What is rheumatoid arthritis?
A chronic autoimmune disease causing pain, swelling, stiffness and loss of function in the joints is called Rheumatoid arthritis (RA).
RA is one of the most common types of autoimmune arthritis, affecting more than 1.5 million people in the United States. Although a person can affected by RA at any age but in general case people are attacked by this diseases between the 40-60 years old.
Joints of our bones are designed in such a way so that they can absorb shock and let smooth movement between bones. During movement friction will occur between the bones causing attrition, but generally attrition does not occur. Do you know why?
Because the ends of bones are covered by cartilage (an elastic tissue) which protects our bone-joints from attrition and give supports during movements. Beneath the caps there is synovium tissue. Synovium tissue produces synovial fluid which acts as a lubricant and nourishes the cartilage.
People who are affected with RA, white blood cells cause swelling in the synovium. As a result, the tissue that lines the walls of the joints becomes thick and inflammation occurs. Gradually, the affected synovium destroys the cartilage and bone associated with it. Everything around that affected area that is supposed to support the joint, such as- muscles, ligaments, and tendons – will weaken. This breakdown of important functions cause pain associated with RA.
To diagnose and begin treatment for rheumatoid arthritis early is very important, otherwise permanent damage can occur.
8 Common Joints Affected by Rheumatoid Arthritis
RA affects the most vital joints in the body, such as-
Symptoms of Rheumatoid Arthritis
Rheumatoid Arthritis initiates slowly and progresses gradually over time; its early symptoms are subtle and not specific. That’s why, it is not easy to identify and diagnose RA. Moreover, symptoms vary patient to patient and many patients experience spans of no symptoms at all. The symptoms of RA are not always physical, symptoms can also be emotional and psychological.
The most common symptoms of RA are:
Heavy inflammation of the joints is called flare. Flares can last for months.
Synovial tissue in the caps of joints becomes damaged and consequently the tissue becomes thick and swells.
Inflamed joints tend to stiffen and are difficult to move properly. Patients generally feel stiffness especially in the mornings or after long periods of rest. Stiffness can last for several hours at a time.
Muscles, ligaments and tendons surrounding the joints give support, but in case of people with RA these will become weak gradually because of wearing down of cartilage and bone within the joints. Consequently, intense pain will be felt.
During a flare or inflammation joints can be warm and may become pink, or even red in color.
RA can make a person unable to function for long periods of time without pain. Works that involve so much moving or sitting can be difficult for a person with RA. Because of being unable to do daily jobs properly, mental illnesses such as depression, anxiety, low self-esteem and feelings of helplessness, insomnia occur in patient.
Some common psychological problems faced by a RA patient are:
When you learn that you are suffering from rheumatoid arthritis, you may try to find the reason of your diseases but when you will see that you always lead a healthy life – you take proper diet, you exercise regularly, you enjoy sound sleep, then you will be confused that why you have attacked by this diseases?
We know that a healthy immune system protects our body against the attack of foreign bacteria and viruses, but RA is an autoimmune disease and autoimmune disease causes the body to attack healthy tissue mistakenly, that means rheumatoid arthritis is triggered by a faulty immune system.
Anger is a normal path of reacting to something that threatens to change our life. Once you’ve gotten over your anger, the next challenge will be to find out a way of turning your anger into the positive energy so that you can live a normal life with RA.
You may become anxious thinking about the future consequence of your diseases. You should take the challenge to pass each day happily.
You may go through a period where you may want to deny the feeling and thinking about your diagnosis. As soon as you overcome this feeling, it will good for you, as early treatment of RA can cure the disease. No matter, if your diseases is not in the early stage, if you continue taking treatment it will help you to keep the diseases in control.
Initial physical symptoms of this disease include fatigue and stiffness and tenderness in the joints
Fatigue, due to rheumatoid arthritis results in lack of energy and it can affect emotions and mood, occupation, relationships with people, sex drive, productivity, attentiveness, creativity, and happiness adversely. Fatigue from rheumatoid arthritis can decrease your appetite and as a result you may lose your weight.
Joint tenderness is a characteristic symptom of Rheumatoid arthritis because the inflamed joint lining tissue has irritated the nerves in the joint capsule. When you compress the irritated joint capsule by external pressure, such as touching the joint, it is frequently tendered. The pain elicited from compression is instant. This is one of the main reasons that RA can cause difficulty in enjoying sound sleep.
