anemia: Many people with rheumatoid arthritis also have anemia. Anemia happens when there are too scarcely any red platelets in the blood. Red platelets convey oxygen to the tissues and organs of the body.
- Rheumatoid factor: If an antibody known as a rheumatoid factor is present in the blood, it can indicate the presence of rheumatoid arthritis. However, not everyone with rheumatoid arthritis is positive for this factor.
Imaging scans and X-rays: An X-ray or MRI of the joint can help the doctor determine the type of arthritis present and monitor the progression of rheumatoid arthritis over time.
Diagnostic criteria: In 2010, the American College of Rheumatology recommended the following criteria for diagnosing rheumatoid arthritis:
- Swelling is present in at least one joint, and it has no other cause
- Results of at least one blood test indicate rheumatoid arthritis
- Symptoms have been present for at least 6 weeks
Treatment for rheumatoid arthritis
The goals of treating rheumatoid arthritis are:
- Control of patient signs and symptoms
- Prevent joint damage
- Maintaining the patient’s quality of life and ability to function
Joint harm, by and large, happens inside the initial two years of determination, so it is critical to analyze and treat rheumatoid joint pain in a “window of opportunity” to forestall long-haul outcomes.
Treatments for rheumatoid arthritis include medication, rest, exercise, physical therapy / occupational therapy, and surgery to correct the damage to the joint.
The type of treatment depends on many factors, including the person’s age, general health, medical history, and the severity of arthritis.
Non-drug therapy is the first step in treatment for all people with rheumatoid arthritis. Non-drug treatments include the following:
Rest: When joints become inflamed, the risk of injuring the joint and nearby soft tissue structures (such as tendons and ligaments) is high. This is why sore joints should be relieved. However, fitness should be maintained as much as possible. Maintaining a good range of motion in your joints and good overall fitness is important in dealing with the general features of the disease.
Exercise: Pain and stiffness often cause people with rheumatoid arthritis to become lethargic. However, inactivity can lead to loss of joint mobility, cramps, and loss of muscle strength. These, in turn, reduce joint stability and increase fatigue.
Regular exercise, especially in a controlled way with the help of physical therapists and occupational therapists, can help prevent and reverse these effects. Useful exercises include a range of motion exercises to maintain and restore joint mobility; Exercises to increase strength, and; Exercises to increase endurance (walking, swimming, cycling).
Physical and occupational therapy: Physical and occupational therapy can relieve pain, reduce inflammation, and help maintain joint structure and function for rheumatoid arthritis sufferers. Certain types of treatment are used to treat specific problems of rheumatoid arthritis:
- Heat or cold can relieve pain or stiffness
- Ultrasound can help reduce inflammation of the sheaths surrounding the tendons (tendinitis)
- It can improve exercise and maintain joint range of motion
- Resting and splinting can help reduce joint pain and improve joint function
- Finger bracing and other assistive gadgets can forestall deformations and improve handwork
- Relaxation techniques can relieve secondary muscle spasms
Occupational therapists also focus on helping people with rheumatoid arthritis to continue to actively participate in work and leisure activities, with special attention to maintaining the good function of the hands and arms.
Nutrition and dietary therapy: Weight reduction might be prescribed for overweight and hefty individuals to diminish weight on aroused joints. People with rheumatoid arthritis are more likely to have coronary artery disease. High blood cholesterol (a danger factor for coronary supply route malady) can react to changes in diet. A nutritionist can recommend specific foods to eat or avoid in order to reach your desired cholesterol level.
Diet changes have been investigated as treatments for rheumatoid arthritis, but no diet has been proven to treat it. There are no herbal or nutritional supplements, such as cartilage or collagen, that can treat rheumatoid arthritis. These treatments can be dangerous and are not usually recommended.
There are many medications to reduce joint pain, swelling, and inflammation and prevent or slow the disease. The type of medication your doctor recommends will depend on the severity of your arthritis and how well you respond to the medications.
