Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation in joints and other parts of the body. Unlike osteoarthritis, which is caused by wear and tear, RA occurs when the immune system mistakenly attacks the body's own tissues, particularly the synovium (lining of joints).

RA typically affects joints symmetrically (both sides of the body) and can cause pain, stiffness, swelling, and eventually joint damage and deformity. Early diagnosis and treatment are crucial to prevent permanent joint damage and maintain function.

RA symptoms can vary in severity and may come and go:

Joint Symptoms:

• Joint pain: Often worse in the morning
• Joint stiffness: Especially morning stiffness lasting more than 30 minutes
• Swelling: Warm, swollen joints
• Tenderness: Joints tender to touch
• Symmetrical involvement: Same joints on both sides
• Reduced range of motion: Difficulty moving joints

Common Joints Affected:

• Small joints of hands and feet
• Wrists
• Elbows
• Shoulders
• Knees
• Ankles

Other Symptoms:

• Fatigue: Feeling tired and weak
• Fever: Low-grade fevers
• Weight loss: Unintended weight loss
• Rheumatoid nodules: Firm bumps under skin (in some people)

Systemic Effects (can affect other organs):

• Eyes (dryness, inflammation)
• Lungs (inflammation, scarring)
• Heart (increased cardiovascular risk)
• Blood vessels (vasculitis)
• Skin (nodules, rashes)

Seek emergency care if:

• Severe joint pain with inability to move
• Signs of infection in joints
• Severe difficulty breathing
• Chest pain
• Severe eye pain or vision changes

Managing RA involves:

1. Take Medications as Prescribed:

   • Disease-modifying medications (DMARDs)
   • Biologics
   • Anti-inflammatory medications
   • Don't skip doses
   • Report side effects

2. Exercise (as able):

   • Low-impact exercises (swimming, walking)
   • Range-of-motion exercises
   • Strengthening exercises
   • Don't overdo it
   • Rest when needed

3. Rest and Activity Balance:

   • Get adequate rest
   • Balance activity with rest
   • Don't push through severe pain
   • Listen to your body

4. Joint Protection:

   • Use assistive devices if needed
   • Avoid repetitive motions
   • Use larger joints when possible
   • Maintain good posture
   • Use ergonomic tools

5. Heat and Cold Therapy:

   • Heat for stiffness (warm baths, heating pads)
   • Cold for inflammation (ice packs)
   • Alternate as needed

6. Stress Management:

   • Stress can worsen symptoms
   • Practice relaxation techniques
   • Get adequate sleep
   • Seek support

7. Healthy Lifestyle:

   • Balanced diet
   • Maintain healthy weight
   • Don't smoke (worsens RA)
   • Limit alcohol

8. Manage Fatigue:

   • Prioritize activities
   • Pace yourself
   • Get adequate sleep
   • Consider energy conservation techniques

• Severe joint pain with inability to move
• Signs of joint infection
• Severe difficulty breathing
• Chest pain
• Severe eye symptoms

• New or worsening symptoms
• Symptoms not improving with treatment
• Side effects from medications
• Need to adjust treatment
• Questions about medications
• Signs of infection
• Flare-ups

• Symptoms well-controlled
• Following treatment plan
• Regular follow-up scheduled
• No new concerns

Diagnosing RA involves:

1. Medical History and Physical Exam:

   • Symptom assessment
   • Joint examination
   • Check for swelling, tenderness
   • Assess range of motion

2. Blood Tests:

   • Rheumatoid factor (RF): Present in many with RA
   • Anti-CCP antibodies: More specific for RA
   • ESR (erythrocyte sedimentation rate): Measures inflammation
   • CRP (C-reactive protein): Measures inflammation
   • Complete blood count

3. Imaging Tests:

   • X-rays: Show joint damage
   • Ultrasound: Shows inflammation
   • MRI: More detailed images

4. Joint Fluid Analysis (if needed):

   • Check for infection
   • Look for crystals (gout)
   • Assess inflammation

Treatment aims to reduce inflammation, relieve symptoms, prevent joint damage, and improve function:

1. Disease-Modifying Antirheumatic Drugs (DMARDs):

   • Methotrexate: Most common
   • Sulfasalazine
   • Leflunomide
   • Hydroxychloroquine
   • Slow disease progression
   • May take weeks to months to work

2. Biologic Medications:

   • Target specific parts of immune system
   • Used when DMARDs aren't sufficient
   • Injectable or infusion
   • Examples: adalimumab, etanercept, infliximab

3. JAK Inhibitors:

   • Oral medications
   • Block specific enzymes
   • Used when other treatments fail

4. Anti-inflammatory Medications:

   • NSAIDs: Reduce pain and inflammation
   • Corticosteroids: Quick relief, short-term use
   • Don't slow disease progression

5. Physical and Occupational Therapy:

   • Exercises to maintain function
   • Joint protection techniques
   • Assistive devices
   • Energy conservation

6. Surgery (if needed):

   • Joint replacement
   • Tendon repair
   • Synovectomy (remove inflamed lining)

7. Lifestyle Modifications:

   • Exercise
   • Weight management
   • Stress management
   • Quit smoking

RA cannot be prevented, but you can:

• Early Treatment: Seek treatment early if symptoms develop
• Don't Smoke: Smoking increases risk and worsens disease
• Healthy Lifestyle: Diet, exercise, weight management
• Regular Monitoring: If at risk, regular check-ups
• Manage Other Conditions: Control other health conditions

In RA:

1. Immune System Activation: Immune system attacks synovium (joint lining)
2. Inflammation: Joints become inflamed
3. Synovial Thickening: Joint lining thickens
4. Cartilage and Bone Damage: Inflammation damages joint structures
5. Joint Deformity: Over time, joints can become deformed

Causes:

• Autoimmune: Immune system attacks body
• Genetics: Family history increases risk
• Environmental factors: Infections may trigger in susceptible people
• Hormones: May play a role (more common in women)
• Smoking: Increases risk

• More common in women (2-3 times more)
• May improve during pregnancy
• May flare after pregnancy
• Hormones may play a role

• Can develop at any age
• May have other health conditions
• May need medication adjustments
• Higher risk of complications

• Higher risk of cardiovascular disease
• May have other autoimmune conditions
• Higher risk of infections (due to medications)
• May need coordination of treatments

RA is an autoimmune disease that causes inflammation. Osteoarthritis is wear-and-tear damage to joints. RA affects joints symmetrically and can affect other organs. Osteoarthritis is usually localized.

There's no cure, but early treatment can slow or stop disease progression and prevent joint damage. Many people achieve remission with proper treatment.

With early and proper treatment, most people maintain good function. Without treatment, joint damage can lead to disability. Early treatment is crucial.

Yes. Exercise is actually beneficial for RA. It helps maintain joint function, reduces stiffness, and improves overall health. Work with your doctor or physical therapist to develop an appropriate program.

There's a genetic component, but it's not directly inherited. Having a family member with RA increases your risk, but many people with RA have no family history.