Loss of joint range during movement
If you are affected by RA for long time, you may loss joint range during movement permanently.
Limping can be caused by many diseases of the nerves, muscles, and bones of the lower extremities but it frequently occurs when rheumatoid arthritis affects the hips, knees, ankles, or feet. Joint swelling, pain and loss of range of motion all may cause a patient of rheumatoid arthritis to have a noticeable limp. Sometimes, young children with rheumatoid arthritis can have a painless limp as the initial sign of the rheumatoid disease.
RA typically affects the body symmetrically, which means it affects the same joints on both sides of the body.
For example, if fingers of one hand are showing symptoms, the other will likely show symptoms at the same time.
RA causes the bone marrow to decrease the release of red blood cells into the circulation. This lowers the red blood count and causes anemia when rheumatoid arthritis is active.
When RA is actively causing inflammation, some people are attacked by fever. Usually, there is only mild low-grade temperature raise and this cures rapidly as the inflammation of rheumatoid arthritis is treated.
Problems in breathing
Due to the inflammation and scarring of the lungs shortness of breath can result in.
Patients of RA may also feel sharp chest pain.
Numbness, tingling, and burning
Inflamed blood vessels can lead to damage in nerves and skin resulting in numbness, tingling, and burning.
Risk factors of Rheumatoid Arthritis
Although researchers are still not sure about what causes the immune system to attack its own tissues, but they have identified some contributing factors.
Certain genes may play a small role in the development of RA indirectly. Researchers have found that people who have one gene in particular, HLA, could be 5 times more susceptible to get RA than people who don’t. However, not every patient of rheumatoid arthritis has the gene and not every person with the gene gets rheumatoid arthritis. Actually, research proposes these genes do not cause RA, but might contribute to develop RA.
Several environmental factors combined with a genetic predisposition, give people a greater risk to develop RA. These environmental factors include:
- Air pollution
- Bacteria and viruses
- Exposure to mineral oils
- Exposure to silica mineral (found in obsidian, granite, diorite, and sandstone)
Although both men and women are susceptible to RA, but women gets RA more than men. In a study, it has been seen that about 75% patients of RA are women in United States.
Changes in hormones (for example, the use of certain contraceptives) may promote the development of RA in people who are genetically vulnerable to develop RA. During pregnancy, Rheumatoid arthritis symptoms tend to improve or disappear completely, but frequent flares commonly appear after the birth. Sometimes, breastfeeding can also cause RA symptoms to flare.
A person can be affected by RA at any age, but it typically occurs between 40-60 years age.
People having a family history of rheumatoid arthritis are more susceptible to develop RA.
People who eat a lot of red meat, drink a lot of coffee have higher chance to get RA.
Smoking may also cause RA in your body.
People who are overweight appear to be at somewhat higher risk of developing rheumatoid arthritis, especially overweight women are diagnosed with this disease when they were 55 years old or younger.
9 Common Complications of Rheumatoid Arthritis
People with rheumatoid arthritis are at increased risk to develop:
Rheumatoid arthritis itself, along with some medications used for treating it can increase your chance of developing osteoporosis (a situation that deteriorates your bones and makes them more vulnerable to fracture)
- Rheumatoid nodules
Rheumatoid nodules are firm bumps of tissue, most commonly generate around pressure points, such as the elbows. However, these nodules can generate anywhere in the body, including the lungs.
- Carpal tunnel syndrome
When rheumatoid arthritis attacks your wrists, the inflammation can compress the associated nerves that help to function most of your hand and fingers.
- Abnormal body composition
People who have rheumatoid arthritis have more fat compared to lean mass; it is also true in the case of people who have a normal body mass index (BMI).
- Dry eyes and mouth
Patients of rheumatoid arthritis are much more susceptible to experience Sjogren’s syndrome – a disorder that decreases the amount of moisture in your eyes and mouth. As a result, the patient’s eye and mouth becomes dry.
- Heart problems
RA can raise your risk of hardened and blocked arteries and swelling of the sac that encloses your heart.
Rheumatoid arthritis itself and many of the medications used to reduce its syndrome can impair the immune system, leading to increased infections.
