What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune condition that causes pain and inflammation in the joints. It occurs when the immune system mistakenly targets synovium, which is the lining that surrounds the joints. This condition typically affects the knees, ankles, or hands of the body. However, rheumatoid arthritis can also affect other parts of the body, including the eyes, heart, skin, mouth, and/or lungs.
Rheumatoid arthritis typically begins to manifest in individuals aged 30 to 60. However, individuals of any age may develop this condition. Young-onset rheumatoid arthritis (YORA) affects adolescents aged 16 to 40, while later-onset rheumatoid arthritis (LORA) affects individuals aged 60 and over.
Causes of rheumatoid arthritis
The root cause of rheumatoid arthritis has not been fully elucidated. Researchers hypothesize that the disease is caused by a complex combination of genetic, hormonal, and environmental factors.
Individuals who are born with human leukocyte antigen (HLA) gene variations have an increased risk of developing rheumatoid arthritis. HLA genes enable the immune system to differentiate between proteins produced by the body and those produced by foreign organisms such as viruses and bacteria.
The immune system is responsible for protecting the body from disease; however, in the case of rheumatoid arthritis, the immune system is triggered to attack the joints. This can be caused by a variety of factors, such as an infection, smoking, and physical or psychological stress.
Stages of rheumatoid arthritis
There are four distinct stages of rheumatoid arthritis, and the degree of symptoms varies with progression. These include:
Stage I: Synovitis
Individuals may experience mild symptoms such as joint pain and stiffness. At this stage, the immune system begins to attack the joint tissues, causing swelling in synovial membranes.
Stage II: Pannus
Continued inflammation has resulted in cartilage thinning. In normal circumstances, cartilage provides a cushion for the bones and facilitates the fluidity of joint movement. Without this cushion, joint discomfort and stiffness become more severe. This can also lead to joint damage. Without cartilage protection, the bones begin to weaken at the joint.
Stage III: Fibrous Ankylosis
The damaged area of the joint begins to fuse with fibrous connective tissue, resulting in a significant reduction in the range of movement, which can hinder individuals from doing even the most basic tasks. At this stage, the joints may appear to be crooked and bent.
Stage IV: Bony Ankylosis
The bones fuse with actual bone tissue instead of connective tissue. During this stage, the pain subsides, but the capacity to move diminishes. The joint is virtually immobile, meaning that it cannot be bent or flexed. Once diagnosed with stage four rheumatoid arthritis, individuals may experience difficulty performing daily activities.
Symptoms of rheumatoid arthritis
The symptoms of rheumatoid arthritis may vary from one person to another. Some individuals experience joint discomfort over a period of years, while others experience a rapid progression of symptoms. Many individuals experience periods of flare-ups, followed by periods of remission (no symptoms). Rheumatoid arthritis symptoms include:
• Joint pain
• Stiffness in joints
• Swelling and tenderness in joints
• Fever
• Weight loss
• Fatigue
Diagnosis of rheumatoid arthritis
After assessing the patient's symptoms, a physical examination may be conducted by a healthcare provider. One or more of the following tests may be ordered to assist in the diagnosis of ankylosing spondylitis.
Imaging scans: Magnetic resonance imaging (MRI), ultrasound, and X-rays can be used to identify erosions, which are the wearing down of bones within a joint.
Blood tests: Blood tests to diagnose RA are Erythrocyte sedimentation rate (ESR), Rheumatoid factor (RF) test, C-reactive protein (CRP) test, cyclic citrullinated peptidase (CCP) test, and ANA blot test.
Anti-CCP test: Anti-CCP test is used to detect CCP (cyclic citrullinated peptide) antibodies in the blood sample. Anti-CCP antibodies are auto-antibodies, which are proteins that attack normal cells in the body. This test is particularly useful in the diagnosis of rheumatoid arthritis.
Interpretation of Anti-CCP test results:
Positive test result:
A positive Anti-CCP test result indicates the presence of CCP antibodies in the blood sample, and individuals are more likely to have rheumatoid arthritis.
Negative test result:
A negative Anti-CCP test result indicates that no CCP antibodies were detected in the blood sample, and individuals are less likely to have rheumatoid arthritis.
Treatment of rheumatoid arthritis
Rheumatoid arthritis is a chronic disease that cannot be cured; however, there are a variety of lifestyle changes and medications available that can help reduce complications, joint damage, and pain associated with the condition. Lifestyle changes and treatments include:
Rest: It is important to rest inflamed joints, as there is a high risk of injury to the joints and soft tissue surrounding the joints (tendons and ligaments) when joints are inflamed.
Exercise: Physical activity can reduce or prevent the loss of muscle strength and joint motion. It is recommended that individuals seek advice from their healthcare providers regarding safe exercise practices.
Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are used to reduce the symptoms of pain and inflammation.
Disease-modifying anti-rheumatic drugs (DMARDs): DMARDs are used to alleviate pain and swelling in the joints.
Corticosteroids: Corticosteroids help temporarily reduce pain and inflammation in the joints.
Surgery: Surgery may be necessary to replace severely damaged joints. Some types of surgery include joint replacement surgery, which involves replacing the damaged joints with an artificial joint.
A combination of imaging scans, physical examinations, and blood tests will be used to assess the effectiveness of the treatment. Healthcare providers will help individuals determine how long treatment should be continued, inform them about side effects from medicines, and plan follow-up visits.
Blood tests such as Anti-CCP blood tests and imaging scans help in determining whether individuals have an increased risk of developing rheumatoid arthritis, and early detection enables early treatment. It is possible to manage symptoms of rheumatoid arthritis with physical therapy/activity to improve mobility, as well as medications for pain relief, inflammation control, etc., and by taking some preventive measures such as avoiding a high-salt diet, exercising 20–30 minutes daily, and avoiding triggers (an infection, smoking, or physical or emotional stress).
