This post was most recently updated on May 6th, 2020
Rheumatoid arthritis (RA) is an inflammatory disease causing pain, swelling, stiffness, and loss of joint function.
It occurs when the immune system, usually in charge of defending the body from foreign agents, turns its weapons against the membranes that line the joint surfaces.
The course of rheumatoid joint pain ranges from mellow to extreme. In most cases, the disease is chronic; that is, it lasts a long time, practically all life.
In many subjects periods of relatively mild illness are interrupted by episodes or flare-ups of worsening. In others, the symptoms are constant.
Arthritis or osteoarthritis?
Arthritis and arthrosis are conditions that affect the joints and both fall into the category of rheumatic diseases; the symptoms are partly overlapping,
- Movement limitation.
But the causes underlying the two pathologies are very different.
Joint pain is an immune system fiery ailment that can occur at any age; arthrosis is instead a degenerative disease typical of the second half of life.
There are numerous forms of arthritis, including
- Gouty arthritis (gout).
- Septic arthritis.
- Psoriatic arthritis.
- Reactive arthritis.
Be that as it may, in this article, we will concentrate on rheumatoid arthritis.
What are the symptoms of rheumatoid arthritis?
Indications frequently grow continuously more than a little while; however, few cases can progress rapidly over days.
The fundamental side effects of rheumatoid arthritis pain are
- The swelling
- Joint stiffness.
It can also cause more general symptoms and inflammation of other parts of the body.
Symptoms vary from subject to subject. They come and go and can change over time. There may be acute episodes when conditions deteriorate, and the symptoms are more intense.
Symptoms in the joints
Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint, although often the first to be affected are the small joints of the hands and feet.
Typically, the disease affects the joints symmetrically (both sides, with the same intensity and at the same time), even if this is not always the case.
The main symptoms of the joints are:
- Pain: Joint pain associated with rheumatoid arthritis is typically described as excruciating and acute. Often, it is more intense in the morning and after a period of inactivity.
- Stiffness: Joints affected by rheumatoid arthritis can be stiff. For example, when the hands are concerned, it may not be possible to completely bend the fingers or close the side in a fist. Like joint pain, stiffness is generally more severe in the morning or after inactivity. The morning stiffness associated with another form of arthritis, osteoarthritis, disappears typically about half an hour after waking up, while that linked to rheumatoid arthritis usually lasts longer.
- Swelling, heat, and redness: The articular surfaces affected by rheumatoid arthritis become inflamed, thus causing the swelling of the joint, which becomes hot and painful to the touch. In some subjects, the swelling takes on a hard character, resulting in the so-called rheumatoid nodules, formations that develop under the skin around the sick joints.
In addition to joint problems, some patients with rheumatoid arthritis experience more general symptoms, such as:
- Fatigue and lack of energy.
- Excessive sweating.
- Loss of appetite.
- Weight loss.
Inflammation associated with rheumatoid arthritis can sometimes cause problems in other parts of the body:
- Dry eyes, if the eyes are affected.
- Chest pain, for the involvement of the heart or lungs.
The characteristic symptoms and signs of rheumatoid arthritis are:
- Sore, hot, and swollen joints.
- The symmetry will occur on affected joints.
- Frequent involvement of the wrist and the bones of the fingers get closest to the hand.
- Occasional participation from different joints, for example, the neck, shoulders, elbows, hips, knees, lower legs, and feet.
- Fatigue, feverish episodes, and loss of energy might be seen on a body.
- Morning pain and stiffness or after prolonged rest lasting more than 30 minutes.
- Symptoms can persist for several years.
- Variability of symptoms among delicate subjects may be seen.
This disease has several characteristics that distinguish it from other types of arthritis, for example:
- Typically symmetrically manifests itself, if it hits one hand the other is also interested.
- The wrist joint may be attacked and those of the fingers closest to the hand.
- It can influence different pieces of the body except for the joints.
- Also, those suffering from the disease may report fatigue.
- Occasional fever and a loss of energy is the primary characteristic of rheumatoid arthritis.
What are the causes of rheumatoid arthritis?
Rheumatoid joint pain is principally an ailment of the joints; it affects around 400 thousand patients in Italy, approximately 1 in 200 people with the highest prevalence in the female population (the ratio to men is 4 to 1).
The joint is the point where two or more bones come into contact.
With few exceptions (for example, the skull and pelvis), the joints are made to allow movements between bones and to absorb shocks caused by actions such as walking or repetitive gestures.
The ends of a bone are covered with a durable and versatile tissue called ligament.
The joint is encompassed by a container that ensures protection and support.
