Rheumatoid arthritis (RA) is a systemic autoimmune disease that affects the joints of the body. The immune system of the body is responsible for the development of RA (Rheumatoid Arthritis) as it produces antibodies that attack the tissues of the body itself without any known cause.

In Rheumatoid arthritis, the antibodies mostly attack the synovial tissue around the wrist, fingers, and knee joints. This leads to inflammation and swelling of the attacked tissue.

The symptoms of Rheumatoid arthritis range from painful joints to morning stiffness in joints. The usual Rheumatoid arthritis symptoms increase in intensity when there is a flare-up in the disease; the person experiences extreme pain and stiffness.

Female gender, obese people, smokers, and people having a family history of RA are at a greater risk of getting the disease.

It is extremely important to treat Rheumatoid arthritis to prevent its progression. As the disease progresses, it can lead to many severe complications, such as osteoporosis, Sjogren syndrome, and pericarditis.

Rheumatoid arthritis treatments include medications such as DMARDs, biologics, NSAIDs, corticosteroids, and pain killers. Surgery is only done when the disease has damaged the joints severely.

Stretching and massage therapies at home will help in reducing the intensity of the symptoms. Exercising regularly and avoiding tobacco smoke will help in the prevention of Rheumatoid arthritis.

What are the Symptoms of Rheumatoid Arthritis?

Rheumatoid arthritis presents with the following signs and symptoms:

• Experiencing pain in two or more joints
• Stiff joints, especially in the morning
• Swollen and tender joints
• Reduced mobility in joints
• Tingling sensation in joints
• Fever
• Fatigue

What are the Types of Rheumatoid Arthritis?

There are two types of RA depending on the presence of a protein called Rheumatoid factor (RF) and an antibody called an anti-cyclic citrullinated peptide (anti-CCP) in the blood.

1. Seropositive Rheumatoid arthritis

Rheumatoid arthritis in which RF (rheumatoid factor) and anti-CCP (Anti-cyclic citrullinated peptides (anti-CCP) an antibody that works against your body's normal antibodies ) are detected in the blood through blood tests is called seropositive Rheumatoid arthritis.

• Seronegative Rheumatoid arthritis

If the blood tests give a negative report for the presence of RF and anti-CCP, then the patient has seronegative Rheumatoid arthritis.

What are the Causes of Rheumatoid Arthritis?

Rheumatoid arthritis is caused by the immune system sending antibodies to the synovial tissue surrounding the joint. These antibodies attack the tissue, causing inflammation and pain. What triggers the immune system to send antibodies to its tissue is not known yet.

What are the Risk Factors of Rheumatoid Arthritis?

There are many risk factors that we need to consider when RA is concerned. They are:

• Obesity

Obesity is considered as one of the risk factors for Rheumatoid arthritis. People who are obese stand at a greater risk of getting RA in their lifetime.

• Smoking

Smokers are more likely to get RA as compared to non-smokers. Moreover, if the patient continues smoking, it will lead to its progression.

• Genes

A family history of RA makes the person prone to this disease. Also, any variation in human leukocyte antigen (HLA) can be a risk factor for RA.

• Age

Though the occurrence of RA can happen in a person at any age, older people in their sixties are more prone to its development in their joints.

• Gender

Women are more susceptible to developing Rheumatoid arthritis. It is said that the percentage of women affected is two to three times higher than men.

What are the complications of Rheumatoid arthritis?

Rheumatoid arthritis is quite a serious disease that can affect vital parts of the body.

The main complications are:

• Rheumatoid nodules

Rheumatoid nodules are tissue bumps that form under the skin near the affected joints. They usually appear around pressure points.

Not only skin, but these nodules can develop on other body parts, including the heart or lungs. The appearance of rheumatoid nodules is an indication that RA is worsening.

• Sjogren’s syndrome

Sjogren’s syndrome is a serious complication of Rheumatoid arthritis. Like RA, it is an autoimmune disease that targets the tear and salivary glands.

