24 Oct 2017
What is Rheumatoid Arthritis (RA)?
Rheumatoid arthritis (RA) is a long term condition that causes pain, swelling and stiffness in the joints. Rheumatoid arthritis is an auto immune disease in which the body’s immune system mistakenly attacks the joints. This creates inflammation that causes the tissue that lines inside of the joints to thicken, resulting in swelling and pain in and around the joints.
Rheumatoid arthritis is a destructive joint disease that is caused by inflammation in the tissue that normally produces lubrication fluid or joints. When the tissue remains inflamed, it leads to deformity by loosening joint ligaments and to joint destruction by eroding away cartilage and bone.
Rheumatoid arthritis autoimmune disease causes chronic inflammation of the joints. Autoimmune diseases are illnesses that occur when the body’s tissue are mistakenly attacked by their own immune system.
The immune system contains a complex organisation of cells and antibodies designed to normally seek and destroy invaders of the body, mostly infections.
Patients who have autoimmune diseases their bodies usually contain antibodies and immune cells in their blood which target their own body tissues, where they can be associated with inflammation.
Whilst inflammation of the tissue around the joints and inflammatory arthritis are characteristic features of RA, the disease can also lead to inflammation and injury in other organs of the body. This leads to affecting multiple organs of the body so rheumatoid arthritis can be referred to systemic disease or rheumatic disease.
What are the Causes of Rheumatoid Arthritis?
• Not yet fully explained.
• This is more likely for women to develop than men.
• Higher chances for people between the age of 40+
• Could be genes/sex- if it runs in families more likely to be inherited
• Environmental factors could be possible cause of RA as well as smoking increasing severity of symptoms
• Could be bacteria or viruses
• Could be a trauma/injury such as bone fractures, joint dislocations, ligament damage
• Could be Obesity- fat in the body releasing cytokines which are compounds relating to inflamed joints.
• Your immune system usually creates antibodies which fight bacteria and viruses helping to fight infection. Your immune system mistakenly sends antibodies in the lining of your joints, where they attack the tissue surrounding your joint.
• This causes the thin layer cells covering your joints to become inflamed and sore releasing chemicals that damage nearby bones, cartilage (the stretchy connective tissue between bones), tendons (the tissue that connects bone to muscle), ligaments (the tissue that connects bones and cartilage).
What are the Symptoms of Rheumatoid Arthritis?
• Fatigue- tiredness, lack of energy, fever, sweating, decreased appetite, can mentally affect people
• Joint Pain- Usually a throbbing and aching pain. This is often worse in the mornings and during inactivity.
• Joint Stiffness- Joints affected by rheumatoid arthritis can feel stiff. For example, formation of fist may cause discomfort due to the pain that making a fist will cause.
• Joint swelling, warmth and redness- When the lining of the joints affected by rheumatoid arthritis become inflamed this can cause the joints to swell, and become hot and tender to touch. This causes discomfort.
• Loss of joint function
• RA related chest pain can also be a symptom of costochondritis
• Over time rheumatoid arthritis can cause joints to deform and shift out of place.
• Possible symptom- neck joints and shoulder joints can sometimes become worn out causing discomfort.
• More than one joint is affected causing discomfort.
• Small joints such as wrists, certain joints of the hands and feet, ankles, knees, elbows begin to ache severely.
• Morning stiffness in joints for 30 minutes or longer.
• Long term unexplained joint pain around 6 weeks.
• RA can cause inflammation of the airways in the lungs and may cause dry cough.
• Joint Tenderness- RA leads to tenderness of involved joints. This is due to the inflamed joint lining tissue irritating the nerves in the joint capsule. When the irritated joint capsule is compressed by external pressure such as touching the joint, it is frequently tender. The pain from the compression is immediate. This is why rheumatoid arthritis can also lead to difficulty sleeping and insomnia due to constant pain.
How are you Diagnosed with Rheumatoid Arthritis?
• Seeing your GP- Your GP will carry out a physical examination, checking your joints for any swelling and to assess how easily they move. Your GP will also ask you about the symptoms which you are experiencing, to make the correct/accurate diagnosis. If your GP believes you have rheumatoid arthritis they will refer to you to a specialist (rheumatologist).
• Blood tests- Main tests include erythrocyte sedimentation rate, C-reactive protein and full blood count.
• If symptoms are present Rheumatoid Factor Test is conducted as a sample blood test that measures rheumatoid factor which is an antibody, if present will signify to your doctor whether you have RA.
• Antibody test- anti cyclic citrullinated peptide. People who test positive for this test are more likely to develop rheumatoid arthritis. Those who test positive for both rheumatoid factor and anti cyclic citrullinated peptide may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment.
• Joint imaging- There are a variety of different scans which help to identify joint inflammation and damage. These scans include
• X-rays- where radiation is passed through your body to examine your bones and joints.
• Ultrasound scans- where high frequency sound waves are used to create an image of joints.
• Magnetic resonance imaging (MRI) scans- where strong magnetic fields and radio waves are used to produce detailed images of your joints.
What are the Treatments Available for Rheumatoid Arthritis?
• Diseases modifying anti-rheumatic drugs- These are tablets and are particularly effective in easing the symptoms of RA condition and slowing down its progression. The way in which they work is by blocking the effects of chemicals released when the immune system attacks the joints, which could otherwise cause further damage to nearby bones, tendons, ligaments and cartilage. There are different types including methotrexate, leflunomide, hydroxychloroquine, sulfasalazine.
• Biological treatments- new form of RA treatment including etanercept, infliximab, adalimumab, certolizumab, golimumab, rituximab, abatacept, tocilizumab. These are given by injection and they function by preventing particular chemicals in the blood from activating your immune system to attack your joints. They are only used if disease modifying anti rheumatic drugs have not been effective or they can be taken in combination with methotrexate.
• Painkillers- such as paracetamols or a combination of paracetamols and codeine including co-codomal to help relieve the pain associated with rheumatoid arthritis.
• Non steroidal anti-inflammatory drugs- such as ibuprofen etc. These medications help to relieve pain whilst also reducing inflammation in the joints.
• Corticosteroids- These are powerful medications to help reduce pain, stiffness and inflammation for RA. They can be used as a tablet, an injection directly into the area of affected joint, an injection into the muscle to help a lot of your joints. They’re usually to provide short term pain relief.
• Physiotherapy- a physiotherapist may help you to improve your fitness and muscle strength, and make your joints more flexible. They can also help using heat or ice packs or transcutaneous electrical nerve stimulation which applies a small pulse of electricity to the affected joint, numbing the nerve endings and help ease the pain for rheumatoid arthritis.
• Occupational therapy- offers training and advice that will help you to protect your joints, both whilst at home and at work.
To find out more information about RA use these links