Rheumatoid arthritis – Causes, Symptoms And Treatment

Rheumatoid Arthritis Information

What is Rheumatoid Arthritis?


Rheumatoid arthritis is a chronic autoimmune inflammation of the joints. It affects women more often than men, and the usual onset is 40 years and above. 

Rheumatoid arthritis usually affects small joints such as hand joints, wrist, and feet the most, but in some patients, there are be a systemic attack of other organs such as the eyes, lungs, and blood vessels.

What are the main causes of rheumatoid arthritis?

The cause of rheumatoid arthritis is not so clear. Still, it involves the autoimmune attack of the synovium of the joint that leads to inflammation of the synovium and swelling of the joint capsule. The continuous attack on the joint leads to the destruction of the entire joint, including cartilages, tendons, ligaments, and surrounding bones. 

What are the primary symptoms of rheumatoid arthritis?

Rheumatoid arthritis can emerge gradually or pretty quickly. The symptoms can differ from person to person and can vary from mild to very severe. Here are the signs and symptoms of rheumatoid arthritis:

  • Red, Warm, swollen painful joints 
  • Morning stiffness of joints that gets better with use.
  • Symmetric affection of joints on both sides of the body
  • Muscle weakness due to loss of muscle strength
  • Fatigue.
  • Joint tenderness when touched
  • Tingling sensation felt in the hands or numbness when a nerve is affected.
  • Difficulty moving fingers or toes
  • Joint deformities: Ulnar deviation, boutonnière deformity, swan neck deformity, hammertoe deformity
  • Loss of appetite
  • Low-grade fever

Who at risk factors for rheumatoid arthritis?

Factors that predispose a person to have rheumatoid arthritis are:

  • Sex: Being female
  • Family History of rheumatoid arthritis
  • Having other autoimmune diseases
  • Obesity
  • Smoking
  • Age: middle age

What are the long term effects of rheumatoid arthritis?

Here are the complications of rheumatoid arthritis include:

  • Carpel tunnel syndrome
  • Osteoporosis
  • Conjunctivitis
  • Pericarditis
  • Rheumatoid nodules in the elbows, knuckles, and heels.
  • Gingivitis which can lead to full-blown periodontitis
  • Interstitial pulmonary fibrosis
  • Peripheral neuropathy

How do doctors test for rheumatoid arthritis?

1. Two types of blood tests are usually used to diagnose rheumatoid arthritis, which are: 

  • Full blood count (specifically to check elevated erythrocyte sedimentation rate (ESR), C-reactive protein, and white blood cell)
  • Serum antibodies (anti-citrullinated peptide (ACPA) and rheumatoid factor)

2. A comprehensive medical history, including a family history of rheumatoid arthritis

3. X-ray of joints will show some joint space narrowing, soft tissue swelling, and multiple erosions.

What are the criteria for diagnosing rheumatoid arthritis?

In 2010 the American college of rheumatology/European league against rheumatism (ACR/EULAR) created a list of criteria to diagnosed rheumatoid arthritis. The criteria use 4 categories and a point system to make a diagnosis. A patient with greater than 6 points is classified as having rheumatoid arthritis.


JOINT INVOLVEMENT: Small joints: proximal interphalangeal, distal interphalangeal, metacarpophalangeal, metatarsophalangeal, and wrist joints.
Large joints: knees, elbows, hip, shoulder and ankle joints.


SCORE
1 large joint 0
1 – 10 large joints 1
1 – 3 small joints 2
4 – 10 small joints 3
>10 joints  5

SEROLOGY
Negative rheumatoid factor (RF) and Negative ACPA 0
Low positive RF and low positive ACPA 2
High positive RF and high positive ACPA 3

ACUTE PHASE REACTANTS
Normal C-reactive protein (CRP) and normal ESR 0
Abnormal CRP and ESR 1

DURATION OF SYMPTOMS
<6 weeks 0
>6 weeks 1

How is rheumatoid arthritis treated?

Treatment for rheumatoid arthritis is aimed at tackling the symptoms with the use of the following: 

  • Disease modified anti-rheumatic drugs (DMARDs): Methotrexate, Hydroxychloroquine, Sulfasalazine, and Leflunomide
  • Tumor necrosis factor A (TNF-alpha): Infliximab and Etanercept
  • Rituximab (monoclonal antibodies against B cells)
  • Anakinra (interleukin 1 blocker)
  • Folic acid
  • Steroids
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Assisted devices
  • Joint replacement surgery

Note:

  • Methotrexate is always combined with folic acid to prevent deficiency of folic acid in the body due to folic acid depletion by methotrexate
  • Disease activity score of 28 (DAS28) is one of the tools used to check disease activity and response to treatment. There is an app for it that can be downloaded on the play store.
  • Moderate exercises are useful to maintain muscle strength.
  • Methotrexate and leflunomide are teratogenic; therefore, they are contraindicated in pregnancy.
  • Hydroxychloroquine, sulfasalazine, and low dose steroids are safe in pregnancy.

Lastly, rheumatoid arthritis cannot be prevented if you experience similar symptoms or persistent ache and swelling in your joints, be sure to consult a doctor.