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Rheumatoid Arthritis

Definition


Disease: Rheumatoid Arthritis Rheumatoid Arthritis
Category: Bones, joints, muscles diseases
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Disease Definition:

The chronic inflammatory disorder that most typically affects the small joints in the hands and feet is a condition called rheumatoid arthritis. Rheumatoid arthritis affects the lining of the joints, causing a painful swelling that can eventually result in bone erosion and joint deformity unlike the wear-and-tear damage of osteoarthritis.
When the immune system mistakenly attacks one's own body tissues, rheumatoid arthritis occurs, meaning that it's an autoimmune disorder. Rheumatoid arthritis can also affect one's whole body with fevers and fatigue, in addition to causing joint problems.
Rheumatoid arthritis is two to three times more common in women than in men and generally occurs between the ages of 40 and 60. Although treatment options have expanded greatly in the past few decades, there's still no cure for rheumatoid arthritis.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Rheumatoid arthritis may cause some of these signs and symptoms:

 

  • Weight loss
  • Joints that are tender to the touch
  • Joint swelling
  • Fever
  • Firm bumps of tissue under the skin on the arms (rheumatoid nodules)
  • Red and puffy hands
  • Morning stiffness that may last for hours
  • Joint pain
  • Fatigue

 

Smaller joints, such as those in the feet, ankles, hands and wrists are affected first by early rheumatoid arthritis. The neck, jaw, hips, knees, elbows and shoulders can also become involved as the disease progresses. Symptoms usually occur symmetrically, in the same joints on both sides of the body.

The signs and symptoms of rheumatoid arthritis may vary in severity and they may even come and go. Periods of increased disease activity, which is called flare-ups or flares, alternate with periods of relative remission, during which the pain, swelling, difficulty sleeping and weakness fade or disappear.

When having persistent discomfort and swelling in multiple joints on both sides of the body, one should make an appointment to see a doctor.

Causes:

When the immune system attacks the synovium, the lining of the membranes that surround the joints, rheumatoid arthritis occurs. The synovium thickens by the resulting inflammation, and it can eventually invade and destroy the cartilage and bone within the joints. The joint gradually loses its shape and alignment when the tendons and ligaments that hold the joint together weaken and stretch.

Doctors don't know what starts this process, although a genetic component appears likely. Genes can make one more susceptible to environmental factors, such as infection with certain viruses and bacteria that may trigger the disease, but these genes don't actually cause rheumatoid arthritis.

The risk of rheumatoid arthritis may increase due to several factors:

Smoking:
Smoking cigarettes increases the risk of rheumatoid arthritis and quitting can reduce that risk.

Family history:  
One may have an increased risk of the disease if a member of his/her family has rheumatoid arthritis. It's believed that a person can inherit a predisposition to rheumatoid arthritis so doctors don't believe that a person can directly inherit rheumatoid arthritis.

Moreover, rheumatoid arthritis is two to three times more common in women than in men and generally occurs between the ages of 40 and 60.

Complications

Complications:

Joint damage that can be both debilitating and disfiguring is caused by rheumatoid arthritis. It may be difficult or impossible to go about daily activities because of the damage to the joints. People may notice at first that accomplishing tasks takes more energy. However, a person can continue doing the activities that he/she enjoys thanks to newer treatments that may prevent or even stop joint damage.

Treatments:

Rheumatoid arthritis has no cure. Medications can reduce inflammation in your joints in order to relieve pain and prevent or slow joint damage. The patient can learn how to protect the joints in occupational and physical therapy. However, surgery may be necessary if the joints are severely damaged by rheumatoid arthritis.

MEDICATIONS:
Many drugs that are used to treat rheumatoid arthritis have potentially serious side effects. Usually, medications with the fewest side effects are prescribed first. As the disease progresses, the patient may need stronger medications or a combination of medications.

Immunosuppressants:
The immune system is tamed by these medications, which is out of control in rheumatoid arthritis. However, the patient may be more susceptible to infections due to these medications. Examples include cyclophosphamide, cyclosporine and azathioprine.

Disease-modifying antirheumatic drugs (DMARDs):
The progression of rheumatoid arthritis can be slowed and the joints and other tissues can be saved from permanent damage by these drugs. Side effects vary but may include severe lung infections, bone marrow suppression and liver damage. Sulfasalazine, minocycline, hydroxychloroquine, methotrexate and leflunomide are some of the commonly used DMARDs.

NSAIDs:  
Pain can be relieved and inflammation reduced with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Gastric ulcers, liver and kidney damage, ringing in the ears, increased bruising, heart problems and stomach bleeding may be some of NSAIDs side effects. Naproxen sodium and ibuprofen are two examples of over-the-counter NSAIDs, but there are also stronger versions of these medications that are available by prescription.  

TNF-alpha inhibitors:  
one of the inflammatory substances that is produced by the body is called tumor necrosis factor-alpha (TNF-alpha). Usually within one or two weeks after treatment begins, TNF-alpha inhibitors can help reduce pain, tender or swollen joints and morning stiffness. Congestive heart failure, injection site irritation, lymphoma, blood disorders, increased risk of infection and demyelinating diseases are some of their potential side effects. Some examples are adalimumab, etanercept and infliximab.

Steroids:  
Joint damaged can be slowed and pain and inflammation reduced with the use of corticosteroid medications, such as methylprednisolone and prednisone. Diabetes, thinning of bones, weight gain, a round face, cataracts and easy bruising may be some of their side effects. With the goal of gradually tapering off the medication, doctors usually prescribe a corticosteroid in order to relieve acute symptoms.

Other drugs:  
The body produces a variety of inflammatory substances that can be targeted by several other rheumatoid arthritis medications. Decreased white blood cell counts, an increase in upper respiratory infections, reactions at the injection site and headache are some of the potential side effects of these drugs. Some examples are rituximab, anakinra and abatacept.


THERAPY:
In order to take stress off the painful joints, an occupational therapist can help the patient find different ways to approach everyday tasks, such as picking up an object using the forearms if the fingers are sore, and leaning into a glass door to force it open rather than pushing the door with sore arms.

Assistive devices can make it easier to continue doing normal daily activities without stressing the painful joints. For example, if the patient has pain in the fingers, he/she may use specially designed gripping and grabbing tools that make it easier to work in the kitchen. The person can also try using a cane to get around. The occupational therapist or doctor may have ideas about what sorts of assistive devices may be helpful. Other places to look for ideas are medical supply stores and catalogs.


SURGERY:
Surgery may be considered to repair joint damage in case medications don’t prevent or slow joint damage. The ability to use the joints may be restored by surgery, which can also correct deformities and reduce pain.  One or more of the following procedures may be involved in rheumatoid arthritis surgery:

Joint Fusion (arthrodesis):
When joint replacement isn’t an option, a person may be recommended surgically fusing a joint in order to relieve pain and stabilize or realign a joint.

Tendon Repair:
Tendons around the joint may loosen or rupture due to inflammation and joint damage. The tendons around the joint can sometimes be repaired.

Total Joint Replacement (Arthroplasty):
The surgeon removes the damaged parts of the joint and inserts a prosthesis made of metal and plastic during a joint replacement surgery.

Removal of the Joint Lining (Synovectomy):
The surgeon may recommend removing the lining of the joint (synovium) if it is inflamed and causing pain.

The benefits and risks may be discussed with the doctor. Infection, pain and bleeding are the potential risks of surgery.

Prognosis:

Not Available

Expert's opinion

Expert's Name:
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