By Dr Ananya Mandal, MD
Rheumatoid arthritis or RA is an inflammatory condition that affects joints primarily leading to pain and stiffness and difficulty in movements. Commonly affected joints are those of the hands, feet and wrists. RA however can also affect other parts of the body.
Symptoms of rheumatoid arthritis
RA mainly causes swelling, stiffness and pain in the affected joints. The sufferer usually feels mild stiffness and difficulty in movement initially that mainly occurs in the morning on waking up. This is called morning stiffness.
Slowly the symptoms may worsen as the joint is affected to a greater extent leading to severe pain on movements and difficulty in performing daily tasks.
Symptoms may suddenly worsen. This is called a flare up. Flare ups may be sudden and without warning and may worsen symptoms to a great extent leading to severe disability.
Pathology of rheumatoid arthritis
RA is an autoimmune disease. The body’s immune system acts as the defence system in the body attacking foreign microbes and proteins. In some disorders, this immune system turns on the body’s own cells and proteins and begins to attack and destroy them. In RA, the immunity attacks the cells that line the joints and make them swollen, inflamed and stiff. This leads to severe pain.
Cartilage and synovium forms a cushion that acts as a shock absorber in the joints. Autoimmunity and inflammatory processes of RA commonly affect these cartilages and synovial cells and damage them. Lack of these elements in the joint, leads to increased friction and damage to the joint.
Rheumatoid arthritis epidemiology
RA affects nearly 600,000 people in England and Wales and affects females between ages 40 and 70 more commonly than males. Worldwide, females are three times more likely to suffer from RA than males.
RA however can affect younger persons. Worldwide around 1% of the total population are affected by this condition.
Diagnosis of rheumatoid arthritis
Diagnosis is primarily suspected with presence of signs and symptoms. There are however several symptoms of RA that are common with other types of autoimmune disorders and arthritis. These diagnoses need to be ruled out before confirming RA. Blood tests including those for Rheumatoid factor and imaging studies like X rays are used for diagnosis of RA.
Treatment of rheumatoid arthritis
Usually treatment is performed by a rheumatologist and his or her team that includes orthopaedic surgeons, physiotherapists, physical medicine specialists, occupational and behavioral therapists and counsellors.
There is no cure for RA. An early diagnosis and treatment can help control symptoms and prevent debility and disability to a great extent. Treatment can be given using medications. This is the commonest modality of therapy.
Medications are prescribed to relieve joint stiffness and pain. Anti-inflammatory agents like Non-steroidal anti-inflammatory agents (NSAIDs) include painkillers relieve pain as well as inflammation. There are several medications that oppose the autoimmune status and prevent the progression of the disease.
Surgery is advised to correct joint deformities and supportive treatments like physiotherapy is offered to obtain maximum movement benefit from the joint. There are complementary methods like acupuncture and massages that many people find beneficial.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)