At a Glance:
- Rheumatoid arthritis (RA) is a chronic autoimmune condition that causes inflammation and pain in the joints as well as potentially affecting other parts of the body
- RA causes the body’s own immune system to attack the lining of joints, the synovial membrane (synovium). As a result, the synovium becomes inflamed, causing pain and limiting the movement of the joint
- People living with RA experience flares during which the symptoms are more severe, as well as remissions during which the symptoms are lessened
- Rheumatoid arthritis typically presents bilaterally. This means that it will usually appear in the same joint on both sides of the body
- Rheumatoid arthritis is a progressive disease, meaning it gets worse over time
- Typical symptoms of RA include stiffness, pain, tenderness and inflammation in the joints. As the disease advances the joints may become deformed
- Other symptoms may affect the blood, eyes, heart, kidneys, liver, lungs, mouth and skin
- No exact cause of RA has been identified, but sex, age, family history and smoking may all increase your risk of developing the condition
- Damage to joints caused by rheumatoid arthritis is not reversible but through a mixture of therapies, including physical therapy, occupational therapy, medication and surgery the symptoms of RA may be managed
What is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune condition that causes inflammation and pain in the joints as well as potentially affecting other parts of the body, including the eyes, lungs, heart, blood vessels and skin.
Unlike osteoarthritis, rheumatoid arthritis is not caused by wear and tear on the cartilage between joints, but rather the body’s own immune system attacking the lining of joints, the synovial membrane (synovium). As a result, the synovium becomes inflamed, causing pain and limiting the movement of the joint.
In a healthy person, the synovium produces a lubricating fluid (synovial fluid) that helps the joints move smoothly. In someone with rheumatoid arthritis, the body’s own immune system attacks the cells of the synovium as if they were a foreign invader, such as a virus or bacteria.
When the synovium is attacked it becomes inflamed and the synovial fluid builds up, leading to joint inflammation and pain. This excess fluid also contains chemicals that may cause the breakdown of the bones, cartilage and ligaments that form the joint. The cartilage that cushions the joint eventually becomes brittle and breaks down, making the joint more difficult to move. Eventually this may lead to bone erosion and joint deformation. The muscles, tendons and ligaments around an affected joint may also be affected, leading to joint instability.
Unlike many other forms of arthritis which may only affect a single joint or group of joints, rheumatoid arthritis typically presents bilaterally. This means that it will usually appear in the same joint on both sides of the body - if you have RA in one elbow or knee, you will most likely have it in the other elbow or knee as well. The bilateral nature of the condition is one of the key ways in which rheumatoid arthritis is distinguished from other forms of arthritis.
Rheumatoid arthritis is a progressive autoimmune disease, meaning it gets worse over time. In many cases, RA starts in the joints connecting the fingers to the hands or the toes to the feet and may spread from there to the wrists, ankles, knees, hips, elbows or shoulders. The inflammation caused by the autoimmune response may also lead to a number of non-joint related symptoms around the body.
RA is most common in people over the age of 75 and currently affects around 456,000 Australians, or around 1.9% of the population. The rates for rheumatoid arthritis are slightly higher for women than they are for men, with around 2.3% of Australian women being affected as opposed to 1.5% of men.
Symptoms of Rheumatoid Arthritis
Typical symptoms of RA are similar to those seen in other forms of arthritis, notably pain, inflammation and stiffness in affected joints. The bilateral nature of rheumatoid arthritis is one of the most common ways in which it is differentially diagnosed from other forms of arthritis.
Another key differentiator is that people living with RA typically experience both flare ups (exacerbations) and periods of remission. During a flare, the inflammation, pain and tenderness in joints becomes worse. The trigger for these flares may differ from person to person but may include food allergies, stress, lack of sleep, illness, reaction to medication and the like.
Unlike most other forms of arthritis, another common symptom is fatigue and potential loss of appetite due to the immune response. A low level fever may also be present in people with RA.
In addition to inflammation and pain in the joint, around 40% of people with rheumatoid arthritis also display symptoms in other parts of the body, including:
- Blood - people with RA may display a lower than average red cell count
- Blood Vessels - the autoimmune response may cause inflammation of blood vessels leading to damage to the skin, organs and nerves the vessels supply
- Eyes - RA symptoms in the eye include dryness, light sensitivity, inflammation, redness and vision problems
- Heart - the heart or surrounding tissues may become inflamed. People living with RA have an increased risk of cardiovascular conditions such as stroke and heart attack (myocardial infarction)
- Kidneys - people with chronic infections or inflammatory conditions such as RA may produce an abnormal protein called an amyloid. These proteins build up in the kidneys, liver, heart and other organs leading to a condition called amyloidosis and a number of symptoms including rapid weight loss, swollen lower extremities and tongue, severe fatigue and muscle weakness, extreme shortness of breath, an irregular heartbeat and more
- Liver - the liver is quite susceptible to inflammation and damage due to RA, either as a result of the autoimmune condition itself or due to a hepatotoxic reaction to medication for the treatment of rheumatoid arthritis
- Lungs - RA may lead to inflammation and scarring of the lung tissue. This may lead to shortness of breath
- Mouth - RA may cause issues with salivary glands and the production of saliva. In addition it may cause gum irritation and inflammation leading to a higher risk of infection
- Skin - people living with RA may develop Rheumatoid Nodules. These are small lumps that form near the bone and under the skin of affected joints or bony areas
In addition to its many symptoms, rheumatoid arthritis may also lead to a number of complications, including:
- Carpal Tunnel Syndrome - inflammation from rheumatoid arthritis in the wrists may compress the nerves servicing the hands and fingers leading to carpal tunnel syndrome
- Depression - as with many other conditions that lead to chronic pain, RA increases the chance of a person living with the disease to experience depression
- Diabetes - the pain, stiffness and reduced mobility caused by RA increases the risk of people with the disease becoming overweight or obese due to lack of exercise. This in turn increases the risk of developing Type 2 diabetes
- Infections - due to a number of treatments for rheumatoid arthritis, and autoimmune conditions in general, suppressing the immune system, people living with RA are at a higher risk for infection
- Lymphoma - people with rheumatoid arthritis have a higher risk of developing lymphoma, a group of blood cancers that affect the lymphatic system
- Osteoporosis - both RA and the medications used to manage symptoms may increase the risk of developing osteoporosis, a condition that causes the bones to lose calcium and become brittle and easily broken as a result.
