Rheumatoid Arthritis

WHAT IS RHEUMATOID ARTHRITIS?

Rheumatoid Arthritis (RA) is a chronic autoimmune inflammaory disease. The cause of RA is unknown¹.

In a joint with RA, the lining of the joint becomes inflamed causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness and deformity.

WHICH JOINTS ARE AFFECTED BY RA?

RA mainly attacks the joints, usually many joints at once, but it can also affect other parts of the body^1,3.

Joints that may be affected include⁴:

WHAT ARE THE SIGNS AND SYMPTOMS OF RA?

With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission¹.

In most cases, symptoms come on gradually³:

Early symptoms^1,2,4

Fatigue
A low-grade fever
Weight loss
Swollen and tender joints
Morning stiffnes

Early RA tends to affect smaller joints first, particularly hands and feet. As the disease progresses, symptoms often spread to the larger joints such as wrists, knees, ankles, elbows, hips and shoulders^4,5.

WHAT ARE THE CAUSES AND RISK FACTORS FOR RA?

Although the specific cause of RA is not known there are some factors that can increase the risk of developing the disease1:

Age. RA can occur at any age, but the risk increases with age. The onset of RA
is highest among adults in their sixties¹.
Gender. Women are affected two to three times more often than men².
Genetics/family history. A family history of RA increases the risk to developing the disease three to five times².
Cigarette smoking^1,6
History of live births. Women who have never given birth may be at greater risk of developing RA¹.
Stress. Some people report emotional stress or trauma before the onset of RA⁶.
Obesity. Being obese can increase the risk of developing RA. The more overweight a person is, the higher the risk of developing RA^1,6

WHAT ARE THE COMPLICATIONS OF RA?

During the clinical course of RA, up to 40% of people may develop extra-articular manifestations⁵:

HOW WILL MY DOCTOR DIAGNOSE MY DISEASE?

The diagnosis is based upon multiple factors including⁸:

Person’s medical history
Physical examination
Results of blood tests
Results of imaging tests

Signs and symptoms of RA are not specific and can look like signs and symptoms of other inflammaory joint diseases¹.

A classification criteria is used as an aid for diagnosis of RA and includes⁴:

Signs of inflammation in 3 or more joints, lasting for 6 weeks or longer⁴.

Diagnostic antibody blood tests:
rheumatoid factor and/or anti-citrullinated peptide/protein antibody^2,8.

Elevated blood levels of C-reactive protein or the erythrocyte sedimentation rate, markers that reflect the level of inflammation in the body^2,8.

Timely and precise diagnosis is of high importance in RA treatment, since early diagnosis can arrest disease in many patients, thereby preventing or slowing disease progression, irreparable joint damage, and disability in up to 90% of RA patients².

IMAGING TESTS

Even though X-rays are still used as a diagnosis technique of late changes in the joints and to monitor disease progression, it has limitations for early diagnosis of RA⁹.

Both ultrasound and magnetic resonance imaging (MRI) are recommended for diagnosing and monitoring disease activity in RA patients².

WHAT ARE THE TREATMENT OPTIONS FOR RA?

The aim of RA treatment is to either reach full remission or at least significantly lower disease activity to control symptoms, prevent joint damage, and maximize patient’s quality of life and ability to function^2,8.

The available therapeutic drugs include non-steroidal anti-inflammatory drugs (NSAIDs), immunosuppressive glucocorticoids, and disease-modifying anti-rheumatic drugs (DMARDs). Drug treatment is typically supplemented by non pharmacological treatment which includes physical therapy to sustain joint mobility, patient counselling to slow down disease progression, and surgery in cases of severe stages of RA which provide pain relief and restore the function of joints^2,9.

NSAIDs²

Only symptom improvement (pain and stiffnes ) but no influence on disease progression
Only used as a symptomatic treatment until diagnosis is established

Non-pharmacological treatment²

Physical therapy
Patient counselling (lifestyle, smoking, exercise, ideal body weight, drug adherence)
Surgery

Glucocorticoids²

Non-specific immune suppression
Rapid systemic disease-modifying effects
But long-term side effects

DMARDs²

Medicine that interferes with signs and symptoms of RA
Target inflammation
Prevent further joint damage

WHAT CAN I DO TO MANAGE MY DISEASE?

There are self-care measures that can help manage the signs and symptoms of RA⁸:

Exercise regularly⁵
Exercise and physical activity improve muscle strength and perceived health status.

Apply heat and cold⁸
Heat treatments can help to relax stiff joints and tired muscles.
Cold is best to reduce pain and inflammation

Stop smoking¹

Reduce stress⁸
There are different ways to relax and stop focusing on pain. They include meditation,
deep breathing, guided imagery and massages.

Healthy dietary habits¹⁰
They can be a useful tool in reducing the risk of RA, related comorbidities, RA progression and disease activity. Mediterranean diet is the most encouraged dietary pattern.

Maintain a healthy weight¹