Rheumatoid arthritis

Rheumatoid arthritis (RA) is a serious inflammatory condition that can develop and affect any joint in the body. In most cases, the joints in the feet and hands are commonly affected. This disorder can damage various body systems such as the lungs, skin, heart, blood vessels, and eyes.

Rheumatoid arthritis is typically an autoimmune condition that emerges when the body's immune system resists and fights your body tissues. It usually alters the lining of the joints, resulting in chronic painful swelling. Over time, this could ultimately lead to joint deformity and erosion of the bone. Furthermore, rheumatoid arthritis triggers inflammation that might damage body parts.

Types of Rheumatoid Arthritis

There are various types of rheumatoid arthritis. Understanding the RA type a person has enables the doctors to give the best treatment.

Seropositive RA: You have a positive rheumatoid factor blood test result if you have seropositive RA. This indicates that the antibodies in the body are making the immune system strike the joints.

Serogenerative RA: You could have seronegative rheumatoid arthritis if you have a negative RF blood test and a negative anti-CCP blood test yet still experience RA symptoms. If you produce antibodies, the diagnosis will change into seropositive RA.

Juvenile idiopathic arthritis: RA in minors aged 17 and below is known as juvenile idiopathic arthritis. Rheumatoid arthritis in children and adolescents was initially known as juvenile rheumatoid arthritis (JRA). The associated symptoms are similar to those of the other forms of RA. However, they may involve eye irritation and developmental problems.

Causes of Rheumatoid Arthritis

When the body's defense mechanism, attack the synovium, rheumatoid arthritis develops. The synovium refers to the lining of the membranes surrounding the joints. The synovium thickens as a result of the inflammation. This can ultimately damage the cartilage as well as the bone inside the joint.

The ligaments and tendons that keep the joint together deteriorate and stretch over time. Also, the joint gradually loses its form and alignment.

Rheumatoid arthritis doctors are not sure of what triggers this process, but it appears to have a genetic factor. Although a person’s genes do not result in rheumatoid arthritis, they can increase the risks of environmental factors, including bacterial and viral infection. This could eventually trigger the disorder.

Signs and Symptoms of Rheumatoid Arthritis

The common rheumatoid arthritis signs and symptoms you are likely to experience include;

• Warm, tender, and swollen joints
• Fever, tiredness, and reduced appetite
• Stiffness of the joints that is normally extreme in the morning or after prolonged inactivity.

During the early stages of rheumatoid arthritis, the smaller joints are often the first to be affected. These joints include those that connect the fingers to the hands and the toes to the feet. With time as the condition advances, the symptoms can spread further to the knees, elbows, wrists, ankles, hips, as well as shoulders. Symptoms appear in similar joints on either side of the body in the majority of the cases.

According to reports, approximately 40% of patients with rheumatoid arthritis have other signs and symptoms that are not associated with joints. The most susceptible non-joint body structures are;

• Eyes
• Heart
• Skin
• Lungs
• Kidneys
• Nerve tissue
• Salivary glands
• Bone marrow
• The blood vessels

The severity of rheumatoid arthritis symptoms and signs can highly vary, and they can come and disappear. Flares (episodes of elevated disorder activity), alternate with remission periods where the pain and swelling diminish or disappear. In addition, rheumatoid arthritis causes joints deformity and makes them move out of place with time.

Rheumatoid Arthritis Risk Factors

These are some of the factors that can increase the chances of developing rheumatoid arthritis;

Age: Although rheumatoid arthritis can strike at any age, it’s most likely to develop in middle-aged adults.  

Gender: Rheumatoid arthritis is more common in women unlike in men.

Family background: You might be at a higher risk of developing rheumatoid arthritis if anyone in your family has it.

Cigarette smoking: If you smoke cigarettes regularly, you're more likely to develop rheumatoid arthritis. This is especially if you have a hereditary predisposition to the disease. In addition, smoking can be associated with a worsening of the disease.

Obesity: Overweight or obese people, particularly women aged 55 and below, might have a slightly increased likelihood of getting rheumatoid arthritis.

Exposure to the environmental factors:  Certain exposures, including asbestos and silica, can increase the possibility of rheumatoid arthritis, even though this cause is unknown. In addition, emergency employers who were exposed to dust following the World Trade Center collapse are more likely to develop autoimmune conditions like rheumatoid arthritis.

