Rheumatoid arthritis can simply be described as an autoimmune disease that causes chronic inflammation of the joints. In some people, the condition can damage a number of body systems, including the eyes, lungs, heart, skin and blood vessels. Because in some cases it can affect multiple other organs of the body, it is referred to as a systemic illness and is sometimes called rheumatoid disease. Autoimmune diseases are illnesses that result when the body’s tissues are mistakenly attacked by their immune system. Patients with autoimmune diseases have antibodies and immune cells in their blood that target their body tissues. The immune system contains a complex organization of cells and antibodies designed normally to seek and fight off invaders of the body, infections in particular. Rheumatoid arthritis affects the lining of the joints thus causing a painful swelling that can eventually result in bone erosion and even joint deformity.
Signs and symptoms of rheumatoid arthritis
Signs and symptoms of rheumatoid arthritis may vary in terms of severity and may sometimes even come and go with periods of increased disease activity, known as flares, alternating with periods of relative remission. This is when the swelling and pain fade or disappear. Early rheumatoid arthritis tends to affect smaller joints first, particularly the joints that connect fingers to your hands and your toes to your feet. Symptoms often spread to the wrist, knees, ankles, elbows, hips, and shoulders as the disease progresses, with symptoms occurring in the same joints on both sides of your body in most cases. Some of the symptoms include;
- Tender, warm, swollen joints
- Fatigue or lack of energy
- Low-grade fever
- Loss of appetite
- Joint stiffness that is usually worse in the mornings and after extended periods of inactivity
- Bumps under the skin referred to as rheumatoid nodules
- Shortness of breath as a result of inflammation or damage to the lungs
The causes and possible risk factors of rheumatoid arthritis
Rheumatoid arthritis occurs when your immune system attacks the lining of the membranes surrounding your joints causing inflammation. This inflammation thickens the linings of the membranes, weakening and stretching the tendons and ligaments that hold the joint together. This destroys the cartilage and bone within the joint resulting in the joint losing its shape and alignment.
Doctors do not know what starts this process, although various theories of why the immune system attacks the joints have been suggested, such as an infection being a trigger, but none of these theories has been proven. However, factors that may increase your risk of rheumatoid arthritis are:
Genetics or family history. Rheumatoid arthritis develops because of a combination of genetic and some environmental factors. It is not clear what the genetic link is, but it is believed that having a relative with the condition increases your chance of developing the condition.
Gender. Rheumatoid arthritis is two to three times more common among women than men, unfortunately placing women at a much higher risk of contracting the disease.
Age. Although the disease can affect adults of any age, it commonly begins in the middle ages of between 40 and 60, with around three-quarters of people who are first diagnosed with rheumatoid arthritis being those of working age.
Obesity. People who are overweight, especially women have a significantly greater chance of developing rheumatoid arthritis.
Diet. There is some evidence that if you eat lots of red meat and do not consume much vitamin C, then you are at an increased risk of developing rheumatoid arthritis.
Smoking. Cigarette smoking significantly increases the risk of developing rheumatoid arthritis particularly if you have a genetic predisposition for developing the disease. Besides, Smoking also appears to be associated with greater disease severity.
Complications associated with rheumatoid arthritis
Rheumatoid arthritis increases the risk of developing:
Dry eyes and mouth. Sjogren’s syndrome is a disorder that decreases the amount of moisture in the eyes and mouth and is common in people who have rheumatoid arthritis.
Heart problems. There is an increased risk of hardened and blocked arteries, as well as inflammation of the sac that encloses the heart.
Lymphoma. This disease increases the risk of lymphoma, a group of blood cancers that develop in the lymph system.
Infections. Many of the medications used to combat the disease can impair the immune system, leading to increased infections.
Lung disease. The scarring of the lung tissues due to inflammation is common in patients with RA. This can lead to progressive shortness of breath.
Osteoporosis. This is a condition that weakens bones and makes them more prone to fracture which commonly results from some medications used for treating RA.
Rheumatoid nodules. These are firm bumps of tissue commonly found around pressure points such as elbows. However, these may form anywhere in the body, including the lungs.
Diagnosis of rheumatoid arthritis
RA in its early stages has signs and symptoms that mimic those of many other diseases thus making it difficult to diagnose. Several examinations can be carried out by a rheumatologist to find out whether a person has rheumatoid arthritis. These include;
Blood tests. Several types of blood tests can be carried out by your health provider to determine whether you have RA. These tests look for c-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide all of which indicate the presence of an inflammatory process in the body.
Imaging tests. An X-ray may be recommended by the doctor to track the progression of rheumatoid arthritis in the joints over time, with ultrasound and MRI commonly used to help the doctor in judging the severity of the disease in the body.
