Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation of the joints, resulting in joint pain, stiffness, and swelling. RA can also affect other parts of the body, such as the skin, eyes, lungs, and blood vessels. In this article, we will discuss the symptoms and causes of RA, as well as its diagnosis and treatment.
Symptoms and Causes
RA symptoms usually develop gradually over time. The symptoms may vary from person to person, but some common symptoms of RA include:
Joint pain and stiffness
Swelling in the joints
Fatigue
Morning stiffness that lasts for hours
Loss of appetite
Fever
Weight loss
Weakness
The exact cause of RA is unknown. However, it is believed that a combination of genetic and environmental factors may be involved. Some of the factors that may increase the risk of developing RA include:
Gender: Women are more likely to develop RA than men.
Age: RA can occur at any age, but it usually develops between the ages of 40 and 60.
Family history: Having a family history of RA increases the risk of developing the condition.
Smoking: Smoking is a significant risk factor for RA.
Obesity: Being overweight or obese increases the risk of developing RA.
Diagnosis
Diagnosing RA can be challenging as the symptoms may mimic other conditions. There is no single test that can diagnose RA. A doctor will perform a physical exam, review the patient's medical history, and order several tests, including:
Rheumatoid factor (RF) blood test: This test measures the level of RF in the blood. RF is a type of antibody that is present in the blood of many people with RA.
Anti-cyclic citrullinated peptide (anti-CCP) antibody test: This test measures the level of anti-CCP in the blood. Anti-CCP is a specific antibody that is present in the blood of many people with RA.
X-rays: X-rays can help identify joint damage and other changes associated with RA.
Treatment
There is currently no cure for RA, but there are several treatment options that can help manage the symptoms and slow down the progression of the disease. The treatment options for RA include:
Medications: Several medications can help relieve pain and inflammation associated with RA. Some common medications used to treat RA include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologic response modifiers.
Physical therapy: Physical therapy can help improve joint flexibility and range of motion, reduce pain and stiffness, and strengthen the muscles around the affected joints.
Surgery: In severe cases of RA, surgery may be necessary to repair or replace damaged joints.
Lifestyle changes: Making lifestyle changes such as maintaining a healthy weight, exercising regularly, and quitting smoking can help manage the symptoms of RA.
In conclusion, RA is a chronic autoimmune disorder that affects the joints and other parts of the body. The symptoms of RA include joint pain, stiffness, and swelling. The exact cause of RA is unknown, but a combination of genetic and environmental factors may be involved. Diagnosing RA can be challenging, but several tests can help identify the condition. Although there is no cure for RA, several treatment options can help manage the symptoms and slow down the progression of the disease.
Here is a list of medications used to treat rheumatoid arthritis along with their side effects and comments.
Nonsteroidal anti-inflammatory drugs (NSAIDs):
Diclofenac
Ibuprofen
Naproxen
Side Effects: Upset stomach, stomach ulcers and bleeding, increased blood pressure, kidney problems, possible increased risk of heart attack and stroke, possible increased risk of bruising and bleeding.
Comments: NSAIDs treat symptoms and decrease inflammation but do not prevent disease progression.
Cyclooxygenase-2 (COX-2) inhibitors (coxibs):
Celecoxib
Side Effects: Kidney problems, increased blood pressure, slightly less risk of stomach ulcers and bleeding compared to other NSAIDs, possible increased risk of heart attack and stroke.
Disease-modifying antirheumatic drugs (DMARDs):
Hydroxychloroquine
Side Effects: Usually mild dermatitis (rash) and skin discoloration, muscle aches or weakness, rarely cardiomyopathy, eye problems.
Comments: All DMARDs can slow joint damage and decrease pain and swelling. They are taken orally.
Leflunomide
Side Effects: Rashes, liver disease, damage to nerves (neuropathy), diarrhea, hair loss, birth defects.
Comments: About as effective as methotrexate. Taken orally.
Methotrexate
Side Effects: Liver disease, lung inflammation, nausea, neutropenia, mouth sores, decreased sperm numbers and fertility in men, hair loss, birth defects.
Comments: Taken orally or by subcutaneous injection.
Sulfasalazine
Side Effects: Stomach problems, neutropenia (usually only at treatment start), breakdown of red blood cells (hemolysis), liver problems, rashes.
Comments: Taken orally.
Corticosteroids:
Prednisone
Prednisolone
Side Effects: Numerous side effects throughout the body with long-term use, including weight gain, diabetes, high blood pressure, thinning of bones (osteoporosis), avascular necrosis (death of bone), cataracts, candidiasis (fungal infection).
