Rheumatoid

Arthritis

RHEUMATOID ARTHRITIS - RA is an autoimmune disease in which the body’s immune system – which normally protects its health by attacking foreign substances like bacteria and viruses – mistakenly attacks areas of the joints body organs such as the heart, skin, eyes and more. Issues involving the joints creates inflammation that causes the tissue that lines the inside of joints (the synovium) to thicken, resulting in swelling and pain in and around the joints. The synovium makes a fluid that lubricates joints and helps them move smoothly. 

​RA can damage cartilage, the elastic tissue that covers the ends of bones in a joint, as well as the bones themselves. Over time, there is loss of cartilage, and the joint spacing between bones can become smaller. Joints can become loose, unstable, painful and lose their mobility. Joint deformity also can occur. Joint damage cannot be reversed, and because it can occur early, doctors recommend early diagnosis and aggressive treatment to control RA.

​Rheumatoid arthritis most commonly affects the joints of the hands, feet, wrists, elbows, knees and ankles. The joint effect is usually symmetrical. That means if one knee or hand if affected, usually the other one is, too. Because RA also can affect body systems, such as the cardiovascular or respiratory systems, it is called a systemic disease. Systemic means “entire body.” 

​​​Rheumatoid Arthritis (RA) affects over 1.5 million people in the United States. Although most people affected with RA are between the ages of 3-60, 50,000 are children under the age of 17.  Of all those affected, about 75 percent are women. Having a family member with RA increases the odds of having RA; however, the majority of people with RA have no family history of the disease.

 

Symptoms

The actual cause of RA remains unknown. However, there is scientific evidence that genes, hormones and environmental factors might be involved.

Researchers have shown that people with a specific genetic marker called the HLA shared epitope have a five-fold greater chance of developing rheumatoid arthritis than do people without the marker. The HLA genetic site controls immune responses. Other genes connected to RA include: STAT4, a gene that plays important roles in the regulation and activation of the immune system; TRAF1 and C5, two genes relevant to chronic inflammation; and PTPN22, a gene associated with both the development and progression of rheumatoid arthritis. Yet not all people with these genes develop RA and not all people with the condition have these genes.

Researchers continue to investigate other factors that may play a role including; infectious agents such as bacteria or viruses, female hormones (70 percent of people with RA are women); obesity; and the body’s response to stressful events such as physical or emotional trauma. Researchers have also indicated that environmental factors may play a role in one's risk for RA. Some include exposure to cigarette smoke, air pollution, insecticides and occupational exposures to mineral oil and silica.

Causes
In the early stages, people with RA may not initially see redness or swelling in the joints, but they may experience tenderness and pain.

​These following joint symptoms are clues to RA:
 

  • Joint pain, tenderness, swelling or stiffness for six weeks or longer

  • Morning stiffness for 30 minutes or longer

  • More than one joint is affected

  • Small joints (wrists, certain joints of the hands and feet) are affected

  • The same joints on both sides of the body are affected

  • Along with pain, many people experience fatigue, loss of appetite and a low-grade fever.


The symptoms and effects of RA may come and go. A period of high disease activity (increases in inflammation and other symptoms) is called a flare. A flare can last for days, months or even years.
​Ongoing high levels of inflammation can cause problems throughout the body. Here of some ways RA can affect organs and body systems:
 

  • Eyes. Dryness, pain, redness, sensitivity to light and impaired vision

  • Mouth. Dryness and gum irritation or infection

  • Inflammation around organs such as the heart.

  • Psoriatic and other skin complications.

  • Skin. Rheumatoid nodules – small lumps under the skin over bony areas

  • Lungs. Inflammation and scarring that can lead to shortness of breath

  • Blood Vessels. Inflammation of blood vessels that can lead to damage in the nerves, skin and other organs

  • Blood. Anemia, a lower than normal number of red blood cells


These issues most likely results in a diminished physical capacity and may lead to death. It has been estimated that of those with RA, 7.9% die as a direct result of the disease.Treatment​
Once your primary physician diagnoses or views symptoms of RA, it is important to obtain a doctor that specializes in the treatment of RA.  These doctors are know as Rheumatologists.

Treatment goals may include:
​​

  • Stop inflammation (put disease in remission)

  • Relieve symptoms

  • Prevent joint and organ damage

  • Improve physical function and overall well-being

  • Reduce long-term complications


To meet these goals, most doctors will follow the following strategies:

  • Early, aggressive treatment. The first strategy is to reduce or stop inflammation as quickly as possible – the earlier, the better.

  • Targeting remission. Doctors refer to inflammation in RA as disease activity. The ultimate goal is to stop it and achieve remission, meaning minimal or no signs or symptoms of active inflammation. One strategy to achieve this goal is called “treat to target.”

  • Tight control. Getting disease activity to a low level and keeping it there is what is called having “tight control of RA.” Research shows that tight control can prevent or slow the pace of joint damage.


Medications for RA. There are different drugs used in the treatment of rheumatoid arthritis. Some are used primarily to ease the symptoms of RA; others are used to slow or stop the course of the disease and to inhibit structural damage.

Drugs that ease pain and other symptoms include Nonsteroidal anti-inflammatory drugs (NSAIDs) and are available over-the-counter and by prescription. They include such drugs as ibuprofen, ketoprofen and naproxen sodium, among others. 

Drugs that may slow disease activity may include Corticosteroids. Corticosteroid medications, including prednisone, prednisolone and methyprednisolone. Because of the risk of side effects with these drugs, doctors prefer to use them for as short a time as possible and in doses as low as possible.

Biologics. These may work more quickly than traditional DMARDs, and are injected or given by infusion in a doctor’s office. Because they target specific steps in the inflammatory process, they don’t wipe out the entire immune response as some other RA treatments do. In many people with RA, a biologic can slow, modify or stop the disease – even when other treatments haven’t helped much.

JAK inhibitors. A new subcategory of DMARDs known as “JAK inhibitors” block the Janus kinase, or JAK, pathways, which are involved in the body’s immune response. Tofacitinib belongs to this class. Unlike biologics, it can be taken by mouth.

Surgery. Surgery for RA may never be needed, but it can be an important option for people with permanent damage that limits daily function, mobility and independence. Joint replacement surgery can relieve pain and restore function in joints badly damaged by RA. The procedure involves replacing damaged parts of a joint with metal and plastic parts. Hip and knee replacements are most common. However, ankles, shoulders, wrists, elbows, and other joints may also be considered for replacement.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.