Rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by systemic inflammation primarily affecting the synovial membranes of joints, but it can also involve other organs such as the heart and lungs. This condition leads to symptoms like joint pain, swelling, stiffness, fatigue, and low-grade fever, often resulting in joint deformities and loss of function over time. Factors contributing to the onset of RA include genetic predispositions, environmental triggers, and possibly infections or stress. Women are significantly more likely than men to develop RA, particularly between the ages of thirty and sixty. Diagnosis involves assessing joint symptoms, conducting blood tests for autoimmune markers, and imaging studies to evaluate joint damage.
Treatment aims to reduce inflammation and pain while slowing disease progression, utilizing medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and corticosteroids. Additionally, lifestyle modifications, physical therapy, and education play vital roles in managing the condition. Surgical options may also be considered for severe cases. Overall, understanding and addressing RA requires a holistic approach that encompasses medical treatment, physical well-being, and emotional support to help individuals maintain their quality of life.
Rheumatoid arthritis
DEFINITION: A chronic, systemic, and inflammatory autoimmune disease that affects the synovial membranes of joints and other organs in the body
ALSO KNOWN AS: Rheumatism
ANATOMY OR SYSTEM AFFECTED: Heart, immune system, musculoskeletal system, respiratory system
CAUSES: Autoimmune response, possibly resulting from stress or infection; genetic factors
SYMPTOMS: Chronic inflammation, swelling, and pain in joint spaces; stiffness; fatigue; weakness; weight loss; low-grade fever
DURATION: Chronic
TREATMENTS: Nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen), disease-modifying antirheumatic drugs, corticosteroids, surgical repair
Causes and Symptoms
Rheumatoid arthritis is one of the most common forms of arthritis. Most experts believe that rheumatoid arthritis (RA) occurs as a result of a complex interplay between environmental and genetic factors, although the initial event triggering the inflammatory response is unknown. Some types of stress on the body, possibly an autoimmune reaction or infection, triggers an autoimmune response characterized by chronic inflammation, swelling, and pain in joint spaces as cartilage erodes and bony cysts cause deformities in the joints and joint motion is lost. Certain genes associated with the immune system have been found to increase the possibility of developing RA. Changes in the STAT4 gene and human leukocyte antigen (HLA) genes are associated with an increased risk for RA. Smoking also increases the risk for RA. The Arthritis Foundation reported that women are three times more likely than men to develop RA, and onset typically occurs between the ages of thirty to sixty years. The global prevalence of RA was estimated by the World Health Organization to be 18 million as of 2019.
Initially, persons with RA may have general, vague complaints such as fatigue, weakness, weight loss, anorexia, low-grade fever, and tingling in the hands and feet. Joint stiffness lessens as the day progresses but may recur after inactivity and is worse after strenuous activity. Although all joints may be affected, the proximal interphalangeal or metacarpophalangeal joints and joints of the wrists, knees, ankles, and toes are most often affected. Rheumatoid nodules may be found on the hands and elbows. Sjögren’s syndrome, a chronic autoimmune disease, or psoriasis may also be present. There is also potential for renal, cardiovascular, pulmonary, neurological, and ophthalmological involvement.
Diagnosis of RA involves identifying at least two painful or swollen joints that have been that way for at least six weeks, as well as a variety of blood tests intended to identify autoimmune disease. These tests may measure rheumatoid factor, anticitrullinated protein antibodies (ACPA), erythrocyte sedimentation rate, and c-reactive protein. X-rays to identify erosions, bony calcifications, and narrowing in affected joints may also be undertaken.
Treatment and Therapy
The goals of rheumatoid arthritis treatment are to reduce inflammation and pain, slow the disease process, improve function, and maintain quality of life. Medications are used for their analgesic, anti-inflammatory, cytotoxic, and immunosuppressive effects. The three main categories of medication used in the treatment of RA are nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and corticosteroids. NSAIDS such as aspirin, ibuprofen, and naproxen reduce joint pain and swelling but do nothing to slow the progression of RA. DMARDs, which include methotrexate, hydroxychloroquine, leflunomide, sulfasalazine, and minocycline, can actually slow the progression of RA. Biologic DMARDs called tumor necrosis factor (TNF) inhibitors target areas of the immune system that cause joint and tissue damage. Examples include etanercept, infliximab, adalimumab, and golimumab. The short-term use of corticosteroids is effective for rapidly reducing joint inflammation. Research has shown that fish oils containing omega-3 fatty acids may also decrease inflammation in joints.
Education for the management of RA includes aerobic and strengthening exercises, stress control, methods to protect joint integrity, and support groups that assist individuals and their families to maintain independence and to plan for care during exacerbations of RA. Surgical interventions to repair damaged joints and joint replacement may also be part of RA therapy.
Perspective and Prospects
The highest incidence of RA occurs in women over the age of sixty-five years. Juvenile rheumatoid arthritis occurs in children aged seventeen years or younger. Research has indicated a possible link between infections and the development of rheumatoid arthritis.
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