Causative & risk factors
Rheumatoid arthritis is an autoimmune condition i.e. the body attacks itself by producing antibodies against its own cells.
The etiology of RA has a genetic component and is hence more common in some families.
Certain races have a higher prevalence of RA especially Caucasians.
Women are more prone to developing RA.
Cigarette smoking is associated with a higher risk of developing Rheumatoid arthritis.
Severe bacterial/viral infections and environmental factors may predispose to RA
Clinical presentation (with complications)
Rheumatoid arthritis presents with bilateral symmetrical involvement of joints and also other symptoms affecting other body systems.
The typical onset of RA is a gradual onset of pain and swelling in the small joints of hands, wrists and feet symmetrically. In the elderly, RA may present suddenly with morning stiffness of joints, pitting edema and multiple joint pains.
The fingers and toes are commonly affected giving rise to swelling, tenderness and various deformities. The commonly found deformities include hitchhiker’s thumb, swan neck deformity and clawed toe deformity.
The American Rheumatism Association has laid down certain criteria to make a diagnosis of RA. At least 4 or more of the following symptoms must be present:
Morning stiffness lasting more than 1 hour
Arthritis of 3 or more joint areas
Arthritis of hand joints
Symmetrical arthritis
Rheumatoid nodules
Rheumatoid factor
Radiological changes
Duration of 6 weeks or more
RA produces several extra-articular or non-joint symptoms such as:
General – Fever, weakness, undue weight loss
Musculoskeletal – Bursitis, muscle wasting, tenosynovitis
Eyes – Episcleritis, scleritis
Heart – Myocarditis, pericarditis, endocarditis
Lungs – Pleural effusion, bronchiolitis
Blood – Anemia, thrombocytopenia
Blood vessels – Arteritis, ulcer formation
Neurological – Compression neuropathies, peripheral neuropathies
Skin – Subcutaneous rheumatoid nodules can be found on the forearm, sacrum, toes and Achilles tendon.
Patients of RA have a high disability rate. Statistics suggest that the average lifespan is reduced by 8-15 years by RA.
Investigations
The diagnosis of Rheumatoid arthritis is made on the fulfillment of criteria laid down by the American Rheumatism Association.
The RA factor may be detected in the blood of some patients. However absence of RA factor does not rule out Rheumatoid arthritis.
X rays of the affected joints are done to visualize the typical radiographic changes of RA.
Other blood tests including C reactive protein and Citrulline antibody are carried out in order to confirm the diagnosis.
Treatment
Medications for RA consist of painkillers, anti-inflammatory drugs (NSAID’s and steroids) and disease modifying anti-rheumatic drugs (DMARD’s)
Physiotherapy for RA includes hot fomentation, splintage of joints, joint mobility exercises and muscle building exercises.
Surgery may be required in some cases of RA. Commonly done procedures include synovectomy (removal of the synovium), bone block operation, tendon lengthening, interposition arthroplasties, total joint replacement and correction of deformities.
Yoga, use of fish oils and certain plant oils is believed to have a beneficial effect on patients with RA.
Recent updates (with references)
A recent research has suggested that Triptergium wilfordii Hook F, a traditional Chinese herbal remedy is fairly effective in relieving joint pain and swelling.