Due to this syndrome, eyes and mouth become extremely dry.

• Osteoporosis

People suffering from Rheumatoid arthritis are at risk of developing osteoporosis. In this disease, there is the weakening of bones. The person affected gets fractures even from a trivial act of coughing.

This can happen either due to the disease itself or the medications patients take to treat it.

• Diabetes

Anyone having Rheumatoid arthritis is at an increased risk of getting type 2 diabetes. To prevent the development of diabetes, proper treatment needs to be done to keep RA under control.

• Complications in lung

Rheumatoid arthritis causes pleurisy, an inflammatory condition in the pleura, that can make breathing difficult for the patient. Also, affected people can develop interstitial lung diseases, which can cause scarring in the lung tissue.

• Complications in heart

Besides being the reason for rheumatoid nodules on the heart, RA can cause pericarditis. The pericardial membrane around the heart becomes inflamed in pericarditis.

Whenever there is a flare-up of Rheumatoid arthritis, there is a risk of getting pericarditis. With continuous episodes of pericarditis, the thickness of the membrane will increase.

If the membrane becomes very thick, the heart will not be able to pump blood as effectively as it should.

• Episcleritis and Scleritis

Having Rheumatoid arthritis most commonly leads to inflammation of the episcleral tissue of the eye, a condition called episcleritis. This disease does not have any serious effect on the eye.

On the other hand, scleritis is an adverse complication, as it involves inflammation of the sclera. This causes pain in the eye and can progress to blindness.

• Thrombocytosis

Rheumatoid arthritis can lead to thrombocytosis; a disease in which there is a high number of platelets in the blood. It is a serious complication as it forms clots that can block the main vessels to the heart or brain.

When to See a Doctor

The person having Rheumatoid arthritis should visit the doctor immediately in situations such as:

• Having a new joint pain or swelling without any cause
• Developing fever and chills
• Having an allergic reaction to the medication they are taking for the disease.

Diagnoses

Blood tests

• A rheumatoid factor test is done for the measurement of RF. Its presence indicates the disease.
• An anti-cyclic citrullinated peptide test is performed to get the level of anti-CCP. High levels of anti-CCP mean there is an attack on body citrulline proteins. 
• Erythrocyte sedimentation rate is performed to know the intensity of inflammation in the body. 
• A C-reactive protein test is done to analyze the levels of C-reactive protein, which is responsible for triggering inflammation. 

Imaging tests

• X-ray helps to see erosions on joints in RA
• MRI and Ultrasound help in diagnosing the disease in the early stages. 

What are the Treatment Options for Rheumatoid Arthritis?

Rheumatoid arthritis treatment includes medication in the beginning. If the disease is under control and does not progress further, surgery is not recommended.

The main focus of any treatment is to reduce the symptoms of the disease and to ensure it does not progress to a severe extent.

·        Medication for Rheumatoid arthritis

1.       Disease-modifying antirheumatic drugs (DMARDs)

DMARDs are the initial drugs that are prescribed to the patients for treatment of Rheumatoid arthritis. These agents suppress the immune system; thus, they reduce the symptom and prevent the disease progression. 

DMARDs are taken orally.

Some of the DMARDs prescribed by doctors are:

• Methotrexate
• Hydroxychloroquine

2.       Biologic response modifiers

Biologic response modifiers, or biologics, affect the inflammation process in the immune system; thus, they help to reduce inflammation in RA. When DMARDs fail to have an impact on the disease, doctors start prescribing biologics with them.

Biologics are given through an intravenous injection.

Commonly prescribed biologics are:

• Abatacept
• Rituximab

3.       Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are widely used as the treatment for Rheumatoid arthritis. Being anti-inflammatory and analgesic agents, they are responsible for the reduction of inflammation and pain in joints.

These agents are taken via the oral route. 

