Rheumatoid Arthritis

RA is a chronic disease that causes pain, stiffness, swelling and limited motion and function of many joints. It is a inflammatory disorder that can affect more than just your joints and can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.
Ra is an autoimmune disorder, it occurs when your immune system mistakenly attacks your own body's tissues. In RA, the focus of the inflammation is in the synovium, the tissue that lines the joint. Immune cells release inflammation-causing chemicals, which can damage cartilage and bone causing a painful swelling that can eventually result in bone erosion and joint deformity. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.
The stiffness seen in active RA is most often worst in the morning and may last one to two hours or even the whole day. Stiffness for a long time in the morning is a clue that you may have RA, since few other arthritic diseases behave this way.

While new types of medications have improved treatment options dramatically, severe rheumatoid arthritis can still cause physical disabilities.

Symptoms and causes

Signs and symptoms of rheumatoid arthritis may include: tender, warm, swollen joints, Joint stiffness that is usually worse in the mornings and after inactivity, low grade fever, fatigue and weight loss

Early rheumatoid arthritis tends to affect your smaller joints first, however as the disease progresses, symptoms often spread to the larger joints including wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

Rheumatoid arthritis signs and symptoms may be intermittent and vary in severity, it left untreated rheumatoid arthritis can cause joints to deform and shift out of place.

Risk factors

It is not clear what exactly starts the process of inflammation, although a genetic would have important role. While your genes don't actually cause rheumatoid arthritis, they can make you more susceptible to environmental factors such as infection with certain viruses and bacteria that may trigger the disease.

Factors that may increase your risk of rheumatoid arthritis include: Age and sex, women are more likely than men to develop RA and commonly begins between the ages of 40 and 60. Family history is an important factor, so if a member of your family has rheumatoid arthritis, you may have an increased risk of the disease. Smoking is associated with greater severity of disease and also increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Other factors include Environmental exposures to substances such as asbestos or silica may increase the risk for developing rheumatoid arthritis Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis.

Complications

Osteoporosis: Rheumatoid arthritis increases your risk of developing osteoporosis. Rheumatoid arthritis itself, along with some medications used for treating rheumatoid arthritis, can increase your risk of osteoporosis. Learn about it by clicking here. (Osteoporosis)

Dry eyes and mouth. People who have rheumatoid arthritis are much more likely to experience Sjogren's syndrome, a disorder that decreases the amount of moisture in your eyes and mouth.

Carpal tunnel syndrome. The inflammation associated with RA and bony deformities can compress the nerve that serves most of your hand and fingers causing condition called carpal tunnel syndrome. Please learn about this disease at our website or click here (Carpal tunnel syndrome)

Lung disease. People with rheumatoid arthritis have an increased risk of inflammation of the lung tissues, which can lead to progressive shortness of breath.

Infections. The disease itself and most of the medications used to control rheumatoid arthritis can impair the immune system, leading to increased infections.

Diagnosis

Diagnosis of RA depends on the symptoms and results of a physical exam, such as warmth, swelling and pain in the joints. Some blood tests also can help confirm RA. It can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis.

Blood tests

People with rheumatoid arthritis often have anemia (low blood count) and elevated erythrocyte sedimentation rate (ESR)or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Imaging tests

X-rays to help track the progression of rheumatoid arthritis in your joints over time. Often, MRI and ultrasound scanning are done to help judge the severity of RA.

Treatment

There is no cure for rheumatoid arthritis. But recent discoveries indicate that remission of symptoms is more likely when treatment begins early with strong medications known as disease-modifying antirheumatic drugs (DMARDs).

Medications

The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis.

NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation.
Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine. Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
- Biologic agents which are 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).
These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections. Biologic DMARDs are usually most effective when paired with a traditional DMARD, such as methotrexate.

Physical Therapy

The best treatment of RA needs more than medicines alone. Patient education, such as how to cope with RA, also is important. Proper care requires the expertise of a team of providers, including rheumatologists, primary care physicians, and physical and occupational therapists. You will need frequent visits through the year with your rheumatologist; therapist can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.

Surgery

If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities. Rheumatoid arthritis surgery may involve one or more of the following procedures: Synovectomy, tendon repair, joint fusion and total joint replacement.

Alternative medicine

Some supplements alternative treatments that have shown promise for rheumatoid arthritis include:

Fish oil. Some preliminary studies have found that fish oil supplements may reduce rheumatoid arthritis pain and stiffness.
Plant oils. The seeds of evening primrose, borage and black currant contain a type of fatty acid that may help with rheumatoid arthritis pain and morning stiffness.
Tai chi involves gentle exercises and stretches combined with deep breathing. Many people use tai chi to relieve stress in their lives. Small studies have found that tai chi may reduce rheumatoid arthritis pain.