Thursday, September 29, 2022

Is Rheumatoid Arthritis An Inflammatory Disease

How Does Rheumatoid Arthritis Affect The Entire Body

Immunology of the rheumatoid joint

Like many autoimmune diseases, rheumatoid arthritis typically waxes and wanes. Most people with rheumatoid arthritis experience periods when their symptoms worsen separated by periods in which the symptoms improve. With successful treatment, symptoms may even go away completely .

Although rheumatoid arthritis can have many different symptoms, joints are always affected. Rheumatoid arthritis almost always affects the joints of the hands , wrists, elbows, knees, ankles, and/or feet. The larger joints, such as the shoulders, hips, and jaw, may be affected. The vertebrae of the neck are sometimes involved in people who have had the disease for many years. Usually at least two or three different joints are involved on both sides of the body, often in a symmetrical pattern. The usual joint symptoms include the following:

These symptoms may keep someone from being able to carry out normal activities. General symptoms include the following:

  • Malaise

Where Can People Get Additional Information On Rheumatoid Arthritis

For more information about rheumatoid arthritis as well as living with RA and for support groups, please consider the following:

  • National Institute of Arthritis: https://www.niams.nih.gov/health-topics/rheumatoid-arthritis
  • National Arthritis and Musculoskeletal and Skin Diseases Clearinghouse

Box AMS

Osteoarthritis And Rheumatoid Arthritis

Osteoarthritis may be primary or posttraumatic . Primary osteoarthritis is a degenerative joint disease occurring in later life. An injury that leaves articular surfaces of a joint incongruous can precipitate secondary osteoarthritis. Osteoarthritis beginswith biochemical alteration of the water content of articular cartilage. The cartilage weakens and develops cracks, called fibrillation. Progressive erosion and thinning of the cartilage result, and the subchondral bone becomes sclerotic, termed eburnation. New bone forms around the edges of the articular cartilage, and these outcroppings are called osteophytes .

The joints usually affected in the hand are the DIP and PIP joints of the fingers and carpometacarpal joint at the base of the thumb. Osteophytes at the DIP joint are called Heberden nodes, and those at the PIP joint are known as Bouchard nodes. The involved joints may be painful, stiff, deformed, or subluxated. Radiographs reveal narrowing of the joint space, sclerosis of subchondral bone, and presence of osteophytes.

T. Dimitroulas, … G.D. Kitas, in, 2017

Recommended Reading: Arthritis In Lower Right Side Of Back

Diagnosis And Management Of Rheumatoid Arthritis

J. ADAM RINDFLEISCH, M.D., and DANIEL MULLER, M.D., PH.D.

University of WisconsinMadison, Madison, Wisconsin

Am Fam Physician. 2005 Sep 15 72:1037-1047.

Patient information: See related handout on rheumatoid arthritis, written by the authors of this article.

Rheumatoid arthritis is characterized by persistent joint synovial tissue inflammation. Over time, bone erosion, destruction of cartilage, and complete loss of joint integrity can occur. Eventually, multiple organ systems may be affected.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Patients with rheumatoid arthritis should be treated as early as possible with DMARDs to control symptoms and delay disease progression.

DMARD = disease-modifying antirheumatic drug NSAID = nonsteroidal anti-inflammatory drug.

A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, see page 983 or

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Patients with rheumatoid arthritis should be treated as early as possible with DMARDs to control symptoms and delay disease progression.

DMARD = disease-modifying antirheumatic drug NSAID = nonsteroidal anti-inflammatory drug.

What Are Tips For Living With Rheumatoid Arthritis

Rheumatic Disease Awareness Month 2019
  • Early and aggressive treatment tends to result in an optimal outcome.
  • Understand how your rheumatoid arthritis, as well as the effects and side effects of its treatment, will be monitored.
  • Maintain a working relationship with your treating doctor. Consider consulting with a rheumatologist.
  • Have a game plan for addressing flare-ups of rheumatoid inflammation.
  • Preplan your treatment options for travel with your doctor.
  • Review with your doctor any concerns about your rheumatoid arthritis, its influence on your lifestyle activities, your avocations, and your long-term life goals.

Don’t Miss: Signs Of Arthritis In Arm

Causes And Risk Factors Of Rheumatoid Arthritis

RA develops when white blood cells, which normally protect the body from foreign invaders such as bacteria and viruses, enter the synovium . Inflammation ensues the synovium thickens, causing swelling, redness, warmth, and pain in the synovial joint.