Treating rheumatoid arthritis
Although there is no cure for rheumatoid arthritis, there are treatments that can help in managing the disease and slow the progression of the condition. These treatments go a long way in managing the pain and controlling the inflammatory response which can in many cases result in remission. Decreasing inflammation also helps to prevent further joint and organ damage. ‘Treat to target rheumatoid arthritis’ is a treatment philosophy that rheumatologists use which has resulted in fewer symptoms and higher remission rates for those with the disease. This strategy involves;
- Setting a specific testing goal that would signal either remission or low disease state
- Followed by testing acute phase reactants and performing, monitoring every month to assess the progress of treatment and management plan
- Finally switching the medication regime where there is no progress
However, you must work with your health provider to determine the best treatment plan for your condition. For most patients, these treatments help them live an active life as well as reduce the risk of long-term complications. They include;
There are many types of medication, some of which help reduce the pain and inflammation while some help to reduce flares and limit the damage that the disease does to the joints. Examples of over-the-counter medications that help reduce the pain and inflammation during rheumatoid arthritis flare are;
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
Examples of drugs that work to slow the damage that RA can cause to your body are;
- Disease; modifying antirheumatic drugs (DMARDs)-they block the body’s immune system response helping to slow down the progress of the disease
- Biologics; these provide a target response to inflammation rather than blocking the body’s entire immune system response.
- Janus kinase inhibitors (JAK); these drugs block certain immune responses and are recommended where both biologics and disease-modifying antirheumatic drugs have not yielded positive results with the patient.
Home remedies and some lifestyle adjustments may help to improve the quality of life of a patient with the disease. These include:
Get enough rest. Try resting more during flare-ups and less during remission. Getting enough rest helps reduce inflammation, pain as well as fatigue.
Exercise regularly. Exercise strengthens muscles thus relieving some of the pressure from the joints. Also, low-impact exercises tend to improve the range of motion in joints as well as increase mobility.
Use assistive devices. Braces and splints help hold the joints in a resting position, reducing pressure and inflammation. Crutches can be used to help in maintaining mobility, even during flares. You can also install household devices such as handrails along staircases.
Applying heat or cold. Ice packs help reduce inflammation and pain. Alternating cold with hot treatments reduces stiffness.
Relaxation. Find ways to cope with the pain by reducing stress in your life through techniques such as deep breathing, guided imagery, and muscle relaxation. All these can be used to control the pain.
It is important for patients suffering from rheumatoid arthritis to avoid trigger foods, as what you don’t eat is just as important as what you eat. An anti-inflammatory diet helps with the symptoms. Foods that have lots of omega-3 fatty acids such as walnuts, flax seeds, fatty fish like salmon and tuna would do the trick. Antioxidants such as vitamins A, C, and E found in foods like spinach, kidney beans, blueberries, and strawberries may also help reduce inflammation.
Eating lots of fiber according to some researchers may help reduce inflammatory responses which may decrease C-reactive protein levels. Choose fresh vegetables and fresh fruits. Foods such as green tea, broccoli, grapes, and soy products contain flavonoids which counter inflammation in the body of the patient.
A physical or occupational therapist can help with exercises that will keep your joints flexible, in addition to suggestions on new ways of doing daily tasks, which will be easier on your joints.
Where medications have failed to prevent or slow joint damage, surgery to repair the damaged joints may be considered. Surgery may help restore your ability to use your joint normally again, as well as reduce the constant pain associated with rheumatoid arthritis. RA surgery may involve one or more of the following procedure;
Tendon repair. Inflammation may cause tendons around your joint to loosen and rupture. These tendons may be repaired through surgery.
Synovectomy. This is a type of surgery performed on the knees, wrists, fingers, elbows, and hips to remove the inflamed lining of the joint called synovium.
Joint fusion. To stabilize or realign a joint for pain relief when a joint replacement isn’t an option may be recommended.
Total joint replacement. This is where your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.
Coping and support for patients with rheumatoid arthritis
A person’s work and family life can be affected to a large extent, by the pain associated with rheumatoid arthritis, with depression and anxiety among the most common, as are feelings of helplessness and low self-esteem. Some of the strategies that one can apply to cope with these feelings are;
Connect with others. Share your feelings with a family member of a friend especially when you are feeling overwhelmed. Also, connect with other patients with the same condition through a support group in your community or online.
Take control. Together with your doctor, make a plan for managing your arthritis and take charge of your disease.
Take some time for yourself. Find time for what you like, whether it’s writing in your journal or listening to music. This can help reduce stress.
Know your limits. Learn to communicate with your body and know when you need to rest. Rheumatoid arthritis often causes fatigue and muscle weakness. A short nap from time to time may help.
Rheumatoid arthritis is a chronic disease that doesn’t currently have a cure. Most people suffering from this disease do not have constant symptoms, but instead have flare-ups followed by relatively symptom-free periods known as remissions. The course of the disease varies from person to person with symptoms ranging from mild to severe.
With rheumatoid arthritis, hands are almost always affected although any joint in the body, including elbows, knees, feet, wrists, hips and even the jaw can be affected. Usually, joints are affected symmetrically. This means the same joints on both sides of the body become affected. This disease can be quite painful, with chronic inflammation sometimes leading to debilitating loss of cartilage, bone weakness, and joint deformity. Joint problems caused by rheumatoid arthritis will usually get worse over time thus the importance of early treatment, which can make your symptoms less painful and save your joints from damage