rheumatoid-arthritis
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Rheumatoid Arthritis

Rheumatoid Arthritis

Last Reviewed : 12/29/2020
Rheumatoid Arthritis

  • Rheumatoid arthritis or RA, is an autoimmune and inflammatory disease, in which body's immune system attacks its own healthy cells, causing inflammation in affected parts of the body. 
  • Rheumatoid arthritis (RA) is estimated to affect approximately 0.24 to 1 percent of the population. The disease occurs in all racial and ethnic groups, but affects two to three times as many women as men.
  • Rheumatoid arthritis is more commonly found in older individuals, although the disease typically begins in middle age. Children and young adults can also be affected.

 

RA mainly attacks the joints, usually many joints at once. RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness and deformity. RA may also cause you to feel unusually tired, to have occasional fevers, and to have a loss of appetite. 

RA can also affect other tissues throughout the body and cause problems in organs such as the lungs, heart, and eyes.

Signs and symptoms of RA include:

  • Pain or aching in more than one joint.
  • Stiffness in more than one joint.
  • Tenderness and swelling in more than one joint.
  • The same symptoms on both sides of the body (such as in both hands or both knees).
  • Weight loss.
  • Fever.
  • Fatigue, or tiredness.
  • Weakness.

There are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.

Risk factors for RA:

  • Age. RA can begin at any age, but the likelihood increases with age. The onset of RA is highest among adults in their sixties.
  • Sex.  New cases are two-to-three times higher in women than men.
  • Genetics/inherited traits. People born with specific genes are more likely to develop RA. These genes, called HLA (human leukocyte antigen) class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
  • Smoking. Cigarette smoking increases a person’s risk of developing RA and can make the disease worse.
  • History of live births. Women who have never given birth may be at greater risk of developing RA.
  • Early Life Exposures. Some early life exposures may increase risk of developing RA in adulthood. Per studies, children whose mothers smoked had double the risk of developing RA as adults. Children of lower income parents are at increased risk of developing RA as adults.
  • Obesity. Being obese can increase the risk of developing RA. 

Unlike the risk factors above which increase risk of developing RA, Breastfeeding decreases risk of RA in women. 

 

How is RA diagnosed?

RA is diagnosed by reviewing symptoms and then by doing physical examination, X-rays and lab tests. 

How is RA treated?

Treatments can help slow or stop disease progression and help people with the disease to lead productive lives. Outcomes are better if  treatment is started early ( esp within 6 months of onset of symptoms). 

Treatment for RA usually includes,

1. Medications which slow disease and prevent joint deformity,

   a. Disease-modifying antirheumatic drugs (DMARDs) are first line drugs ( Common DMARDs include methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).

   b. Biological response modifiers ( biologicals like abatacept(Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) infliximab (Remicade), rituximab (Rituxan, MabThera), sarilumab (Kevzara) and tocilizumab (Actemra) etc are medications that are an effective second-line treatment. 

2. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help with joint pain and inflammation. Corticosteroids are used on a short-term basis to help with inflammation.

   -In addition to medications, self-management strategies are proven to help people manage RA and reduce pain and disability, allowing them to perform daily activities. 

3. Surgery, such as joint replacement surgery helps people with severe joint damage that limits joint function.

People with RA are also at a higher risk for developing other diseases such as heart disease, lung disease, diabetes, infections, lymphoma, osteoporosis etc. 

 

 

People with RA can relieve pain and improve joint function by learning to use five simple and effective arthritis management strategies.

For more information about the treatment of RA, review the Clinical Practice Guidelines for the Treatment of Rheumatoid ArthritisExternal from the American College of Rheumatology (ACR) or the ACR’s Rheumatoid Arthritis Patient pageExternal.

Source: American college of Rheumatology, National institue of arthritis and muscoloskeletal and skin diseases, centers for disease control and prevention. 

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