Rheumatoid Arthritis Diagnosis

RA diagnosis can take some time and might as well require several laboratory tests to verify the clinical exam results. The doctor will thus diagnose the condition through several procedures and techniques.

They can first inquire about your medical history and the symptoms you are currently experiencing. They will also conduct a physical examination of the joints which involves;

• Assessing the function of the joint and the range of motion
• Checking for any redness or swelling
• Gently touching the impaired joints to feel the tenderness and warmth
• Examining the strength of the muscles and reflexes

If the doctor suspects rheumatoid arthritis, he or she will perform other additional tests. Alternatively, they can refer you to a professional rheumatologist.

Rheumatoid arthritis blood tests:

The medical provider or rheumatologist may conduct a variety of blood tests to identify if you have RA. They include the following:

Test for rheumatoid factor: This test aims at looking for rheumatoid factor, a protein that causes the disease. Autoimmune diseases, especially RA, are linked to high levels of rheumatoid factor.

Antinuclear antibodies test: Medical providers conduct antinuclear antibody testing to determines whether or not the immune system is releasing antibodies. A person’s body produces antibodies in response to a variety of problems, including rheumatoid arthritis.

Anti-CCP (anti-citrullinated protein antibody test): Doctors use this test to check for an antibody linked to rheumatoid arthritis. Individuals with this antibody are more likely to develop the disorder. This antibody, however, is not found in every person with RA. The anti-CCP Ab test is more accurate in detecting RA, unlike the RF test.

Sedimentation of erythrocytes rate: This test is used to assess the extent of the inflammation present in your body. The doctor will be able to know if inflammation is present based on the results. It does not, however, reveal the cause or trigger of the inflammation.

C-reactive protein (CRP) test: The liver produces C-reactive protein in response to a serious infection or major inflammation in any part of the body. RA is linked to increased levels of the inflammatory marker.

Imaging tests:

The medical provider can suggest using rheumatoid arthritis x-rays to monitor the progress of the condition within the joints with time. Your doctor can also use MRI and ultrasound tests to assess the seriousness of the illness in your body.

Rheumatoid Arthritis Treatment

There is no current cure for rheumatoid arthritis. However, the available treatment options are helpful in a number of ways, including;

• Relieving pain
• Minimizing inflammation around the joints
• Slowing down or preventing any more damage to the joints
• Reducing the loss of functions due to joint damage, deformity, rheumatoid arthritis disability, and pain

Medications:

The doctor can prescribe rheumatoid arthritis medication based on the intensity of the symptoms and the duration of time you have had the condition. These medications can include;

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

These forms of medications aim at alleviating joint pain and inflammation. Ibuprofen (such as Advil and Motrin IB), as well as naproxen sodium (Aleve), are examples of over-the-counter NSAIDs. Prescriptions are available for stronger NSAIDs. Stomach irritation, kidney damage, heart problems and are the possible side effects of these medications.

• Disease-modifying antirheumatic drugs (DMARDs)

These medications can help to delay the progression of RA and prevent permanent damage to the joints or other tissues. Methotrexate (such as Trexall and Otrexup, among others), leflunomide (Arava), sulfasalazine (Azulfidine), and hydroxychloroquine (Plaquenil) are the common DMARDs. Damage of the liver, bone marrow suppression and extreme lung infection are some of the possible side effects.

• Steroids

Prednisone and other corticosteroid drugs can help minimize inflammation and discomfort while also slowing down joint damage. However, it may be associated with several side effects including bone thinning, diabetes, and weight gain. To alleviate acute symptoms, physicians often recommend a corticosteroid, with the intention of slowly weaning patients off the drug.

• Biologic agents

This newer category of DMARDs is also referred to as the biologic response modifiers. They include;

• Adalimumab (Humira)
• Anakinra (Kineret)
• Certolizumab (Cimzia)
• Etanercept (Enbrel)
• Abatacept (Orencia)
• Golimumab (Simponi)
• Infliximab (Remicade)
• Baricitinib (Olumiant)
• Rituximab (Rituxan)
• Tocilizuma (Actemra)
• Tofacitinib (Xeljanz)
• Sarilumab (Kevzara)

These medications can target immune system components that cause inflammation, which leads to the damage of joints and tissue. In addition, these medications can increase the likelihood of infection. High doses of tofacitinib are likely to pose blood clots risks within the lungs in people suffering from rheumatoid arthritis. When combined with a nonbiologic DMARD, like methotrexate, biologic DMARDs are typically the most efficient and successful.

