What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune disease that mainly attacks the synovial tissues within the joints. Autoimmune diseases occur when the body’s immune system mistakes its own tissues for foreign invaders, such as bacteria or viruses. The confused immune system develops antibodies to seek out and destroy the “invaders” in the synovium.
RA is a systemic disease, which means it can affect the whole body. It can attack organs, such as the heart, the lungs, or other tissues like muscles, cartilage, and ligaments. RA causes chronic swelling and pain that is sometimes severe, and it can cause permanent disability.
Symptoms and risk factors
At the onset of RA, you might notice that small joints like your fingers and toes are warm, stiff, or swollen. These symptoms might come and go, and you may think it’s nothing. RA flare-ups can last just a few days or a few weeks before they disappear again.
Eventually, RA will affect larger joints, such as hips, shoulders, and knees, and the period of remission will shorten. RA may damage joints within three to six months of onset. Sixty percent of people with inadequately treated RA are unable to work 10 years after onset.
Other symptoms associated with RA include:
- low-grade fevers
- pain and stiffness for longer than 30 minutes in the morning or after sitting
- weight loss
- rheumatoid nodules, or firm lumps, beneath the skin, primarily in the hands, elbows, or ankles
RA can be hard to diagnose because the types and severity of symptoms vary from person to person. They’re also similar to symptoms of other types of arthritis, which makes misdiagnosis possible.
The cause of RA is unknown, but a number of risk factors could contribute, such as:
- lifestyle (for example, smoking)
Women are about two to three times more likely to get RA than men. Hormones in both genders may play a role in either preventing or triggering it.
RA generally starts between the ages of 30 and 60 in women and somewhat later in life in men. The lifetime risk of developing RA is 3.6 percent for women and 1.7 percent for men. However, RA can strike at any age — even small children can get it.
RA increases the risk of heart disease or stroke, because it can attack the pericardium (lining of the heart), and cause inflammation through out the body. Risk of heart attack is 60 percent higher one year after being diagnosed with RA than it is without the disease.
People with RA may avoid exercise because of joint pain, risking weight gain and placing extra strain on the heart. People with RA are twice as likely to suffer from depression, which may be due to decreased mobility and pain.
The damage RA can do isn’t limited to the joints. The disease also can affect your:
- vascular system
Infections may be responsible for one quarter of deaths in people with RA.
Although there is no cure for RA, there are many different treatment options that can successfully relieve symptoms and prevent long-term joint damage. Doctors may prescribe medication, lifestyle changes, or a combination of both, with a goal of achieving a state of remission.
There are currently four different drug classes used for treatment of RA:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), the mildest class of medications, primarily work to reduce pain by reducing inflammation, but don’t effect the progression of RA.
- Corticosteroids more powerfully work to quickly decrease inflammation, and are ideally for short-term usage.
- Disease-modifying antirheumatic drugs (DMARDs), the most standard RA treatment, work to slow down the progression of RA, but may cause moderate to severe side effects.
- Biologic response modifiers (biologic DMARDs), often used in combination with DMARDs, work to modify immune systems that have trouble responding to DMARDs.
A recent approach to treatment for RA suggests the use of aggressive treatment in the early stages of the onset of RA in order to prevent it from graduating to a more serious and long-lasting state.
Living with RA can be not only physically taxing, but also emotionally taxing as well.
It’s suggested for people with RA to find a balance between rest and exercise to keep their inflammation down while continuing to maintain strength and flexibility. Your doctor will generally recommend certain exercises beginning with stretching, and then working up to strength training, aerobic exercises, water therapy, and tai chi.
Experimenting with dietary changes, such as elimination diets, can help people with RA discover certain foods that may trigger or relieve RA symptoms. There is some scientific evidence correlating diet and RA treatment, such as decreasing sugar, eliminating gluten, and increasing omega-3’s. There are also many herbal remedies used for the treatment of RA, although the current scientific research that proves their effectiveness remains controversial.
Because many people living with RA often experience chronic pain, it can be very beneficial to learn stress management and relaxation techniques, such as guided meditation, mindfulness, breathing exercises, biofeedback, journaling, and other holistic coping modalities.
RA can make simple tasks like getting out of bed and getting dressed in the morning challenging, let alone holding down a regular job. People with RA are more likely to:
- change occupations
- reduce their work hours
- lose their job
- retire early
- be unable to find a job (compared to people without RA)
A study from 2000 estimated that RA costs $5,720 per person who has the disease every year. Annual medication costs can reach $15,000 to $20,000 per person treated with a biologic agent, even though there are multiple options.
In addition to the financial costs of this disease, the cost of quality of life is high. Compared to those without arthritis, people with RA are more likely to:
- report fair or poor general health
- need help with personal care
- have health-related activity limitation
RA doesn’t have a cure at this time. Many effective treatments have been developed over the last 30 years, but none of them “cure” RA. Instead, they aim to lower inflammation and pain, prevent joint damage, and slow the progression and damage of the disease.