Rheumatoid Arthritis: Treatment, Symptoms, Causes & Diagnosis
Written By: Dr. Kirthi Raju
Dr. Kirthi Raju completed her MBBS from Mahatma Gandhi University, Kottayam, India and MD ( Internal Medicine) and DM (Rheumatology) from the Tamilnadu Dr..M.G.R. Medical University, Chennai, India. She further pursued a specialty certificate in Rheumatology, Federation of Royal College of Physicians of The UK and The British Society of Rheumatology, UK.
Updated On:November 21, 2021
What is Rheumatoid Arthritis?
Arthritis is a blanket term which means inflammation of the joints. Rheumatoid Arthritis, more specifically, refers to an autoimmune disease that is chronic and systemic in nature. An autoimmune disease refers to the body’s immune and natural defense system mistakenly attacking its own healthy tissues. It primarily causes inflammation in the joints and is subsequently linked to premature disability.
Rheumatoid Arthritis Symptoms
The symptoms most commonly associated with rheumatoid arthritis are joint pain, joint swelling and stiffness. The symptoms and their duration can fluctuate, even on a daily basis. Periods where rheumatoid arthritis’ symptoms are experienced are called flare ups, while periods where they do not manifest, or do so to a lesser extent, are referred to as remission. It is pertinent to diagnose and adequately start treating it early, as a failure to do so for long periods of time can lead to disability, erosive joint damage and many forms of impairment which can also affect a person’s cardiovascular and cognitive abilities. On the other hand, early detection of rheumatoid arthritis can prevent long-lasting damage and may lead to remission. Early symptoms can be detected by noticing minimal interferences such as joint pain in smaller joints, unusual fatigue, and minor forms of swelling in the joints, as well as body-stiffness in the morning, which are also common yet ignored symptoms of rheumatoid arthritis.
When to see a doctor for Rheumatoid Arthritis
It is advised that you visit your doctor if you experience the following symptoms:
- Persistent joint pain
- Inflammation indicated by joint swelling, stiffness, redness, and/or warmth
- Joint deformity
- Loss of range of motion or flexibility in a joint
- Extreme fatigue, lack of energy, weakness, or a feeling of malaise
Causes of Rheumatoid Arthritis
It is unknown and unclear what causes the immune system to attack the healthy body, although certain factors increase the risk of developing rheumatoid arthritis. A normal immune system protects the body against foreign particles such as bacteria and viruses by identifying the foreign antigens and initiating an immune response. Your body’s cells have their own antigens that the immune system can sometimes mistake as foreign and therefore initiate a response against your cells. An immune response against joint cells characterizes rheumatoid arthritis.
Risk Factors of Rheumatoid Arthritis
There are certain factors that may affect the prevalence of the disease, such as age, sex, weight and lifestyle.
- Age: The elderly are at higher risk of developing rheumatoid arthritis.
- Sex: Rheumatoid arthritis arises more among women than men.
- Weight: Being overweight increases the risk of developing rheumatoid arthritis.
- Lifestyle: Smoking increases risk of rheumatoid arthritis and has an adverse impact on the disease.
- Genetic factors: People with human leukocyte antigen class II genotypes have a higher genetic disposition to rheumatoid arthritis.
Rheumatoid arthritis is believed to arise more in women than men, while being elderly also puts you at a much higher risk. Other factors such as obesity and lifestyle habits such as smoking can increase the risk of rheumatoid arthritis as well as have an adverse impact on the disease. Furthermore, certain people such as those with human leukocyte antigen class II genotypes, have a higher genetic disposition to the disease.
Complications Rheumatoid arthritis
Patients with Rheumatoid Arthritis have an increased risk of developing certain conditions:
- Osteoporosis: Rheumatoid arthritis increases the risk of developing osteoporosis, a condition that weakens the bones.
- Rheumatoid nodules: These stiff bumps are found around pressure points but can also grow in the heart and lungs.
- Sjogren’s Syndrome: Rheumatoid arthritis increases the risk of developing Sjogren Syndrome, a condition that causes dryness of eyes and mouth.
- Infections: The disease itself as well as medication used for its treatment affect the patient’s immune system, leading to infections.
- Abnormal body composition: The ratio of fat to lean mass is higher among patients of rheumatoid arthritis.
- Carpal Tunnel Syndrome: Rheumatoid arthritis in the wrist can compress the nerve of the hand and fingers.
- Cardiac Issues: Rheumatoid arthritis increases chances of developing hardened and blocked arteries.
- Lung disease: Rheumatoid arthritis increases the risk of inflammation and scarring of tissue.
