Arthritis refers to the inflammation and swelling in one or more joints. Common symptoms include joint pain and stiffness, often worsening as people age. Osteoarthritis and rheumatoid arthritis are the two most prevalent types.
Contents
Overview
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects the joints on both sides of the body, setting it apart from other forms of arthritis. Common symptoms include pain and inflammation in the:
- Fingers
- Hands
- Wrists
- Knees
- Ankles
- Feet
- Toes
Uncontrolled inflammation can harm the cartilage, which normally cushions the joints. Over time, this can deform the joints and lead to bone damage. The body may try to protect itself by causing the joints to fuse together.
Who is affected by rheumatoid arthritis?
Rheumatoid arthritis (RA) typically begins between the ages of 30 and 60, though it can affect people of any age. When RA develops in children and young adults, usually between 16 and 40 years old, it’s known as young-onset rheumatoid arthritis (YORA). If symptoms appear after age 60, it’s referred to as later-onset rheumatoid arthritis (LORA). It’s 2.5 times more common in females than male.
Types of rheumatoid arthritis
To help diagnose rheumatoid arthritis, doctors order a blood test to check for two specific proteins. One is called rheumatoid factor (RF), and the other is anti-CCP (or ACPA). ACPA is a more recent test that is more sensitive than RF and can appear earlier in the progression of RA.
Seropositive: Seropositive RA is the more common form, affecting 60%-80% of people with rheumatoid arthritis. If you have seropositive RA, your blood contains antibodies that can attack your body and inflame your joints. These antibodies are known as anti-cyclic citrullinated peptides (anti-CCPs) or anti-citrullinated protein antibodies (ACPAs).
Seronegative: Seronegative RA means you either lack anti-CCPs and rheumatoid factors in your blood or have very low levels of them. If you experience RA symptoms but test negative for anti-CCPs, you likely have seronegative RA or possibly a different condition.
Does having a positive RF or anti-CCP test mean you definitely have RA?
A positive RF or anti-CCP test alone doesn’t confirm RA. Other signs must be present, such as joint pain and swelling, inflammation in multiple joints, morning stiffness lasting over 45 minutes, and x-ray evidence of typical joint damage. Additionally, RA may show extra-articular symptoms, like nodules outside the joints. Blood tests like ESR and CRP, which measure inflammation levels, are also commonly used before diagnosis.
Signs and Symptoms
Symptoms of rheumatoid arthritis
Signs and symptoms of rheumatoid arthritis may include:
- Tender, warm, and swollen joints.
- Joint stiffness, particularly worse in the morning or after inactivity.
- Fatigue, fever, and loss of appetite.
In its early stages, rheumatoid arthritis typically affects smaller joints, especially those connecting your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often extend to larger joints like the wrists, knees, ankles, elbows, hips, and shoulders. In most cases, the same joints on both sides of the body are affected.
Additionally, about 40% of people with RA experience symptoms beyond the joints. These areas may include:
- Skin
- Eyes
- Lungs
- Heart
- Kidneys
- Salivary glands
- Nerve tissue
- Bone marrow
- Blood vessels
Rheumatoid arthritis symptoms can vary in intensity and may come and go. Periods of increased activity, known as flares, alternate with times of remission, when pain and swelling lessen or disappear. Over time, the disease can cause joint deformities and misalignment.
Causes and Risk factors
Causes of rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disorder, meaning it occurs when the immune system attacks healthy body tissue. However, the exact cause of rheumatoid arthritis remains unknown.
Normally, your immune system produces antibodies to attack bacteria and viruses, helping to fight infections. In rheumatoid arthritis, the immune system wrongly targets antibodies to the joint lining, causing inflammation of the synovium and releasing chemicals that damage nearby structures, including:
- Bones
- Cartilage, the flexible tissue between bones
- Tendons, which connect bone to muscle
- Ligaments, which connect bone to cartilage
If left untreated, these chemicals gradually cause the joint to lose its shape and alignment, eventually leading to complete joint destruction.
Risk factors of rheumatoid arthritis
Factors that may increase your risk of developing rheumatoid arthritis include:
- Sex: Women are more likely than men to develop rheumatoid arthritis.
- Age: While RA can occur at any age, it most often starts in middle age.
- Smoking: Smoking, especially in those with a genetic predisposition, raises the risk of developing RA and is linked to more severe cases.
- Excess Weight: Individuals with excess body weight is associated with a slightly higher risk of developing rheumatoid arthritis.
- Family History: Having a family member with rheumatoid arthritis increases your risk of the disease.
Complications of rheumatoid arthritis
Rheumatoid arthritis increases your risk of developing the following conditions:
- Infections: RA and its treatments can weaken the immune system, increasing vulnerability to infections. Vaccinations for illnesses like influenza, pneumonia, shingles, and COVID-19 are recommended.
