Rheumatoid arthritis is a condition which relates to inflammation of the joints often resulting in pain, redness, swelling, and stiffness in the joints. Rheumatoid arthritis may also cause inflammation of the tissues surrounding the joints like ligaments, muscles and tendons.
The term arthritis is referred to as joint inflammation. Rheumatoid arthritis is a type of autoimmune disease causing chronic inflammation of the joints. Due to the characteristic features like inflammatory arthritis and inflammation of the tissue surrounding the joints, rheumatoid arthritis may also injure or inflame the other organs in the body.
Autoimmune diseases are those diseases which are caused when the immune system attacks the healthy tissues of the body. The immune system consists of a complex organization of the antibodies and cells which helps in destroying the invaders of the body such as infections. Individuals suffering with autoimmune diseases contain antibodies in their blood which often target the tissues of the body resulting in inflammation of the joints.
Rheumatoid arthritis can affect multiple organs of the body hence it is also referred to as a systemic illness or rheumatoid disease.
Rheumatoid arthritis is a chronic disease which usually continues for many years. Due to the slow progression of rheumatoid arthritis, the patients may not experience the symptoms for a long duration. Once the disease progresses, it leads to severe functional disability and joint destruction.
Sometimes patients with rheumatoid arthritis often suffer with chronic inflammation which results in damaging of the bone, ligaments, and cartilage leaving the joints deformed. Rheumatoid arthritis affects the joints as it progresses further though the pain, stiffness or swelling of the joints may not necessarily correlate with the degree of damage occurred.
- Juvenile Rheumatoid Arthritis: Juvenile rheumatoid arthritis refers to arthritis that affects individuals in the age group of 16 years or less. Juvenile rheumatoid arthritis can be of different types which specifically affects children. Juvenile rheumatoid arthritis is classified into three types:
- Pauciarticular Juvenile Rheumatoid Arthritis: This type is very mild in nature. The pain in up to four joints is often experienced by the child.
- Polyarticular Juvenile Rheumatoid Arthritis: This type is quite severe in nature. In this type, many joints get affected. The condition also gets worse with passage of time.
- Systemic Juvenile Rheumatoid Arthritis: This is the most severe type of juvenile rheumatoid arthritis. In this type, the pain is felt in several of the joints. This may also spread to the other organs of the body.
- Systemic Lupus Erythematosus: Systemic lupus erythematosus is an autoimmune disease. The immune system becomes overactive and damages the healthy tissues of the body. Systemic lupus erythematosus is a chronic disease which often includes skin rash, weakness and fatigue, muscle aches, joint pain, stiffness and inflammation.
- Ankylosing Spondylitis: Ankylosing spondylitis is a type which mainly affects back and the spine. In ankylosing spondylitis, the joints and ligaments around the spine become inflamed creating difficulty for the movement of the spine. The spinal bones may also fuse together. The joints often become stiff due to ankylosing spondylitis, which may include the shoulders, hips, and knees. Although ankylosing spondylitis is a chronic disease, this can be managed with medications, attention to posture, patient education and exercise.
Epidemiology of Rheumatoid Arthritis (Chronic Inflammation of Joints)
Rheumatoid arthritis is a very common rheumatic disease all over the world. All the races equally get afflicted by rheumatoid arthritis. Approximately 1.3 million individuals in the United States get affected with rheumatoid arthritis. Women are noted to be affected three times more when compared to men with rheumatoid arthritis. Rheumatoid arthritis may affect people at any age, even in childhood such as juvenile rheumatoid arthritis. Rheumatoid arthritis often affects individuals in the age group of 40 to 60 years.
Causes and Risk Factors of Rheumatoid Arthritis (Chronic Inflammation of Joints)
The main cause of rheumatoid arthritis is still not known, however there are few uncertain reasons such as fungi, viruses and bacteria which have been suspected for causing this disease but this could not be taken as an accurate cause for developing rheumatoid arthritis.
- Rheumatoid arthritis may be caused at any age. Middle age individuals often get affected with this disease.
- Women easily get affected with rheumatoid arthritis than men.
- Rheumatoid arthritis may be caused due to infections spread through environmental exposure which often activates the immune system in susceptible people. The affected immune system further damages the healthy tissues of the body.
- The misdirected immune system may also lead to inflammation of the joints and sometimes eyes or lungs may also get affected.
- Few individuals may genetically develop the condition of rheumatoid arthritis as certain genes are suspected to result in rheumatoid arthritis.