The earlier rheumatoid arthritis is detected the more effectively it may be managed. If you’re experiencing stiffness, tenderness and pain in your fingers or toes, or you have a family history of RA, schedule an appointment to see your doctor for a test. It may be nothing but it’s always better to be safe than sorry.
What Causes Rheumatoid Arthritis?
The exact reason for the immune system attacking the synovium is unknown. It appears as though there is a strong genetic component to the development of RA but not in a direct way. There is no identifiable gene for rheumatoid arthritis but it appears as though certain inherited or genetic characteristics may make a person more susceptible to the condition being triggered by a viral or bacterial infection or environmental factors.
While an exact cause may not be known, a number of risk factors that increase the chance of developing rheumatoid arthritis have been identified, including:
- Age - RA becomes more common with age. The condition typically begins around middle age and is most common in people over 75
- Environment - the exact environmental triggers that may increase the risk of developing rheumatoid arthritis are not understood at the moment but it appears that some particulates, such as asbestos and silica may increase the chance of developing the condition.
Emergency workers exposed to dust from the collapse of the World Trade Centre have exhibited increased rates of autoimmune conditions including rheumatoid arthritis.
- Family History - having a family history of rheumatoid arthritis increases the chance of a person developing RA
- Obesity - it appears as though people over 55 (especially women) who are obese have an increased risk of developing RA
- Sex - women are slightly more likely to develop rheumatoid arthritis than men
- Smoking - smoking appears to increase the risk of developing rheumatoid arthritis and has also been linked to the severity of the disease, with smokers experiencing worse symptoms than non-smokers
Treatment for Rheumatoid Arthritis
Treatment for RA typically involves one or more of the following - physical therapies, medication and surgery.
Physiotherapy
Exercise to increase mobility and to strengthen the muscles around affected joints is a proven method of managing some symptoms of rheumatoid arthritis. A regular exercise plan put together by a physiotherapist or exercise physiologist also reduces the risk of developing other health complaints that may result from inactivity, such as obesity and Type 2 diabetes.
The exact form of exercise may vary from person to person depending on the severity and location of the rheumatoid arthritis.
Occupational Therapy
An occupational therapist may work with a person living with rheumatoid arthritis to help discover ways of performing tasks in a manner that puts less stress on affected joints. An OT may also recommend specialised tools made to be easily used by people with limited movement, such as cutlery with large ergonomic handles that are easy to grip with little strength, button hooks and other dressing aids, benches in showers and the like.
Medication
A combination of medications may be recommended to both help manage pain and inflammation as well as modify the immune system to reduce the instances of flares.
- NSAIDs (Non Steroidal Anti-Inflammatory Drugs) - over the counter drugs such as ibuprofen and naproxen are commonly used to help manage inflammation and pain due to RA. Stronger prescription NSAIDs may also be recommended
- Steroids - cortisone injections into affected joints may help relieve pain and inflammation. The number of injections per year should be limited to two as repeated injection may actually accelerate the degeneration of the joint, and can weaken and rupture the soft tissues around the joint including ligaments and tendons
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs) - these medications may help slow the progress of rheumatoid arthritis by suppressing the immune response. Common DMARDs include methotrexate and hydroxychloroquine
- Biologics - a relatively new form of DMARDs, more specifically targeting parts of the immune system related to inflammation. In the treatment of rheumatoid arthritis, biologics are typically used in conjunction with a non-biologic DMARD to maximise their effectiveness
Surgery
Depending on the progress of the joint damage, surgery may become a treatment option.
- Arthrodesis - the fusing of bones into position. While the fused joint loses all mobility, the procedure also significantly reduces if not eliminates related pain. The procedure is most commonly performed in the fingers and thumb, wrists and ankles. This can then lead to increased loading on adjacent joints, so is often a last resort option
- Arthroplasty - the replacement of joints. During this procedure the joint is removed and replaced with one made of plastic, ceramic, metal or a combination thereof. Knees and hips are the most common joint replacement surgeries, though most joints can be replaced should the need arise
- Synovectomy - the removal of inflamed synovial tissue. This surgery is most commonly performed in the fingers, wrists, elbows, hips and knees
If you’ve been diagnosed with rheumatoid arthritis, book a consultation with a physiotherapist to help strengthen your joints, increase mobility and increase your quality of life. The fastest and easiest way to search for and book medical appointments online is through MyHealth1st.