- Dry Eyes and Mouth: Individuals with RA are more prone to developing Sjogren’s syndrome, a condition that reduces moisture in the eyes and mouth.
- Osteoporosis: Both RA and some of its treatments can raise the risk of osteoporosis, a condition that weakens bones, making them more likely to fracture.
- Rheumatoid Nodules: These firm tissue bumps typically form around pressure points, such as the elbows, but can also appear in other areas of the body, including the heart and lungs.
- Lymphoma: RA elevates the risk of developing lymphoma, a type of blood cancer that affects the lymphatic system.
- Carpal Tunnel Syndrome: Inflammation in the wrists caused by RA can compress the nerve that controls most of the hand and fingers, leading to carpal tunnel syndrome.
- Heart Problems: RA can increase the risk of hardened or blocked arteries, as well as inflammation of the sac surrounding the heart.
- Lung Disease: Those with RA have a higher risk of lung tissue inflammation and scarring, which can lead to progressive shortness of breath.
- Abnormal Body Composition: People with RA often have a higher proportion of fat to lean mass, even if their body mass index (BMI) is normal.
Diagnosis
Diagnosis of Rheumatoid Arthritis
The diagnosis involves multiple factors, including a physical exam, a review of your medical history, and an evaluation of your symptoms. Blood tests and imaging studies are key parts of the process. Blood tests help identify inflammation and specific antibodies linked to RA, such as:
- Erythrocyte sedimentation rate (ESR), also called “sed rate,” which confirms the presence of joint inflammation.
- C-reactive protein (CRP), a marker for inflammation.
- Around 80% of individuals with RA test positive for rheumatoid factor (RF).
- Between 60% and 70% of RA patients have anti-cyclic citrullinated peptide (CCP) antibodies, which are proteins linked to the disease.
Your rheumatologist might also request imaging tests to check for joint damage, which occurs when the bones within joints start to erode. These imaging methods can include:
- X-rays
- Ultrasounds
- Magnetic resonance imaging (MRI)
What are the criteria for diagnosing rheumatoid arthritis?
Diagnostic criteria for RA include specific symptoms, clinical signs, and test results used by healthcare providers to diagnose the condition. These guidelines are based on extensive research and clinical practice. While not everyone with RA meets all criteria, the general guidelines include:
- Inflammation in two or more large joints such as the shoulders, elbows, hips, knees, or ankles.
- Inflammation in smaller joints, typically in the hands or feet.
- Positive results on blood tests for biomarkers like rheumatoid factor (RF) or CCP antibodies.
- Elevated CRP levels or an increased sed rate.
- Symptoms that have lasted for more than six weeks
Treatment and Management
Treatment of rheumatoid arthritis
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are used to ease pain and reduce inflammation. Some common NSAIDs include:
- Ibuprofen (Advil®, Motrin®)
- Naproxen (Aleve®)
- Aspirin
COX-2 Inhibitors
A specialized type of NSAID, COX-2 inhibitors, are designed to minimize gastrointestinal side effects like stomach bleeding. One example is celecoxib (Celebrex®).
Corticosteroids
Steroids, or corticosteroids, like prednisone and cortisone, are also effective in managing inflammation and joint pain.
Disease-Modifying Antirheumatic Drugs (DMARDs)
DMARDs work differently from NSAIDs, as they can actually slow down the disease by modifying the immune system. They can be used alone or combined with other drugs. Commonly used DMARDs include:
- Methotrexate (Trexall®)
- Hydroxychloroquine (Plaquenil®)
- Sulfasalazine (Azulfidine®)
- Leflunomide (Arava®)
Janus Kinase (JAK) Inhibitors
JAK inhibitors are a newer class of DMARDs, often prescribed when methotrexate alone is not effective. Examples include:
- Tofacitinib (Xeljanz®)
- Baricitinib (Olumiant®)
Biologics
When traditional DMARDs are not enough, biologic agents may be prescribed. These drugs target specific molecules that cause joint inflammation, providing a more precise approach to treatment. Examples of biologics include:
- Etanercept (Enbrel®)
- Infliximab (Remicade®)
- Adalimumab (Humira®)
- Rituximab (Rituxan®)
- Tocilizumab (Actemra®)
Biologics often work quickly, typically within two to six weeks, and can be used alone or in combination with other medications like methotrexate.
When is Surgery Considered for Rheumatoid Arthritis?
If medications fail to control pain or if joint damage is severe, surgery may be an option. Surgical interventions for RA include joint replacements, such as knee or hip replacements, as well as surgeries to correct deformities caused by the disease.
Focus keywords: Arthritis, Rheumatoid arthritis, RA, Rheumatoid factor, RF
Written by Liya Sunny
Source
https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis
https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
Seropositive and seronegative rheumatoid arthritis (RA) | NRAS