Signs and Symptoms of Rheumatoid Arthritis (Chronic Inflammation of Joints)
Rheumatoid arthritis equally affects the joints on both sides of the body. The joints which often get affected may include knees, feet, wrists, ankles and fingers. Rheumatoid arthritis usually starts slowly with fatigue, stiffness and minor joint pains. Some of the common symptoms may include:
- Stiffness, which is often experienced in the morning hours which may continue up to an hour.
- Warmth, tenderness and stiffness over the joints when not in use for an hour.
- Pain in the joints on both sides of the body may also be experienced.
- Range of motion of the joints may reduce over time.
- Chest pain while breathing.
- Dryness in the mouth and eyes may also be experienced.
- Discharge from the eyes with itching and burning.
- Development of nodules under the skin could also be noted.
- Burning, numbness and tingling in the feet and hands.
- Difficulties with sleep.
Treatment for Rheumatoid Arthritis (Chronic Inflammation of Joints)
The procedure for treating rheumatoid arthritis is very lengthy which usually involves medications, physical therapy, exercises, education, and probably surgery. Aggressive treatment in the early stages of rheumatoid arthritis can delay joint destruction.
Medications for Rheumatoid Arthritis (Chronic Inflammation of Joints)
Given below are few of the commonly used medications.
- Analgesics: Analgesics help in decreasing the pain, but they do not have any antiinflammatory effects. Few of the analgesics include tramadol, narcotics containing hydrocodone such as Vicodin and Lortab or oxycodone such as Percocet and Oxycontin, and acetaminophen drugs such as Tylenol.
- Disease-modifying Antirheumatic Drugs (DMARDs): These drugs are frequently used for the treatment of rheumatoid arthritis. DMARDs often help in slowing down the immune system from damaging the joints of the body. DMARDs may include hydroxychloroquine and methotrexate. Methotrexate is very commonly taken DMARD for rheumatoid arthritis. These drugs must be taken with special care due to their severe side effects. Regular blood tests may be required for continuous monitoring and watching out for side effects.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs help in reducing both inflammation and pain. Generally, NSAIDs include naproxen and ibuprofen such as in Motrin and Advil. Oral NSAIDs often lead to irritation of the stomach, and may sometimes increase the risk of stroke and heart attack. NSAIDs may also be found in the form of gels and creams to gently rub on the joints.
- Antimalarial Medications: Antimalarial medications may include hydroxychloroquine which is often used with the combination of methotrexate.
- Corticosteroids: Corticosteroids include cortisone and prednisone which help in suppressing the immune system and reducing the inflammation. Corticosteroids are either consumed orally or injected into the affected joint.
- Biologic Response Modifiers: Biologic response modifiers are the drugs that target the protein molecules present during an immune response. Examples of biologic response modifiers are infliximab and etanercept. Biologic response modifiers are mostly given subcutaneously i.e. under the skin or intravenously i.e. directly into the vein.
Surgery for Rheumatoid Arthritis (Chronic Inflammation of Joints)
Surgery is required in severe cases only when conservative measures fail to work properly. Given below are few of the different forms of surgeries performed.
- Joint Replacement: This procedure is performed by removing the affected joint and replacing it with an artificial joint. The most frequently replaced joints are the knees and the hips.
- Joint Fusion: This procedure is more frequently performed for the small joints like as those in the fingers, wrist and ankle. This is performed by placing the ends of the two bones of the infected joint locking them together and holding them until they unite and heal to form one single bone.
- Synovectomy: Synovectomy is performed for removing the inflamed tissue of the joint i.e. synovium. Synovectomy is often performed by using arthroscopy.
Watch 3D Video of Knee Joint Rheumatoid Arthritis:
Physical Therapy for Rheumatoid Arthritis (Chronic Inflammation of Joints)
Physical therapy is really helpful in treating rheumatoid arthritis. Performing exercises often improves range of motion, reduces pain, and improves joint flexibility. This also strengthens cartilage tissues, bones and joints surrounded by the muscles. Assistive and supportive devices like splints, braces, cane, walker, crutches and elastic bandages may also be used. Heat or ice is also applied to the affected joints periodically during daytime.
Additional modalities such as ultrasound and electrical stimulation are also used to alleviate the pain.
Investigations for Rheumatoid Arthritis (Chronic Inflammation of Joints)
There is no particular test available to diagnose rheumatoid arthritis, however, some of the tests, which may help in diagnosing rheumatoid arthritis are given below.
The Lab Tests Which Often Assist in Diagnosing Rheumatoid Arthritis May Include:
- Anti-CCP antibody test.
- Rheumatoid factor test.
- Erythrocyte sedimentation rate.
- Synovial fluid analysis.
- Complete blood count.
- C-reactive protein.
Other Tests May Include:
- Joint x-rays.
- Joint ultrasound or MRI.