These include medicines:
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen
- Corticosteroids (oral and injection forms)
- COX-2 inhibitor (celecoxib [Celebrex®])
- Disease-modifying antirheumatic drugs (DMARDs) such as hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex, Trexall), sulfasalazine, and leflunomide
It may take four to six weeks of treatment with methotrexate, one to two months with sulfasalazine, and two to three months with hydroxychloroquine to see improvement in symptoms.
- Biological agents, such as infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab (Cimzia), golimumab (Simponi), tocilizumab (Actemra), rituximab (Rituxan), abatacept (Orencia) ), anakinra (Kineret), tofacitinib (Xeljanz)
Biology tends to work quickly, within two weeks for some drugs and within four to six weeks for others. Biopharmaceuticals may be used alone or in combination with other disease-modifying drugs. It is usually intended for patients who do not respond adequately to DMDs, or if a patient’s disease prognosis (outlook) is a problem.
Other precautions to be noted with these medications:
- Cancer-modifying medications and biological agents interfere with the immune system’s ability to fight infection and should not be used by people with serious infections.
- Anti-TNF agents such as infliximab, etanercept, adalimumab, certolizumab, and golimumab are not recommended for people with lymphoma or who have been treated for lymphoma. People with rheumatoid arthritis – especially those who are very ill – have an increased risk of developing lymphoma, regardless of the treatment used. Anti-TNF agents were associated with a further increase in the risk of developing lymphoma in some studies but not in others. More research is needed to determine this risk.
- Tuberculosis (TB) test is required before starting anti-TNF treatment. People with evidence of TB should be treated earlier than TB because there is an increased risk of developing active TB while receiving anti-TNF treatment.
Some of these medicines are traditionally used to treat other conditions, such as cancer, inflammatory bowel disease, and malaria. When these medications are used to treat rheumatoid arthritis, doses are much lower and the risks of side effects tend to be much lower. However, the risks of side effects from treatment must be weighed against the benefits on an individual basis.
Whenever you have prescribed any medication, it is important to meet your doctor regularly so that he can monitor for any side effects.
When bone damage from arthritis becomes severe or pain is not controlled with medications, surgery is an option to restore function to the damaged joint.
Complications of rheumatoid arthritis
Since rheumatoid arthritis is a systemic disease, its inflammation can impact organs and areas of the body other than the joints.
- The inflammation of the eye and mouth glands associated with arthritis can cause dryness in these areas and is referred to as Sjogren’s syndrome. Dry eyes can erode the cornea.
- Inflammation of the white parts of the eye (sclera) is referred to as scleritis and can be very dangerous to the eye.
- Rheumatoid inflammation of the lining of the lung (pleuritis) causes chest pain accompanied by deep breathing, shortness of breath, or coughing. The lung tissue itself can become inflamed and scarred, and sometimes inflammatory nodules (rheumatic nodules) develop inside the lungs.
- Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause chest pain that usually changes in intensity when lying down or bending forward.
- Rheumatoid arthritis is associated with an increased risk of a heart attack.
- Rheumatoid disease can decrease the number of red blood cells (anemia) and white blood cells.
- Decreased white cells can be associated with an enlarged spleen (referred to as Felty’s syndrome) and can increase the risk of developing infections.
- The risk of developing lymphoma (lymphoma) is higher in patients with rheumatoid arthritis, especially those with persistent active arthritis.
- Hard lumps or hard bumps under the skin (subcutaneous nodules called rheumatic nodules) can occur around the elbows and fingers where there is repeated pressure. Although these nodules usually do not cause symptoms, they can sometimes become infected.
- Nerves in the wrists can become pinched to cause carpal tunnel syndrome.
- Inflammation of the blood vessels (vasculitis) is a rare serious complication, usually with chronic rheumatoid disease. Vasculitis can impair blood flow to tissues and lead to tissue death (necrosis). This often appears initially as small black areas around the nail bed or as leg sores.