Surgery:

You or the medical provider can consider a surgical procedure to correct the impaired joints. This is usually if medications do not prevent or delay joint damage. An operation is essential in helping you regain the ability to move the joint accordingly. It can also help with pain and joint functionality.

The doctor can thus recommend one or more of these surgical procedures to address rheumatoid arthritis;

Synovectomy: This is the surgical removal of the synovium, the inflamed or impaired lining of your joint. The surgeon can perform a synovectomy on the knees, wrists, elbows, hips, and fingers.

Repair of the tendon: Tendons on the joint can rupture or loosen as a result of joint damage and inflammation. The surgeon can thus correct the tendons within the joint through a surgical operation.

Total joint replacement: The surgeon will remove the affected and damaged areas of the joint and replace them with a metal and plastic prosthesis during joint replacement surgery.

Fusion of the joints: If a joint replacement is not a good option, fusing the joint surgically may be advisable to soothe or realign the joint. This also provides significant pain relief.

Rheumatoid arthritis surgeries are associated with several risks and complications, including pain, bleeding, and infection. Due to this, it’s essential to discuss with your healthcare provider on the benefits and possible risks of this procedure.

Therapy:

If necessary, the doctor can refer you to a physical therapist or an occupational therapist to train you on the significant exercises to maintain joint flexibility. The therapist can also recommend new methods to complete everyday activities that are less stressful on the joints. An example of this is the situation where you need to pick up something with your forearms.

Assistive equipment can help you avoid putting unnecessary strain on your sore joints. A kitchen knife with a handgrip, for example, will help secure your wrist joints and fingers. A special tool like buttonhooks will help make dressing a lot easier. Medical supply stores, as well as catalogs, are excellent sources of inspiration.

Complications of Rheumatoid Arthritis

Rheumatoid arthritis is associated with a number of complications such as;

Osteoporosis: Rheumatoid arthritis, as well as certain drugs used to treat the condition, may pose the risk of developing osteoporosis. This is a disease that deteriorates the bones, making them more susceptible to breakage or fracture.

Rheumatoid nodules: These are the rigid tissue bumps that mostly occur around the pressure spots, like the elbows. The rheumatoid arthritis nodules, on the other hand, can appear in any part of the body, such as the lungs.

Mouth and eyes dryness: Sjogren's syndrome is more common in patients with rheumatoid arthritis. This is a condition in which the level of moisture in the eyes and mouth reduces.

Infections: Rheumatoid arthritis and some of the drugs used to address it may affect the body's immune system. This could result in a range of infections.

Body composition that is abnormal: For patients with rheumatoid arthritis, the proportion of the body fat to the lean mass is usually high. This also includes individuals with a standard body mass index (BMI).

Carpal tunnel syndrome: This is a condition of the hands and wrists. If rheumatoid arthritis develops in the wrist, the associated inflammation will put pressure on the nerve serving the fingers and hands.

Heart disorders: In some cases, rheumatoid arthritis can lead to clogged and hardened arteries. It can as well cause inflammation of the sac surrounding the cardiac.

Lung problem: Rheumatoid arthritis patients are highly susceptible to lung tissue inflammation and scarring. This could result in ongoing shortness of breath problems.

Lymphoma: This is a condition whereby a series of blood cancers form in the lymph nodes or lymphatic system. It’s more common in people with rheumatoid arthritis.

Rheumatoid Arthritis Home Remedies

Doctors often recommend some home remedies as well as lifestyle changes to help enhance the quality of life for people with rheumatoid arthritis. Examples of these home remedies options include;

• Exercise

Medical providers can recommend low-impact exercises to help boost your mobility and enhance the range of motion within the joints. Furthermore, exercise can help in strengthening the muscles which eventually alleviates some of the joint pressure. You can as well try out moderate yoga to enable you to recover joint flexibility and strength.