The joint capsule is aligned with a type of fabric, the synovium, which secretes the synovial fluid, a transparent substance that lubricates and nourishes the cartilage and bones inside the capsule.
Like many other rheumatic diseases, RA is an autoimmune disease; the diction originates from the fact that the subject’s immune system, in reasonable condition to defend the body against infections and illnesses, attacks its articular tissues for unknown reasons.
The leukocytes (white blood cells), which are the cellular expression of the immune system, reach the synovium and cause inflammation (synovitis), which is manifested by
The typical symptomatology of rheumatoid arthritis.
During the inflammatory process, the synovium, thin in normal conditions, thickens and causes the joint to swell, making it soft and sometimes warm to the touch.
As the disease progresses, the inflamed synovia invades and destroys cartilage and bone within the joint.
The supporting and stabilizing apparatus of the joint, therefore surrounding muscles, ligaments and tendons, weakens and is never again ready to satisfy its capacity.
These effects determine the pain and joint damage often seen in rheumatoid arthritis.
Those who study rheumatoid arthritis currently believe that bone damage begins during the first or second year of illness, which is one of the reasons why early diagnosis and treatment are so important.
Risk factors of rheumatoid arthritis
The reasons why in rheumatoid arthritis, the immune system attacks its tissues are not completely clear, but in recent years, scientific research has begun to put together the factors involved.
Genetic (hereditary) factors: It has been discovered that some genes, known for their role in the immune system, are associated with the tendency to develop rheumatoid arthritis.
For related genes, the frequency of single “risky” genes is only slightly more significant in subjects with rheumatoid arthritis than in healthy controls.
In other words, individually, a gene in itself carries only a relatively small risk of illness.
Some individuals with these genes never develop the disease.
These observations suggest that although genetic makeup plays an essential role in determining the possible development of the disease, it is not the only factor involved.
Instead, there are many genes involved in determining whether a person will develop the disease as well as its severity.
Environmental factors: Many researchers believe that there must be a trigger to activate the disease in people genetically predisposed to rheumatoid arthritis. Various factors have been proposed, but a specific agent has not been identified.
Other: Some think that hormonal factors also come into play, and this hypothesis derives from the observation that:
- Women are more at risk than men.
- The disease can improve during pregnancy and then become acute again.
- Breastfeeding can also worsen the disease.
- The use of contraceptive drugs may increase the risk of developing the disease.
This seems to indicate that the hormones, or the possible lack or variation of some, may favor the progression of the disease in genetically predisposed people, exposed to environmental triggers.
Although there are no absolute certainties, one thing is sure: rheumatoid arthritis is the result of the interaction of several factors.
What could be the complications of rheumatoid arthritis?
The evolution of rheumatoid arthritis varies from subject to subject. Some patients have mild or moderate forms, with periods of deterioration, or exacerbations, and periods in which they are better, remissions.
Others are suffering from severe forms of the disease, almost always active; Arthritis lasts for several years or a lifetime and causes severe joint damage and disability.
Although rheumatoid arthritis is primarily an articular pathology, its effects are not only physical. Many subjects encounter problems such as:
- The lense of powerlessness.
- Low self-esteem.
The disease can affect virtually any component of a person’s life, from work to family life. It can, in like manner, intrude with the joys and duties of family life and hinder planning compared to procreation.
Fortunately, current treatment strategies allow many individuals with the disease to lead an active and productive life.
These strategies include painkillers and therapies that slow down joint damage, a balance between rest and exercise, and patient education and support programs.
In recent years, research has provided new keys to understanding the disease and has increased the chances of finding even better ways to treat the condition shortly.
Some individuals with rheumatoid arthritis also have non-articular symptoms. Many patients develop anemia or reduced red blood cell production. Less frequently, sufferers have neck pain and dry eyes and mouth. Finally, in some patients, we observe:
- Carpal tunnel syndrome.
- Diffuse inflammation, which can affect.
- Lungs (with cough, shortness of breath).
- Heart (pericarditis).
- Eyes (Sjogren’s syndrome).
- Blood vessels (vasculitis).
- Cardiovascular diseases (diabetes, high blood pressure, metabolic syndrome, atherosclerosis).
Rheumatoid arthritis can be challenging to diagnose in its early stages for several reasons.
- There is no single exam for the disease.
- The symptoms differ, starting with one patient then onto the next and can be more intense in some subjects; they can be indistinguishable from those of other types of arthritis and joint diseases.
- It may, therefore, take some time to rule out other conditions.
- Finally, the full range of symptoms develops gradually; in the early stages of the disease, the symptoms may be modest.
- As a result, the doctor employs a variety of diagnostic approaches to identify the disease and rule out other ailments.
