Medical & Legal Information on Rheumatoid Arthritis: Causes & Treatment Options
• Rheumatoid Arthritis Overview
• Who Is at Risk?
• Risk Factors
• Rheumatoid Arthritis Complications
• Signs and Symptoms
• Diagnosing Rheumatoid Arthritis
• Treating Rheumatoid Arthritis
Rheumatoid Arthritis Overview
Rheumatoid Arthritis (RA) is a complex autoimmune disease that commonly affects the joints of the wrists, hands, elbows, feet, ankles and knees. Instead of the immune system protecting the health of the body by attacking invading foreign substances like viruses and bacteria, it misguidedly attacks the body’s joints. The inflammation caused by the disease thickens the lines of the synovium (the inside of a joint) causing pain, swelling and discomfort around and in the joints, not allowing the lining fluids to lubricate around the joint so it can move smoothly.
When the inflammation caused by rheumatoid arthritis goes untreated, it can cause significant damage to the body’s elastic tissue (cartilage) and eventually damage the bones. As the disease progresses, the loss of cartilage minimizes the spacing between the components of the joint making them smaller, painful, unstable, loose and eventually immobile. Over time, the irreversible damage of the joint can cause deformity.
Who Is at Risk?
More than 1.3 males and females in the United States suffer from this chronic disease. Scientists, doctors, and researchers have yet to uncover the specific causes of rheumatoid arthritis and have not developed a cure for the disease.
Women have the greatest risk of developing rheumatoid arthritis, at a rate more than three times higher than men, and are likely to develop the disease younger in life than men do on average. The most common age or individuals begin being affected by the disease occurs between 30 and 60 years of age although both men and women tend to first notice the condition around their 60s.
Scientists have discovered the four potential risk factors related to the onset of rheumatoid arthritis that includes:
- Genetics – Any individual with one or both parents diagnosed with the disease are four times more likely to develop rheumatoid arthritis compared to both men and women in the general population. However, scientists are yet to make the claim that the disease is hereditary. This is because many individuals who are not genetically predisposed to rheumatoid arthritis have developed the disease.
- Hormones – Because women have such a significantly higher potential of developing rheumatoid arthritis, many scientists believe there is a strong correlation between the onset of symptoms involving the disease and changes in female hormones. Some research indicates that the decreasing levels of female estrogen, progesterone and pregnancy hormones occurring later in life might be a potential trigger for the development of rheumatoid arthritis.
- Obesity – Overweight and obese individuals appear to have a higher potential risk of developing rheumatoid arthritis, especially females who have been diagnosed with the condition prior to 55 years of age.
- Environment – Research studies have revealed numerous potential environmental triggers of rheumatoid arthritis that include exposure to secondhand smoke, chemicals, and pollution along with participating in or witnessing traumatic events.
- Lifestyle – Patients experience a specific set of clinical symptoms associated with the onset of rheumatoid arthritis that includes:
- Joint stiffness and pain
- Redness and swelling of the joint
- Symmetrical symptoms that affect each side of the body
- Multiple joint symptoms involving the fingers and hands
- Long-lasting symptoms (six months or more)
- Extensive morning stiffness of the joints lasting 30 minutes or longer
Rheumatoid Arthritis Complications
Specific complications can increase the potential of men and women developing the disease that includes:
- Osteoporosis – Both rheumatoid arthritis and the medications prescribed to treat the disease have a risk of increasing the potential development of osteoporosis, where the bones become weak and prone to fractures.
- Dry Mouth and Eyes – There is a correlation between rheumatoid arthritis and Sjogren’s syndrome which decreases the level of moisture in the mouth and eyes.
- Rheumatoid Nodules – Firm tissue bumps can develop just under the skin around joint pressure points or deep within the body including in the lungs.
- Carpal Tunnel Syndrome – The disease can cause information to the wrists by compressing nerves used by the fingers and hands.
- Infection – Rheumatoid arthritis and drugs used to treat the disease can affect the immune system, making the body more susceptible to infections.
- Lung Disease – Rheumatoid arthritis has the potential of increasing the risk of scarring and inflammation of lung tissues causing ongoing shortness of breath.
- Heart Conditions – Studies show there is a correlation between blocked and hardened arteries and rheumatoid arthritis.
- Lymphoma – The disease has the potential of increasing the risk of developing lymphoma (lung system cancer).
- Abnormal Body Mass Index – There is a correlation between rheumatoid arthritis and a disproportionate amount of fat compared to lean mass.
Signs and Symptoms
There are significant symptoms associated with the onset development of rheumatoid arthritis that includes:
- Swollen, warm and tender joints
- Unexplained weight loss
- Ongoing fever
- Chronic fatigue
- Joint stiffness
- Malaise and illness
- Loss of appetite
Typically, the small joints are affected during the onset of the disease, particularly in the finger, hand and toe joints. Over time, the progression of the disease tends to spread the symptoms to the wrists, elbows, ankles, knees, shoulders and hips. Many individuals experience the pain, swelling, and discomfort on both the right and left side of the body. Approximately four out of every ten individuals suffering from rheumatoid arthritis also experience other symptoms that affect non-joint structures including:
- Bone marrow
- Nerve tissue
- Salivary glands
- Blood vessels
The severity of the symptoms often varies greatly during different stages of the disease’s progression. Even so, many individuals experience remission followed by increasing flares of symptoms where the pain and swelling greatly intensified.
Diagnosing Rheumatoid Arthritis
Doctors are often challenged to diagnose rheumatoid arthritis in its onset stage because many of the symptoms associated with the disease mimic other conditions. A diagnostician will perform a comprehensive physical exam, obtain a complete family history and check the patient’s joints for warmth, redness, and swelling, along with muscle strength and reflexes.
The doctor will also conduct a wide-ranging blood test to look for (anti-CCP) anti-cyclic citrullinated peptide and other rheumatoid factor antibodies. Additionally, the doctor may recommend the patient undergo an ultrasound test, MRI (magnetic resonance imaging) and x-rays to determine the progression of the disease.
Treating Rheumatoid Arthritis
No cure has been found for rheumatoid arthritis. However, the disease can be treated using one or more medications, therapies, surgical procedures and alternative treatments.
- Medications – The doctor may consider recommending NSAIDs (non-steroidal anti-inflammatory drugs to reduce inflammation and relieve pain. The doctor might also prescribe corticosteroids like prednisone to slow joint damage, minimize pain and reduce inflammation, or DMARDs (disease modifying antirheumatic drugs) like Trexall, Rasuvo, Otrexup, Arava, Plaquenil, and Azulfidine) and biological response modifiers (Orencia, Humira, Enbrel, Rituxan, Simponi, Cimzia, and Kineret) to slow the disease’s progression and save the joints.
- Therapy – Occupational or physical therapy can help exercise the joints to keep them flexible.
- Surgery – Surgical options are available including a synovectomy to remove synovium after it becomes inflamed, along with tendon repair, total joint replacement or joint fusion.
Alternative treatments are also available that can relieve many of the signs and symptoms associated with rheumatoid arthritis.