Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, causing inflammation, pain, swelling, stiffness, and potential joint damage. It can also affect other organs and systems in the body. RA is characterized by periods of disease activity (flares) and periods of remission, during which symptoms may improve or disappear.
Causes of Rheumatoid Arthritis:
The exact cause of rheumatoid arthritis is not fully understood, but it is believed to involve a combination of genetic, environmental, and immune system factors.
Genetic Predisposition: There is a strong genetic component to rheumatoid arthritis, as certain genetic markers and variations (such as specific human leukocyte antigen – HLA – genes) have been associated with an increased risk of developing the condition. However, not everyone with these genetic predispositions will develop rheumatoid arthritis, indicating that other factors also play a role.
Autoimmune Dysfunction: Rheumatoid arthritis is considered an autoimmune disease, where the immune system mistakenly attacks healthy tissues in the body, particularly the synovium (the lining of the joints), leading to inflammation and joint damage. The triggers for this autoimmune response are not fully understood but may involve environmental factors such as infections or environmental toxins.
Environmental Triggers: Environmental factors such as infections (particularly viral infections), smoking, hormonal changes, or exposure to certain chemicals or pollutants may trigger or exacerbate the autoimmune response in genetically susceptible individuals.
Symptoms of Rheumatoid Arthritis:
The symptoms of rheumatoid arthritis can vary widely among affected individuals and may develop gradually over time. Common symptoms may include:
Joint Pain: Chronic or intermittent pain, swelling, tenderness, and stiffness in the joints, particularly in the small joints of the hands, wrists, feet, and ankles. Joint symptoms typically occur symmetrically on both sides of the body.
Morning Stiffness: Morning stiffness and reduced joint mobility, particularly upon waking or after periods of inactivity, which may last for hours.
Fatigue: Generalized fatigue, weakness, or malaise, which may be due to the chronic inflammation and immune system activation associated with rheumatoid arthritis.
Joint Deformity: Progressive joint deformities, such as swan-neck deformity (flexion of the finger joints with hyperextension of the distal joint), boutonniere deformity (flexion of the proximal joint with hyperextension of the distal joint), or ulnar deviation of the fingers.
Rheumatoid Nodules: Firm, painless nodules under the skin, typically over bony prominences or pressure points, which may develop in some individuals with rheumatoid arthritis.
Systemic Symptoms: Systemic symptoms such as low-grade fever, weight loss, or loss of appetite may occur during disease flares.
Extra-articular Manifestations: Rheumatoid arthritis can affect other organs and systems in the body, leading to complications such as rheumatoid lung disease, rheumatoid vasculitis, pericarditis, or eye inflammation (such as scleritis or uveitis).
Diagnosis and Treatment of Rheumatoid Arthritis:
Diagnosis of rheumatoid arthritis is based on a combination of medical history, physical examination, laboratory tests, and imaging studies such as X-rays, MRI, or ultrasound. Key features that may suggest rheumatoid arthritis include symmetrical joint involvement, morning stiffness lasting more than one hour, and evidence of joint inflammation or damage on imaging studies.
Treatment of rheumatoid arthritis aims to alleviate symptoms, reduce inflammation, prevent joint damage, and improve overall quality of life. Treatment options may include:
Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are often prescribed to reduce pain and inflammation. Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, hydroxychloroquine, sulfasalazine, or biologic medications may be used to suppress the underlying autoimmune response and slow the progression of joint damage.
Corticosteroids: Oral or intra-articular corticosteroids may be prescribed to provide short-term symptom relief and reduce inflammation during disease flares.
Physical Therapy: Physical therapy exercises, stretches, and modalities such as heat or cold therapy can help improve joint flexibility, strength, and function, as well as relieve pain and stiffness associated with rheumatoid arthritis.
Exercise: Regular exercise, including low-impact activities such as swimming, walking, or cycling, can help maintain joint mobility, improve muscle strength, and reduce fatigue in individuals with rheumatoid arthritis.
Joint Protection: Joint protection techniques, ergonomic modifications, and assistive devices such as splints or orthotics may be recommended to reduce stress on the joints and improve function.
Surgery: In severe cases of rheumatoid arthritis with significant joint damage or deformity, surgical interventions such as joint replacement surgery (arthroplasty) may be considered to restore joint function and relieve pain.