Over the counter NSAIDS include:

• Ibuprofen
• Aspirin

If these drugs fail to give the patient relief, doctors can prescribe the following NSAIDs:

• Celecoxib
• Flurbiprofen

4.       Corticosteroids

Corticosteroids help in managing inflammation by reducing it.

These agents are taken orally.

Prednisone is the corticosteroid that is usually given to treat Rheumatoid arthritis.

5.       Painkillers

Painkillers are only responsible for the reduction in pain.

Over-the-counter painkillers used by RA-affected people is Acetaminophen, which is taken orally.

·         Surgical approach

If the disease continues to progress and damages the joints to a greater extent, doctors intervene by doing surgery. The common surgeries are done are:

1.       Arthrodesis

In this surgery, surgeons remove the affected joint and fuse the neighboring bones. Though there is a reduction in the patient’s mobility, they get more stable with less pain in the joints.

People having RA in the joints of their wrist, finger, ankles, or toes usually get treated by undergoing arthrodesis.

2.       Joint replacement surgery

Joint replacement surgery involves removing the damaged joint partially or completely and replacing it with an artificially made joint.

This surgery is best for joints of large size, including knees, hips, and shoulder joints. Smaller joints such as joints in the wrist and finger can also undergo replacement surgery.

There are risks associated with this surgery, though, such as the risk of developing infections in the synthetic joint.

3.       Synovectomy

In synovectomy, the swollen synovial tissue covering the joint is partially removed. When surgeons perform synovectomy, their goal is to either eliminate the symptoms or lessen their intensity.

Due to the partial removal of inflamed tissue, the remaining tissue might present with the symptoms of RA again.

What are the home remedies for Rheumatoid arthritis?

Besides the medication prescribed by the doctor, treating RA at home via other means can greatly improve the quality of life by reducing symptoms.

·         Exercise

Exercise plays an effective role in the prevention of RA from progressing further. It helps in strengthening the muscles of affected joints. The person suffering from RA should incorporate aerobic exercises in their routines, such as walking, biking, and swimming.

·         Stretching

If the muscles surrounding the joints affected by RA are stretched, it will help in reducing the symptoms of the disease. Before attempting to stretch any muscle, the affected person should consult their doctor first.  

·         Massage therapy

The Rheumatoid arthritis patient will benefit from massage therapy significantly. Massaging the area around the affected joint will increase the circulation of the area, leading to a reduction in swelling of the joint.

·         Thermotherapy

Thermotherapy is known to have a positive impact in alleviating the symptoms of RA. Using heating pads or cold packs reduces the pain and inflammation in the joints. 

·         Supplements

Fish oil supplements, containing omega-3 fatty acids, play a role in the treatment of Rheumatoid arthritis. Taking them will help in the reduction of the inflammation in joints having RA.  

Due to their significant impact on inflammation, doctors might lower the dose of other RA medications.

·         Rest

Rest is necessary when Rheumatoid arthritis is flaring up. A resting period of one or two days will help the patient to relax and will reduce the inflammation and pain that came due to the flare-up.

·         Meditation

Meditation is beneficial for the mental health of the person having Rheumatoid arthritis. It provides pain relief to them and helps them to deal with the stress associated with RA.

How to Prevent RA?

 To prevent Rheumatoid arthritis, certain measures can be taken such as: 

• Smoking is one of the very common risk factors of RA. Stopping it will have a significant impact on the prevention of disease. 
• Keeping active by indulging in many low-impact and aerobic exercises to keep the body healthy. It will prevent unnecessary build-up of fat.
• Maintaining a normal body weight by eating healthy. Indulging in meals containing fish, vegetables, low-fat dairy, and whole-grain cereals. Avoiding sodas, fried foods, and processed meat. 
• Avoiding places where there is exposure to harmful pollutants such as silica and asbestos. 
• Making an early appointment with a doctor as soon as there is any sign or symptom of RA in the body.