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What is Rheumatoid Arthritis?

Rheumatoid arthritis is a chronic inflammatory disease that can cause pain, swelling, and stiffness in a person’s joints. It is not uncommon for patients to lose the ability to move. Joints involved with rheumatoid arthritis include the wrist, fingers, and knees. In rare cases, it can affect the eyes or be associated with internal organs such as the lungs or brain.

Causes of Rheumatoid Arthritis

Rheumatoid arthritis occurs when the immune system attacks the body’s tissues and organs. It is thought that an infection spread by bacteria triggers a reaction in the immune system, which leads to inflammation in the joints.

High-risk Factor Individuals

Although there is no single cause for rheumatoid arthritis, some factors have been identified as high risk. According to the Centers for Disease Control and Prevention (CDC), the following factors can help increase the chance of involvement with rheumatoid arthritis:

1. Genetic
Rheumatoid arthritis is caused by a genetic variation that affects the RA-specific protein known as “cathepsin K.” By altering the levels or function of this protein, rheumatoid arthritis is triggered. This variation can get passed down from parent to child.

2. Gender
Rheumatoid arthritis affects women twice as much as men. Hormonal differences drive this occurrence.

3. Age
The average onset age for rheumatoid arthritis is between 40 and 50 years, with people over 60 being most susceptible to the disease.

4. Weight
Rheumatoid arthritis is more common in overweight people than those with a normal BMI. It is due to larger fat deposits that allow the body to store more type II collagen. Rheumatoid arthritis can also contribute to weight gain or weight loss.

5. Smokers
Smokers are twice as likely to develop rheumatoid arthritis than non-smokers. It is due to the strong inflammatory response from nicotine.

Signs and Symptoms

1. Joint Pain
Rheumatoid arthritis is characterized by chronic joint pain. The pain can vary from a dull ache to severe throbbing pain. The joints most commonly affected include the wrists, fingers, elbows, and knees.

The pain is mainly caused by damage to the cartilage in the joints that serves as a cushion between two bones.

2. Swelling
Rheumatoid arthritis can show as a painful swelling of the joints, usually the wrists, fingers, or knees. Swelling can also occur in the ankles, calves, and feet.
The swelling is visible in the early stage of rheumatoid arthritis, subsides in the middle stage, and returns in the later stages of the disease.
The swelling is caused by tissues within the affected joint becoming inflamed. It can lead to a condition known as synovitis; a thickening of the joint lining caused by inflammation.

3. Painful Eyes
Eye pain may signify that the disease has spread to other body parts. The eyes may have a red, watery appearance. Some patients may also experience inflammation of the eyelids.

4. Cardiovascular Diseases
Rheumatoid arthritis patients may have high cholesterol levels, inflammation leading to plaque build-up in the arteries, and damage to blood vessels due to inflammation or clots. These can lead to cardiovascular diseases such as heart attack, stroke, and aneurysm.

5. Pain in Muscles and Chest Wall
The muscle pain may be caused by inflammation of the muscles and tendons. The muscles on one side of the chest may also become inflamed and painful due to the involvement of the intercostal nerves, which carry messages from the brain to various organs, including the heart and lungs.

6. Appetite Loss/Weight Changes
The loss of appetite is caused by various factors, including fatigue and pain experienced when using the joints.
Weight loss occurs because of muscles wasting away or bone deterioration. Weight gain can also occur due to symptoms, medication(s) and overall health.

7. Skin Changes
Skin redness and swelling of the face and neck may be another sign that the disease has spread to other body parts.
Swelling of the hands can also occur due to damage to tendons and ligaments.
Patients may also have a rash on their skin due to inflammation affecting tissues such as nerves and muscles in the joints.

8. Kidney Problems
Kidney problems may occur as a result of rheumatoid arthritis. These include kidney stones or scarring that can lead to minimal function or pain in the lower back and thighs.
Kidney damage can also occur due to rheumatoid arthritis connection to lupus erythematosus. This disease causes inflammation of both kidneys and skin.

9. Fatigue
Older rheumatoid arthritis patients are more likely to experience fatigue related to pain and tiredness. Many patients also experience sleep disturbance due to joint pain.

10. Cognitive Deficiency
In rare cases, rheumatoid arthritis may cause symptoms of psychosis such as hallucinations, paranoia, or delusions.
Stress and anxiety also contribute to cognitive impairment in rheumatoid arthritis patients.
Cognitive deficits are mainly common in the elderly, particularly those with other conditions such as Alzheimer’s.

Treatment Options

There are various treatment options for people who have rheumatoid arthritis. Some of the main ones include:

1. DMARDs
Oral drugs for rheumatoid arthritis include methotrexate and sulfasalazine. These drugs are referred to as traditional disease-modifying antirheumatic drugs (DMARDs). They do not cure rheumatoid arthritis but can help manage symptoms and reduce inflammation.
Other oral medications include leflunomide, minocycline, and corticosteroids. These can help relieve pain in the joints and prevent the progression of rheumatoid arthritis into a more advanced stage.
The only downside to using these drugs is their considerable side effects.

2. Physical Therapy
The overall aim of physical therapy is to restore patients’ mobility and independence. It can also help reduce pain, improve joint function, and prevent damage.
Physical therapy includes exercises prescribed by a physiotherapist, such as strengthening the muscles around the affected joints.
Therapists also include other forms of treatment such as heat treatment, massage, and electrical stimulation. These treatments reduce pain and help prevent contractures in the joints, which can limit the body’s movement.

3. Surgery
People who have rheumatoid arthritis have a high chance of developing a condition known as osteoarthritis. It occurs in the most used joints and can cause pain, stiffness, and instability. If this happens, doctors may recommend surgery to remove bone spurs or cartilage that is not functional enough. During this operation, the bones are aligned with manipulation and cutting.

Percutaneous vertebroplasty is another form of surgery for rheumatoid arthritis. It involves injecting medications into the damaged vertebrae to stimulate the new bone cells in the disc space.

4. Diet
Diet is an important aspect of treatment for rheumatoid arthritis. Some people rely on a special diet called the Specific Carbohydrate Diet (SCD). This diet restricts certain foods, such as starchy foods.
Other patients may use more general dietary advice to help manage their condition.

5. NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve pain and inflammation. These drugs are also easy to obtain.
However, they have several side effects and cause gastrointestinal bleeding in some people. Also, the body becomes dependent on these drugs after a while.
The patient should only use the drug for short periods before consulting a doctor or pharmacist about switching to another painkiller.

6. Biologics
Biologic agents for rheumatoid arthritis include infliximab, etanercept, adalimumab, and anakinra. These drugs are commonly known as anti-TNF alpha drugs or TNF inhibitors.
They suppress the immune system so it will not attack the body’s joints. These drugs are effective but have side effects such as infection and decreased blood counts.
The patients should also be careful about taking these drugs in combination with other medications that weaken the immune system.

Bottom-line

Rheumatoid arthritis is a disease that affects the joints, bones, and muscles. The symptoms may vary from person to person but typically include joint pain in the hands, wrists, ankles, and knees. However, various treatments can help manage the condition and improve the quality of life. Feel free to contact us whenever you have specific questions regarding the condition.

References

https://www.medicalnewstoday.com/articles/323361#risk-factors
https://www.nhs.uk/conditions/rheumatoid-arthritis/treatment/
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653
https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/