Rheumatoid arthritis

Description of Rheumatoid arthritis

 
Definition
 
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects the joints. It is a chronic disease that gradually worsens with time, causing inflammation in the joints and resulting in painful deformity and immobility. It especially affects small joints of the fingers, wrists, feet, and ankles.
 
Causes and Risk Factors
 
While the exact cause is still unknown, it is believed to be caused by a combination of these factors:
1. Genetic factors: RA is hereditary in nature. Certain genes have been identified that increase the risk for RA.
2. Environmental factors: Certain environmental factors play a major role. These include smoking, exposure to silica, insecticides, and air pollution
3. Infections: Certain bacteria, viruses, and fungi are believed to increase the risk of RA.
4. RA is an autoimmune disorder where the immune system starts attacking our own body. The antibodies present in bloodstream target body’s own tissues and this results in inflammation.
5. RA is three times more common in women as compared to men. The prevalence rate increases after the age of 40 years.
6. A strong family history of RA increases the chances of a person being diagnosed with it.
 
Signs and Symptoms
 
1. RA is a systemic disease, which means that the inflammation can affect other organs too apart from joints.
2. RA generally starts with tenderness and pain in small joints simultaneously in both right and left sides followed by stiffness or swelling which limits joint movement.
3. Small joints of hand, feet, and neck are commonly involved. Some people may also experience loss of appetite, fever, rash, and fatigue.
Typically, the symptoms subside and flare-up alternatingly over weeks to a month. So, there might be a symptom-free period for months followed by a sudden flare-up.
 
Investigations
 
1. Diagnosis of RA is mainly through a detailed history of signs and symptoms, examination followed by x-rays and confirmatory blood tests.
2. In the blood test, testing for the presence of rheumatoid factor (RF) and anticitrullinated protein antibody (ACPAs) is done.
3. Other tests like ESR, C-reactive protein, kidney function, liver test, and full blood count are also performed.
 
Treatment
 
Treatment of RA involves one or more of the following drugs based on severity of the symptoms,
1. Medications: Analgesics such as NSAIDS (nonsteroidal anti-inflammatory drugs) and DMARDs (disease modifying anti-rheumatic drugs) are used to treat the pain and inflammation, and decrease joint damage.
2. Surgery: Synovectomy, i.e., removal of the damaged joint lining is performed to give relief. At a later stage, joint replacement surgery might be needed.
3. Physiotherapy: Physiotherapy is recommended to keep joints supple and flexible. Regular exercise is a must to maintain overall physical function. Hot water bag or electric heating bags can be used to give temporary relief from joint pain and swelling on a daily basis.
4. Diet: A diet rich in omega-3 fatty acid and gamma-linolenic acid have proved to reduce joint pain, tenderness, and stiffness.
 
Complications and When Should You See a Doctor
 
Inflammation at a later stage can affect other organs in our body. Signs and symptoms related to other organs due to RA:
1. Lungs: Inflammation of the membrane that surrounds the lung can lead to shortness of breath.
2. Heart: Inflammation around the heart which can cause chest pain.
3. Eyes: Inflammation of glands of eyes which can result in pain, redness, and sensitivity to light.
4. Blood: Lowers red blood cell count and leads to anemia
5. Skin: Rheumatoid nodules (firm lumps that form under the skin close to the affected joints. Size may be variable (from pea-sized to walnut-sized), RA is also known to increase the chances of skin cancer in patients.

Frequently Asked Questions about Rheumatoid arthritis

Rheumatoid arthritis is treated with pain killers like NSAIDs to relieve joint pain and swelling. Drugs called DMARDs too are used to control the course and worsening of symptoms over years e.g. methotrexate.
Unfortunately, rheumatoid arthritis is not curable. However, it can be managed well with medicines and exercise. Drugs like methotrexate and NSAIDs like ibuprofen are used to control the symptoms.
Yes. Rheumatoid arthritis is an autoimmune disease. This means the cells of our own immune system start damaging the cells of the body e.g of the joints, lungs, etc. causing inflammation and symptoms.
No. Rheumatoid arthritis is an autoimmune disease and occurs because of factors within the body. It cannot be acquired from another person via a bacteria, virus or any infectious agent.
Yes. Rheumatoid arthritis has a strong genetic link. If parents, grandparents or siblings have the disease, there is a high risk of you being diagnosed with it in the future.
No. Rheumatoid arthritis does affect vital organs like lungs and heart over course of time, but it is unlikely to cause death if managed well with medications.
Yes. Rheumatoid arthritis can affect the white of the eye i.e. sclera causing redness and inflammation i.e. scleritis. This can also cause watering of the eyes and pain.
Yes. Rheumatoid arthritis progresses in a wave-like pattern. Patients often experience symptom-free period called remission for weeks to months followed by a flare up in which the symptoms reappear.
Yes. Rheumatoid arthritis can often make you feel tired and weak. As it causes inflammation within joints and other organs, it can cause fatigue without any apparent cause.
Yes. Rheumatoid arthritis can cause muscle pain (myalgia) as a result of general inflammation occurring in the body.

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