Rheumatoid arthritis (RA) is an autoimmune disease where the immune system – which normally defends your body from bacteria, viruses and damaged cells in the body – attacks healthy joints. It is not due to “wear and tear”.
RA results in inflammation of multiple joints, resulting in pain, stiffness and swelling. RA tends to affect small joints of the hands, wrists, elbows, shoulders, knees, ankles and toes. In some patients, it may also affect other organs such as the lungs, eyes, skin and heart.
If left untreated, the inflammation can lead to significant joint deformity and loss of function.
Whilst RA can happen at any age, it most commonly occurs between the age of 25 and 40. It affects women more commonly than men.
The first symptoms of RA are pain and swelling, accompanied by joint stiffness, especially in the mornings. The pain and stiffness can last for hours and usually involve the joints on both sides of the body. Typically, the fingers and wrists are the first to be affected, but in some patients, other joints such as the knees, or toes may be affected first.
There may also be other symptoms related to the amount of inflammation present – these include low-grade fever, tiredness and loss of weight and appetite.
In advanced RA, there are joint deformities as most of the joint surface is destroyed. This is what we are trying to prevent.
There is no proven cause for RA but there are various theories involving genetic and environmental factors. A disorder in the immune system or an over-reaction to an unknown trigger such as a virus infection can set off the condition.
In normal circumstances, your body’s immune system helps to fight infection. However in RA, your immune system mistakenly sends signals to and attacks the lining of your joints, resulting in inflammation – hence the term “autoimmune disease”.
Some risk factors for Rheumatoid Arthritis (RA) are:
1. A positive family history – this highlights the contribution of genetic factors. If one of your family members has RA, you may have an increased risk of the disease.
2. Smoking – cigarette smoking increases your risk of developing RA and also increases the severity.
3. Being overweight
4. Gender – women are at a higher risk of developing RA than men. This could be related to hormonal factors.
As with many other chronic diseases, while there is no cure as yet for RA, it is a treatable condition and can be effectively managed with medications and other strategies. It is advised that you consult your doctor for an individually tailored treatment plan as not all medications may be suitable for you.
a. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the joint inflammation, and thereby improve the pain and swelling that you might experience. These drugs, however, will only control your symptoms and have no effect on stopping the progression of the disease.
b. Disease-modifying anti-rheumatic drugs (DMARDs) are prescribed to slow the progression of RA and protect the joints from further irreversible damage. As they may take some time to work, steroids are often prescribed concurrently to control inflammation in the initial stages. Some examples of DMARDs include methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide.
c. Biologic agents and small molecules which can control the disease quickly and effectively, are prescribed for patients who are intolerant of or have poor response to DMARDs. Whilst effective, they can be more expensive. Not everyone with RA would need or are suitable for such medications.
2. Exercise and physiotherapy is important for rebuilding of the muscles and ligaments that have been weakened by arthritis. This helps to stabilise the joints. Your doctor would typically recommend you to a physiotherapist who would teach you specific exercise routines. You would be advised to follow the exercises prescribed at home.
3. Surgery may sometimes be needed to correct joint deformity or replace a joint that has been destroyed by the arthritis.
A healthy and balanced diet, regular exercise, regular dental check-ups and avoidance of smoking may help prevent and reduce the severity of RA. Consulting a doctor early for consideration of treatment may help prevent joint deformities and disabilities. RA is a chronic disease and you will require regular long term follow-up. This may mean more frequent visits in the early stages.
At each visit, your doctor may order blood tests to monitor the state of your condition and also to assess if you have any problems with your medications. It is important to discuss the treatment options with your doctor and ensure that you take the medications as prescribed.