Rheumatoid arthritis is a chronic inflammatory autoimmune condition of the joints affecting mainly the limbs on both sides. It principally affects the synovial membrane which surrounds flexible joints. The inflammation of the membrane leads to pain and difficulty in the movement of the joint. The condition is of systemic nature and can also affect the membranes covering the lungs and the heart in progressive stages. Rheumatoid arthritis tends to start in young adults compared to osteoarthritis which is mainly seen in older people.
In rheumatoid arthritis, the small joints of fingers and toes are the first to be affected. Joint pain, swelling and stiffness are the main symptoms. It affected joints on both sides of the body (bilateral). The condition generally presents with signs of inflammation – the affected joints may become red, swollen and warm to touch. Muscle atrophy around the joint is commonly seen in chronic cases. The joint pain and stiffness are worse during morning hours.
As the condition progresses it tends to involve multiple joints, a condition called as polyathritis. Large and weight bearing joints are frequently affected. Fever, weakness, fatigue and weight loss is also evident in rheumatoid arthritis. The skin may show characteristic lesions known as rheumatoid nodules. Numbness in the extremities where the joints are affected may be experienced.
Rheumatoid arthritis can also affect the heart, lungs and kidneys. Patients with rheumatoid arthritis have an increased risk of heart diseases, rheumatoid lung disease and renal amyloidosis. Dry eyes, anemia and osteoporosis may also develop in cases of rheumatoid arthritis.
The exact cause of rheumatoid arthritis is unknown. The condition is more prevalent in woman in the 20 to 45 year ago group. Rheumatoid arthritis is an autoimmune disorder primarily affecting the joints. In autoimmune disorders, the body develops antibodies against its own tissues. In case of rheumatoid arthritis these antibodies attack the joint cavity and synovial membrane, which leads to inflammation of the joints. The inflammation eventually leads to erosion of joint surfaces leading to stiffness and loss of function. Eventually the joint becomes fused.
The probable cause of rheumatoid arthritis could be events that trigger autoimmunity. Infections, genes and hormones may possibly be trigger factors. Certain infections such as Mycoplasma, rubella and herpes virus infections are believed to be associated with development of rheumatoid arthritis. Family history remains one of the strongest risk factors for developing rheumatoid arthritis. However, this does not explain the majority of cases of rheumatoid arthritis.
The treatment is aimed reduction of pain and swelling, preservation of the joint function and prevention of deformities. Limiting strain to the joint and physical therapy are the main approaches to managing rheumatoid arthritis in the long term. Local treatment to reduce joint pain and discomfort includes heat, diathermy, muscle strengthening exercises and hydrotherapy. Weight loss is advised in obese patients.
To relieve pain and inflammation, corticosteroid injections are sometimes given directly into the affected joints. Non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac and piroxicam can be given for symptomatic relief. Slow acting anti-rheumatoid drugs such as hydroxyl chloroquine sulfate, sulphasalazine and methotrexate are also prescribed.
In early phases of the disease, surgery can be carried out to remove the affected synovial membrane. The procedure is known as synovectomy. In chronic cases where the joints are severely damaged, joint replacement procedures for certain joints can be considered.