What is it? Rheumatoid arthritis 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 the joints. This 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. (as from ‘Arthritis Foundation‘)
If inflammation goes unchecked, it 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 Causes
The cause of RA is not yet fully understood, although doctors do know that an abnormal response of the immune system plays a leading role in the inflammation and joint damage that occurs. No one knows for sure why the immune system goes awry, but there is scientific evidence that genes, hormones and environmental factors are involved.
Researchers have shown that people with a specific genetic marker called the HLA shared epitope have a fivefold 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. These factors include infectious agents such as bacteria or viruses, which may trigger development of the disease in a person whose genes make them more likely to get it; 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. Research also has indicated that environmental factors may play a role in one’s risk for rheumatoid arthritis. Some include exposure to cigarette smoke, air pollution, insecticides and occupational exposures to mineral oil and silica.
- Rheumatoid Arthritis Symptoms:- Along with joint inflammation and pain, many people experience fatigue, loss of appetite and a low-grade fever. Because RA is a systemic disease, it may also affect organs and body systems.
- Rheumatoid Arthritis Diagnosis:- A rheumatologist is a specialist with specific training and skills to diagnose and treat RA. To make a proper diagnosis, the doctor will collect information on personal and family medical history, perform a physical exam and order diagnostic tests.
- Rheumatoid Arthritis Treatment:- The goals of RA treatment are stop inflammation (put disease in remission), relieve symptoms, prevent joint and organ damage, improve physical function and overall well-being, and reduce long-term complications.
- Rheumatoid Arthritis Self-Care:- You can be an effective self manager of RA by taking a proactive role in your own treatment and maintain a good quality of life. As a complement to a medication program, here are some ways that can help manage symptoms and promote overall health.Read More >>
- Rheumatoid Arthritis:- Rheumatoid arthritis 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 the joints.
Rheumatoid Arthritis Treatment
The goals of rheumatoid arthritis (RA) treatment are to:
- 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, the doctor will follow these strategies:
Early, aggressive :- 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 Symptoms
Nonsteroidal anti-inflammatory drugs (NSAIDs) are available over-the-counter and by prescription. They are used to help ease arthritis pain and inflammation. NSAIDs include such drugs as ibuprofen, ketoprofen and naproxen sodium, among others. For people who have had or are at risk of stomach ulcers, the doctor may prescribe celecoxib, a type of NSAID called a COX-2 inhibitor, which is designed to be safer for the stomach. These medicines can be taken by mouth or applied to the skin (as a patch or cream) directly to a swollen joint.
Drugs That Slow Disease Activity
Corticosteroids :- Corticosteroid medications, including prednisone, prednisolone and methyprednisolone, are potent and quick-acting anti-inflammatory medications. They may be used in RA to get potentially damaging inflammation under control, while waiting for NSAIDs and DMARDs (below) to take effect. 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.
DMARDs :- An acronym for disease-modifying antirheumatic drugs, DMARDs are drugs that work to modify the course of the disease. Traditional DMARDs include methotrexate, hydroxycholorquine, sulfasalazine, leflunomide, cyclophosphamide and azathioprine. These medicines can be taken by mouth, be self-injected or given as an infusion in a doctor’s office.
Biologics :- These drugs are a subset of DMARDs. Biologics 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 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 be considered for replacement.