Rheumatoid arthritis is an inflammatory autoimmune disorder of the joints in arm, hands and knees. The body’s immune system attacks the normal tissues of the body resulting in inflammation.

Immune system protects the body against foreign invaders like bacteria, virus, etc., in case of infection. It transfers extra fluid to the infection area causing inflammation. In rheumatoid arthritis, this immune response in unnecessary and inflammation occur inside the joint. As inflammation is reduced, the capsule surrounding the synovial membrane become unable to place the joint in this position. The joint becomes unstable and then deformed.

In severe condition, rheumatoid arthritis affects other body parts skin, eyes, heart, circulatory system and so on. 

Signs and symptoms[i]

Initially, rheumatoid arthritis is characterized by pain, there is not any inflammation of the joints. Later on, the symptoms worsen and include:

  • Pain in joints
  • Swelling in the joints
  • Smaller joints are affected first
  • Usually, it affects more than single joint
  • Similar joints on both sides are affected
  • Stiffness in the morning lasting up to thirty minutes
  • Joint deformation resulting in loss of mobility
  • Feeling of tiredness
  • High temperature
  • Loss of appetite
  • It can affect vital organs of the body including eyes, kidneys, heart lungs, etc., in nearly forty percent of the patients

Symptoms go and come frequently. Periods to recurrence of the disease are followed by periods of remission and time of recurrence and remission varies from one individual to another.

Causes of rheumatoid arthritis

As explained earlier, rheumatoid arthritis is due to over active immune system. It attacks the normal body tissues, thereby damaging them.

It is not exactly known what causes the immune system to react spontaneously. However, it is believed that there are genes probably activated by environmental factors like bacteria, virus, stress, etc., that predispose people to rheumatoid arthritis.

There are certain risk factors that increases the chances of occurrence of rheumatoid arthritis which are:

  • Age: adults more than sixty years of age are more prone to develop rheumatoid arthritis.
  • Sex: it is more prevalent in females than males
  • Gene: people having HLA (human leucocyte antigen) genes alongwith environmental triggers worsen the symptoms
  • Smoking: increases the chances and exacerbates the condition. Children with parents who smoke develop rheumatoid arthritis more than non-smoker parents
  • Overweight: more obese a person is, more his chances of having the disease
  • Birth rate: women who do not give birth are more likely to have rheumatoid arthritis
  • Earning: low-income people develop rheumatoid arthritis due to poor diet

Linked to other diseases

Patient of rheumatoid arthritis are susceptible to various other diseases as well. Most common are:

  • Osteoporosis, weakening of joints
  • cardiovascular diseases
  • hypertension
  • high blood sugar
  • overweighing
  • dryness of eyes and mouth
  • inflammation affecting vital organs of the body
  • various infections like pneumonia, influenza, etc.
  • cancer
  • stress
  • depression

Diagnosis

In initial stages, it is not easier to diagnose because the symptoms bear resemblance to various other diseases. A doctor will diagnose the disease by conducting physical examination based on previous medical history. Tender, swollen painful joints symptomize rheumatoid arthritis.

  1. Blood test: ESR (erythrocyte sedimentation rate) and CRP (C- reactive protein) levels help to determine inflammation in joints.
  2. CBC: to count the RBCs in blood, lower level indicate anemia which is common in people with rheumatoid arthritis
  3. RF antibody: 80 perecnt of the patients diagnosed with rheumatoid arthritis have an antibody called rheumatoid factor in blood.
  4. Imaging: X-rays, sonography, magnetic imaging are all used to detect damage as well as severity of inflammation in joints

How to treat[ii] rheumatoid arthritis?

There isn’t any cure of chronic autoimmune rheumatoid arthritis. However, some treatments options are good enough to prevent the progression and manage the severity of the symptoms. Three different ways for treatment are:

  1. Medications

Four different types of drugs are used in various combinations for treatment: analgesic drugs, NSAIDs (non-steroidal anti-inflammatory drugs), DMARDs (disease modifying anti-rheumatic drugs) and corticosteroids.

  • NSAIDs ameliorate the inflammation, pain and stiffness. Celebrex, advil, Mobic naproxen are few ibuprofins categorized as NSAIDs. Their long-time usage produces various side effects like hypertension, kidney, liver problems, heart diseases, etc.
  • DMARDs slow the disease progress and prevent permanent damage to the tissues by hindering the function of immune system. Common drugs are methotrexate, leflunomide, hydroxychloroquine and sulfasalazine. Potential side effects are loss of hair, liver/kidney damage, nausea, ulcers, infectious diseases, etc.
  • A new classs of DMARDs called biologics has been proven effective in patients who do not respond to conventional DMARDs. TNF (tumor necrosis factor) alpha is produced during an infection causing inflammation. TNF inhibitors suppress the TNF alpha, an inflammatory substance, to stop inflammation. Examples are Enbrel, Remicade and Humira. Biologics also pose some serious side effects as heart arrest, infections, demyelination of nerve fibers, skin allergies, etc.
  • Steroids like prednisone are effective during initial stages of the disease. They are also injectable which provide immediate relief from pain. But the effectiveness of steroids disappears after longer use. Steroids also cause hypertension, obesity, cardiovascular diseases.
  1. Physical therapies

A physiotherapist will suggest some exercises and new ways to pick up things which will eventually let the patient to carry on its normal daily activities. Yoga has also been proven effective for rheumatoid arthritis.

  1. Surgery

Surgery is not usually practiced for rheumatoid arthritis treatment. A doctor can suggest a surgery to permanently cure the disease. Surgery can help to recover the joint, reduce pain and swelling. It may involve:

  • Joint replacement: removal of damaged part of the joint and inserting prosthetics to replace them
  • Androdesis: fusion of bones after removing the damaged part of the joint. It is used smaller joint, for wrists, fingers, ankles and toes.
  • Synovectomy: removal of synovium around the joints reduces pain.
  • Repairment of tendons: ruptures tendons around the joints are repaired

[i] https://www.healthline.com/health/rheumatoid-arthritis#diet

[ii] https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment