The Classic Features Of Rheumatoid Arthritis Take Time To Develop
The most important question, in our patient, is whether she has a potentially damaging disease such as RA. The answer is not always obvious since RA in its early stages tends not to fit the textbook description. For example, seropositivity for rheumatoid factor, radiographic erosions and subcutaneous nodules are all absent. As mentioned above, at the time of presentation many patients with RA have normal inflammatory markers moreover, about 60% are seronegative for rheumatoid factor and more than 70% have normal plain radiographs. Thus negative results with these do not exclude the diagnosis. In our patient, reasons for strongly suspecting RA are the longstanding inflammatory symptoms and the symmetrical involvement of MCP, PIP and MTP jointsjoints that are commonly affected in RA.
What Are The Signs And Symptoms Of Ra
With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.
Signs and symptoms of RA include:
- Pain or aching in more than one joint
- Stiffness in more than one joint
- Tenderness and swelling in more than one joint
- The same symptoms on both sides of the body
- Weight loss
Rheumatoid Arthritis: Causes Symptoms Treatments And More
Rheumatoid arthritis is an inflammatory type of arthritis that can causes joint pain, swelling and damage. Learn what causes RA and how to treat it.
Rheumatoid arthritis causes joint inflammation and pain. It happens when the immune system doesnt work properly and attacks the lining of the joints . The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body. But sometimes, RA causes problems in other parts of the body as well, such as the eyes, heart and circulatory system and/or lungs. For unknown reasons, more women than men get RA, and it usually develops in middle age. Having a family member with RA increases the odds of developing RA.
Causes
In a healthy person, the immune system fights invaders, such as bacteria and viruses. With an autoimmune disease like RA, the immune system mistakes the bodys cells for foreign invaders and releases inflammatory chemicals that attack, in the case of RA, the synovium. Thats the tissue lining around a joint that produces a fluid to help the joint move smoothly. The inflamed synovium gets thicker and makes the joint area feel painful and tender, look red and swollen and moving the joint may be difficult.
Researchers arent sure why some people develop RA. They think that these individuals have certain genes that are activated by a trigger in the environment, like a virus or bacteria, or physical or emotional stress or some other external factor.
Symptoms
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Living With Juvenile Rheumatoid Arthritis
Whether your childs symptoms come and go or are long-lasting some things can help. This includes:
- Take a hot shower. Use a hot or cold pack or sleep in a warm bed to relieve stiffness.
- Stretching and do range-of-motion exercises. This reduces joint stiffness and improves flexibility. Exercise at the same time every day. Make it easy. Do it while watching TV or with family members.
- Take medicine at the right time and consistently. Have your child take his or her medicine at the same time as another activity. This makes it easy to remember.
Being active is important in managing the disease. Children who have the disease may need emotional support. This is important in managing the anger and sadness of having the disease.
What Does Arthritis Feel Like
Arthritis feels like pain in the joints, but theres a lot more to it than just that. In addition to the early signs of arthritis described above, individuals who are in the early stages of developing arthritis may experience general weakness,7 difficulty sleeping,10 loss of appetite,6 and weight loss. It is also common to have dry mouth, dry eyes, eye discharge, or chest pain early-on.
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How Is Juvenile Rheumatoid Arthritis Diagnosed
Your childs doctor will ask about your childs symptoms and do a physical exam. It can be hard to diagnose. You doctor may do an X-ray or blood test to rule out other illnesses. X-rays also can show more severe damage or deformities. Your childs doctor may want to take a sample of fluid from an actively inflamed joint or spinal fluid. It may take a few months before your doctor makes a diagnosis. This is so he or she can watch your childs symptoms over time.
What Are The Less Common Forms Of Rheumatoid Arthritis
Rheumatoid arthritis can begin in less common forms. For example, it can begin with the involvement of only a single joint or a few joints. Sometimes, this can later evolve to the more common presentation of many joints on both sides of the body.
Rarely, the earliest symptom of rheumatoid disease is inflammation of a body area that does not even involve a joint. For example, the lining of the lungs can become inflamed to cause pleurisy many months before arthritis develops.
Occasionally, only a few joints are involved and the doctor may suspect another type of inflammatory arthritis. Again, this can sometimes only later evolve to become the more typical symmetrical polyarthritis by including many joints on both sides of the body.
The caveat is that by recognizing the early symptoms of rheumatoid arthritis rheumatologists and their patients can address the disease early, thereby affording optimal outcomes for those affected.
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Initial Diagnosis And Treatment
If a primary care physician doesnt refer a patient like Jasmine to a rheumatologist the type of physician who treats systemic autoimmune conditions such as rheumatoid arthritis the diagnosis can be missed. But in this way at least, Jasmine was lucky. She was referred to a rheumatologist.
There are blood tests that can help to confirm a diagnosis of rheumatoid arthritis in most patients. Because some patients may not have a positive test, it is still very important for people to be evaluated by a rheumatologist with a detailed medical history and physical exam, says Peck.
