RHEUMATOID ARTHRITIS-Causes, Symptoms & Treatment FAQs

INTRODUCTION

Rheumatoid arthritis or RA refers to a chronic autoimmune disease that typically affects the joints. The joints affected in this disease are symmetrical i.e. both sides of the body are usually affected. The most commonly affected joints include hands, feet, wrists, knees, ankles, elbows, and shoulders. It's essential to note that while these joints are most frequently affected, RA can influence any joint in the body. Generally, the immune system can differentiate between our own body cells and foreign substances but, in the case of rheumatoid arthritis, this ability is impaired leading to the destruction of the body's own cells and tissues. This causes chronic pain and swelling in the joints. If left untreated, may lead to permanent joint damage.

Pain in the wrist due to Rheumatoid arthritis. Anatomy Stock photos by Vecteezy

CONTENTS

1. Introduction
2. Causes 
3. Signs and symptoms
4. Diagnosis 
5. Treatment options
6. FAQs

CAUSES

However the exact cause of RA remains unknown, the immune system plays a significant role in the development of the disease. It is considered that there is a combination of other factors along with immune dysfunction that contributes to the occurrence of rheumatoid arthritis including, genetic and environmental factors. The risk of developing RA increases significantly by having a family history of the disease. 

It is essential to note that while the above-mentioned factors may significantly contribute to the development of RA, they do not guarantee that a person will develop the disease. 

SYMPTOMS

RA usually affects the joints, but it can also cause symptoms to occur in other parts of the body. Some of the most commonly observed signs and symptoms of the disease are given below:

• Joint pain
• Red and swollen joints
• Joint stiffness
• Fatigue
• Low-grade fever
• Loss of appetite 
• Tenderness in joints
• Rheumatoid nodules

The symptoms of RA come in flares i.e. periods of increased symptoms followed by periods of remission when the symptoms begin to decrease or disappear. Usually, the pain and stiffness in the joints worsen in the morning or after periods of inactivity. You may begin to feel tired and experience weight loss due to loss of appetite. Some less common symptoms of RA may include, shortness of breath, coughing, inflammation of the heart, eye inflammation, numbness or tingling sensation felt in hands and feet. 

In some cases, people suffering from rheumatoid arthritis may develop firm lumps under the skin that are usually formed near the affected joints referred to as rheumatoid nodules. These are typically considered painless and movable while sometimes they may become inflamed, painful, and ulcerated. 

DIAGNOSIS

RA can be diagnosed by simply having a look at the patient's medical history, physical examination, and some laboratory tests. The medical history allows your doctor to assess if the cause of the disease might be genetic by considering the history of any type of autoimmune disease in your family as well as to observe your symptoms in more detail. Your doctor may order imaging tests such as X-rays, Ultrasound, or MRI scans to look for early signs of RA in joints such as swelling due to fluid buildup and joint damage. The laboratory tests that may be performed typically include,

• Rheumatoid Factor generally referred to as RF is the most commonly performed laboratory test for the diagnosis of rheumatoid arthritis. However, not everyone with RA has a positive RF which means, additional tests must be performed to confirm the diagnosis. 
• Anti-CCP or Anti-cyclic citrullinated peptide antibodies test is performed to identify the presence of disease in early phases hence, it is considered more specific.

In addition, a complete blood count (CBC) or Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be performed to measure the levels of Inflammation in the body.

TREATMENT

The goal of the treatment is to reduce pain, and inflammation, slow down the process of progression of disease, and improve the overall quality of life, The treatment options for rheumatoid arthritis generally include anti-inflammatory and pain relieving medications along with some lifestyle modifications and physical therapy. 

