Rheumatoid arthritis (RA) is an autoimmune disease that can cause joint pain and damage entire your body. In the autoimmune disease in which the body’s immune system normally protects your health by attacking foreign bodies like bacteria and viruses, although it mistakenly attacks the joints. In some instances, the condition further can damage a wide variety of body systems, including the eyes, lungs, skin, heart and blood vessels.
Rheumatoid arthritis most commonly affects the joints of the hands, wrists, elbows, feet, knees, and ankles. The joint effect is usually symmetrical. That means if one knee or hand is affected, usually the other one is, too. This is one way that physicians differentiate RA from other forms of arthritis, such as osteoarthritis (OA).
Rheumatoid arthritis creates inflammation that causes the tissue that lines the inside of joints (the synovium) to thicken, resulting in swelling and pain in and around the joints. The synovium produces a fluid that lubricates joints and supports the joints to move smoothly.
If inflammation goes unchecked, it can damage cartilage, the cartilage that covers the ends of bones in a joint. Over time, the loss of cartilage reduces the joint spacing between bones. Joints can become loose, unstable, painful, lose their mobility and Joint deformity also occur. Joint damage cannot be reversed because it can occur early. If physicians early diagnosis of rheumatoid arthritis and aggressive treatment to control Rheumatoid Arthritis.
Roughly 1.5 million people in the United States become rheumatoid arthritis (RA). Approximately three times as many women have the disease as men. In women, rheumatoid arthritis most usually begins between ages 30 and 60. In men, it often happens later in life. Becoming a family member with RA increases the having RA; however, the majority of people with RA have no family history of the disease.
Treatments work best when rheumatoid arthritis is diagnosed early, so it’s important to learn the signs. Early rheumatoid arthritis treatment can help reduce inflammation in the joints, relieve pain, prevent or slow joint damage, and reduce disability.
Rheumatoid Arthritis Causes
The cause of rheumatoid arthritis is not yet fully understood, although doctors do know that an abnormal response of the immune system plays a role in the inflammation and joint damage that occurs. In the case of RA, the immune system mistakenly attacks the synovium — the lining of the membranes that surround the joints.
The resulting inflammation thickens the synovium, that can ultimately destroy the cartilage and bone in the joint.
The tendons and ligaments that keep the joint together weaken and stretch. Ultimately, the joint loses its shape and alignment.
Physicians don’t know what causes this process, although there is scientific data that genes, hormones and environmental factors such as infection with certain viruses and bacteria, that may trigger the disease.
Researchers have shown that there’s some evidence that rheumatoid arthritis can run in families. People with a specific genetic marker called HLA shared epitope have a fivefold greater chance of developing rheumatoid arthritis. The HLA genetic site regulates immune responses. Other genes linked to RA include TRAF1 and C5, two genes connected to chronic inflammation; STAT4, a gene that performs significant roles in the regulation and activation of the immune system; and PTPN22, a gene linked with both the development and progression of rheumatoid arthritis. Yet not all characters with these genes acquire RA and not all characters with the disease have these genes.
Researchers continue to investigate other factors that may combine infectious agents such as bacteria or viruses, which may trigger rheumatoid arthritis in a person whose genes make them more likely to get it.
Rheumatoid arthritis is various common in women than men, which may be the effects of the hormone estrogen, although this connection hasn’t been proven.
Environmental factors & Smoking
Some data implies that people who smoke are at an enhanced risk of acquiring rheumatoid arthritis. The study also has indicated that environmental factors may perform a role in risk for rheumatoid arthritis. Some involve exposure to air pollution, insecticides and occupational illnesses to mineral oil and silica.
Rheumatoid Arthritis Symptoms
In the early stages, the foremost symptoms of rheumatoid arthritis are joint pain, swelling, and stiffness. The rheumatoid arthritis symptoms often develop gradually over several weeks, but some circumstances can progress quickly over a number of days.
The following joint symptoms are evidence of RA:
- Morning stiffness for 30 minutes or longer.
- Joint pain, swelling, tenderness, or stiffness for six weeks or longer.
- More than one joint is affected.
- Small joints (joints of the hands and feet) are more likely affected.
- The same joints on both sides of the body are affected.
The rheumatoid arthritis symptoms and effects may come and go. Along with pain, many people feel fatigue, loss of appetite and a low-grade fever. A period of increases in inflammation and other symptoms is named a flare. A flare can continue for days or months.
Continuing high levels of inflammation can produce problems throughout the body. Hereabouts of some ways RA can affect organs and body systems:
- Eyes- Dryness, redness, pain, sensitivity to light and impaired vision.
- Mouth-Dryness and gum inflammation.
- Skin-Rheumatoid nodules a small lumps under the skin covering bony areas.
- Lungs-Inflammation and scarring that can commence to shortness of breath.
- Blood Vessels-Inflammation of blood vessels that can commence damaging to the nerves, skin and other organs.
