Rheumatoid Arthritis

A chronic inflammatory disorder that can affect more than just the joints. The condition can damage a wide variety of body systems including the skin, eyes, lungs, heart and blood vessels.

Rheumatoid arthritis is an autoimmune disorder that occurs when the immune system mistakenly attacks the body’s tissues.

Rheumatoid arthritis affects the lining of the joints and causes a painful swelling that can eventually result in bone erosion and joint deformity.

The inflammation is what damages other parts of the body as well. While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis may still cause physical disabilities.

What causes the Rheumatoid Arthritis?

It occurs when the immune system attacks the synovium (lining of the membranes that surround the joints).

This results in inflammation which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch and the joint loses its shape and alignment gradually.

Professionals are certain what starts this process, although a genetic component appears likely. While rheumatoid arthritis is not inherited, they may make you more susceptible to environmental factors.

What are the risk factors of rheumatoid arthritis?

Factors that can increase your risks:

• Gender: Females are more likely than males to develop this condition.
• Age: While it can occur at any age, it most commonly starts between the ages of 40 and 60.
• Family history: You may have an increased risk of the disease if a member of your family has it.
• Smoking: Cigarette smoking increases your risk, especially if you have a genetic predisposition for developing the disease. It also appears to be associated with greater severity of the disease.
• Environmental exposures: Some exposures such as asbestos or silica may increase the risk for developing the condition although uncertain and poorly understood.
• Obesity: People who are obese or overweight are at higher risk of developing the condition, especially in women diagnosed with the disease when they were 55 or younger.

SYMPTOMS OF RHEUMATOID ARTHRITIS

• Tender, warm, swollen joints
• Joint stiffness (usually worse in the mornings and after inactivity)
• Fatigue, fever and weight loss

Early rheumatoid arthritis affect the smaller joints first. The joints that attach your fingers to your hands and your toes to your feet in particular.

Symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders as the disease progresses. Symptoms occur in the same joints on both sides of your body in most cases.

About 40 percent of the people who have the condition also experience signs and symptoms that are nonjoint. This condition can affect many nonjoint structures such as:

• Skin
• Eyes
• Lungs
• Heart
• Kidneys
• Salivary glands
• Nerve tissue
• Bone marrow
• Blood vessels

The signs and symptoms may vary in severity and may even come and go. There may be periods of increased disease activity (flares) and periods of relative remission (swelling and pain fade or disappear). Over time, this condition can cause joints to deform and shift out of place.

TREATMENT OPTIONS AVAILABLE FOR RHEUMATOID ARTHRITIS

There is no cure for this condition. However, recent discoveries indicate that remission of symptoms is more likely when treatment starts early with strong medications known as disease-modifying antirheumatic drugs (DMARDs). The goals are to:

• Stop inflammation
• Relieve symptoms
• Prevent joint and organ damage
• Improve physical function and overall well-being
• Reduce long-term complications

The doctor will follow these strategies to achieve the goals:

• Early, aggressive treatment: To reduce or stop inflammation as quickly as possible.
• Targeting remission: To stop inflammation achieve remission. This means minimal or no signs or symptoms of active inflammation. One strategy to achieve this goal is known as “treat to target.”
• Tight control: Reducing disease activity to a low level and keeping it there is what is called having “tight control of RA (rheumatoid arthritis)”. Tight control may prevent or slow the pace of joint damage.

Medications

Medication recommended by your doctor will depend on the severity of your symptoms and how long you’ve had the condition for.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Can help to relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve) while stronger NSAIDs are available by prescription. Side effects that may be experienced include ringing in your ears, stomach irritation, heart problems, and liver and kidney damage.
• Steroids: Corticosteroid medications like prednisone can help to reduce inflammation, pain and slow joint damage. Side effects that may be experienced include thinning of bones, weight gain and diabetes. A corticosteroid is often prescribed to relieve acute symptoms with the goal of gradually tapering off the medication.
• Disease-modifying antirheumatic drugs (DMARDs): Slow down the progression and save the joints and other tissues from permanent damage. Common types of DMARDs include methotrexate (Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). The side effects will vary but may include liver damage, bone marrow suppression and severe lung infections.
• Biologic agents (biologic response modifiers): This newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), tocilizumab (Actemra) and tofacitinib (Xeljanz). They target parts of the immune system that trigger inflammation that can cause joint and tissue damage. These drugs also increase the risk of infections. They are usually most effective when paired with a nonbiologic DMARD like methotrexate.

Therapy

You may be referred to a physical or occupational therapist who will teach you exercises to help keep your joints flexible. New ways to perform daily tasks may also be recommended which will be easier on your joints. For instance, picking up an object using your forearms if your fingers are sore.

Certain assistive devices can help to make it easier to avoid stressing your painful joints. For example, a kitchen knife equipped with a saw handle can help protect your finger and wrist joints. Tools such as buttonhooks may make it easier to get dressed. Catalogs and medical supply stores are also good places to look for ideas.

Surgery

Surgery may be considered to repair damaged joints if medications fail to prevent or slow joint damage. It may help restore the ability to use your joint and can also reduce pain and correct deformities.

One or more of the following procedures may be involved:

• Synovectomy: To remove the inflamed synovium (lining of the joint). It can be performed on knees, elbows, wrists, fingers and hips.
• Tendon repair:  Tendons around your joint may become loose or rupture due to inflammation and joint damage. The tendons around your joint may be able to be repaired.
• Joint fusion: When a joint replacement isn’t an option, surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief.
• Total joint replacement: Your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic during joint replacement surgery.

DIAGNOSING RHEUMATOID ARTHRITIS

It may be difficult to diagnose the condition in the early stages as the early signs and symptoms mimic those of many other diseases. There isn’t 1 blood test or physical finding that can confirm the diagnosis.

• Physical examination: Your doctor will check your joints for swelling, redness and warmth. Your reflexes and muscle strength may also be checked.
• Blood tests: Often, people with rheumatoid arthritis have an elevated erythrocyte sedimentation rate or C-reactive protein. This may indicate the presence of an inflammatory process in the body. Other common blood tests may be ordered to look for rheumatoid factor and anti-cyclic citrullinated peptide antibodies.
• Imaging tests: X-rays may be recommended to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests may also be ordered to help your doctor determine the severity of the disease.