Typically, people are in their 60s when they develop symptoms of rheumatoid arthritis. But women tend to develop the disease at a younger age than men. They are also three times more likely than men to develop the disease.
Once diagnosed, treatment for rheumatoid arthritis is two-pronged: controlling the occasional flare-ups or periods of increased disease activity characteristic of rheumatoid arthritis and managing the long-term course of the disease. Rheumatoid arthritis is a systemic disease, meaning it can affect not only the joints but the entire body over time.
It is common to start steroid medications such as prednisone to immediately control symptoms, but its not a good long-term medicine, so we use it cautiously, says Peck.
Most patients arrive at a rheumatologists door during a flare-up, when joints are actively painful, stiff and swollen. This was the case with Jasmine.
Age Of Onset For Women With Rheumatoid Arthritis
RA is often thought to be a condition related to old age, but this is not the case.
According to the Arthritis Foundation, the average onset of RA is between the ages of 30 and 60 years old, and children can also get it.
Women tend to be diagnosed slightly earlier than men, potentially due to hormonal changes in the mid-30s and then again after the mid-40s.
RA is a chronic condition that can progress over time with periods of increased disease activity, called flares, and periods of remission.
Symptoms of RA vary from person to person depending on the severity of their condition.
An older study on a small group of middle-aged women with RA found that they reported fewer joint symptoms during post-ovulation in their menstrual cycles and also during pregnancy. This is when levels of estrogen and progesterone are higher.
Medical experts tend to agree that the effect of sex hormones combined with environmental and genetic factors could explain the higher prevalence of women diagnosed with RA.
Research continues to seek more answers.
As mentioned, RA isnt only a disease for older people.
According to the , the diagnoses in the United States of all types of arthritis from 2013 to 2015 are as follows:
| Age range |
|---|
- unintentional weight loss
These signs can precede the painful joint symptoms commonly associated with RA.
Recurrent bouts of fatigue along with a general sense of not feeling well may occur weeks or months before other symptoms.
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Why Age Of Ra Onset Matters
The age of onset of rheumatoid arthritis matters for several reasons. Depending on the age of onset, the severity, progression, and treatment options for RA may look different.
Studies have shown late-onset rheumatoid arthritis , also referred to as elderly-onset RA, is associated with greater disease activity, reduced function at baseline, and more radiological damage. On the other hand, young-onset RA results in a long road with the disease and presents in a different way physically and in blood testing.
Overall, it’s important to get diagnosed and treated early if possible, given the progressive, systemic nature of RA.
Key Points About Rheumatoid Arthritis
- RA is a long-term that causes joint inflammation.
- RA can also affect many nonjoint areas such as the lungs, heart, skin, nerves, muscles, blood vessels, and kidneys.
- RA may cause deformities in the joints of the finger, making movement difficult.
- The joints most often affected by RA are in the hands, wrists, feet, ankles, knees, shoulders, and elbows.
- Symptoms may include joint pain, stiffness, and swelling decreased and painful movement bumps over small joints and fatigue or fever.
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Chronic Swelling And Inflammation In Synovial Lining In Joints
No one knows exactly why RA targets the small joints of the feet and hands first, but experts do know that the synovial lining is involved.
The synovial lining is the thin layer of cells between all joints. A joint is where two bones meet, and the synovial lining is the thin layer of cells between them. Joints are covered in cartilage to cushions them, and the synovial lining between joints nourishes both the cartilage and bones.
Experts believe that RA develops when the white blood cells that normally protect the body turn on the joints instead, causing inflammation. This may occur because a person is predisposed, due to genes or environmental factors.
This inflammation is why people with RA experience pain, heat, and swelling early in the disease process .
How To Treat Ra
Like every chronic disorder known to humankind, managing rheumatoid arthritis effectively begins with early and appropriate treatment. We cant underscore this enough. According to the ACR, people who receive early treatment intervention have a better chance of improving their lives sooner, are more likely to lead an active life, and are less likely to need joint replacement therapy caused by excessive joint damage.11
Above all else, it is important to seek out a rheumatologist a doctor who specializes in arthritis and autoimmune diseases who can help develop a treatment plan for your individual needs and therapy goals.
There are a number of treatments that your doctor may recommend based on the severity of your symptoms and how long youve had RA. No matter the approach, the goals should be to stop the inflammation causing the disease, relieve your symptoms, prevent further joint and organ damage, and improve your overall health, per the Arthritis Foundation.
To accomplish these goals, your doctor may start with a standard treatment approach which involves using aggressive therapies to rapidly reduce inflammation and get the disease under control .12-14
But dont get scared off by the word aggressive these therapies generally include a range of medications, such as:
- corticosteroids
- a class of drugs called disease-modifying anti-rheumatic drugs
- biologic DMARD agents and
- a relatively new class of drugs called Janus kinases inhibitors .
