Rheumatoid Arthritis (RA)

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints.  RA can also affect the tissues and organs and can cause inflammation in the lungs, pleura and pericardium.

It is believed that;

  • About 1% of the world's population is afflicted by rheumatoid arthritis
  • Women are three times more likely to suffer from the condition than men
  • Onset is most frequent between the ages of 40 and 50, but people of any age can be affected

It is primarily diagnosed on the presentation of a series of signs and symptoms. Additionally, a blood test, called rheumatoid factor, supports the diagnosis. Xrays may also be used. Diagnosis and long term management are typically performed by a rheumatologist who is an expert in the diseases of joints and connective tissues.

To understand the process of rheumatoid arthritis, it is first helpful to understand the anatomy of the joints.

A joint is a union between two bones.  The bone ends articulate with one another to allow movement.  The surface ends of the bones that form a joint are covered with a lining known as cartilage.  The cartilage is lubricated by a thick, slippery fluid called synovial fluid.  The joint is then surrounded by a joint capsule that forms a wall to keep the fluid within and further protect the cartilage and joint integrity.  Ligaments additionally support the joint and attach bone to bone.  Tendons (which attach muscle-bone) allow the muscles to move the bones that make up the joint.
The diagram below, you will see a ‘normal’ joint.  The image on the right clearly displays the attack on the articular cartilage and ankylosis of the joint

The exact cause of rheumatoid arthritis is unknown however it is believed that autoimmunity plays a pivotal role in its chronicity and progession. Autoimmunity means that the white cells and antibody proteins in your blood that usually fight infections enter your joints and cause inflammation. This causes heat, swelling and excess fluid to be produced.

Some believe that genes, environment and hormones may contribute.

Rheumatoid arthritis is normally a slow, progressive condition.  People will initially notice discomfort in a few joints such as the fingers, knuckles, wrist or balls of your feet. RA is typically a ‘symmetrical’ arthritis – this means that you will experience symptoms in both hands or feet.
For a few, RA will develop quickly and painfully and can cause major upset to everyday activities until it is correctly managed.
There are a few classic symptoms highlighted below, but ultimately RA will affect everyone differently.

  • Inflammation around the affected joint(s) include pain and swelling making it tender and warm
  • stiffness in the morning, or following a period of inactivity
  • poor grip strength
  • tiredness, making you feel irritable and depressed
  • flu-like symptoms such as fever
  • weight loss
  • rheumatoid nodules – fleshy lumps

Some people will experience flare-ups with no symptoms in between. Flare-ups are often unpredictable in pattern and intensity.

There is no cure for rheumatoid arthritis. However, the symptoms can be eased and/or managed with the advice below;

Balance – it is important to find the correct balance between rest and exercise.  It is vital that you exercise your joints from becoming stiff and weak and find a balance so as not to overdo things.  Swimming is a great way to stay active and does not load the joint(s).

  • Physiotherapy can assist in creating a daily rehab program to ensure that you manage your symptoms.  Physiotherapy can also offer advice on the correct form of exercise for you.

Medication is extremely useful to help control the inflammatory nature of the condition.  Your rheumatologist will be able to advise on the most appropriate medication for you and your symptoms.  Medications include:

  • Pain killers e.g. paracetamol/cocodamol
  • Non-steroidal anti-inflammatory drugs (NSAIDs) help reduce the symptoms of inflammation relieving pain and swelling
  • Disease-modifying anti-rheumatic drugs (DMARDs) slow down the progression of RA and will help ease its symptoms.

Injections – corticosteroid injections are sometimes injected into a specific joint to help reduce inflammation

Acupuncture can be used in additional or as an alternative pain relief.

Surgery – as understanding of the condition improves, surgery is less likely needed. However, if you have severely damaged joints or medicines haven’t help then one of the following may be suggested;

  • Joint Replacement
  • Joint Fusion to make the joint more stable and
  • Synovectomy to remove the lining of the inflamed joint
  • Removal or repair of a damaged tendon