What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease that mainly affects joints. It is called an autoimmune disease because the immune system mistakenly attacks the tissues of your own body. The main feature of RA is the symmetric inflammation of the hand and feet joints, though any joint lined by a synovial membrane may also be involved. The inflammation caused by RA can affect other organ systems as well.

Possible Causes:

The cause of the autoimmune diseases still remains unknown, however, some hypotheses suggest that autoimmune diseases have a genetic predisposition. Normally the immune system attacks viruses and bacteria in our body and the attack results in inflammation. In RA the immune system attacks healthy tissue in the joints because of an unknown cause. The inflammation caused by the immune system affects joints causing joint pain and swelling. Environmental, hormonal, immunologic, and infectious factors may trigger the disease.

Risk Factors:

The following factors may increase the risk of developing RA:

• Sex - About 75% of RA patients are women.
• Age - RA usually appears in middle age.
• Lifestyle factors - Smoking and excessive weight increase the risk of developing RA.
• Genetics - People who are born with certain genes are more prone to develop RA.

Signs and Symptoms:

RA symptoms include warm, tender and swollen joints, fatigue, fever, and loss of appetite. Joint stiffness is usually worse in the morning and after inactivity and it decreases after physical activity. RA tends to affect smaller joints first, particularly the upper and lower extremity finger joints. Along with progression, the disease can spread to wrists, knees, ankles, elbows, hips, and shoulders joints. RA can also affect skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow, blood vessels. The intensity of RA signs and symptoms might fluctuate and may even come and go. When the disease activity is increased it's called flares, when the swelling and pain fade or disappear it's called relative remission. RA can cause joints to deform and shift out of place over time.

Diagnosis:

There is no single test that can be used to diagnose RA. Blood test results, physical examination of joints and organs, and evaluation of x-ray or ultrasound pictures are used to diagnose RA.

Abnormal blood tests commonly seen in RA include:

• Anemia (a low red blood cell count)
• Rheumatoid factor (an antibody seen in 80% of patients with RA)
• Antibodies to cyclic citrullinated peptides (an antibody seen in 60-70% of patients with RA)
• Inflammation markers ( elevated C-reactive protein, erythrocyte sedimentation rate, interleukins)

Treatment:

There is no cure for RA. In the last 30 years, RA treatment has advanced dramatically. Current treatments provide patients with long “remission” with no signs of active disease. Disease-modifying antirheumatic drugs (DMARDs) are the first-choice treatment for patients with RA. DMARDs can be prescribed along with nonsteroidal anti-inflammatory drugs (NSAIDs) and/or low-dose corticosteroids, to lower swelling and pain. Patients with a more serious stage may need medications called biologic agents. RA patients have to frequently visit their rheumatologist so the doctor can manage the disease and check for any side effects of medications.