Researchers don’t know exactly what causes the immune system to invade the synovium, but it’s believed that genes and environmental factors play a role in the development of RA.

Rheumatology

But not everyone with these identified gene variants develops RA, and people without them can still develop it. So, it’s likely that environmental factors often trigger the disease, particularly in people with a genetic makeup that makes them more susceptible to it. These factors include:

  • Viruses and bacteria
  • Female hormones
  • Obesity, which also increases progression of disability for people with RA.Obese patients are less likely to achieve RA remission regardless of the treatment they receive.
  • Severely stressful events
  • Foods

Children up to age 16 who experience prolonged swollen or painful joints anywhere in the body are typically diagnosed with juvenile idiopathic arthritis .

What Are Complications Of Rheumatoid Arthritis

Common complications of rheumatoid arthritis include the following:

Overall, the rate of premature death is higher in people with rheumatoid arthritis than in the general population. The most common causes of premature death in people with rheumatoid arthritis are infection, vasculitis, and poor nutrition. Fortunately, the manifestations of severe, long-standing disease, such as nodules, vasculitis, and deforming are becoming less common with optimal treatments.

Don’t Miss: Ways To Help Arthritis In Hands

Major Players In The Autoimmune Response: Leukocytes

Leukocytes or white blood cells are key immune system cells that play a central role in the autoimmune response that occurs during RA. Leukocytes include a number of different types of white blood cells with different functions. Those with key involvement in the RA autoimmune response include neutrophils, lymphocytes , monocytes, macrophages, and dendritic cells . In addition to leukocytes, another immune system cell called a mast cell plays an important role in the autoimmune process, releasing cytokines, chemokines, and enzymes called proteases.

  • Synthesize range of immune system chemicals

What Are The Signs And Symptoms Of Ra

Rethinking Rheumatoid Arthritis – Mayo Clinic

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

Recommended Reading: Arthritis Itchy Skin

Why Are Rest And Exercise Important For Ra

You need to be active, but you also have to pace yourself. During flare-ups, when inflammation gets worse, itâs best to rest your joints. Using a cane or joint splints can help.

When the inflammation eases, itâs a good idea to exercise. Itâll keep your joints flexible and strengthen the muscles that surround them. Low-impact activities, like brisk walking or swimming, and gentle stretching can help. You may want to work with a physical therapist at first.

How Is Rheumatoid Arthritis Diagnosed

The diagnosis of rheumatoid arthritis is based on a combination of factors, including:

  • Morning stiffness that lasts at least one hour and has been present for at least six weeks
  • Swelling of three or more joints for at least six weeks
  • Swelling of the wrist, hand, or finger joints for at least six weeks
  • Swelling of the same joints on both sides of the body
  • Changes in hand x-rays that are hallmarks of rheumatoid arthritis
  • Rheumatoid nodules of the skin
  • Blood test that is positive for rheumatoid factor* and/or anti-citrullinated peptide/protein antibodies

* The rheumatoid factor may be present in people who do not have rheumatoid arthritis. Other diseases can also cause the rheumatoid factor to be produced in the blood. A test called CCP antibody can sometimes help to determine whether the rheumatoid factor antibody is due to rheumatoid arthritis or some other disease. This is why the diagnosis of rheumatoid arthritis is based on a combination of several factors and NOT just the presence of the rheumatoid factor in the blood.

It is also important to note that not all of these features are present in people with early rheumatoid arthritis, and these problems may be present in some people with other rheumatic conditions.

In some cases, it may be necessary to monitor the condition over time before a definitive diagnosis of rheumatoid arthritis can be made.

Also Check: Ra Hand Pain

Can Ra Go Into Remission

RA remission means your disease is no longer active. For some people, that means they no longer experience RA symptoms, and for others, it could mean symptom-free periods with an occasional, mild flare-up.

Remission should be a long-term goal for you and your healthcare provider, and it is possible to experience it. But because there is no specific definition of “remission,” it is hard to know exactly how many people with RA experience it.

For example, a 2017 review of RA remission studies published in Therapeutic Advances in Musculoskeletal Disease found that remission rates ranged from 5% to around 45% based on the criteria used to define remission.

That review also shares that people with RA who maintain remission for six or more months have achieved sustained remission. The authors note sustained remission is linked to improved outcomes in function, patient-reported outcomes, and survival.

Your healthcare provider will use measures to determine if you are in remission based on the American College of Rheumatology criteria. These include:

  • Less than 15 minutes of stiffness in the morning
  • Little or no joint pain, tenderness, or swelling
  • Blood tests that show low levels of inflammation

What Happens If You Go Untreated For Rheumatoid Arthritis

PPT

If rheumatoid arthritis is not diagnosed and appropriately treated, the disease can progress leading to complications and disabilities.

Complications of RA include the following:

  • Osteoporosis: Weakening of the bones, making them more prone to fractures.
  • Rheumatoid nodules: Firm bumps of tissue around the pressure points of joints, lungs, etc.
  • Sjogren’s syndrome: An autoimmune disorder that attacks the glands making tears and saliva, causing dryness of eyes and mouth…

You May Like: What To Do For Rheumatoid Arthritis In Hands

What Are Causes And Risk Factors Of Rheumatoid Arthritis

The cause of rheumatoid arthritis is not known. Many risk factors are involved in the abnormal activity of the immune system that characterizes rheumatoid arthritis. These risk factors include

  • genetics ,
  • hormones , and
  • possibly infection by a bacterium or virus.

Other environmental factors known to increase the risk for developing rheumatoid arthritis include

  • silica exposure, and
  • periodontal disease.

Medical scientists have shown that alterations in the microbiome exist in people with rheumatoid arthritis. Emerging research shows that the microbiome has an enormous influence on our health, immune system, and many diseases, even those previously not directly linked to the gastrointestinal tract. Studies have shown different kinds of bacteria in the intestines of people with rheumatoid arthritis than in those who do not have rheumatoid arthritis. However, it remains unknown how this information can be used to treat rheumatoid arthritis. Treatment is probably not as simple as replacing missing bacteria, but this may explain why some individuals with rheumatoid arthritis feel better with various dietary modifications.

What Are Tips For Managing And Living With Rheumatoid Arthritis

The following tips are helpful in managing and living with RA:

  • Live a healthy lifestyle: Eat healthy foods. Avoid sugar and junk food. Quit smoking, or don’t start. Don’t drink alcohol in excess. These common-sense measures have an enormous impact on general health and help the body function at its best.
  • Exercise: Discuss the right kind of exercise for you with your doctor, if necessary.
  • Rest when needed, and get a good night’s sleep. The immune system functions better with adequate sleep. Pain and mood improve with adequate rest.
  • Follow your doctor’s instructions about medications to maximize effectiveness and minimize side effects.
  • Communicate with your doctor about your questions and concerns. They have experience with many issues that are related to rheumatoid arthritis.

You May Like: How To Stop Arthritis In Hands

Complications Of Rheumatoid Arthritis

It’s well established that rheumatic diseases such as RA increase the risks for developing a variety of health conditions.

The most common RA comorbidity is cardiovascular disease, but the condition is also associated with several specific cardiovascular issues, including heart attack, stroke, congestive heart failure, peripheral vascular disease, and atherosclerosis.

RA can also lead to inflammation in other areas of the body, including blood vessels, where it’s known as rheumatoid vasculitis the lungs, resulting in rheumatoid lung disease or other conditions the eyes and the wrists, causing carpal tunnel syndrome.

How Your Treatment Changes As Ra Progresses

What is Rheumatoid Arthritis?

Early stage. A key focus is to control the inflammation. Thatâs especially critical in the early phase of the disease to prevent joint damage. You may get:

  • A disease-modifying antirheumatic drug , such as methotrexate
  • Nonsteroidal anti-inflammatory drugs , such as aspirin and ibuprofen, for pain

Quitting smoking and losing any extra weight also can help slow your RA.

Moderate stage. This is when you may have trouble with regular daily activities because of pain. You also may tire more easily. There are several options. Your doctor may have you try combining methotrexate with two other DMARD medications, sulfasalazine and hydroxychloroquine. Another option is a stronger form of DMARDs, called biologic DMARDs, including:

  • Tofacitinib
  • Upadacitinib

If a certain joint is particularly inflamed, your doctor may give the joint steroid shots. Once your pain is under control, itâs important to exercise to keep ahead of your RA. You also may need physical therapy.

Severe stage. If a TNF inhibitor fails to improve your symptoms, your doctor may recommend you try a different TNF inhibitor or a different class of biologic. If you donât respond to one, you may respond to another.

