Rheumatoid Arthritis (RA) is a chronic inflammation of the joints that arises due to an abnormal response of the immune system.
Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body.
The three stages for RA are:
- Initiation phase (non-specific inflammation)
- Amplification phase
- Chronic inflammation
SIGNS & SYMPTOMS OF RHEUMATOID ARTHRITIS
- Inflammation of the synovial membrane.
- Tender, warm, stiff & swollen joints.
- Early morning stiffness
- Limit of movement in joints
- Loss of joint function & deformity
- Hammer toe
- Fever, malaise & loss of appetite.
- Firm tissue lumps & swelling on the skin filled with dead WBCs & lymphocytes.
- Fissure & ncecrosis on the skin.
- Found over elbow, heel & knuckles.
- Inflammation of the blood vessels in the skin.
- Nodules in the lungs.
- Inflammation of the wall protecting the heart.
- Increased platelet count
- Inflammation of the eye & mouth layers.
- Weakness of the bones.
COMPLICATIONS ARISING FROM RHEUMATOID ARTHRITIS
- Erosion of surface of the joints & total loss of function.
- Deformity of the hands & fingers.
- Deformity in which the joint near the knuckle is permanently bent towards the palm.
- Also deformity of the joints near the fingers that get permanently bent towards the palm.
- Skin ulceration & nerve death.
- Painful ulcers on the skin that can progress to necrosis.
- Sudden onset of fever, elevated levels of WBCs in the skin with papules.
- Reddening of the skin of the palms, fingers, feet, etc.
- Loss of hair from some parts of the body.
- Fluid accumulation in the lungs & fibrosis of the lungs.
- Higher risk of heart attack & stroke.
- Low WBC count.
- Build up of abnormal level of protein in the kidneys.
- Inflammation of the multiple layers of the eye that can lead to blindness.
- Death of nerves in the spinal cord.
- Higher chance of lymphoma.
CAUSES & RISK FACTORS
- Family history of Rheumatoid Arthritis increases the risk about 3 to 5 times.
- Presence of other autoimmune disorders like autoimmune cirrhosis.
- Smoking increases the risk of the disease by 3 to 5 times.
- Exposure to silica can cause Rheumatoid Arthritis.
- No association of infectious diseases with RA.
- More risk in females than in males.
- Hormonal medications.
- Gut bacteria.
DIAGNOSIS FOR RHEUMATOID ARTHRITIS
- Blood Tests:
a) Blood test for detecting Rheumatoid Factor (RF) found positive in 65-75% of patients with Rheumatoid Arthritis. Although a negative test does not generally rule out the probability of RA.
RF can be present in 10% of healthy individuals & even in patients with other conditions.b) Blood test for detecting ACPAs, measured as anti-CCP antibodies which are more specific for RA. ACPAs can be detected before the symptoms for RA have even started.
c) Test for ACPAs is the anti CCP ELISA test.
- Imaging tests like X-rays & MRI are done for assessing the joint deformity & presence of erosion in the bones & joints.
TREATMENT & MANAGEMENT
- Although there is no cure for Rheumatoid Arthritis, some drugs that can be used for management of symptoms are;
- Disease modifying anti-rheumatic drugs like methotrexate, hydroxychloroquine, sulfasalazine.
- TNF alpha blockers
- Monoclonal antibodies
- Cyclosporin in progressive RA.
- Combination of low doses of glucocorticoids & conventional therapy.
- COX-2 inhibitors
- Paracetamol for pain relief.
- Topical cream & gels for pain relief.
- Synovectomy for affected hands, fingers & wrists.
- Joint replacement surgery such as knee replacement.
- Electrical nerve stimulation.
- Dietary supplements like Omega-6 & Omega-3 fatty acids.
- Herbal drugs & remedies are being currently researched.
- Cessation of smoking.