Rheumatoid Arthritis

“Take control of RA — early treatment to protect your joints and your quality of life.”

What is Rheumatoid Arthritis?

Rheumatoid arthritis, also known as RA, is a chronic autoimmune disease that causes pain, swelling, and stiffness in the lining of the joints. It affects joints in the hands, fingers, wrists, knees, ankles, feet, and toes. This condition usually affects the same joints on both sides of the body, which distinguishes it from other types of arthritis.

RA causes uncontrolled inflammation that damages the cartilage, which normally acts as a shock absorber in the joints. Over time, it may deform the joints, and eventually, the bone begins to erode. It may lead to the fusion of your joints. Such fusion makes the joints weak, causing pain, inflammation, and stiffness, which affects your quality of life.

Some specific cells in the immune system aid the process. The substances in the joints circulate and cause symptoms throughout the body. Besides affecting the joints, rheumatoid arthritis affects several other parts of the body, including the skin, mouth, eyes, lungs, and heart.

Rheumatoid arthritis is categorized into the following stages:

• Stage 1: It is the early stage of RA that causes inflammation in the tissue around the joints. You may experience joint pain and stiffness.
• Stage 2: The inflammation starts damaging the cartilage in the joints. You may notice stiffness and a decreased range of motion.
• Stage 3: Under this stage, the pain becomes very severe and starts damaging the bones. You may experience more pain, stiffness, and even less range of motion. Physical changes start appearing in your body.
• Stage 4: The inflammation stops; however, the condition of the joints worsens. You will experience severe pain, swelling, stiffness, and loss of mobility.

What are the Causes of Rheumatoid Arthritis?

The exact cause of rheumatoid arthritis remains unknown. According to researchers, this condition may be caused by a combination of genetics, hormones, and several environmental factors. In general, your immune system protects your body from diseases. In the case of RA, something triggers the immune system, and it starts attacking your own joints. Some triggers of this condition include an infection, physical stress, emotional trauma, and smoking.

What are the Symptoms of Rheumatoid Arthritis?

Rheumatoid arthritis, in its early stages, doesn’t show any symptoms. Only some redness or swelling may appear in your joints. Be watchful of the following signs and visit a doctor if you experience them for prolonged periods:

• Pain, swelling, stiffness, or tenderness in the joints lasting for six weeks or more
• Morning stiffness lasting for 30 minutes or longer
• More than one joint is affected
• Pain and stiffness in the small joints of the body, including hands and feet
• Pain in the same joints on both sides of the body
• Fatigue and low-grade fever
• Inflammation and frequent flare-ups lasting for days or months.

How is Rheumatoid Arthritis Diagnosed?

Upon experiencing these symptoms, you should visit a rheumatologist, a doctor with specialized training in treating arthritis. They will ask about your symptoms and take into consideration your medical history. They will also ask if any member of your family has this condition or any other autoimmune condition.

The rheumatologist will carry out a physical examination of your joints. They will check for symptoms like joint tenderness, swelling, warmth, and bumps under the skin, low-grade fever, or painful or limited movement.

Some blood tests will also be ordered to look for inflammation and blood proteins linked to RA:

• Erythrocyte sedimentation rate and C-reactive protein (CRP) levels are considered as inflammation markers. A high ESR or CRP with other signs may indicate RA.
• Rheumatoid factor or RF is an antibody found in 80% of people with RA. Antibodies to cyclic citrullinated peptide or CCP are found in 60-70% of people with RA.

Besides blood tests, the rheumatologist may order some imaging tests to check for any inflammation in the bones. RA causes the ends of the bones within a joint to wear down. Any imaging test, such as X-ray, ultrasound, or MRI, may help look for such erosions. In case the signs do not show up on the first tests, it may mean that RA is in its early stage and hasn’t damaged the bone as yet.

What are the Treatment Options for Rheumatoid Arthritis?

The treatment goal of RA is to reduce joint pain, stiffness, and swelling. The long-term goal of the treatment remains to slow down or stop joint damage. As there is no cure for this condition, managing joint inflammation may help reduce pain and other symptoms and improve your quality of life.

The first line of treatment for rheumatoid arthritis includes medication. In complex cases, the rheumatologist may suggest surgery. While deciding the treatment option, various factors, such as your age, medical history, health, and severity of symptoms, are taken into consideration.

Medication

Early treatment with certain drugs may improve the long-term outcome of the condition. The rheumatologist may prescribe a combination of drugs instead of a single-drug therapy. Medications for RA are aimed at decreasing joint pain, swelling, and inflammation. Some drugs may also prevent or slow down the progression of the disease. Depending on your severity, the rheumatologist may prescribe the following medicines.

• Disease-modifying antirheumatic drugs (DMARDs)
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Janus kinase (JAK) inhibitors
• Biologics

Surgery

Surgery may be an option to restore function and is recommended in severe cases when the joints are severely damaged. The rheumatologist may as well suggest surgery if medication fails to reduce the pain or symptoms of RA. The following surgical options may be used, depending on your condition.

• Knee replacement
• Hip replacement
• Other surgeries to correct deformity.

Self-Care

In addition to treatments, you may work with the rheumatologist and take measures on your own to manage RA and ease its symptoms:

• A balanced and nutritious diet consisting of the recommended amounts may help promote wellness and make it easy to maintain a healthy weight.
• Daily movement, including light exercise, is another self-care routine you should practice for overall wellness.
• It is important to stay physically active during a flare-up, but resting is equally important when RA is active, and joints feel swollen, stiff, and painful.
• You can take hot and cold treatments, including heat pads, warm baths, or cold compresses, to soothe stiff joints and reduce inflammation.
• Ensure your mental and emotional health is in place. Try different relaxing techniques, including exercising, reading a book, meditation, and deep breathing.

For expert evaluation and treatment of rheumatoid arthritis, consult Dr. Ashwani Maichand.