Surgery is a last-resort treatment for very severe RA. That includes when your joints are deformed and damaged and limit your mobility. The three most common surgeries for RA are:

Recommended Reading: Can You Get Arthritis In Your Legs

What Are The Symptoms Of Rheumatoid Arthritis

The symptoms of rheumatoid arthritis include the following:

  • Stiffness, especially in the morning or after sitting for long periods
  • Fatigue

Rheumatoid arthritis affects each person differently. In most people, joint symptoms may develop gradually over several years. In other people, rheumatoid arthritis may proceed rapidly. A few people may have rheumatoid arthritis for a limited period of time and then go into remission .

Cartilage normally acts as a shock absorber between the joints. Uncontrolled inflammation causes the destruction and wearing down of the cartilage, which leads to joint deformities. Eventually, the bone itself erodes, potentially leading to fusion of the joint . This process is aided by specific cells and substances of the immune system, which are produced in the joints but also circulate and cause symptoms throughout the body.

When To Get Medical Advice

See a GP if you think you have symptoms of rheumatoid arthritis, so they can try to identify the underlying cause.

Diagnosing rheumatoid arthritis quickly is important, because early treatment can prevent it getting worse and reduce the risk of joint damage.

Find out more about diagnosing rheumatoid arthritis.

Recommended Reading: How Does Arthritis Affect Your Body

Amplification In The Synovium

Once the generalized abnormal immune response has become established which may take several years before any symptoms occur plasma cells derived from B lymphocytes produce rheumatoid factors and ACPA of the IgG and IgM classes in large quantities. These activate macrophages through Fc receptor and complement binding, which is part of the intense inflammation in RA. Binding of an autoreactive antibody to the Fc receptors is mediated through the antibody’s N-glycans, which are altered to promote inflammation in people with RA.

This contributes to local inflammation in a joint, specifically the synovium with edema, vasodilation and entry of activated T-cells, mainly CD4 in microscopically nodular aggregates and CD8 in microscopically diffuse infiltrates. Synovial macrophages and dendritic cells function as antigen-presenting cells by expressing MHC class II molecules, which establishes the immune reaction in the tissue.

Epidemiology Pathophysiology And Diagnosis Of Rheumatoid Arthritis: A Synopsis

Rheumatoid Arthritis RA Is An Auto Immune Disease And Inflammatory Type ...

Allan Gibofsky, MD, JD, FACP, FCLMSupplements and Featured Publications

Rheumatoid arthritis is one of the more common autoimmune disorders, affecting approximately 1% of the population worldwide. The exact cause of RA is not known however, initiation of disease seems to result from an interaction among genetic susceptibility, environmental triggers, and chance. RA is characterized by dysregulated inflammatory processes in the synovium of the joint that eventually leads to the destruction of both cartilaginous and bony elements of the joint, with resulting pain and disability. Systemic inflammation associated with RA is associated with a variety of extra-articular comorbidities, including cardiovascular disease, resulting in increased mortality in patients with RA. RA is also associated with several psychosocial disorders. Classification criteria for RA that were promulgated jointly by the American College of Rheumatology and the European League Against Rheumatism in 2010 emphasize early detection of RA so that effective management can be initiated before pathological changes become irreversible.

The pain, fatigue, and disability associated with RA result in a significant reduction in health-related quality of life.4 Additionally, RA imposes a substantial economic burden upon patients, due to both increased cost of medical care and loss or reduction of employment, frequently during peak working years.5,6

Epidemiology

Pathophysiology

Assessment of Disease Activity

Recommended Reading: Ra And Tendonitis

Research On Rheumatoid Arthritis

In the last decade, much research has been conducted to increase our understanding of the immune system and what makes it malfunction. There have also been new therapies developed to help treat the disease. Some of the topics of intense research include:

What are the genetic factors that predispose people to develop rheumatoid arthritis?

Some white blood cells, commonly known as T cells, are important in maintaining a healthy and properly functioning immune system. However, scientists have discovered a variationcalled single nucleotide polymorphism in a gene that controls T cells. When the SNP gene variation is present, T cells attempt to correct abnormalities in joints too quickly, causing the inflammation and tissue damage associated with RA. The discovery of SNP may help determine peoples risk for getting RA and might help explain why autoimmune diseases run in families.

At conception, twins have an identical set of genes. So why would only one twin develop RA?

Popular Articles
Related news