Rheumatoid Arthritis: An Overview

Rheumatoid Arthritis (RA) is a type of autoimmune disorder of joints classified by inflammation, pain, and swelling in the joints. It may lead to temporary or sometimes permanent damage and deforming of joints if left untreated. It is different from more common osteoarthritis because, in Rheumatoid arthritis, the body’s immune system starts attacking its own cells and tissues (Autoimmunity), in this case, the synovium (lining of the joints).

1.0Signs and Symptoms of Rheumatoid Arthritis

Rheumatoid Arthritis symptoms may vary from person to person according to the severity of the condition. Some of the common signs of Rheumatoid Arthritis are: 

• Joint Pain: Pain, tenderness, and swelling in several joints, including hands, wrists, knees, and feet.
• Morning stiffness: It is a condition of stiffness of the joints, persisting for more than 30 minutes after getting up in the morning.
• Fatigue: Persistent tiredness and lack of energy, often accompanied by fever.
• Joint Deformities: Untreated RA causes gradual damage to the joints and leads to deformities as a result of continuous inflammation.
• Loss of Joint Function: Reduced mobility and inability to accomplish activities of daily living because of swelling and pain.

2.0Rheumatoid Arthritis Causes

The main reason for Rheumatoid Arthritis is immune system malfunction. Although the main behind autoimmunity is still under the covers, several factors lead to this condition:

1. Genetic Predisposition: Certain genes, specifically those related to the immune system, are the main reasons for predisposition to RA. For example, human leukocyte antigen (HLA) genes help the immune system efficiently recognise and attack harmful alien components like bacteria and viruses. Genetic variation in some people can lead to malfunction of these genes, leading to autoimmunity. 
2. Environmental Triggers: Environmental factors can trigger and even worsen the autoimmunity in genetically predisposed individuals. Environmental triggers include infections, smoking, exposure to chemicals, etc. 
3. Immune system Dysfunction: Immune system is the key reason for RA. In normal conditions, the immune system produces antibodies to defend against infections and foreign invaders, but in autoimmune conditions, the immune response mistakenly targets the body’s own tissues. This can happen by some bacteria or viruses that may alter our immune system’s functions through molecular mimicry. In this, the bacteria or virus mimics the cell pattern and activities of the host cells, and the immune system fails to recognise the foreign element and mistakenly attacks the body’s own cells. 

Primarily, two types of immune responses contribute to joint damage: 

• Autoantibodies: These are antibodies (compounds that fight foreign elements) that react with self-tissues. Rheumatoid arthritis with Rheumatoid factor is the most common immune response that leads to RA. The other important autoantibody is anti-cyclic citrullinated peptide (anti-CCP) against citrullinated proteins.
• T-cell activation: T-cells are another type of immune cell used in RA. Through activation, they can attack the synovium and chronic inflammation. Immune cell activation is due to a combination of genetic and environmental factors.

3.0Rheumatoid Arthritis Diagnosis and Treatment:

Rheumatoid Arthritis Diagnosis

Diagnosis typically includes the combination of medical history, blood test, imaging, and physical test: 

1. Blood Tests:

• Rheumatoid Factor (RF): A high level of RF may indicate RA, but it is not specific to the disease.
• Anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies: This antibody is more specific to RA and can be a better marker for the disease.
• C-Reactive Protein (CRP) & Erythrocyte Sedimentation Rate (ESR): These are indicators of inflammation, which are high in RA.

2. Imaging Tests:

• X-rays: These indicate joint damage, erosion, or swelling, which are characteristics of RA.
• MRI & Ultrasound: These imaging techniques can provide more information related to joint inflammation and damage.

3. Physical Examination:

A doctor will also check for signs of rheumatic arthritis, such as joint inflammation, swelling, deformities, and limited movement, as part of the physical exam.

Rheumatoid Arthritis Treatment: 

Although there are no direct methods for treating RA, various methods, such as medications, surgery, etc., are used to reduce and manage symptoms: 

1. Medication: 

Several drugs, such as Nonsteroidal anti-inflammatory drugs (NSAIDs), Disease-modifying antirheumatic drugs (DMARDs), Corticosteroids, Biologic agents (target specific inhibitors), etc., are used for managing pain and inflammation and also to reduce the progression rate of RA to prevent further joint damage.

2. Rheumatoid Arthritis Self Care: 

Self-care is important for managing rheumatoid arthritis effectively. Some key self-care strategies include: 

• Regular exercise: It includes low-impact activities such as swimming, walking, and yoga that can improve joint function and reduce stiffness.
• Heat and cold therapy: Applying heat can help relax stiff joints, while cold packs can reduce swelling and numb pain.
• Healthy diet: It includes a diet rich in omega-3 fatty acids, fruits, and vegetables that help reduce inflammation.
• Stress management: Techniques including deep breathing, meditation, & relaxation exercises might help reduce the impact of stress on the body.
• Assistive devices: Special tools or devices, like splints or braces, can help support joints and make daily tasks easier.

3. Surgery: 

Surgical procedures are followed only in some severe cases when the pain becomes unbearable for individuals. These surgeries are joint replacement or synovectomy (removing the inflamed joint lining). 

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