Rheumatoid Arthritis: Symptoms, Diagnosis and Treatment

What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is recognised as a chronic inflammatory disorder predominantly impacting joints. Characterised as an autoimmune disease, it arises when an individual's immune system erroneously targets the body's tissues. This condition contrasts with osteoarthritis caused by physical wear and tear. In RA, the joint lining becomes inflamed, leading to painful swelling. Over time, this can cause bone erosion and deformity in the joints.

Signs and Symptoms of Rheumatoid Arthritis

Individuals with rheumatoid arthritis disease often exhibit a range of signs and symptoms, including:

• Joints that are tender, warm, and swollen.
• Stiffness in the joints typically worsens in the mornings or after periods of inactivity.
• General fatigue, fever, and a decrease in appetite.

In the early stages of rheumatoid arthritis, smaller joints are usually affected first, particularly those connecting the fingers to the hands and the toes to the feet.

As the condition progresses, it often extends to larger joints, such as the wrists, knees, ankles, elbows, hips, and shoulders. Symptoms usually manifest symmetrically, affecting the same joints on both sides.

Beyond the joints, approximately 40% of individuals with rheumatoid arthritis experience symptoms in other body areas, including:

• The skin
• Eyes
• Lungs
• Heart
• Kidneys
• Salivary glands
• Nerve tissues
• Bone marrow
• Blood vessels

The severity of the symptoms of rheumatoid arthritis can fluctuate, often marked by periods of heightened disease activity known as flares. These flares alternate with periods of relative remission, during which swelling and pain may lessen or disappear. Over time, the chronic inflammation associated with rheumatoid arthritis can lead to joint deformity and displacement.

Rheumatoid Arthritis Causes

Rheumatoid arthritis is classified as an autoimmune disease, where the immune system, which typically serves to protect the body from infections and diseases, mistakenly targets healthy joint tissue.

The exact cause of this autoimmune reaction remains unclear to medical professionals, but a genetic predisposition plays a significant role. Although genetics do not directly cause rheumatoid arthritis, they may increase an individual's susceptibility to environmental triggers, such as certain viruses and bacteria, potentially initiating the disease.

Read more: Inflammatory Arthritis: Types, Causes and Diagnosis

Rheumatoid Arthritis Diagnosis

When visiting a rheumatoid arthritis specialist in Delhi or elsewhere, diagnosing rheumatoid arthritis involves a combination of methods, as no single test can definitively diagnose the disease. Here are the key steps and tools used in the diagnosis:

Medical History and Physical Examination

The diagnosis of rheumatoid arthritis begins with an evaluation of the patient’s medical history and a physical examination. The rheumatologist will ask questions about the symptoms, and their duration and severity. During the physical exam, the rheumatoid arthritis doctor checks for joint swelling, redness, warmth, and range of motion in the joints.

Blood Tests

Several blood tests help in diagnosing RA:

• Rheumatoid Factor (RF): This test checks for the presence of the rheumatoid factor antibody. While not exclusive to RA, a high level of RF is commonly found in people with the disease.
• Anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies: This test is more specific than the RF test for diagnosing RA. A high level of anti-CCP is strongly indicative of RA.
• Erythrocyte Sedimentation Rate (ESR, or Sed Rate): This test measures the speed at which red blood cells settle at the bottom of a test tube in an hour. A faster-than-normal rate can indicate inflammation in the body.
• C-Reactive Protein (CRP) level: A high level of CRP is another indication of inflammation.

Imaging Tests

Imaging tests provide visual evidence of the condition of joints and can help track the progression of RA over time.

• X-rays: X-rays can show joint damage and bone erosion, although these signs might not be present in the early stages of RA.
• Ultrasound and MRI: Ultrasound and MRI can detect early signs of RA, as they can show more details of the soft tissues and fluid in joints.

Rheumatoid Arthritis Treatment

One of the primary goals of rheumatoid arthritis treatment is to find ways to cure the condition permanently. While a complete rheumatoid cure may not be currently achievable, managing symptoms and minimising joint damage are critical. Here's an overview:

Medications

• Disease-modifying antirheumatic drugs (DMARDs): These are often the first-line treatment and include medications like methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine. DMARDs can slow the progression of RA and prevent joint and organ damage.
• Biologic agents: These are a newer class of DMARDs, including tumour necrosis factor (TNF) inhibitors and other biologics targeting different aspects of the immune response. They are often used when traditional DMARDs are ineffective.
• Janus kinase (JAK) inhibitors: A medication that blocks the Janus kinase pathways involved in the body's immune response.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter NSAIDs such as ibuprofen and naproxen can relieve pain and reduce inflammation. Stronger NSAIDs are available by prescription.
• Corticosteroids: Medications like prednisone can control severe symptoms or flares. They are often used in the short term due to long-term side effects.

Physical and Occupational Therapy

These physical therapies can help improve joint function, increase range of motion, and strengthen muscles. Occupational therapy can also provide ways to protect joints during daily activities.

Lifestyle Modifications

• Regular exercise: Low-impact exercises like walking, swimming, or yoga can increase muscle strength and flexibility without harming the joints.
• Healthy diet: A balanced diet rich in fruits, vegetables, and whole grains can help control weight and maintain overall health. 
• Smoking cessation: Smoking can worsen RA symptoms and potentially reduce the effectiveness of treatment.

Surgery

In cases where joint damage is severe, surgery may be necessary to repair or replace damaged joints. Common procedures include synovectomy, tendon repair, joint fusion, or total joint replacement.

Rheumatoid Arthritis Complications

Individuals with rheumatoid arthritis are at a higher risk of developing several other health conditions, including:

• Osteoporosis: RA and certain medications used for its treatment can heighten the risk of osteoporosis, a condition that weakens bones and makes them more susceptible to fractures.
• Rheumatoid nodules: These are firm tissue bumps that often develop around pressure points like the elbows, but can appear anywhere in the body, including the heart and lungs.
• Dry eyes and mouth: There is a significantly increased likelihood of developing Sjogren's syndrome, a disorder that reduces moisture in the eyes and mouth in those with RA.
• Infections: RA and the medications used to treat it can compromise the immune system, leading to a heightened susceptibility to infections. Vaccinations against diseases like influenza, pneumonia, shingles, and COVID-19 are essential for protection.
• Abnormal body composition: Even with an average Body Mass Index (BMI), people with RA often have a higher proportion of fat to lean mass.
• Carpal tunnel syndrome: In cases where RA affects the wrists, the inflammation can compress the nerve that serves most of the hand and fingers, leading to carpal tunnel syndrome.
• Heart problems: RA can increase the risk of hardened and blocked arteries and inflammation of the pericardium, the sac surrounding the heart.
• Lung disease: There's an elevated risk of inflammation and scarring in the lung tissue for those with RA, which can result in progressive shortness of breath.
• Lymphoma: The risk of lymphoma, a group of blood cancers that develop in the lymph system, is increased in individuals with rheumatoid arthritis.

Conclusion

Rheumatoid arthritis is a chronic autoimmune condition marked by joint inflammation and a variety of systemic symptoms. Accurate diagnosis and effective treatment, involving medications and lifestyle adjustments, are crucial for managing its impact. For expert care and personalised treatment plans, consider consulting with the specialists at Max Healthcare.. Our dedicated team is committed to providing comprehensive support and advanced therapies for those living with RA.