Rheumatoid arthritis RA (1)

It is an autoimmune disorder that affects more than just joints. Unlike Osteoarthritis, rheumatoid arthritis targets the lining of joints leading to painful swelling. It results in joint deformity and bone erosion. In this disorder, the immune system accidentally attacks the body’s tissues. It mainly targets the joints in the wrists, hands, and knees. The inflammation in rheumatoid arthritis can also spread to other regions of the body.

Progression patterns of RA (2)

Progression patterns of RA vary from person to person. Few of them are as follows:

  • Long remissions

In this, the stiffness and pain go away even if the disease is not cured. In about 5% to 10% of all cases, RA starts suddenly, and people show no symptoms for several years.

  • Short-term symptoms

In this, symptoms come and go. It happens in about 15% of people.

  • Progressive rheumatoid arthritis

In this situation, the patient needs long-term treatment to reduce the symptoms and prevent the condition from getting worst.

Stages

There are four stages of RA:

  1. Stage 1.

This is the early stage of rheumatoid arthritis in which the inflammation of synovium occurs. This inflammation swells up the tissues making the joint painful and stiff. In this stage, bones are not affected yet.

  1. Stage 2

This is the moderate stage in which inflammation progresses and damages the cartilage. Cartilage provides a cushioning effect on the bones. Joints become stiffer, and the person becomes unable to move it.

  1. Stage 3

This is the severe stage of rheumatoid arthritis. Inflammation erodes cartilage and bones around the joints.  The patient is seen with deformities in the bones and he feels swelling, pain, and loss of motion.

  1. Stage 4

This is the last stage where inflammation stops but damage does not. The patient faces difficulty in moving joints. In this stage muscles also become weak. Joint replacement surgery is done at this stage.

Causes (3)

It is an autoimmune disease, so an agent that disrupts an immune system can be the cause of rheumatoid arthritis. But the exact causative agent of rheumatoid arthritis is still unknown. Some risk factors can increase the susceptibility of a person to develop the disease.

Risk factors

  • Smoking

Several studies have revealed that cigarette smoking enhances a person’s risk of getting RA and can make it worse.

  • Inherited traits

People who have specific genes called human leukocyte antigen HLA Class 2 genotypes are more likely to develop RA. The risk of getting this disorder increases when such people are exposed to other factors such as smoking and obesity.

  • Age

This disorder can begin at any age, but chances are high in elders.

  • Sex

Women are 2-3 times more prone to RA than men.

  • Early life exposure

Early life exposures increase the risk of getting RA in adulthood. For example, smoking mothers will have their children with a high risk of developing RA.

  • Obesity

Obesity makes the bones and joints weaker thus chances of the disorder increase with the weight of the person.

Symptoms

It includes:

  • Warm, swollen joints
  • Joint stiffness usually worse after inactivity and in the early morning
  • Fatigue
  • Fever
  • Loss of appetite

RA begins in the smaller joints such as the joints of fingers and toes. As it progresses symptoms start appearing in the knees, wrists, elbows, ankles, shoulders, and hips. About 40% of the patients show signs and symptoms in non-joint areas of the body such as eyes, heart, lungs, kidneys, bone marrow, nerve tissues, and blood vessels.

Complications

  • Rheumatoid nodules

These tissue bumps are formed around the joints that deal with pressure such as elbows. However, these nodules can also originate in any region of the body, for example, lungs.

  • Osteoporosis

RA and medications to treat RA enhance the risk of osteoporosis, which eventually weakens the bones and makes them vulnerable to fracture.

  • Carpal tunnel syndrome

In this syndrome, inflammation caused by RA suppresses the nerves that are present in hand and fingers.

  • Sjogren’s syndrome

It is a disorder that reduces the moisture in the mouth and eyes. RA can trigger that syndrome.

  • Heart problems

RA can harden the arteries and cause inflammation of the heart sacs leading to heart problems.

  • Lymphoma

RA enhances their risk of lymphoma (development of blood cancer in lymph system)

  • Infections

The compromised immune system in RA can develop other infections as well.

Diagnosis (4)

Diagnosis of RA is done through physical examination, blood tests, and imaging tests.

  1. Physical examination; in which the doctor checks the joints for redness, swelling, and warmth. He also examines muscle strength.
  2. Blood test; in which values of different determinants are checked. Increased erythrocyte sedimentation rate ESR and C-reactive protein CRP indicate the inflammatory cascade in the body.
  3. Imaging tests; include X-rays, ultrasounds, and magnetic resonance imaging MRI that determines the severity and progression of the disease.

Treatment

It includes the remission of symptoms by using early medicines known as disease-modifying antirheumatic drugs (DMARDs)

  • Medications
  • NSAIDs; help to relieve the pain and lessen the inflammation, Such as ibuprofen, naproxen sodium, diclofenac sodium.
  • Steroids; reduce inflammation as well as pain and slow down joint damage. An example is prednisone.
  • DMARDs; slow down the progression of the disease and protect the tissues and joints from lifetime damage. Examples are hydroxychloroquine, methotrexate, and sulfasalazine.
  • Therapy

Along with medications, the patient is also referred to a physiotherapist. He suggests the patient an exercise that keeps the joint moveable and flexible. For example, he may ask a patient to lift anything using forearms.

  • Surgery
  • Tendon repair

Inflammation causes the tendon to loosen up and get ruptured. The surgeon repairs these tendons near the joints.

  • Synovectomy

A type of surgery that removes inflamed synovium.

  • Joint fusion

Joint fusion realigns the joint and provides relief from pain.

  • Total joint replacement

The surgeon replaces the damaged areas of the joint with a metallic or plastic prosthesis.

 

References

  1. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
  2. https://www.webmd.com/rheumatoid-arthritis/ra-progression
  3. https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
  4. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653