Rheumatoid Arthritis (RA) is an autoimmune disease (a disease in which the body’s immune system acts in a way it’s not supposed to, attacking the body’s cells instead of foreign cells like viruses and bacteria) and is a form of inflammatory arthritis (a disease of the joints involving inflammation and progressive symptoms and damage). In RA, as a result of the immune cells in the body attacking the body’s synovium (the membrane that lines the joints), fluid builds up in and around the joints. The result is inflammation throughout the entire body. RA is always a chronic disease (meaning it is incurable and causes consistent issues for the patient), but people with RA experience differences in severity and course of disease. Some RA patients have “flares,” where RA symptoms are intense for a time period then subside, some RA patients have long periods of remission (where they have long periods without disease activity), and some have RA that gets continually worse and more active as time goes on. Studies of RA and RA patients have shown that it is very important to diagnose RA as early as possible and treat it aggressively until the disease goes into remission. If treatment is early and aggressive, RA patients have the best chance of avoiding disability, damage to other organs, and destruction of their joints.
Though every RA patient is different and each patient’s RA symptoms can change over time or even daily, there are some characteristics that many RA patients have in common. RA is a symmetrical disease, meaning that joints are affected on both sides of the body, not one side or the other. Joints may be swollen, inflamed, and painful. Joints may also have decreased range of motion and be warm to the touch. Since inflammation is through the entire body, systemic effects may also occur (like anemia, low-grade fever, fatigue). The outcome of the joint damage and inflammation caused by RA is often deformity and disability of the joints. Many joints are affected, and RA can damage the tissue around the joints like tendons, ligaments, and even bones. The inflammation involved in RA can also affect many other organs and systems in the body as time progresses. Some RA patients develop rheumatoid nodules, which are lumps that form under the skin (often near areas that are bony and under pressure). Rheumatoid nodules occur most often around the elbows but can be found other places on the body, including the fingers, heels, around the spine, etc.
Diagnosis of RA
To diagnose RA in a patient, a physician looks at the patient’s medical history, perform blood tests, and perform a physical exam. X-rays or other scans may be performed in order to determine the amount of bone damage or erosion around affected joints. When reviewing medical history and performing physical exam, a physician will look for specific signs and symptoms that distinguish RA from other types of arthritis and other disease states, like other autoimmune conditions. Some particular things a physician will look for would be swollen, warm joints, joints with limited range of motion, symmetrical symptoms (symptoms occur on both sides of the body, not one or the other), and whether a patient has reported fatigue or other systemic issues that are associated with RA. Blood tests will look for antibodies, markers of inflammation, and other markers associated with RA. Not every patient will have positive blood tests for antibodies, but blood work still helps to isolate inflammatory disease. Patients who are diagnosed with RA should begin treatment immediately because research has shown and continues to show that this is key to decreasing the progression of RA and lessening joint damage.
Treatment of RA
Treatments for RA can be divided into 2 different groups: medications that treat symptoms (especially inflammation) and medications designed to put the disease into remission or slow its progression. NSAIDs (non-steroidal anti-inflammatory drugs), which can be traditional NSAIDs available OTC (ibuprofen or naproxen), traditional NSAIDs that are prescription only (such as diclofenac and meloxicam), NSAIDs that are COX-2 inhibitors (designed to be safer for the stomach, such as celecoxib), or NSAIDs that are salicylates (like aspirin, though used less because side effects are too risky at the large doses needed to treat RA), are used to decrease both pain and inflammation. Corticosteroids (like prednisone) are also used to reduce inflammation and symptoms of RA. There are 2 categories of drugs used to modify the disease: DMARDs (disease-modifying anti-rheumatic drugs) and biologic agents. DMARDs include methotrexate, leflunomide, sulfasalazine, and many others. DMARDs can prevent debilitating damage from occurring as a result of RA, but they take time to work and need to be started as soon as possible after diagnosis. DMARDs suppress the immune system, so patients must be cautious of any signs of infection, and there are side effects to some DMARDs (like birth defects and damage to the liver) that may mean they are not an option for some patients. Biologic agents include Humira (adalimumab), Enbrel (etanercept), Simponi (golimumab), Actemra (Tocilizumab), Remicade (Infliximab), and Xeljanz (Tofacitinib Citrate) . Biologic agents are agents made from one living organism to treat disease in another living organism (vaccines are also biologic agents). Biologics used to treat RA block specific steps in the process of inflammation, and they are effective for many RA patients and even lead to remission in many patients who respond to them. Patients must watch for signs of infection with biologics as well, and biologics and DMARDs are often given together.
RA patients should also lead a healthy lifestyle to decrease fatigue and damage from their disease. Light to moderate physical activity including stretching will improve overall health for RA patients and will also increase flexibility and range of motion as well as strength. A healthy diet is important, since many nutrients in healthy foods can reduce inflammation, and also to improve overall health.
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