What is Rheumatoid Arthritis?
Rheumatoid Arthritis (RA) is a chronic inflammatory condition and autoimmune disorder that generally affects the lining of the joints in your hands and feet. Rheumatoid arthritis causes a painful swelling that can eventually lead to deformity and erosion of your joints and bones. It is often confused with osteoarthritis, which causes a wearing and tearing of your joints where the protective cartilage on the ends of your bones wears down over time. Like many other autoimmune disorders, such as lupus, RA occurs when your immune system attacks both unhealthy and healthy cells and tissues. This abnormal immune response can lead to damage of other organs and systems of your body including your skin, eyes, lungs and circulatory system. RA is a very common overlap disease that often accompanies systemic lupus erythematosus. Joint and bone pain along with swelling, typically found in patients with RA are some of the symptoms included in the 11 criteria used to make a lupus diagnosis. RA typically moves from your smaller, minor joints to larger, major joints. Early signs of RA can be found within your hands and feet but eventually RA can move into your ankles, elbows, knees, hips and shoulders. Unfortunately, like other chronic autoimmune conditions, symptoms may flare and then fade away or disappear altogether. The severity of RA fluctuates widely from person to person, and the inconsistency of symptoms may delay concern and/or a proper diagnosis.
What are the Symptoms of RA?
- Rheumatoid nodules (hard bumps of tissue under the skin along your arms)
- Pain, swelling, stiffness, redness, warmth, tenderness in your joints
- Stiffness, fatigue in your bones
- Fatigue, fever and weight loss
- Soft tissue such as the tendons, muscles, and/or ligaments around your joints may also be affected.
Other, perhaps less common, symptoms that might seem unrelated to RA but may pose a serious threat are:
- Shortness of breath
- Numbness or tingling in the hands or feet
- Inability to move your hands or feet
- Spots on or around the fingertips
- High fever or other signs of infections
- Redness or irritation of the eyes
- Suddenly bruising easily
- Digestion issues or upset stomach
If you are experiencing any of the above symptoms or anything else out of the norm for you, please seek medical attention immediately.
How do physicians diagnose RA?
Rheumatoid arthritis can be difficult to diagnose in its early stages as it can mimic many other conditions. Like with lupus, there is no single test that can determine a diagnosis of rheumatoid arthritis. Physicians will typically use several tests and criteria to diagnose RA. Some of them are:
- Physical Exam: Your doctor will check your reflexes and muscle strength and examine your joints for swelling, redness and warmth.
- Blood tests: Your physician will order tests to check for inflammatory activity in the body. People with RA tend to have an elevated erythrocyte sedimentation rate (ESR, or sed rate) which can be seen in a blood test. Other common blood tests taken will look for a rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
- X-rays: Your physician may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time.
In 1987, the American College of Rheumatology defined the following criteria for the diagnosis of rheumatoid arthritis. At least four of the below criteria need to be met for a diagnosis:
- Morning stiffness of more than an hour most mornings for a period of at least six weeks.
- Arthritis and soft-tissue swelling of more than 3 of 14 joints/joint groups, present for a period of at least six weeks.
- Arthritis of hand joints, which are present for a period of at least six weeks.
- Symmetric (occurring on both sides of the body evenly) arthritis, which is present for a period of at least six weeks.
- Subcutaneous nodules (lump under the skin) in specific places.
- Rheumatoid factor (an antibody that is detectable in the blood of 80% of adults with rheumatoid arthritis) at a level greater than the 95th percentile .
- Radiological changes (as seen in an xray) suggestive of joint erosion.
There may sometimes be a worse outcome if the doctor waits until all of the American College of Rheumatology criteria are met so please visit your doctor at least annually (or more!) if you have medical concerns or notice anything out of the ordinary for your body. It is important to report ALL of your symptoms to your physician, not just symptoms that you think might mean that you have rheumatoid arthritis. Keeping a journal may help you remember all of your symptoms and what may have triggered them.
What causes rheumatoid arthritis?
The cause of RA is currently unknown, but it is a very active area of worldwide research dedicated to RA.
Here are some guesses on what may cause RA:
- Environmental factors: Scientists have reported that smoking tobacco, exposure to the mineral silica (many common construction materials contain silica including, for example, asphalt, brick, cement, concrete, drywall, grout, mortar, stone, sand, and tile) typically in dust form due to grinding or cutting of the material,and chronic periodontal disease (inflammation affecting the bone and tissues of the teeth) can all increase the risk of developing rheumatoid arthritis.
- Infectious Agents: Although bacteria, viruses, and fungi have long been suspected, none has been proven as the cause.
- Heredity: It is believed that the tendency to develop RA may be inherited genetically. Certain genes have been identified that increase the risk for rheumatoid arthritis.
How is RA treated?
As of now, there is no known cure for rheumatoid arthritis. The main goal of treatment in rheumatoid arthritis is to maximize joint function, reduce inflammation and pain in the joints, and prevent further damage and deformity in the joints. Receiving early medical intervention has been shown to be key in improving outcomes and the quality of life for RA patients. You will likely be treated by a rheumatologist, as they specialize in treating people with arthritis and other rheumatic diseases. This is also the physician who typically treats lupus patients. Your physician will monitor your levels of disease activity, or inflammation, on a regular basis through exams and blood tests. This will help tell both you and your physician how well treatment is working. Your medications and therapies may be changed, your dosages may be adjusted, or new medications might be added, based on the findings of these tests. There are a number of medications available to help ease symptoms, reduce inflammation, and slow the progression of the disease. No single drug works for everyone but many people find treatments that are very effective.
The ideal treatment for RA will be comprehensive and involve a combination of:
- Joint and muscle strengthening exercises and therapy
- Joint protection
- Assistive devices (canes, railings, adapters for making utensils easier to hold, etc.)to make daily life easier when living with limited mobility and pain. Check out the Arthritis Foundations list of Ease of Use Products.
- Patient (and family) education.
- Alternative or complimentary treatments can also help relieve the pain and discomfort from RA and other autoimmune diseases. These can include acupuncture, yoga, Tai chi, or nutritional supplements.
- Surgery- Surgical repair may be considered if medications and other treatments fail to prevent or slow damage to the joints. This option can reduce pain, correct deformities and help restore the ability to move the affected joint(s). Because surgery carries inherent risks, please discuss any benefits and risks with your doctor.
No matter what treatment plan you and your physician decide upon, it is very important to have clear and open communication and cooperation between you and your physician to receive your best possible outcome.
Pain and disability can be managed with medications and the other treatments we mentioned, often very successfully. It is also important to remember that caring for your mental well-being and outlook can make an enormous difference in the success of treatment and your daily life. The Gratitude Attitude is a mindset of positivity and reality-based optimism that can help anyone suffering with a chronic disease such as RA, fibromyalgia, lupus, or scleroderma just to name a few. If you feel like you are struggling with the emotional impact of living with your disease, joining support groups or seeking professional help might help provide you with the tools you need to navigate through the difficult task of accepting a diagnosis of a chronic illness.