What is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic inflammatory disease in which the lining of your joints becomes inflamed, causing pain, swelling, and stiffness. It is an autoimmune disease because it occurs when your immune system, which normally fights against infection, starts destroying healthy joints. Severe rheumatoid arthritis can be very painful and even cause deformity in a joint. It also affects your ability to perform routine activities.
Causes of Rheumatoid Arthritis
In rheumatoid arthritis, the immune system attacks the synovium, the membrane that lines the joints. Why this happens is unclear. It could be genetic or triggered by a bacterial or viral infection. The inflamed and thickened synovium damages the cartilage and bone as well as the other structures surrounding and supporting the joint. There is weakening of the tendons and ligaments and eventually, the joint becomes deformed and out of alignment.
Rheumatoid arthritis can affect anyone, but it occurs more often in women, between the ages of 40 to 60, those who are obese and smokers.
Symptoms of Rheumatoid Arthritis
The symptoms of rheumatoid arthritis often affect the small joints of the hands and feet, and later spread to the larger joints such as the shoulders, elbows, hips and knees. Both sides of the body are usually affected. Symptoms include:
- Swelling, warmth and tenderness at the joints
- Joint stiffness that is worse in the morning, or after periods of rest or inactivity
- Weight loss
The symptoms may vary in severity. They sometimes flare up or worsen, and at other times, are controlled (in remission). Joint deformity occurs at a later stage.
Rheumatoid arthritis may also affect other structures of the body such as the skin, eyes, salivary glands, lungs, heart, blood vessels, bone marrow, kidneys and nerves.
Complications Associated with Rheumatoid Arthritis
If you have rheumatoid arthritis, you are more likely to develop the following conditions:
- Osteoporosis, both from rheumatoid arthritis as well as its treatment
- Infections due to an impaired immune system
- Heart problems due to inflammation of the surrounding membranes
- Lung disease due to inflammation and scarring of the lung tissue
- Carpal tunnel syndrome
- Tissue lumps or growths called rheumatoid nodules
- Increased body fat
- Blood cancers originating in the lymphatic system
Diagnosis of Rheumatoid Arthritis
To diagnose rheumatoid arthritis, your doctor will review your symptoms and medical history, and perform a physical examination of your joints as well as your reflexes and strength. Diagnosis is difficult in the early stages as there are no definitive tests or physical findings for rheumatoid arthritis, and symptoms may be common to other conditions.
Your doctor may order:
- Blood tests that detect inflammation in the body
- Imaging tests such as X-rays, ultrasound or MRI to view the joints and check the progress of the disease
Treatments for Rheumatoid Arthritis
Several treatment modalities are available for the management of rheumatoid arthritis including
- Medications: These include disease-modifying anti-rheumatic drugs (DMARDs), biologic agents (newer DMARDs), nonsteroidal anti-inflammatory drugs and steroids. The DMARDs reduce the body’s immune response against the joints whereas the NSAIDs and steroids reduce swelling and pain. Medications are combined for greater efficacy. If your disease is refractory to conventional DMARDs therapy, a rheumatologist would prescribe bDMARDs a special type of medication (infusions, under skin injections or tablets) as the most effective biological therapy against these rheumatological diseases.
- Physical therapy: Physical therapy exercises should be performed regularly to increase the strength of the muscles and flexibility of the joints. Transcutaneous electrical nerve stimulation (TENS) is a type of electrotherapy that is provided for pain relief.
- Occupational therapy: Occupational therapy helps you to perform daily activities at home and at work independently. Stress on the joints is minimized by modifying your movements or using adaptive equipment. It also helps you adapt to your condition using relaxation and stress-management techniques.
- Surgery: Surgical treatment is considered if you have severe rheumatoid arthritis and your symptoms do not improve with the conservative treatments. The benefits of surgery are pain relief and improvement in joint function. Surgical procedures include synovectomy (removal of inflamed synovial membrane), joint replacement, joint fusion and tendon repair.