Described as a chronic auto immune disease,
rheumatoid arthritis causes inflammation of the joints and tissues of the body.
It may cause pain, swelling, stiffness and loss of function in your joints.
Rheumatoid arthritis can produce diffuse
inflammation in the lungs, pericardium, pleura, sclera, and nodular lesions and
in subcutaneous tissues under the skin. The symptoms of rheumatoid arthritis
are recurring. In certain cases, it may lead to long-term joint damage,
resulting in chronic pain, loss of function and disability. Rheumatoid
arthritis affects approximately 1% of the adult population. It is found that
more women than men are affected with rheumatoid arthritis.
Causes of rheumatoid arthritis
Though the exact cause of rheumatoid arthritis is
not clear, research indicates that rheumatoid arthritis might be the result of
bacterial, viral or fungal infection that triggers auto immune response. Other
possible factors that might contribute to the occurrence of rheumatoid
arthritis include heredity and hormones. Environmental factors like smoking
tobacco are also found to increase the risk of developing rheumatoid arthritis.
It is also said that rheumatoid is the result of
autoimmunity. To understand autoimmunity, we need know the working of our
immune system. The human immune system contains cells and proteins that fight
infections. Auto immune disease is the result of failure in the immune system
wherein it fails to recognize part of our body that is affected by virus and
Though rheumatoid arthritis affects other
tissues, the principal target is synovial membrane (synovium) that secrets
synovial fluid to the joints. The fluid, also termed as joint fluid, lubricates
and nourishes the joint. When the membrane is affected or destroyed, it becomes
inflamed and can thicken and erode. As a result, the synovial fluid is also
destroyed and is not secreted in the joints. In certain cases, the structures
surrounding the joints also get affected thus leading to joint deformities.
Symptoms of rheumatoid arthritis
Rheumatoid arthritis is generally characterized
by pain in one or many joints of the body. For instance, one can feel the pain
as well as swelling both wrists. Hand joints like knuckle joints, and wrists,
elbows, knees, ankles, feet and larger joints like shoulders, hips, and jaw are
often affected by rheumatoid arthritis. People who suffer from the condition
for many years might feel stiffness in the vertebrae of the neck.
Rheumatoid arthritis often occurs in a
symmetrical pattern affecting different joints on both sides of the body. The
general joint symptoms of rheumatoid arthritis include
Stiffness resulting in the inability to move the
joints. Some may feel the stiffness in the joints soon after they wake up that
does not subside for more than 30 minutes.
- Inflammation causing redness, tenderness and warmth in
the affected area/joint
- Swelling or puffiness around the affected joint
- Nodules or hard bumps might appear on or near the
joint, especially near the elbows.
- Pain because of inflammation or swelling of the joint.
Pain might also occur from working the joint too hard.
Other than joint symptoms, the normal symptoms
associated with rheumatoid arthritis include the following
loss of appetite
muscle aches and
weakness or loss of energy
Rheumatoid arthritis may also trigger the
following condition in certain people.
Inflammation / dryness of the glands of the eyes and
mouth resulting in Sjogren's syndrome
Pleuritis, inflammation of the lung lining resulting in
chest pain with deep breathing, shortness of breath or coughing.
Nodule inflammation of the lungs
Pericardium, inflammation of the tissue surrounding the
heart called pericarditis. This can cause chest pain that changes in intensity when
lying down or leaning forward.
Anemia, decreased number of red blood cells
Felty's syndrome that appears because of decrease in
the white blood cells.
Tiny black areas around the nail beds or leg ulcers
resulting in vasculitis, a very rare condition that impairs blood supply to
tissues and leads to tissue death (necrosis).
There is no single proven method to diagnose
rheumatoid arthritis. The physician performs a variety of tests to confirm that
you have rheumatoid arthritis and plans for a treatment accordingly. This might
include all or any one of the following
Medical History : The doctor checks whether you have history of joint aches, or
joint stiffness. This might be done through a Health Assessment Questionnaire
(HAQ) and the Arthritis Impact Measurement Scales (AIMS).
Physical Exam : The physician might perform physical examination like checking the
joints for swelling or tenderness, motion of the joints, and mal alignment of
the joints. He/She might also check for symptoms in other organs like skin,
lungs, and eyes.
Lab Tests : Lab test is prescribed in cases where the diagnosis becomes difficult
through physical examination. These tests might include complete blood count
test, Erythrocyte Sedimentation Rate (ESD or sed rate), C-Reactive Protein,
Rheumatoid Factor, and Antinuclear antibodies (ANA).
Imaging Studies : Imaging studies including X-rays, Magnetic Resonance Imaging
(MRI), Joint Ultrasound, and Bone Densitometry (DEXA) might also be prescribed
to diagnose the presence of rheumatoid arthritis.
Treatment of rheumatoid arthritis
There is no cure for rheumatoid arthritis.
However, the symptoms or the pain could be alleviated through several methods
including medications and exercises. It is ideal to meet a doctor soon as you develop
any of the above said symptoms.
is found to be an effective treatment for rheumatoid arthritis. Your physician
might advise you to partake of foods consisting of omega-3 fatty acids. Being
overweight marks the entry point for any condition; rheumatoid arthritis being
exception. Your doctor might prescribe you to lose weight, so that the pains and stiffness in the joints could be
decreased. The other treatment includes exercise and rest. Regular cardiovascular exercise like swimming
bicycling, stretching can alleviate your joint pains.
Occupational therapy and physical therapy are
also found to be somewhat effective in treating rheumatoid arthritis.
Occupational therapies include exercises to the commonly affected areas like
wrists, fingers, and joints. This might include education of body biomechanics,
use of splints like hand splints and wrist splints. Your physician might sketch
out a structured program upon the diagnosis of your symptoms.
The best way to alleviate pains or swelling
in the joints would be to use ice, heat, massage, ultrasound, warm wax and
electric stimulation around the affected areas. However, consult your physician
before performing the same.
Oral medications like non-steroidal anti-inflammatory
drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and etodolac are commonly
prescribed for treating rheumatoid arthritis. These medications are at times
combined with sucralfate and misoprostol or proton pump inhibitors like
omeprazole or pantoprazole, since NSAIDs might cause some stomach problems.
Steroids either in oral form or injection are also recommended for the
treatment of rheumatoid arthritis.
DMARDS or disease-modifying anti-rheumatic
drugs including hydroxycholoquine, sulfasalzine, methotrexate, D-penicillamine,
gold salts, azathioprine, and cyclophosphamide are used as the second-line
medications in treating rheumatoid arthritis. These are generally taken for
months or years. Other medications prescribed for treating the condition
include Methotrexate, D-penicillamine, and Anti-TNF alpha factor medications.
Cortisone injections are also prescribed in treating symptomatic joints.
Surgery is the last option for rheumatoid arthritis
and it is very rarely performed. The surgical options include either a total
hip replacement, or total knee replacement, if the hip or knee is affected.