• Applying heat or cold

Cold compresses and ice packs can help relieve inflammation and joint pain. These techniques can also be helpful in the treatment of muscle spasms. You may as well interchange cold methods with hot remedies, including hot compresses and warm showers. This can aid in the reduction of stiffness, relieving pain, and relaxing tension.

• Getting adequate rest

Enough rest is highly essential during rheumatoid arthritis flare-ups. On the other hand, you require less rest during the remission period. Generally, having adequate rest can help minimize pain and inflammation, or even fatigue.

• Relaxation

If you are living with rheumatoid arthritis, you should consider finding significant ways to help you cope or deal with pain. This reduces stress in your general life. Approaches such as muscle relaxation, guided imagery, and deep breathing are all useful in controlling pain.

• Opting for assistive tools

Some assistive devices, including braces and splints, help keep the joints in a resting place. This can also aid in the reduction of inflammation and pain. Moreover, crutches and canes can be useful in maintaining mobility, more so during flare-ups. For more simplicity, you can consider installing household devices, including handrails and grab bars especially along the stairs and in the bathrooms.

Diet for Rheumatoid Arthritis

The doctors or dietitians can sometimes advise on an anti-inflammatory diet as a way of dealing with symptoms. This diet consists of foods that are rich in omega-3 fatty acids. They include chia seeds, salmon, herring, tuna, or mackerel, walnuts, and flax seeds.

Vitamins A, C, and E, as well as selenium, are antioxidants that can help ease inflammation. Antioxidant-rich foods include blueberries, strawberries, cranberries, and goji berries, dark chocolate, kidney beans, spinach, artichokes, and pecans

It's also essential to eat a lot of fiber. Fiber, according to some studies, can help ease inflammatory responses lowering C-reactive protein levels. You can thus consider whole grain products, fresh fruits, and fresh vegetables. Strawberries might as well have a lot of health benefits.

Lastly, foods with flavonoids can be helpful in countering the inflammation associated with rheumatoid arthritis. Examples of these foods are soy products (miso and tofu), berries, broccoli, green tea, and grapes.

When adjusting to a rheumatoid arthritis diet, ensure that you try as much as possible to stay away from trigger foods. Examples of such foods are fats (saturated or trans) and carbohydrates.

Rheumatoid Arthritis in the Hands

Rheumatoid arthritis in the hands is common. It can begin as a mild burning sensation that you experience as the day ends. With time, you might eventually feel the pain that is not a result of using your hands. If not treated, such pain can become very serious. Furthermore, you are likely to experience warmth, swelling, stiffness, and redness.

You might begin to see deformities in the hands with time as the cartilage inside the joints wears off. You can as well experience a grinding sensation in the joints around the fingers, hands, or major joints. This is usually associated with total deterioration of the cartilage. 

Over time, fluid-filled sacs called synovial cysts form around the wrists, ankles, elbows, knees, and within the small joints of the hands. Such cysts are not associated with any risks, and the rupture of the tendon is possible in certain instances.

You are likely to get knobby growths known as bone spurs around the affected or damaged joints. These bone spurs could make it difficult to use the hands with time.

Rheumatoid Arthritis versus Osteoarthritis

As with rheumatoid arthritis, osteoarthritis (OA) also causes painful and rigid joints, making it difficult to move about. After prolonged exercise, a person with OA can experience joint swelling. On the other hand, osteoarthritis does not result in a severe inflammatory response that leads to redness of the impaired joints.

OA is not an infectious disorder like the rheumatoid arthritis autoimmune disease. It can occur due to trauma or as a result of normal wear and tear of the joints because of age.

The majority of people with OA are over the age of 60. It can, however, appear in younger people who frequently overuse a joint; for instance, the tennis players and athletes. It can also occur in individuals who have suffered a serious injury.

Bottom Line

Rheumatoid arthritis is a chronic condition without a specific cure at the moment. It is a debilitating, long-term disease that can affect joints, making it hard for one to carry out everyday activities. Most individuals with RA do not have regular symptoms but experience flares accompanied by symptom-free stages known as remissions.

You should immediately consult a rheumatoid arthritis doctor near you if you experience swelling and pain in two or more joints. Early diagnosis and proper treatment can help minimize or prevent long-term complications.