Rheumatoid Arthritis-All you wanted to know
Rheumatoid arthritis causes:
Certain factors increase your chance of developing rheumatoid arthritis (RA). Those risk factors are:
- Sex: Women are two to three times more likely to develop rheumatoid arthritis than men(3).
- Age: people in the productive age group (20-50) are more prone to develop RA
- Smoking: Smoking increases your chance of developing and severity of RA (4).
- Genetics: there is a strong relationship between genetic factors and RA, as genetics are associated with human leukocytes antigen (HLA).
- Pregnancy: nulliparous women (women who have not given birth) are at increased risk of developing RA (5).
- Infections: certain infectious agents have been associated with the development of RA such as Epstein-Barr virus, parvovirus, and bacteria such as Mycoplasma and Proteus (5).
- Obesity: obese people are at more risk of developing RA (6).
Rheumatoid arthritis is an autoimmune disease, which denotes a condition in which our immunity wrongly identifies our body tissues as foreign organisms and starts producing antibodies attacking it. The antibodies form immune complexes and they deposit on the synovial membranes of the joint leading to the development of arthritis symptoms.
The symptoms of rheumatoid arthritis can be divided into arthritis symptoms and non-arthritis symptoms.
Arthritis symptoms include:
- Painful, warm, and swollen joints (7)
- Morning stiffness: painful joints and morning stiffness in the joints are the first symptoms that occur in RA (7).
- Two or more joints are involved at the same time.
- Same joints are involved on both sides- this feature helps us to differentiate RA from other types of arthritis.
- Small joints such as wrist, elbow, ankles, and hand joints are affected usually. But sometimes large joints such as knee joints and shoulder joints are also affected (7).
- As the disease progresses fibrous tissues form in the inflamed joints leading to adhesion of opposing bones in the joints and causing deformities.
- Loss of appetite
- Weight loss
- Skin: rheumatoid nodules are seen in 30% of the patients (8).
- Lungs: complications of rheumatoid arthritis can manifest in the lung as fluid accumulation in the lung, the formation of nodules in the lung, and fibrosis of the lung.
- Heart: RA can affect the heart and lead to conditions such as pericarditis and cardiomyopathy (7)
- Anemia (7)
- Eyes: it can affect the iris, cornea and can even lead to blindness (8)
- Nervous system: peripheral neuritis, neuropathies, carpal tunnel syndrome
- Blood vessels: RA can increase your chances of developing atherosclerosis (deposition of fat in the blood vessels), heart attack, and stroke (8).
Diagnosis of rheumatoid arthritis:
Diagnosis of RA is difficult in the early stages of the diseases as the spectrum of symptoms can overlap with other forms of arthritis. Diagnosis is confirmed by considering symptoms, clinical examination findings, blood investigations and radiological investigations (9).
Clinical examination findings may show swollen joints, edema of tissues surrounding the joints, spasm of muscles, restriction of the range of movements, rheumatoid nodules on the skin, and deformity in advanced stages (7).
- Erythrocyte sedimentation rate: elevated in people with RA but not a specific test for rheumatoid arthritis.
- Hemoglobin: hemoglobin levels will be low in some patients with rheumatoid arthritis indicating anemia
- Rheumatoid factor: this test checks for the presence of immunoglobulin called the rheumatoid factor in the blood. It can be done by latex fixation test and rose-waaler test.
- C-Reaction protein test: C reactive protein is elevated in most of the severe infective and inflammatory conditions. It is significantly elevated in rheumatoid arthritis.
The radiological investigations performed for the diagnosis of RA are:
- X-ray of the joints: x-ray of the joints can showdecreased joint space, erosion of bony surfaces in the joint, cysts below thesurface of the bone, and deformities
- Other tests: other radiological investigations for the diagnosis of rheumatoid arthritis are MRI and ultrasonography.
There is no cure for RA. The treatment aims to reduce symptoms, prevent complications and stop further progression of the disease.
The medical treatment of RA includes:
- NSAIDs: non-steroidal anti-inflammatory drugs can decrease inflammation and relieve pain.
- Disease modifying anti-rheumatic drugs: they are the first-line of drugs used in the treatment of rheumatoid arthritis. Few of the commonly used DMARDs are methotrexate, adalimumab, azathioprine, minocycline, and sulfasalazine (10).
- Steroids: steroids are used to decrease inflammation and decrease the outburst of symptoms.
Other treatment methods
the other treatment methods used to treat RA are physiotherapy, synovectomy, bone block operations, tendon lengthening, tendon transfers, interposition arthroplasties, and total joint replacements (7).
Diet for Rheumatoid arthritis
Including some foods in the diet can help in reducing the symptoms of RA. They are:
- Omega-3 fatty acids: Foods rich in omega-3 fatty acids are salmon, tuna, sardines, nuts and herring (11).
- Dietary fiber: foods rich in dietary fiber are whole grains, oats, fruits, and vegetables (9).
- Antioxidants: antioxidants can help in reducing inflammation. Foods rich in antioxidants are berries, oranges, vitamin c, grapes, dark chocolate, and spinach (9).
4. Cigarette smoking and rheumatoid arthritis severity. Kenneth G Saaga, James R Cerhanc, Sheela Kolluric, Kenjirou Ohashid, Gary W Hunninghakeb, David A Schwartzb. auguist 1, 1997, Annals of the Rheumatic Diseases , pp. 463-469.
5. Silman, A. J. and Hochberg, M. C. Epidemiology of the rheumatic diseases. s.l. : oxford university press. 0192631497.
6. Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis. Results from a primary care‐based incident case‐control study in Norfolk, England. Deborah P. M. Symmons MD, FRCP Clare R. Bankhead MSc Beverley J. Harrison BSc, MRCP Paul Brennan PhD Alan J. Silman Elizabeth M. Barrett BSc David G. I. Scott MD, FRCP. 11, november 1997, arthritis and rheumatology, Vol. 40, pp. 1955-1961.
7. maheshwari, J. arthritis and related diseases. essential orthopaedics. new delhi : jaypee brothers medical publishers, 2011.