What Causes Rheumatoid Arthritis?
The exact cause of RA is unknown, but it is suspected that a bacterial or viral infection could trigger the onset in genetically susceptible individuals. Smoking is also known to be a risk factor. RA is an autoimmune disease, meaning the body’s immune system starts to attack healthy tissue in error. In RA, it targets the synovium – the membrane lining the joints. This causes the synovium to thicken and produce excess synovial fluid, resulting in stiffness, swelling and pain. Rheumatoid Arthritis is sometimes confused with rheumatism, when they are not the same.
Who Gets Rheumatoid Arthritis?
RA can affect anyone at any age, but is more common in:
- Women
- People aged 40-60 years
- Those with a family history of RA
What Are the Symptoms?
RA typically affects the smaller joints first, such as those in the hands and feet, before progressing to larger joints like the knees and elbows. Symptoms may come and go in episodes known as flares. Common signs include:
- Swelling, warmth and redness affecting multiple joints
- Stiffness lasting over an hour, especially in the mornings
- Chronic joint pain, worse at night
- Low energy and fatigue
- Fever
- Loss of appetite
- Anaemia in some cases
How is Rheumatoid Arthritis Diagnosed?
A doctor will suspect RA based on a person’s symptoms and medical history. They will examine the affected joints and look for rheumatoid nodules – firm lumps under the skin. Blood tests can help confirm the diagnosis and identify the type of arthritis. Common tests include:
- Rheumatoid factor – an antibody found in most RA patients
- Anti-CCP – detects antibodies targeting citrullinated proteins
- ESR – a marker of inflammation
Imaging tests like X-rays can also be used to assess joint damage.
Treatment Goals
The main goals of rheumatoid arthritis treatment are to:
- Reduce inflammation
- Relieve pain
- Slow or stop joint damage
- Improve physical function
With today’s medications, most people with RA can achieve these goals and find a treatment plan that works for them.
How is Rheumatoid Arthritis Treated?
While there is no cure, a range of treatments can help slow progression, relieve symptoms and improve quality of life. Options include:
Medications such as:
- Painkillers like paracetamol and ibuprofen
- Prescription NSAIDs are stronger anti-inflammatory pain relievers. Your doctor may prescribe NSAIDs like naproxen or diclofenac.
- DMARDs to suppress the immune system and inflammation
- Biologic DMARDs target specific parts of the immune system. Examples are etanercept, adalimumab and infliximab. They are effective for many patients but can increase infection risk.
- JAK inhibitors are newer drugs that block inflammation pathways in the immune system. Xeljanz is one example. These provide similar benefits to biologics for some patients.
Lifestyle measures including:
- Exercise programs tailored to your condition
- Splints, braces or walking aids to support joints
Corticosteroid injections can rapidly reduce swelling and pain in one or a few joints. However, frequent injections can damage cartilage.
Non-Drug Therapies
Exercise improves joint mobility and strengthens muscles supporting the joints. Swimming and cycling are ideal low-impact options.
Assistive devices like splints, braces and canes reduce stress on tender joints. TENS Machines can provide drug free pain relief.
Heat and cold therapies can alleviate joint pain and stiffness. Heat packs relax muscles while ice numbs nerve endings.
Stress management techniques help cope with the challenges of living with RA. Relaxation, meditation or cognitive behavioural therapy may help.
Surgery like joint replacements can relieve severe joint damage and improve function. The joints most often replaced are knees, hips and fingers.
Seeking Support
Education, social support and shared advice can help people better manage rheumatoid arthritis. Consider joining local arthritis workshops or online patient communities. Rheumatology nurses and occupational therapists also provide specialized assistance.
How Does Rheumatoid Arthritis Progress?
The course of RA varies considerably between individuals. For some it is mild with minimal joint damage, while others develop more progressive disease leading to loss of joint function. Most treatment focuses on controlling inflammation to limit further joint destruction. Potential complications include:
- Joint deformities
- Rheumatoid nodules under the skin
- Dry eyes and mouth
- Inflammation of the heart or lungs in rare cases
Symptoms are often worse in the morning and during cold, damp weather.
Can Rheumatoid Arthritis Be Prevented?
There is no known way to prevent RA. However, steps like maintaining a healthy diet, staying active, avoiding smoking and achieving a healthy weight can help prevent further problems.
While rheumatoid arthritis is a challenging condition, the outlook today is far better than in the past thanks to improved medications and a range of management strategies. Most people with RA can expect to live active and fulfilling lives when the disease is properly controlled.
Photo “Rheumatoid Arthritis (RA)” by Anthony Cunningham for Zoom Health
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