What Is Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation in the joints. This happens when the body’s immune system starts attacking itself instead of foreign pathogens, such as bacteria or viruses.
The result is a thickening of the lining inside the joints, causing swelling and pain. Over time, RA can cause a loss of cartilage and bone, as well as joint deformity.
About 1.5 million Americans have RA. It’s almost three times more common in women than in men. Women usually develop this disorder between the ages of 30 and 60, and men usually develop it later in life.
What Are the Symptoms of RA?
Symptoms of RA include:
- warm, sore, and swollen joints
- body stiffness, especially in the mornings, that can last for several hours
- hard lumps (rheumatoid nodules) under the skin on the arms
- unintentional weight loss
RA usually affects the body’s smaller joints first, especially the joints in the fingers and toes. Over time, RA may also spread to the following joints:
RA may also affect more than your joints. Symptoms in other parts of the body may include:
- blood vessels
RA can present itself in different ways. However, symptoms are usually symmetrical, meaning they affect the same parts of the body on both sides at the same time. Also, symptoms often come and go.
What Causes RA?
The exact cause of RA is unknown, but like many autoimmune diseases, it is likely caused by several different factors that may be genetic or environmental.
Certain genetic markers put you at a greater risk for developing the disease. Other factors are still being studied, such as obesity and environmental triggers.
How Do Hormones Affect RA?
Medical experts have been investigating links between RA and hormone levels. For women, maintaining normal levels of the reproductive hormones estrogen and progesterone appear to have a protective effect against RA.
Research on a small group of middle-aged women with RA found that they tended to report fewer joint symptoms during the postovulatory stage of their menstrual cycles and during pregnancy. These events cause the levels of estrogen and progesterone to increase.
Women with RA also reported that their symptoms worsened after childbirth and during the second week of their menstrual cycles when reproductive hormone levels were lowest.
The levels of reproductive hormones in women’s bodies decrease with age. Women who are approaching or who have gone through menopause have decreased levels of these hormones. Some researchers believe that’s why this group of women experience RA more than any other segment of the population. This is also why some doctors recommend women experiencing menopause begin hormone replacement therapy (HRT).
Research suggests that HRT, which involves using a combination of progesterone and oestrogen, can decrease the overall activity of a woman’s RA.
However, it may increase the intensity of disease flare-ups when they do occur. There are also some possible side effects that include:
- fluid retention
- breast tenderness or swelling
- mood swings
It’s important that you understand the possible side effects of HRT before you start treatment.
Other RA Treatments
Joint damage may affect many parts of the body. Because the damage can’t be reversed, doctors have found that early diagnosis and treatment usually provide the best outcome.
There is no cure for RA, so the main goals of treatment are to control symptoms and prevent further joint damage. Common RA treatments include:
- nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and stop inflammation
- steroids to decrease pain and inflammation
- disease-modifying antirheumatic drugs to slow down the progression of RA
- biologic agents to stop certain parts of the immune system from triggering inflammation
It’s important to discuss the benefits and side effects of each medication with your doctor when deciding on a treatment plan.
A physical therapist can teach you exercises that will help keep your joints flexible, which may alleviate some RA symptoms. Physical therapists may also suggest easier ways to perform daily activities and show how to use assistive devices such as vanes and buttonhooks.
In very severe cases, surgery is used to replace joints that are significantly damaged. Surgery may allow a person with RA to regain their ability to use a damaged joint. It may also reduce pain and fix any joint deformities caused by RA. There are several surgical procedures that include:
- Total joint replacement: Damaged parts of a joint are removed and replaced with prosthetic joints made of metal and plastic.
- Tendon repair: Tendons that may have ruptured or are at high risk of rupturing around affected joints are repaired.
- Joint fusion: One joint is fused to another bone or joint to make it more stable and to relieve pain. This option is used when joint replacement isn’t possible.
As with most surgeries, RA surgeries come with the risks of bleeding, infection, and pain. It’s best to review the risks and benefits of surgery with your doctor.
There is still a limited understanding of the link between female hormones and RA. More research is needed to determine if establishing certain hormone levels can effectively prevent or alleviate a woman’s RA symptoms.