History of rheumatoid arthritis
The doctor starts by asking the patient for a description of the symptoms, on how and when they will occur, and their course over time.
The doctor will also reconstruct the patient’s and relatives’ overall medical history, even inquiring about any ongoing therapies.
Accurately answering these questions helps to diagnose and frame the impact of the disease on the subject’s life.
Physical examination of rheumatoid arthritis
The doctor examines the reflexes and overall health of the subject, including muscle strength. It will inspect the symptomatic joints and observe how the patient can walk, bend over, and conduct daily activities.
It will also examine the skin for eruptions and will auscultate the chest in the event of lung inflammation.
Various laboratory tests exist to confirm the diagnosis of rheumatoid arthritis. The most common are:
- Rheumatoid factor (Reuma test):
It is an antibody present in the blood of most people with rheumatoid arthritis (the antibody is a specific protein produced by the immune system, normally to fight foreign substances). Not all subjects are positive for this test, and some positive people will never develop the disease. The rheumatoid factor may also be decisive in other conditions; however, a positive rheumatoid factor in a subject with symptoms consistent with rheumatoid arthritis may be useful to confirm the analysis. Moreover, elevated amounts of rheumatoid factor are related to increasingly severe forms of rheumatoid arthritis.
- Anti-CCP antibodies:
This blood test detects anti-citrulline antibodies (anti-CCP). It is positive in many subjects with RA; it can be positive even many years before the disease develops. Used in combination with rheumatoid factor, it gives valuable results for diagnosis.
- Other examinations:
Other standard laboratory tests, such as leukocyte count, blood counts for anemia (frequent in affected subjects), erythro-sedimentation rate (ESR) and C-reactive protein (PCR), indicative of ongoing inflammatory processes they are valid aids both in making the diagnosis and in monitoring the disease and the response to anti-inflammatory therapy.
Radiographs are useful for assessing the degree of joint destruction.
They have no use in the early stages of rheumatoid arthritis when bone damage is not apparent; however, they can be used to rule out other causes of joint pain. Subsequently, they become relevant to monitor the progression of the disease.
What could be the preventions for rheumatoid arthritis patient?
There are various therapeutic approaches for rheumatoid arthritis. They are used in multiple combinations and at different times of the disease and are chosen based on the situation of the individual patient.
Regardless of the treatment identified, however, the purpose is always the same:
- Alleviate torment.
- Decrease aggravation.
- Back off or stop joint harm.
- Improving the patient’s level of well-being and functional capacity.
Effective treatment requires a good relationship between the patient and the patient. An association of trust helps to ensure that physical activity and pain management programs are delivered as needed and that drugs are appropriately prescribed.
It is also vital to support for those who have to make decisions about surgery.
Current therapeutic approaches include:
- Continuous monitoring and care.
Some activities may help improve a person’s ability to function independently and maintain a positive attitude.
Rest and exercise:
The patient with rheumatoid arthritis needs the right balance between rest and exercise: prevalence of rest when the disease is active, the incidence of training when it is not. Rest helps reduce active joint inflammation and pain, as well as being an antidote for fatigue.
The duration of rest varies according to the subject; in general, frequent rests are still more effective than long periods of bed rest.
Exercise is also vital to keep muscles healthy and robust, safeguarding joint mobility and maintaining flexibility.
This can help you sleep better, reduce pain, maintain a positive attitude, and body weight within limits.
The exercise programs should take into account individual physical abilities, limits, and needs that change over time.
In some subjects, the temporary use of splints around painful joints reduces pain and swelling thanks to the support and rest action exerted by the reinforcements.
They are used mainly on the wrists and hands, but also ankles and feet. The choice of a splint and the verification of its adequacy can be made by a doctor, a physiotherapist, or an occupational therapist.
Stress on joints can also be reduced through self-help devices (such as zipper pullers, shoehorns with long handles), aids for getting up and sitting down from chairs, toilet and bed, and changes to how the subject carries on his daily.
The subject suffering from rheumatoid arthritis faces emotional as well as physical difficulties.
Feelings of fear, anger, and frustration, perceived as a result of illness, combined with any painful stimulus or physical limitation, can increase the level of stress. Even though there is no reliable information on the fact that stress plays a role in causing illness, it can make acceptance more difficult.
Stress can also influence how much pain the patient feels. There are various effective techniques for managing stress.
Regular rest periods can help, as well as relaxation, distraction, or visualization exercises. Exercise programs, participation in support groups, and excellent communication with the healthcare team are other ways of reducing stress.
