What Causes Rheumatoid Arthritis?
Rheumatoid arthritis (RA) is an autoimmune disorder (the body's immune system mistakenly attacks its own cells). The exact cause of RA is unknown. However, it may have a genetic predisposition along with environmental triggers.
Certain factors increase the risk of RA. Common risk factors include the following:
- Sex: Women are at a higher risk of RA than men. The incidence is four to five times higher in women younger than 50 years of age. However, between 60 and 70 years, the female/male ratio is only about 2.
- Age: RA most commonly begins in middle age. In some cases, RA may begin in teens younger than 16 years (juvenile RA) of age.
- Family history: A positive family history increases the risk of RA.
- Obesity: Women younger than 55 years of age with obesity are at a higher risk of RA than men.
- Smoking and other environmental exposures: Environmental exposure to asbestos or silica and smoking are common risk factors for RA.
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically affects the joints and other body systems such as the skin, eyes, lungs, heart, and blood vessels. RA is an autoimmune disorder, which means a condition in which the body's immune system attacks its own body tissues.
Osteoarthritis occurs as a result of wear and tear of the joints, whereas RA affects the lining of the joints, leading to inflammation, pain, and swelling that eventually leads to bone erosion and joint deformities. RA causes inflammation and damages other parts of the body.
RA is a chronic disease with multiple flare-ups of signs and symptoms and periods of remission (asymptomatic periods). Initially, the small joints are affected, especially the joints of the fingers and toes. As the disease progresses, other joints may be affected such as the wrists, knees, ankles, elbows, hips, and shoulders. Additionally, RA occurs with systemic signs and symptoms, and body systems other than joints may be affected in 40% of the cases. If not diagnosed early and appropriately treated, RA can lead to permanent deformities, disabilities, and serious systemic complications. Although newer medications have improved treatment options dramatically, severe RA can still cause physical disabilities.
What are the signs and symptoms of rheumatoid arthritis?
Signs and symptoms in the joints include the following:
- Tender, warm, and swollen joints
- Joint stiffness that is usually worse in the mornings and after inactivity
- Loss of joint function
- Joint deformities
Systemic signs and symptoms are as follows:
- Fatigue
- Fever
- Loss of appetite
- Loss of weight
- Vasculitis (inflammation of the blood vessels)
- Ulcers
- Muscle wasting
- Anemia
- Scleritis (inflammation of the sclera or white of the eyes)
- Pericarditis (Inflammation of the outer covering of the heart)
- Myocarditis (Inflammation of the heart muscles)
- Neuritis (inflammation of the nerves)
What happens if you go untreated for rheumatoid arthritis?
If rheumatoid arthritis (RA) is not diagnosed and appropriately treated, the disease can progress leading to complications and disabilities.
Complications of RA include the following:
- Osteoporosis: Weakening of the bones, making them more prone to fractures.
- Rheumatoid nodules: Firm bumps of tissue around the pressure points of joints, lungs, etc.
- Sjogren's syndrome: An autoimmune disorder that attacks the glands making tears and saliva, causing dryness of eyes and mouth.
- Infection: Systemic infections can occur due to disease or medication.
- Weight gain
- Carpal tunnel syndrome: Inflammation can compress the nerve that supplies the hand and fingers.
- Cardiac (heart) complications: Pericarditis (Inflammation of the outer covering of the heart) and myocarditis (Inflammation of the heart) can occur.
- Lung complications: Scarring of the lungs (fibrosis) causes breathing difficulty.
- Lymphoma: RA increases the risk of lymphoma (blood cancers that develop in the lymph system).
What are treatments for rheumatoid arthritis?
There is no cure for rheumatoid arthritis (RA). There are various treatment options available to control the progression of the disease and prevent complications. Treatment may usually involve a combination of more than one treatment modality. Treatment options are as follows:
Medications
- Nonsteroidal anti-inflammatory drugs: These can relieve pain and reduce inflammation.
- Steroids: Corticosteroid medications suppress the immune system and reduce inflammation, pain, and joint damage.
- Disease-modifying antirheumatic drugs (DMARDs): These drugs are effective in the treatment of RA. They suppress inflammation and relieve symptoms. They can slow the progression and prevent joint deformities and systemic complications. Some commonly prescribed DMARDs are methotrexate, hydroxychloroquine, sulfasalazine, and Arava (leflunomide).
- Biological modifiers: These are a newer generation of DMARDs and usually taken with other DMARDs. They suppress inflammation. Some commonly used biological agents are infliximab, rituximab, etc.
- Patients are usually referred for physical or occupational therapy to learn exercises to improve and maintain joint flexibility and for the rehabilitation of joints.
- Doctors may perform surgical procedures to help restore joint function and anatomy and reduce pain.