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Demographic Data At Baseline And After 5 Years
Descriptive data for all patients, which were divided into the two groups, that is, YORA and LORA are presented in Table . The total study group of 950 patients at baseline comprised 357 women and 118 men in the YORA patient group and 292 women and 183 men in the LORA group. Among the patients who reached the 5-year follow-up point , there were 262 women and 89 men in the YORA group and 197 women and 117 men in the LORA group. The mean duration from the first sign of symptoms of rheumatoid disease until inclusion into the Swedish Early RA Registry was 6.9 months for YORA patients and 6.5 months for LORA patients with no sex differences, that is, 6.5 months for men and 6.8 months for women .
Table 1 Descriptive data for 950 patients with early rheumatoid arthritis at time of inclusion and at 5-year follow-upa
In these multiple models, male sex was significantly related to a greater radiological progression at 24 months .
How To Know If Your Ra Is Progressing
You will know your joints will tell you, Dr. Bhatt says. The pain will get worse and you could have more swelling. Dr. Lally says that although periods of pain may resolve on their own in early RA, these episodes tend to become more frequent and longer in duration until the classic features of RA persist. In addition, Dr. Bhatt says to pay attention to non-joint symptoms like increased shortness of breath or red, painful eyes, which could be signs the RA is affecting other systems in the body. Let your doctor know if your RA symptoms are changing at all.
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Can Ra Be Fatal
RA alone is not fatal. Fatality occurs due to complications associated with the inflammation caused by RA. In severe cases, patients can develop other medical conditions. The other medical conditions that patients need to be aware when it comes to shortened RA life expectancy include:
- Heart disease
- Respiratory conditions like Chronic Pulmonary Obstruction Disorder
- Infection
Off course, these are conditions that everyone should be concerned about. Keeping your body healthy through diet, exercise, and positive habits will go a long way to reducing the risk of fatality from any of these conditions.
Stage : Symptoms Are Visible
In this latter, more severe stage, blood tests and imaging are less relevant for diagnosis because you can actually see the effects of the disease. The joints start becoming bent and deformed, the fingers become crooked, Dr. Bhatt says. These misshapen joints can press on the nerves and can cause nerve pain as well, he says. In the older days we used to see more deformed joints when we did not have much treatment, but now we are seeing less and less, Dr. Bhatt says.
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What Are The Symptoms Of Arthritis In Seniors
Senior Arthritis: Symptoms & Care. In fact, there are many kinds of arthritis, each with different symptoms and treatments. Most types of arthritis are chronic with symptoms lasting years. Arthritis can attack joints in almost any part of the body. Some forms of arthritis cause changes you can see and feel such as pain, swelling,
Joint Swelling And Pain
When the disease is active, affected joints become red, swollen, painful, and feel warm to the touch.
In the early stages of RA, smaller joints in the hands, wrists, and feet tend to be affected first. Over time, larger joints in the knees, shoulders, hips, and elbows may become affected.
What differentiates RA from other types of arthritis is that RA symptoms attack symmetrically. This means that if your left wrist is inflamed, your right wrist likely will be inflamed as well.
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When Does Rheumatoid Arthritis Develop In Middle Age
Rheumatoid arthritis, an autoimmune inflammatory type of arthritis, can develop at any age. Systemic lupus erythematosus usually develops between infancy and old age, with peak occurrence between 15 to 40 years of age. Fibromyalgia is typically diagnosed in middle age and prevalence increases with age.
Joint Damage Pain Deformities Loss Of Function: Late
It is important for people with these symptoms to be diagnosed as soon as possible, because if RA isnt diagnosed and treated early the synovial lining can become so inflamed that it damages and erodes the cartilage this makes bone loss more likely.
Moving joints becomes more difficult, and flare-ups can occur with greater frequency. These joint changes are called erosions, and they can lead to deformities of the bone, such as crooked fingers, says Daniel Solomon, MD, MPH, chief of the section of clinical sciences in the division of rheumatology at Brigham and Womens Hospital in Boston. In severe cases, bones may eventually fuse together. All of this further contributes to pain and loss of function.
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Heart Disease Risk Increases With Ra
One of the most concerning conditions that can evolve in people with RA is cardiovascular disease, especially ischemic heart disease, in which there’s a reduced blood supply in the heart.
Other cardiovascular issues people with RA are at increased risk for include heart attack, stroke, congestive heart failure, peripheral vascular disease, and atrial fibrillation.
Its crucial that people with RA continue to be monitored for heart disease risks by their general practitioner or cardiologist. In a review of preventative measures for people with RA, published in June 2020 in the journal Nature Reviews Rheumatology, the authors noted that catching risk factors early, such as high blood pressure or high blood lipids, is especially important for preventing a serious cardiac event.
In addition, people with RA are more likely to develop type 2 diabetes another cardiovascular risk factor as those without RA, possibly because the inflammation of RA affects blood sugar levels and insulin resistance.