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Rheumatoid arthritis: Symptoms, diagnosis, treatment
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Arthritis is an umbrella term used to describe inflammation in the joints. Rheumatoid arthritis is a type of persistent arthritis that affects joints on both sides of the body, such as the hands, wrists and knees.
Causes
Rheumatoid arthritis is an autoimmune disease in which the immune system — which typically protects the body against disease — attacks the joints, and sometimes other organs, of a healthy person. The cause of this process is not fully understood, although genetics are thought to play a role in the development of rheumatoid arthritis, and there is evidence to suggest that the condition runs in families.
Risk Factors
More than 1 million people in the United States are impacted by rheumatoid arthritis. According to the Mayo Clinic, some factors may increase the risk of developing rheumatoid arthritis, including:
- sex;
- age;
- family history;
- smoking;
- environmental exposures; and
- ·obesity.
The disease affects women 2.5 times more often than men, and onset typically occurs between ages 20 and 50 years. Children and elderly people, however, can also develop the condition.
Rheumatoid arthritis symptoms
In its early stages, rheumatoid arthritis usually affects smaller joints first, specifically the joints attaching fingers to the hand and toes to the foot.
Symptoms of rheumatoid arthritis may include:
- swollen, warm and tender joints;
- joint stiffness, particularly in the mornings and after inactivity; and
- fatigue, fever and sudden weight loss.
Gradually, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. Rheumatoid arthritis symptoms may vary in severity and may come and go. It can also cause joints to become deformed and shift over time.
Complications
Rheumatoid arthritis can increase the risk for several comorbidities, whether from the disease itself or the treatment medication. These include:
- ·osteoporosis;
- rheumatoid nodules;
- infections;
- carpal tunnel;
- dry eyes and mouth;
- abnormal body composition;
- cardiovascular problems;
- lung disease; and
- lymphoma.
Diagnosing rheumatoid arthritis
While diagnosing rheumatoid arthritis in its early stages can be difficult because its symptoms can mimic other diseases, the physician will examine your joints for warmth, redness and swelling. A test to check reflexes and muscle strength may also be administered.
Those with rheumatoid arthritis usually have increased erythrocyte sedimentation rates or C-reactive protein. This may indicate the presence of an inflammatory process in the body. X-rays, MRIs and ultrasound tests can also assist a physician in diagnosing the severity of rheumatoid arthritis.
Types of rheumatoid arthritis
Rheumatoid arthritis is classified by type — seropositive or seronegative disease. Seropositive is most common among patients with rheumatoid arthritis and marks the presence of symptom-causing antibodies (rheumatoid factor and anti-cyclic citrullinated peptides) in the blood. However, additional symptoms must accompany the presence of antibodies to diagnose rheumatoid arthritis.
Patients who test negative for these antibodies may still be diagnosed with rheumatoid arthritis via demonstration of rheumatoid arthritis symptoms and X-rays. This is known as seronegative type disease. Patients with seronegative rheumatoid arthritis may have milder symptoms than patients with seropositive disease.
Rheumatoid arthritis treatment
For most patients with rheumatoid arthritis, disease-modifying antirheumatic drugs, or DMARDs, are the first line of treatment. DMARDs provide symptom relief and help decrease the progression of joint damage.
DMARDs are often used in combination with non-steroidal anti-inflammatory drugs, or NSAIDs, and low-dose corticosteroids. Both agents are prescribed to reduce the swelling and pain associated with rheumatoid arthritis.
Biologic therapy is a new type of DMARD used in rheumatoid arthritis. These agents lower the chemical signals that prompt the inflammation that causes joint damage. Biologic therapy can be prescribed as a single agent or in combination with other, non-biologic DMARDs, such as methotrexate.
Lifestyle modifications
Lifestyle changes can also improve the symptoms of rheumatoid arthritis and quality of life for patients.
Low-impact activities like walking and swimming can improve muscle strength and reduce pressure on joints. Physical and occupational therapy can also help to reduce pain and decrease inflammation.
Patients with rheumatoid arthritis are also encouraged to maintain a healthy weight, as extra weight can increase stress on inflamed joints.
Smoking has been identified as a risk factor for developing rheumatoid arthritis; it may also worsen the condition in people who are already diagnosed. Patients who have rheumatoid arthritis, or those at risk for the condition, are encouraged to quit — or never start — smoking.
Prognosis
Rheumatoid arthritis is a chronic condition and has no cure. However, there are many methods and treatments that can effectively decrease pain and inflammation, as well as slow the progression of the disease.
According to the Cleveland Clinic, a positive prognosis relies heavily on early diagnosis and effective treatment.
Additional information can be found on these websites:
https://my.clevelandclinic.org/health/articles/rheumatoid-arthritis
https://www.rheumatology.org/i-am-a/patient-caregiver/diseases-conditions/rheumatoid-arthritis
http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/home/ovc-20197388
https://www.rheumatoidarthritis.org/ra/symptoms/progression/