Rheumatoid Arthritis: Symptoms, Diagnosis, Treatment

Rheumatoid arthritis is an autoimmune inflammatory disease in which your immune system mistakenly attacks healthy cells in your body. This disease affects the joints, usually the knees, hands, and wrists. It can also affect tissues in other parts of the body and, if left untreated, can damage the heart, lungs, and eyes.

Joints affected by rheumatoid arthritis become inflamed, and as a result, the joint tissue becomes damaged. This then causes chronic pain, lack of balance or unsteadiness, and even deformity of the joint.

Rheumatoid arthritis causes

Although we know that rheumatoid arthritis results from one's immune system attacking healthy tissue, the specific reason this happens is unknown.

For people with rheumatoid arthritis, their immune systems activate antibodies to attack tissue lining in the joints. This causes the lining cells, also known as synovial cells, to divide, causing inflammation. Additionally, chemicals released during this process can damage cartilage, ligaments, tendons, and bones in the area.

Rheumatoid arthritis risk factors

• Age: The risk of developing rheumatoid arthritis increases with age.
• Gender: Women are two to three times more likely to develop rheumatoid arthritis than men.
• Genetics: Those born with HLA class II genotypes have an increased risk of developing rheumatoid arthritis. The risk is higher when individuals with these genes are overweight or smoke.
• Early exposure to smoking: Children with mothers who smoke have twice the risk of developing rheumatoid arthritis when they are adults.
• Smoking: Individuals who smoke are at a greater risk of rheumatoid arthritis.
• Obesity: Individuals who are obese are at a greater risk of rheumatoid arthritis.

Rheumatoid arthritis symptoms

• Pain and/or stiffness in more than one joint. Stiffness worsens in the mornings and/or after inactivity
• Swelling and/or tenderness in more than one joint
• Similar symptoms both sides of the body, for example, in both hands
• Fatigue
• Weakness
• Weight loss
• Fever

There are times when rheumatoid arthritis symptoms can get better (remission) or worse (flares). 

Early signs of rheumatoid arthritis include pain or tenderness in small joints such as those in your fingers. However, it is not uncommon to have pain in larger joints such as your shoulder or knee. You must recognise the early signs as early treatment will help to prevent permanent joint damage. 

Extra-articular manifestations of rheumatoid arthritis

Besides the symptoms mentioned above that mostly affect the joints, rheumatoid arthritis can also affect other organ systems. This is referred to as extra-articular disease.  

1. Atherosclerosis: This cardiovascular manifestation is one of the most common in rheumatoid arthritis patients. Fats, and cholesterol clog the artery walls, causing plaque that narrow arteries and block blood flow. Chronic inflammation due to rheumatoid arthritis can lead to atherosclerosis.  
2. Rheumatoid nodules: Nodules happen in 20% to 30% of seropositive patients. They are usually on extensor surfaces of elbows and arms. However, they can also develop at pressure points of the knees and feet. The eyes, heart, and lungs can also be affected, although this is very uncommon. 
3. Cardiopulmonary disease: Pulmonary manifestations of rheumatoid arthritis include intrapulmonary nodules, diffuse interstitial fibrosis, and pleurisy with/without effusion. These conditions result in reduced lung capacity.
4. Eye disease: Sicca or dry eyes are common issues. Episcleritis, which is the inflammation of the episclera, can also develop. Rheumatoid arthritis patients with episcleritis may have eyes that look very red and even painful. 
5. Sjogren’s syndrome: This is an autoimmune condition affecting the salivary and lacrimal glands. Symptoms of Sjogren’s syndrome include dry eyes, dry mouth, dental decay, fatigue, and joint pain. It can lead to lung, kidney, blood, nervous system, and gynaecologic diseases if not treated. 
6. Rheumatoid vasculitis: This condition causes the rheumatoid arthritis patient’s blood vessels to be inflamed. It can affect blood vessels on the skin, nerves, eyes, heart, finger, and toes. Symptoms of rheumatoid vasculitis include skin sores or ulcers, purplish bruises, pain and gangrene in fingers and toes, loss of feeling or tingling and pain in certain parts of the body, eye pain or redness, blurry vision, chest pain, and abnormal heart rhythms.
7. Neurologic disease: Neurological manifestations of rheumatoid arthritis include entrapment neuropathies (carpal tunnel syndrome, tarsal tunnel syndrome), sensory peripheral neuropathy in the lower extremities, and cervical myelopathy.

Rheumatoid arthritis diagnosis

Early diagnosis means that patients can begin treatment as soon as possible. This helps to slow and even stop the disease from progressing and thus, reduce damage to the joints.

Your doctor would first question your general health and symptoms before conducting a thorough physical examination.

Diagnosis is made based on your reported symptoms, physical examination, and investigations.

In addition to these, the orthopaedic specialist may order the following tests:

• Blood tests
• Joint and organ examination
• X-ray 
• Ultrasound

Rheumatoid arthritis treatment options

Medication and self-management strategies can help treat and manage rheumatoid arthritis. Rheumatoid arthritis medications like disease-modifying antirheumatic drugs and biological response modifiers (biologics) slow the disease. Corticosteroids (prednisone and cortisone) are used to help with pain and inflammation.

Self-management strategies can also help rheumatoid arthritis patients to be in control of their condition. This includes being active and exercising safely, maintaining a healthy weight, protecting joints, and avoiding joint injuries, and seeing your doctor to control and manage the disease.

Make an appointment at Gleneagles Hospitals

If you are experiencing any of the symptoms of rheumatoid arthritis, get in touch with us to find out more about our Rheumatology Services and Orthopaedic Services at your nearest Gleneagles Hospital.

Gleneagles Hospital works with rheumatologists and orthopaedic specialists to assist patients through diagnosis and treatment. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care.