- Blood-Anemia, a reduce the number of red blood cells.
The symptoms differ from person to person.
Symptoms affecting the joints
The main Rheumatoid Arthritis symptoms are affecting the joints are outlined below.
The joint pain linked with rheumatoid arthritis is normally a throbbing and aching pain. It is usually worse in the mornings and following a period of inactivity.
Joints swayed by rheumatoid arthritis can feel stiff. For instance, if your hands are affected, you may not be capable.
Similar to joint pain, the stiffness is often more hard in the morning or after a time of inactivity. Morning stiffness linked with another type of arthritis called osteoarthritis normally wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness usually lasts longer than this.
Swelling, warmth, and redness
The lining of joints affected by rheumatoid arthritis display inflamed, which can induce the joints to swell, and become hot and tender to touch. In some bodies, firm swellings called rheumatoid nodules can further develop under the skin around affected joints.
As well as difficulties affecting the joints, some people with rheumatoid arthritis undergoing a range of more general symptoms, such as:
- Tiredness and a lack of energy
- A high temperature (fever)
- Poor appetite
- Weight loss
Rheumatoid Arthritis Diagnosis
Rheumatoid arthritis can be confusing to diagnose because many health conditions make joint stiffness and inflammation and there’s no definitive test for the disease.
A primary care practitioner may suspect RA based in part on a person’s signs and symptoms. If so, the patient will be referred to a rheumatologist to diagnose and treat RA. In its early stages, RA may mirror other forms of inflammatory arthritis. No single test can validate RA. To make a precise diagnosis, the rheumatologist will ask questions regarding personal and family medical history, conduct a physical exam and order diagnostic tests.
The physician will ask about your personal and family medical history as well as recent and current symptoms (pain, tenderness, stiffness, and difficulty moving).
If you have been diagnosed with rheumatoid arthritis, your physician will examine each joint, looking for tenderness, swelling, warmth and painful or limited movement. You may be asked to fill in a questionnaire on how properly you can do things like dress, walk and eat, and how good your grip strength is. The number and pattern of the joints affected can additionally indicate RA. For example, RA tends to affect joints on both sides of the body. The physical exam may exhibit other signs, such as rheumatoid nodules or a low-grade fever.
The blood tests will measure inflammation levels and look for biomarkers such as antibodies linked with RA.No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but a number of tests can show possible indications of the condition. The main tests include:
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- Full blood count
The full blood count measures your red cells to rule out anaemia. Anaemia means the blood is unable to carry enough oxygen because of a lack of blood cells. Anaemia is common in people with rheumatoid arthritis, although having anaemia doesn’t prove you have rheumatoid arthritis.
Rheumatoid factor and anti-CCP antibodies
Particular blood tests can support diagnose rheumatoid arthritis but aren’t accurate in everyone. Nearly half of all people with rheumatoid arthritis have a positive rheumatoid factor present in their blood when the disease starts, but about 1 in 20 people without rheumatoid arthritis also positive for the test.
An antibody test perceived as anti-cyclic citrullinated peptide (anti-CCP) is available. People who become positive for the anti-CCP test are very likely to develop rheumatoid arthritis, but not everybody found to possess rheumatoid arthritis has this antibody.
Those who become positive for both rheumatoid factor plus anti-CCP may be more possible to have severe rheumatoid arthritis requiring higher levels of treatment.
A number of different scans can help tell the difference between different types of arthritis and can be used to monitor how your condition is progressing over time.
- Scans that may be carried out to diagnose and monitor rheumatoid arthritis include:
- X-rays ( examine your bones and joints)
- MRI scans ( detailed images of your joints)
Rheumatoid arthritis Treatment
The Rheumatoid arthritis treatment can help diminish inflammation in the joints, relieve pain, limit or slow joint damage, and reduce disability. Although there’s no cure for rheumatoid arthritis, early treatment and care can diminish the risk of joint damage and limit the consequence of the condition.
The aims of rheumatoid arthritis (RA) treatment comprise:
- Reduce symptoms.
- Stop inflammation.
- Improve physical function and overall well-being.
- Prevent joint and organ damage.
- Reduce long-term complications.
To reach these goals, the physician will follow these strategies:
Early, aggressive approach. The first strategy is to decrease or stop inflammation as soon as possible – the quicker, the better.
Targeting remission. Physicians refer to inflammation in RA as disease activity. The terminal goal is to stop it and achieve remission, indicating minimal or no signs or symptoms of progressive inflammation. One approach to achieve this aim is called “treat to target.”
Tight control. Getting disease activity to a low level and keeping it. Research points out that tight control can prevent or reduce the pace of joint damage.
Drugs That Reduce Symptoms
Nonsteroidal anti-inflammatory drugs (NSAIDs)can relieve pain and reduce inflammation. They are employed to help ease arthritis pain and inflammation. NSAIDs drugs as ibuprofen, ketoprofen, and naproxen sodium. For people who become had at risk of stomach ulcers, the physician may prescribe celecoxib, a type of NSAID called a COX-2 inhibitor, which is intended to be competent for the stomach.