Comments: Can reduce inflammation quickly but may not be useful long term due to side effects. Taken orally or by injection.
Biologic agents (TNF inhibitors):
Adalimumab
Certolizumab pegol
Etanercept
Golimumab
Infliximab
Side Effects: Potential risk of infection reactivation, skin cancers, reactivation of hepatitis B, occasionally systemic lupus erythematosus, demyelinating neurologic disorders.
Comments: Produce a prompt response, slow joint damage. Administered subcutaneously or intravenously.
Biologic agents (other):
Abatacept
Side Effects: Lung problems, increased susceptibility to infection, headache, upper respiratory infection, sore throat, nausea.
Comments: Given intravenously or subcutaneously.
Anakinra
Side Effects: Pain, redness, itching at injection site, increased infection risk, neutropenia.
Comments: Given subcutaneously.
Rituximab
Side Effects: Itching, rashes, back pain, high/low blood pressure, fever, increased risk of infections and possibly cancer after treatment.
Comments: Used when TNF inhibitors and methotrexate are ineffective. Given intravenously.
Sarilumab
Side Effects: Neutropenia, platelet suppression, increased liver enzymes.
Comments: Given subcutaneously.
Tocilizumab
Side Effects: Serious infections, neutropenia, platelet suppression, anaphylaxis, increased liver enzymes, rare intestinal perforation.
Comments: Used when other drugs are ineffective. Administered intravenously or subcutaneously.
Janus kinase (JAK) inhibitors:
Tofacitinib
Side Effects: Risk of infection, skin cancer, high cholesterol, cardiovascular events, lung cancer.
Comments: Used when methotrexate is inadequate. Taken orally.
Baricitinib
Side Effects: Risk of infection, skin cancer, high cholesterol, deep vein thrombosis, cardiovascular events, lung cancer.
Comments: Taken orally.
Upadacitinib
Side Effects: Risk of infection, skin cancer, high cholesterol, venous thromboembolism, cardiovascular events, lung cancer.
Comments: Used when methotrexate is inadequate. Taken orally.
Note: Suppression of blood cell production in the bone marrow can lead to decreased numbers of infection-fighting white blood cells called neutrophils, increasing susceptibility to infection.
(Source: MSD Manuals)
Commonly Asked Questions:
What is the main cause of rheumatoid arthritis?
What are the 3 stages of rheumatoid arthritis?
What are usually the first signs of rheumatoid arthritis?
Can rheumatoid arthritis be cured?
The exact cause of rheumatoid arthritis (RA) is not fully understood. However, it is believed that a combination of genetic and environmental factors may contribute to the development of the disease. Some environmental factors that have been associated with an increased risk of developing RA include smoking, obesity, and exposure to certain infections.
RA typically progresses through three stages:
The first stage is characterized by swelling and inflammation of the synovial membrane, which lines the joints. This can cause pain, stiffness, and swelling in the affected joint.
In the second stage, the inflammation can cause damage to the cartilage and bone in the affected joint, leading to deformity and reduced mobility.
In the third stage, the inflammation can spread to other parts of the body, causing additional symptoms such as fatigue, fever, and weight loss.
The first signs of RA can vary from person to person, but some common early symptoms include:
Joint pain and stiffness, particularly in the morning
Swelling and tenderness in the joints
Fatigue
Loss of appetite
Low-grade fever
Weight loss
Although there is currently no cure for RA, there are several treatment options that can help manage the symptoms and slow down the progression of the disease. Early diagnosis and treatment are essential for managing the symptoms and preventing further joint damage. Treatment options for RA include medications, physical therapy, and surgery in severe cases. Making lifestyle changes, such as maintaining a healthy weight and exercising regularly, can also help manage the symptoms of RA.
Sources:
"Rheumatoid Arthritis." Mayo Clinic, Mayo Foundation for Medical Education and Research, 23 Mar. 2021, https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
"Rheumatoid Arthritis (RA)." Centers for Disease Control and Prevention, 15 Oct. 2020, https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
"Rheumatoid Arthritis." Arthritis Foundation, https://www.arthritis.org/diseases/rheumatoid-arthritis
"Rheumatoid Arthritis." National Institute of Arthritis and Musculoskeletal and Skin Diseases, U.S. Department of Health and Human Services, https://www.niams.nih.gov/health-topics/rheumatoid-arthritis
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