MEDICATION

• NSAIDs i.e. Non-Steroidal Anti-Inflammatory Drugs provide pain relief and help in reducing the inflammation in joints. The most commonly used over-the-counter pain relievers are ibuprofen and naproxen. 
• DMARDs or Disease Modifying Anti-Rheumatic Drugs have been considered very effective and crucial for the treatment of Rheumatoid arthritis. They play a significant role in delaying the progression of disease and preventing further damage to the joints by suppressing the abnormal immune response. Methotrexate, the "gold standard" for RA treatment is highly effective in slowing down the progression of disease and reducing swelling. DMARDs show best results when used in combination with other medications. 
• Corticosteroids are considered very powerful anti-inflammatory drugs as they can provide rapid pain relief and reduce swelling but have significant side effects. The most commonly prescribed corticosteroid drug for RA is Prednisone. 

LIFESTYLE MODIFICATIONS

Regular exercise such as walking, running, and strength training help in maintaining the flexibility and strength of the overall joints and muscles of the body. Balancing periods of physical activity with rest is essential to prevent and manage fatigue. Including exercise in your daily routine, can help manage weight as excessive weight adds stress to the joints exposing them to greater risk of damage and increased rate of disease progression. Consuming a balanced diet that contains all the nutrients, vitamins, and minerals necessary to improve and maintain overall health and well-being is recommended. Incorporating stress management techniques such as meditation and yoga can help increase the adherence of patients to the treatment plan of the disease as well as improve the overall quality of life.

Heat therapy and cold therapy can help in temporarily relieving the symptoms of pain and inflammation. 

PHYSICAL THERAPY APPROACH

The aim of using a physical therapy approach in treating rheumatoid arthritis is to reduce pain and swelling, improve the movement and overall function of the joints, improve cardiovascular health, and enhance the quality of life. 

Physical therapy for RA can include various joint and muscle exercises such as range of motion exercises, strength training, aerobic exercises including walking, jogging, swimming, cycling, postural exercises to improve posture and maintain the correct alignment of the body parts and relaxation techniques such as Tai Chi and yoga. These help in maintaining the range of motion of joints, flexibility, endurance, and strength of the muscles around the joints along with preventing stiffness and formation of contractures or adhesions.  Tai Chi and yoga are beneficial in improving balance and overall fitness of mind and body. 

Assistive devices such as braces, splints, and adaptive equipment can be used to reduce joint strain and protect them from further damage. 

In some cases, surgery may be performed when all other treatment options have failed to provide relief or considerable joint damage and dysfunction are observed.

FAQs

Are rheumatoid arthritis drugs dangerous?

Every drug has its own benefits and side effects depending upon its use and the overall health of the individual patient. The long-term use of the drugs used to treat RA can have potential side effects such as lung problems, liver damage, and increased risk of infections. Corticosteroid drugs if taken for a long period may cause weight gain, increased blood sugar levels, or osteoporosis. 

Can rheumatoid arthritis kill you?

Rheumatoid arthritis itself is not considered a life-threatening disease. It is an autoimmune disorder that most commonly affects the joints, but can also affect organs of the body such as the heart, lungs, and other organs. It can cause serious complications if left untreated which may include, cardiovascular disease and pulmonary fibrosis. The immunosuppressant drugs given to manage RA can increase the susceptibility to infections which can be serious or fatal. 

Can rheumatoid arthritis be cured?

Unfortunately, there is no cure available for rheumatoid arthritis at present. However, several treatment options such as medication including NSAIDs, DMARDs, physical therapy, and lifestyle changes can significantly help in managing the overall symptoms and slowing the progression of the disease. Early diagnosis and prompt treatment can remarkably improve the quality of life of people with RA.

Can rheumatoid arthritis go away?

As rheumatoid arthritis is an autoimmune disease accompanied by flares of symptoms where a person experiences periods of increased pain and discomfort followed by periods of remission where the symptoms may decrease or disappear for a while, but it generally does not "go away". It can not be cured and the symptoms can only be managed through various treatment options. 

Can rheumatoid arthritis cause back pain?

Yes, it can cause back pain. RA most commonly affects the joints of hands, wrists, and feet, but in some cases, it can affect the spine causing pain and inflammation of the spine and its surrounding structures, This leads to back pain. However, back pain can also be caused by RA of other joints that have led to postural changes and malalignment of the body parts.