- Lung disease
Patients of rheumatoid arthritis have an increased risk of swelling and scarring of the lung tissues, which may lead to progressive shortness of breath.
Lymphoma is a group of blood cancers that generates in the lymph system. Rheumatoid arthritis increases the risk of developing lymphoma.
Stages of Rheumatoid Arthritis
There are four specific stages of rheumatoid arthritis progression. Treatment of RA varies depending on which stage your diseases in.
The early stage of RA involves inflammation in the joint capsule and swelling of synovial tissue.
Symptoms of first stage:
First stage induces the symptoms of joint pain, swelling, and stiffness.
This is the moderate stage of rheumatoid arthritis when the swelling of synovial tissue becomes severe enough to cause cartilage damage.
Symptoms of second stage:
This stage induces the symptoms of loss of mobility and loss range of motion.
This is the severe stage of RA when inflammation in the synovium starts to destroy both the bones and the cartilage of the joint.
Symptoms of third stage:
Potential symptoms of the third stage of RA include increased pain and swelling, physical deformities on the joint and a further decrease in mobility and even muscle strength.
This is the last stage and most severe stage of RA diseases. In this stage, the inflammatory process finishes and joints stop functioning altogether.
Symptoms of fourth stage:
Pain, swelling, stiffness and loss of mobility etc. are the primary symptoms in this stage.
Diagnosis of Rheumatoid Arthritis
It is not so easy to detect RA at its early stage because the symptoms mimic other diseases too. Doctors generally do the following tests to diagnose RA:
- Blood tests
Blood chemistry reveals a lot of information about RA. Generally elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP) tests are done to diagnose RA as these tests indicate the presence of an inflammatory process in the body. If certain antibodies such as – Rheumatoid factor or RF remains in the blood then there is 80% chance of developing RA.
- Image testing
Your doctor may recommend X-rays, MRI or ultrasound tests to track the progression of rheumatoid arthritis in your joints over time.
Treatment of Rheumatoid Arthritis
Rheumatoid arthritis cannot be cured completely but by taking strong medications severity of its symptoms can be reduced. It can be treated by medications, therapy or sometimes surgery can also be needed to do.
Medications for Rheumatoid Arthritis
Corticosteroid medications reduce inflammation and pain and slow joint damage. Doctors prescribe a corticosteroid to relieve severe symptoms, with the aim of gradually tapering off the medication.
Example – prednisone.
Side effects of steroids:
- Thinning of bones
- Weight gain and
Non-steroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) can provide the patient relief from pain and reduce inflammation.
Example -Over-the-counter NSAIDs include naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB). Stronger NSAIDs are obtainable by prescription.
Side effects of NSAIDs:
- Stomach irritation
- Ringing in your ears
- Heart problems
- Liver and kidney damage.
Disease-modifying antirheumatic drugs (DMARDs)
Disease-modifying antirheumatic drugs (DMARDs) drugs can slow down the progression rate of rheumatoid arthritis and protect the joints and other tissues from permanent damage.
Example- methotrexate (Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine) etc.
Side effects of DMARDs
- Liver damage
- Bone marrow suppression and
- Severe lung infections.
Biologic response modifiers
Biologic response modifiers, also known as this newer class biologic agent is a new type of DMARDs. Biologic DMARDs work best when they are paired with a nonbiologic DMARD, such as methotrexate.
Example- abatacept (Orencia), anakinra (Kineret), etanercept (Enbrel), adalimumab (Humira), rituximab (Rituxan), golimumab (Simponi), infliximab (Remicade), tocilizumab (Actemra), certolizumab (Cimzia), and tofacitinib (Xeljanz).
Side effects of biologic agent:
- Increasing the risk of infections.
Therapies for Rheumatoid Arthritis
A tailored program includes a balance of three types of exercises – range of motion or stretching or flexibility exercises, strengthening, and endurance can reduce the symptoms of arthritis and protect joints from further damage.
Physical therapy provides the following benefits:
- Increase muscle flexibility and strength
- Develop endurance and cardiovascular fitness
- Help to maintain normal movement of joint
- Help to maintain weight to lessen pressure on joints
- Help keep bone and cartilage tissue healthy and strong
Range of motion exercise or stretching or flexibility exercises
Range of motion exercise, also called stretching or flexibility exercises is the measurement of the amount of movement around a particular joint or body part. Now, the question is –
How the amount of movement around a particular joint or body part is measured?
