Rheumatoid arthritis

Definition:

Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body. It occurs mostly in the

• Fingers
• Wrists
• Elbows
• Shoulders
• Jaw
• Hips
• Knees
• Toes

Causes:

RA is caused by a combination of genetic and environmental factors that trigger an abnormal immune response.

Possible causes

• Genetic factors—certain genes that play a role in the immune system are associated with RA development.
• Defects in the immune system can cause ongoing inflammation.
• Environmental factors—certain infectious agents, such as some viruses or bacteria, may increase susceptibility to RA.
• Other factors—some evidence suggests that hormonal factors may promote RA development in combination.

Risk Factors:

These factors increase your chance of developing RA. Tell your doctor if you have any of these risk factors

• Family members with RA
• Sex: female
• Ethnic background: Pima Indians
• Heavy or long-term smoking

Symptoms:

When RA begins, symptoms may include

• Joint pain and stiffness that is:

• Symmetrical
• Most prominent in the morning
• Lasts for at least half an hour

As RA progresses, it may cause complications with the

• Heart
• Lungs
• Eyes
• Skin
• Liver
• Kidneys
• Blood
• Nervous system
• Blood vessels

It is also linked to early cardiovascular disease and death.

Diagnosis:

The doctor will ask about your symptoms and medical history. You will also be examined. To be diagnosed with RA, you must have at least one swollen or tender joint or a history of a swollen joint. How many joints, and which joints are involved will help aid your doctor in coming to the diagnosis. The doctor will also rule out other conditions that may have similar symptoms, like lupus or gout.

To aid the diagnosis, your doctor will order tests, such as:

• Blood tests to determine if you have an autoimmune disease:
• Rheumatoid factor (RF)
• Anti-citrulinated protein antibody
• Erythrocyte sedimentation rate(ESR)
• C-reactive protein(CRP)
• Imaging tests, such as X-rays

Treatment:

There is no cure for RA. The goals of treatment are to:

• Relieve pain
• Reduce inflammation
• Slow down joint damage
• Improve functional ability

Medications:

There are a variety of medicines to treat the pain and inflammation of RA. In some cases, medicines may be used in combination.

• Disease-modifying anti-rheumatic drugs (DMARDS)—to slow the course of the disease; used early in the course of the disease to prevent long-term damage:

• Methotrexate (eg, Rheumatrex)
• Hydroxychloroquine (eg, Plaquenil)
• Sulfasalazine(eg, Azulfidine)
• Leflunomide (eg, Arava)
• Cyclosporine(eg, Neoral)
• Penicilamine (eg, Cuprimine)
• Gold(eg, Ridaura)
• Minocycline (eg, Minocin)

• Immunosuppressive drugs (only used when other DMARDS are ineffective):
  • Azathioprine(eg, Imuran)
  • Cyclophosphamide (eg, Cytoxan)—rarely used
  • Chlorambucil (eg, Leukeran) – rarely used
• Over-the-counter medicines:
  • Acetaminophen (eg, Tylenol)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen and naproxen
• Biologic response modifiers—drugs that interfere with the autoimmune response; includes TNF-inhibitors, such as:
  • Etanercept(eg, Enbrel)
  • Infliximab(eg, Remicade)
  • Adalimumab(eg, Humira)
  • Golimumab (eg, Simponi)
  • Cetrolizumab(eg, Cimzia)

Steroids:

Low-dose corticosteroids (eg, prednisone) are often used first. They may be tapered when other drugs start working. Avoid long-term steroid use. Corticosteroid injections to inflamed joints may also be used.

Rest and Exercise:

Rest reduces active joint inflammation and pain and fights fatigue. Exercise is important for maintaining muscle strength and flexibility. It also preserves joint mobility.

Joint Care:

Splints applied to painful joints may reduce pain and swelling. Devices that help with daily activities can also reduce stress on joints.