Side effects may comprise stomach irritation, ringing in your ears, heart problems, and liver and kidney damage.
Drugs That Slow Disease Activity
Steroids-including prednisolone, prednisone, and methylprednisolone are effective and fast-acting anti-inflammatory medications. They may be applied in rheumatoid arthritis treatment to get the potentially damaging inflammation under control while waiting for NSAIDs and DMARDs to take outcome. Side effects may comprise thinning of bones, weight gain, and diabetes. Because of the chance of side effects with these drugs, physicians prefer to use them for as short a time as possible and in doses as low as possible.
DMARDs-These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. An acronym for disease-modifying antirheumatic drugs, that work to modify the course of the disease. Common DMARDs combine methotrexate (Trexall, Otrexup, Rasuvo), hydroxychloroquine (Plaquenil), leflunomide (Arava), and sulfasalazine (Azulfidine). These medications can be taken by mouth, be self-injected or administered as an infusion in a doctor’s office.
Side effects vary but may involve liver damage, bone marrow suppression, and severe lung infections.
These drugs are a subset of DMARDs, also known as biologic response modifiers. Biologics may work more quickly than traditional DMARDs and are injected or administered by infusion in a doctor’s office. Because they target particular steps in the inflammatory process, they don’t wipe out the whole immune response as some other RA medications do. In numerous people with RA, a biologic can reduce, modify or withdraw the disease – even when other treatments haven’t helped much.
This newer class of DMARDs includes adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), abatacept (Orencia), etanercept (Enbrel), infliximab (Remicade), rituximab (Rituxan), golimumab (Simponi), tocilizumab (Actemra) and tofacitinib (Xeljanz).
Biologic DMARDs are ordinarily effective when paired with a nonbiologic DMARD, such as methotrexate.
A new subcategory of DMARDs perceived as “JAK inhibitors” block the JAK, pathways, which are linked in the body’s immune response. Tofacitinib belongs to this class. JAK inhibitors can be taken by mouth. These medicines include tofacitinib & baricitinib.
If medications fail to prevent or slow joint damage, Surgery for RA may never be needed, but it can be an important option for people with permanent damage that limits daily function. Surgery may likewise be suggested to reduce pain or correct deformities.
Tendon repair. Inflammation and joint damage may induce tendons around your joint to loosen or rupture. Your consultant may repair the tendons around your joint.
Synovectomy can be performed on the knees, elbows, wrists, fingers, and hips. Surgery to remove the inflamed synovium (lining of the joint).
Joint fusion. Surgically fusing a joint may be suggested to realign a joint and for pain relief when a joint replacement isn’t an opportunity.
Total joint replacement.J joint replacement surgery can alleviate pain and rebuild function in joints badly damaged by RA. Your surgeon removes the damaged parts of your joint and implants a prosthesis constructed of metal and plastic.
Rheumatoid Arthritis Home Remedies
Some home remedies and lifestyle modifications may help to improve your quality of life while living with RA:
Low-impact exercises can support to improve the range of motion in your joints and improve your mobility. Exercise can further strengthen muscles, which can assist to relieve some of the pressure from your joints. You can attempt gentle yoga, which will support you to regain strength and flexibility.
Get adequate rest
You may require more rest during flare-ups and less during remission. Taking enough nap will help to decrease inflammation and pain as well as fatigue.
Use heat or cold
Ice packs can help to diminish inflammation and pain. They may also be useful against muscle spasms. You can apply an alternate cold with hot treatments. These treatments may help to reduce stiffness.
Researches have revealed that turmeric and omega-3 fish oil supplements may support rheumatoid arthritis pain and morning stiffness. Though, talk with a specialist before taking any supplement to address side effects and potential interactions.
Use assistive devices
Some devices such as splints and wrist braces can keep your joints in a resting position. This may assist to decrease inflammation.
Rheumatoid arthritis diet
Your dietitian may recommend an anti-inflammatory diet to help with your rheumatoid arthritis symptoms. This type of diet comprises foods that have lots of omega-3 fatty acids.
Foods high in omega-3 fatty acids include:
- Fatty fishes, including tuna, salmon, herring, and mackerel
- Flax seeds
- Chia seeds
Antioxidants, such as vitamins A, C, and E, and selenium, may additionally help diminish inflammation. Foods high in antioxidants include:
- Berries, such as blueberries, cranberries, goji berries, and strawberries
- Dark chocolate
- Kidney beans
Eating lots of fibre is also important, the fibre may help reduce inflammatory responses which can be seen as a decrease in C-reactive protein levels in. Keep whole-grain foods, fresh vegetables, and fresh fruit.
Foods containing flavonoids can also help to counter inflammation in rheumatoid arthritis. They combine:
- Green tea
- Soy products, such as tofu and miso