Except for several specific types of oil, there is no reliable data on whether foods or nutrients help or harm a person with rheumatoid arthritis, but a globally balanced diet with an adequate but not excessive amount of calories, proteins and football is important.
Some patients must pay attention to alcohol due to drug therapy. Subjects who take methotrexate may have to abstain entirely from liquor because among the most severe side effects of prolonged use of the drug; there is liver toxicity.
A study of approximately 1,700,000 patients showed a possible link between the Mediterranean diet and a decrease in the danger of creating rheumatoid arthritis.
From a more general point of view, a correct dietary approach allows to reduce the risk of developing chronic cardiovascular diseases, including obesity, often detectable in patients who have rheumatoid arthritis.
In some cases, arthritis tends to get worse when the weather changes abruptly, but there is no certainty about the possible action to prevent or reduce the effects of the disease caused by specific weather conditions.
Moving to a spot with an alternate atmosphere generally makes no difference in the long term on the course of the disease.
Most patients take drugs. Some medicines (analgesics) are used only to relieve pain; others, such as corticosteroids and NSAIDs (non-steroidal anti-inflammatory drugs), to reduce inflammation.
Still, others often referred to by the acronym DMARDs (from the English disease-modifying antirheumatic drugs, or antirheumatic drugs that alter the course of the ailment), are used to try to slow down the progression of the disease.
Among the DMARDs, there are hydroxychloroquine, leflunomide, methotrexate, and sulfasalazine. Other DMARDs, also called biological response modifiers, are indicated in subjects with the most severe forms.
They are genetically engineered drugs that help reduce inflammation and structural damage to joints by interrupting the cascade of events underlying the inflammatory process.
Currently, several biological response modifiers are approved for the treatment of rheumatoid arthritis, including abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab.
Finally, we have recently introduced in Italy Barcitinib, a molecule able to counteract pro-inflammatory proteins at the cellular level; formulated in tablets and taken once a day, the drug is today an alternative to biologics for those patients who for some reason are not suitable for their administration.
For many years the specialists used to start therapy with aspirin or other analgesics for rheumatoid arthritis, waiting for the disease to get worse before giving more potent drugs.
In the last few decades, this therapeutic approach has changed, because research has shown that early treatment with more potent medicines and the use of combinations than a drug can only be increasingly compelling in lessening or counteracting joint harm.
A patient with symptoms of persistent rheumatoid arthritis should consult a doctor who has experience of the infection and its treatment to diminish the danger of damage.
Many medicines that help reduce the disease in rheumatoid arthritis work by reducing the inflammation that can cause pain and joint damage. However, in some circumstances, inflammation is one of the mechanisms used by the body to stay healthy; it is, for example, necessary to fight infections and perhaps to stop the growth of a tumor.
It is difficult to estimate the risk derived from the treatment because infections and tumors can arise in individuals with rheumatoid arthritis not being treated, and perhaps even more frequently than in healthy subjects. Attention and vigilance are, nevertheless justified.
Various surgical approaches are available for patients with severe joint damage.
The primary purpose of these procedures is the reduction of pain, the functional improvement of the affected joints, and the ability to perform daily activities.
Surgery is not indicated in all cases, and the decision to use it should only be made after a careful doctor-patient evaluation.
They will have to discuss together the general health conditions of the patient, those of the joint or tendon that will undergo the operation, the reasons, and the benefits-risks of the surgical procedure. The cost may also affect the assessment.
Continuous monitoring and care
Regular medical attention is to import to monitor the course of the disease, determine the effectiveness and possible adverse effects of the drugs, and change the therapies as needed.
Monitoring typically requires regular medical visits. It might likewise incorporate blood and urine tests, other laboratory tests, and X-rays.
The person with rheumatoid arthritis may want to address osteoporosis prevention with the doctor as part of their long-term care.
Osteoporosis is a condition wherein bones moved toward becoming weak and fragile.
Rheumatoid joint inflammation expands the danger of creating osteoporosis in both men and women, especially when being treated with corticosteroids. These patients will have to evaluate with their doctors the possible benefits of calcium and vitamin D supplements or other osteoporosis treatments.
Optional and reciprocal treatments
Individual weight control plans, nutrient enhancements, and other elective methodologies to the treatment of rheumatoid arthritis have been suggested.
Scientific research has shown that some of these, such as fish oil supplements, can help reduce joint inflammation. Most of the time, however, either no controlled scientific studies have been performed, or no particular benefits have been identified for these therapies.
As with any other treatment, the patient should discuss the benefits and limitations of the doctor before starting an alternative or new type of therapy.
If the doctor considers the approach valid and not dangerous, the choice may be part of the patient’s treatment plan. However, it is essential not to neglect traditional medical care.