Written by Dr. Sanjana V.B Bhms,dbrm,cdn

Founder & medical director of siahmsr wellness.in

Reviewed by SIAHMSR

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Rheumatoid arthritis

Overview

Rheumatoid arthritis is a chronic inflammatory joint disease, which can cause cartilage and bone damage as well as disability. It is an autoimmune disease in which your own immune cells attack the joints and other organ systems.

 In addition to joints, the condition can damage many parts of your body including the skin, eyes, lungs, heart and blood vessels.

Rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

It is a chronic inflammatory condition and inflammatory markers are activated in this condition. Various cytokines play an essential role in disease formation such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, IL-17, and macrophages; osteoclast is also activated by the cytokines, which cause bone degradation. Early diagnosis is important for optimal therapeutic success.

Signs & symptoms

·       Tender, warm, swollen joints

·       Joint stiffness that is get worse in the mornings and after inactivity

·       Fatigue, fever and loss of appetite

In the early phase of rheumatoid arthritis smaller joints are affected first. Finger and toe joints inflammations may cause pain and swelling. As the disease advances inflammation of the wrists, knees, ankles, elbows, hips and shoulders may occur. Most often joints of both side of the body may be affected.

In 40% of the rheumatoid arthritis patients apart from joints other body systems also may get affected.

signs and symptoms may vary in severity and may even come and go.

Disease may get aggravated for sometimes and later period of remission may follow. Periods of increased disease activity, called flares, alternate with periods of relative remission.

Risk factors for Rheumatoid arthritis

·       It is found more commonly in female population

·       Although it can affect all age groups, rheumatoid arthritis most commonly begins in middle age.

·       The presence of the disease in the family enhances the risk for occurrence of disease.

·       Smoking increases the risk of developing rheumatoid arthritis, particularly in people having a family history of the disease.

·       Obesity increases the risk

Diagnosis

Consult your healthcare provider if you experience joint pains and swelling for quite a long time.

Diagnosis of rheumatoid arthritis is difficult in the early stages as symptoms may be vague. There is no single specific test for diagnosing rheumatoid arthritis. Also, symptoms vary from person to person.

 The medical history &family history are very important as they can provide some clue to the diagnosis.

Lab tests

·       Rheumatoid factor (RF)

This blood test checks for RF, an antibody that many people with rheumatoid arthritis can eventually have in their blood. all people with rheumatoid arthritis disease may not test positive for RF; some people may test positive for RF but never develop the disease; and some people test positive but may have another disease. However, doctors use this test correlating with all other tests, examination findings and signs &symptoms to diagnose rheumatoid arthritis.

·       Anti-citrullinated peptide antibodies (ACPAs)

This autoantibody is present in 60-80% of patients with rheumatoid arthritis.

·       Complete blood count

 This blood test measures different blood cell counts and can help diagnose anemia, which is common in people with RA.

·       Erythrocyte sedimentation rate (ESR]

 This test measures inflammation in the body and monitors disease activity and response to treatments.

·       C-reactive protein

 This is another common test for inflammation that can help diagnose rheumatoid arthritis and monitor disease activity and response to treatments.

·       Other blood tests.

Your doctor may also use other tests to check your kidney function, electrolytes, liver function, thyroid function, muscle markers, other autoimmune markers, and markers of infection to evaluate for your overall health and evaluate for other diagnoses.

·       X-rays

Xray  is not generally abnormal in the early stages of rheumatoid arthritis, before joint damage occurs.

·       Magnetic resonance imaging (MRI) and ultrasound may help diagnose rheumatoid arthritis in the early stages of the disease. In addition, these imaging tests can help evaluate the amount of damage in the joints and the severity of the disease.

Other imaging tests sometimes considered for rheumatoid arthritis include computed tomography (CT) scanning, positron emission tomography (PET) scan, bone scan, and dual-energy X-ray absorptiometry (DEXA).

Treatment

·       Medications.

Anti-inflammatory medications to provide pain relief and lower inflammation.

Corticosteroids that can help decrease inflammation, provide some pain relief, and slow joint damage.

Disease-modifying antirheumatic drugs (DMARDs) that can help to slow or change the progression of the disease.

Biologic response modifiers, which are also DMARDs, if your disease does not respond to initial therapies.

·       Physical therapy and occupational therapy.

·       Surgery

Your doctor may recommend surgery if you have permanent damage or pain that limits your ability to perform day-to-day activities.

·       Routine monitoring and ongoing care.

·       Complementary therapies.

 Homeopathy offers pain relieving medications as well as diseases to reduce inflammation and degenerative changes.

·       Stress management

Rheumatoid arthritis associated flare up and remissions may cause great stress .Relaxation techniques such as deep breathing, meditating, or listening to quiet sounds or music are very effective .

·       Movement exercise programs, such as yoga and tai chi.

·       Healthy diet. A healthy and nutritious diet that includes a balance of calories, protein, and calcium is important for maintaining overall health.

References

1.    https://www.niams.nih.gov/health-topics/rheumatoid-arthritis/diagnosis-treatment-and-steps-to-take

2.    https://www.nature.com/articles/s41413-018-0016-9

3.    https://www.bmj.com/content/384/bmj-2022-070856

4.    https://www.researchgate.net/publication/377428188_Comprehensive_Review_Of_Rheumatoid_Arthritis_Insights_Challenges_And_Prospects

5.    https://pubmed.ncbi.nlm.nih.gov/33257900 /