- Lymphoma: Rheumatoid arthritis also increases the risk of developing Lymphoma - a cancer in the lymphatic system.
Rheumatoid Arthritis Diagnosis
Rheumatoid arthritis symptoms vary and range from minimal interferences to those that cause excruciating pain. Therefore, the nature of the disease makes it fairly difficult to diagnose, especially in its earlier stages. It is also very important to consult a doctor even when faced with minor symptoms. The diagnosis of rheumatoid arthritis follows a comprehensive assessment and often includes an amalgam of methods to effectively identify the presence of such a disease. However, there is no specific test that can conclusively determine whether one has rheumatoid arthritis and therefore it must be distinguished from other medical conditions which manifest similar symptoms, such as lupus, psoriatic arthritis, lyme disease and osteoarthritis. To do so, rheumatologists often employ different tests and diagnosis methods, including:
Blood tests for rheumatoid arthritis:
There are certain conditions more prevalent in those who have rheumatoid arthritis.
- Test checking for C-Reactive Protein (CRP Levels). As has been earlier discussed, the most common feature of rheumatoid arthritis is inflammation. A result of a higher CRP level in your blood is a strong indicator of inflammation in the body.
- This is often paired with an erythrocyte sedimentation rate test, where it is timed as to how long it would take for one’s red blood cells to reach the end of a test tube filled with liquid, which is another strong indicator of inflammation.
- Other blood tests that may help in diagnosing the disease include full blood count tests, which if concluded that one is anemic, could also help as anemia is very common in patients suffering from rheumatoid arthritis.
- Tests for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies are also firm indicators of the disease.
Imaging tests for rheumatoid arthritis:
Scans that check for damage or inflammation in the joints may also be used in conjunction to diagnose rheumatoid arthritis. Scans such as X-Rays indicate the disease’s progression in the joints, while ultrasound scans and magnetic resonance imaging scans are also used.
Rheumatoid Arthritis Treatment
Research shows that effective treatment of symptoms leads to an alleviation of the symptoms and can lead to the condition’s remission. This includes:
Rheumatoid arthritis medications:
The mainstay of treatment for RA are Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. 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. Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs used to alleviate pain and combat the inflammation. Steroids in addition to NSAIDs can be used to reduce joint pain and swelling in the short to medium term. Taken by mouth or as an injection. Can cause weight gain, a rise in blood pressure and blood glucose. Bone thinning can happen if used for longer periods.
Rheumatoid arthritis physical therapy:
Physical therapy for rheumatoid arthritis serves a number of functions, including preventing joint stiffness by promoting flexibility, as well as learning new methods to avoid strains and sprains.
Rheumatoid arthritis surgery:
Advances in treatment for rheumatoid arthritis (RA) during the past 2 decades have resulted in dramatic improvements in quality of life for these patients. The development of biologic therapies targeting molecules involved in the pathogenesis of RA has led to significant improvements in the signs and symptoms of disease in as many as 60% to 70% of patients and resulted in remission in 10% to 50% of patients. When the patient with rheumatoid arthritis develops joint deformities that are unresponsive to medical management, orthopedic intervention is often necessary. Less often painful deformities often persist and even progress after a thoroughly optimized trial of medical management. Surgery to alleviate pain, provide stability, end the progression of deformity, and improve cosmesis then becomes the treatment of choice. Some examples of such surgeries include Synovectomy, Joint Fusion, Joint Replacement and Tendon Repair.
Rheumatoid Arthritis Home Remedies
While it is important to see a doctor and follow their guidance pertaining to rheumatoid arthritis, there are certain home remedies that can be used in conjunction to manage the symptoms, including:
- Light forms of exercise, which can reduce fatigue and strengthen muscles which support joints and in turn help with managing joint pain.
- Various kinds of relaxing methods such as lyengar yoga and meditation, which are shown to help fatigue as well as aid in developing an acceptance of the pain that accompanies rheumatoid arthritis.
- Good sleep, which is recommended to those who suffer from the disease. Studies show that poor sleep adversely affects pain and causes stiffness in the body.
- Cold therapy or applying cold materials where the joints are inflamed can help reduce the pain as well as swelling.
Rheumatoid Arthritis Prevention
Simple lifestyle changes can reduce the risk of developing rheumatoid arthritis. These changes reduce inflammation in the body and help maintain healthy bones. They include:
- Quitting smoking
- Limiting alcohol consumption
- Taking care of bone health via dietary supplements
- Improving oral health
- Maintaining a healthy body weight
- Exercising regularly
For more information on the diagnosis and treatment of rheumatoid arthritis, get in touch with us.
Meet our doctors from the Rheumatology department