Rheumatoid arthritis (RA) usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body.
Common symptoms include stiff joints, especially upon getting up in the mornings or after sitting down for a while. Some people often experience fatigue and a general feeling of being unwell.
The Rheumatoid Arthritis Support Network estimate that RA affects up to 1 percent of the world’s population and over 1.3 million people in America.
What is rheumatoid arthritis?
RA is an autoimmune disease. It is also a systemic disease, which means it affects the whole body.
It occurs when a person’s immune system mistakes the body’s healthy tissues for foreign invaders.
As the immune system responds, inflammation occurs in the target tissue or organ.
In the case of RA, this can be the joints, lungs, eyes, and heart.
Symptoms
Symptoms of RA include:
- pain, swelling, and stiffness in more than one joint
- symmetrical joint involvement
- joint deformity
- unsteadiness when walking
- a general feeling of being unwell
- fever
- loss of function and mobility
- weight loss
- weakness
According to the Centers for Disease Control and Prevention (CDC), the symptoms usually affect the same joints on both sides of the body
Symptoms tend to come and go. During a remission, they can disappear, or they can be mild. However, during a flare, they can be severe.
Causes
Nobody knows what causes the immune system to malfunction.
Some people appear to have genetic factors that make it more likely. One theory is that bacteria or a virus triggers RA in people who have this genetic feature.
In RA, the immune system’s antibodies attack the synovium, which is the smooth lining of a joint. When this happens, pain and inflammation result.
Inflammation causes the synovium to thicken. Eventually, if left untreated, it can invade and destroy cartilage — the connective tissue that cushions the ends of the bones.
The tendons and ligaments that hold the joint together can also weaken and stretch. The joint eventually loses its shape and configuration. The damage can be severe.
If a person receives a diagnosis of RA, the doctor may refer them to a specialist known as a rheumatologist, who will advise on treatment options.
There is currently no cure for RA, but treatment can help to:
- reduce inflammation to the joints
- relieve pain
- minimize any loss of function caused by pain, joint damage, or deformity
- slow down or prevent damage to the joints
Options include medications, physical therapy, occupational therapy, counseling, and surgery.
Medications
Some drugs can help to relieve symptoms and slow disease progression.
Nonsteroidal anti-inflammatory drugs (NSAIDs): These are available over-the-counter from pharmacies. Examples include Advil, Motrin, and Aleve. Long-term use and high doses can lead to side effects, such as bruising, gastric ulcers, high blood pressure, and kidney and liver problems.
Corticosteroids: These medications reduce pain and inflammation and may play a role in slowing down joint damage, but they cannot cure RA. If NSAIDs do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. It can last a few weeks or months, depending on the severity of symptoms.
Corticosteroids can help with acute symptoms or short-term flare-ups. Long-term use of corticosteroids can have serious side effects. These include cataracts, osteoporosis, glaucoma, diabetes mellitus, and obesity.
Disease-modifying antirheumatic drugs (DMARDs)
DMARDs can slow the progression of the RA and prevent permanent damage to the joints and other tissues by interfering with the overactive immune system. A person usually takes a DMARD for life.
It is most effective if a person uses it in the early stages, but it can take from 4 to 6 months to fully experience the benefits.
Some people may have to try different types of DMARD before finding the most suitable one.
Examples include leflunomide (Arava), methotrexate (Rheumatrex, Trexall), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin), and hydroxychloroquine (Plaquenil).
Side effects can include liver damage and immune-related problems, such as bone marrow suppression, and a higher risk of severe lung infections.
Other types of immunosuppressants include cyclosporine (Neoral, Sandimmune, Gengraf), azathioprine (Imuran, Azasan), and cyclophosphamide (Cytoxan).
Tumor necrosis factor-alpha inhibitors (TNF-alpha inhibitors)
The human body produces tumor necrosis factor-alpha (TNF-alpha), an inflammatory substance.
TNF-alpha inhibitors prevent inflammation. They can reduce pain, morning stiffness, and swollen or tender joints. People usually notice an improvement 2 weeks after starting treatment.
Examples include (Enbrel), infliximab (Remicade) and adalimumab (Humira).
Possible side effects include:
- a higher risk of infection
- blood disorders
- congestive heart failure
- demyelinating diseases, involving an erosion of the myelin sheath that normally protects nerve fibers
- lymphoma
Occupational therapy
An occupational therapist can help the individual learn new and effective ways of carrying out daily tasks. This can minimize stress to painful joints.
For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool.
Surgery
If medication and physical therapy do not help, a doctor may recommend surgery to:
- repair damaged joints
- correct deformities
- reduce pain
The following procedures are possible:
- Arthroplasty: In a total joint replacement, the surgeon removes the damaged parts and inserts a metal and plastic prosthesis, or artificial joint.
- Tendon repair: If tendons have loosened or ruptured around the joint, surgery may help restore them.
- Synovectomy: This procedure involves removal of the synovium if it is inflamed and causing pain.
- Arthrodesis: The surgeon will fuse a bone or joint to decrease pain and realign or stabilize the joint.
Some people with RA use the following, but there is little scientific evidence to confirm that they work:
- acupuncture
- chiropractic
- electrotherapy
- hydrotherapy
- massage
- nutritional supplements, for example, fish oil
- osteopathy
Prevention
It may not be possible to prevent RA, but the CDC suggest the following:
- avoiding or quitting smoking
- maintaining a healthy body weight
Takeaway
RA is a painful and chronic condition that can cause joint damage and make it difficult for a person to carry out their daily tasks.
Anyone who experiences pain and swelling in two or more joints should see a doctor, as early treatment can reduce the risk of long-term problems.
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