Definition and Overview

Rheumatoid arthritis, which is one of the many different forms of arthritis, is a chronic inflammatory disorder wherein the lining of the joints are severely affected, putting the patient at risk of suffering from joint deformity and bone erosion. This autoimmune disease, which is typically characterized by periods of flares and remissions, affects mostly women, smokers, and people with hereditary links to the disease.

Rheumatoid arthritis can also inflame and injure other body parts; thus, it is referred to as a systemic illness.

Causes

As a form of arthritis, rheumatoid arthritis is considered an autoimmune disease, which sets in when the body’s immune system starts attacking healthy tissues. Once this attack is triggered, the immune cells migrate toward the joints, wear down the cartilage and release inflammatory substances that affect the tissue that lines the joints, causing them to expand and potentially damage the bones. With the cartilage worn down, the bones start rubbing against each other, causing severe pain.

What triggers the attack is unknown, although these factors may be involved:

  • Hormonal – Rheumatoid arthritis is commonly experienced by women mainly because of the presence of higher level of estrogen in their system, but it tends to cause more severe symptoms among male sufferers.

  • Environmental – Based on official figures, smokers and middle-aged persons are more susceptible to the disease.

  • Genetic – Experts have previously presented evidence that links genes with rheumatoid arthritis. However, their studies confirmed that the risk of inheriting the disease is significantly low.

  • Viral or bacterial infections – Since the main attack occurs initially on the immune system, certain infections are also suspected to trigger the disease.

Key Symptoms

The key symptoms of rheumatoid arthritis include:

  • Joint pain
  • Swelling/inflammation
  • Morning stiffness that lasts for more than an hour
  • Stiffness after long periods of no movement or activity
  • Fatigue
  • Affected area is warm to the touch
  • Tenderness
  • Bumps or nodules under the skin
  • Weakness
  • Low fever
  • Weight loss/anorexia

Diagnosis

Who to See

Patients who experience the above symptoms may see a general physician or a doctor of internal medicine. If rheumatoid arthritis is suspected, patients are referred to rheumatologists.

During the course of treatment, rheumatologists may bring in other health professionals to provide the patient with comprehensive medical care. The team of professionals may include the following:

  • Orthopedic surgeons – In cases that require surgery, orthopedic surgeons, who specialize in surgery for joint diseases, will be called in.

  • Physical therapists – Physical therapists help patients improve the functions of their affected joints.

  • Occupational therapists – These health professionals teach patients how to minimize pain and protect their joints while conducting their daily activities.

  • Dietitians/Nutritionists – These professionals help patients in maintaining a healthy weight particularly during treatment.

  • Nurses – Nurses provide extra care, as well as assistance, in the implementation of treatment plans.

  • Psychologists – As the disease may have psychological factors that may affect the patient’s ability to adapt to his home or workplace, psychologists may be brought in to help them cope.

Diagnostic Tests

Diagnosis of rheumatoid arthritis is conducted through a series of laboratory blood tests. These are performed to identify certain indicators including RF antibody, Anti-CCP, Anemia, and ANA (antinuclear antibody). The condition is confirmed if blood tests show that the patient has rheumatoid factor RF antibody and cylic citrulline antibody in their system. It can also be confirmed if the patient has elevated erythrocyte sedimentation rate and C-reactive protein levels, both of which indicate inflammation. Patients who also tested positive in the antinuclear antibody test, which is a clear indication that an autoimmune disease is present, are immediately presented with treatment options.

Treatment and Management

Proper management of the disease may include one or a combination of the following treatment options:

  • Medication – Medications are used mainly to relieve the pain and stop the swelling. The most commonly prescribed medications include analgesic, glucocorticoids, disease-modifying anti-rheumatic drugs, biologic response modifiers, and non- steroidal anti-inflammatory medications.

  • Rest – Patients are advised to refrain from doing certain activities particularly in times of inflammation and pain flare-ups.

  • Exercise – Exercise helps keep the joints flexible and strengthens the surrounding muscles to prevent further deterioration.

  • Surgery – For severe cases wherein the pain can no longer be controlled by medication, specialists recommend surgery. Total Joint Replacement and Knee Replacement surgeries are performed to take out the damaged structures and replace them with prosthesis or artificial joint.

  • Surveillance – Since rheumatoid arthritis is sometimes linked to heart, lung, and other organ-related problems, surveillance for infection and malignancy, as well as onsets of related diseases such as osteoporosis, is necessary.

In choosing the right kind of treatment, the following factors should be considered:

  • The severity of the condition
  • Age
  • General state of health
  • Medical history
  • Reactions to medications

If medications are chosen, the following may be considered based on the renal and hepatic state of the patient:

  • Topical pain relievers
  • Anti-inflammatory pain relievers (aspirin or ibuprofen)
  • Narcotic pain relievers
  • Disease-modifying anti-rheumatic drugs DMARDs, which include immune suppression drugs and biologic medications

There is currently no permanent cure for rheumatoid arthritis, but with the right treatment plan, long-term effects and disability may be prevented. Early use of DMARDs has been shown to slow the progression of the disease.

Overall management of the disease has shown major improvements in the past 30 years, which means current sufferers of rheumatoid arthritis are more or less able to function normally and live with the disease.

References:

  • The American Journal of Medicine: “Rheumatoid Arthritis: Diagnosis and Management”
  • American College of Rheumatology: “Rheumatoid Arthritis”
  • The Arthritis Society: “Role of A Rheumatologist”
  • American Academy of Family Physicians: “Diagnosis and Management of Rheumatoid Arthritis”
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Handout on Health: Rheumatoid Arthritis”
  • American Autoimmune Related Diseases Association: “Autoimmune Diseases in Women”
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