It is measured by using a device called goniometer which is a metal or plastic handheld instrument with two arms. Numbers representing angular distance are on the device, just like a protractor.
Range of motion exercise using a goniometer
Range-of-motion exercise is a painless therapy but sometimes after a surgery you may feel a short-term pain. There are basically 3 types of range-of-motion exercise and they are-
- Active range-of-motion exercise
- Passive range-of-motion exercise
- Active-assistive range-of-motion exercise
- Active range-of-motion exercise
Active range-of-motion exercise needs no other person or device to help your movement. When you are able to begin moving independently after injury or surgery, and little or no protection from further injury is needed, active range-of-motion exercise is used then.
I am showing here an example of active range-of-motion exercise of neck.
- Bow your head gently and try to touch your chin to your chest. Then uphold your chin back to the initial position. After that, tilt your head back as far as you can. Finally, return your head to the initial position.
- Tilt your head to the side, taking your ear toward your shoulder. Return your head to the initial position.
- Turn your head side to look over your shoulder and tilting your chin down try to touch your shoulder. But do not elevate your shoulder to your chin. Look forward again.
Caution: Do not start any exercise without taking the suggestion of your therapist, because only he/ she can give you the proper suggestion about the right therapy that is needed to resolve your problem.
- Passive Range of Motion
When someone else, such as- your physical therapist or any equipment help you to move your muscles, it is called passive range of motion therapy.
- Active Assistive Range of Motion
Active-assistive ranghe of motion used when you are able to move your injured body part, but still you may require some help to move to prevent further injury or damage.
You can do strengthening exercises every day, unless you feel extreme pain. Strengthening exercise helps in preventing bone loss associated with inactivity. Muscle strengthening increases function when you practice it regularly maintaining a particular routine.
Any activity – walking, jogging, and swimming – that increases your heart rate and breathing for an extended period of time are known as endurance exercises. Endurance exercises are very helpful to reduce the symptoms of RA.
An occupational therapist is an expert who helps people with RA to maximize their ability to perform activities safely and enhance their quality of life. He/she works with you to detect problem areas in your daily life and find out ways to eliminate them, or work around them.
For instance, you type on a key board most of the time and your hands and wrists could be swollen and you may feel pain. The occupational therapist will help you modify your work area so that you can use the computer more comfortably and avoid overuse injuries.
Mind-body therapies for RA include mindfulness meditation, biofeedback, breathing exercises, and guided relaxation. Certain types of exercise, e.g- yoga, qi gong, and tai chi inspire you to focus your mind in such a way so that ways that you can cope with pain, and improve your strength and flexibility at the same time.
Yoga for rheumatoid arthritis
Yoga helps you to make you stronger and a healthy weight which in turn gives pressure on your joints. According to the Arthritis Foundation, a program of yoga poses, breathing, and relaxation can make a significant improvement in joint tenderness and swelling, the better you feel, the more you will be able to handle your RA.
Stress worsens the symptoms of RA and even the disease itself. So it is very important to manage stress effectively. When you practice yoga, you learn how to relax and how to let go of muscle tension.
Caution: Do not start your practice with any complex yoga method, it may affect your body badly instead of doing good. So, it is better to start with a simple method.
Qigong for rheumatoid arthritis
Qigong is an ideal exercise for arthritis patients. You can do it while moving, lying down, sitting or standing. Qigong done with correct posture reduces the load/strain on joints but incorrect posture can lead to injuries and joint strain and blocks Qi flow.
Caution: All Qigong are not beneficial for arthritis so it is better to talk to an experienced qigong instructor about which exercises you should practice.
Tai Chi for rheumatoid arthritis
Tai chi has been recognized for centuries as an effective therapy for treating arthritis. Tai chi combines deep breathing and relaxation techniques with slow and gentle movements maintaining good postures. Patient with rheumatoid arthritis who practiced tai chi experienced a noteworthy development in their range of motion of the joints of the legs and ankles in particular.
Surgery for Rheumatoid Arthritis
Sometimes your doctor may suggest you to do surgery to treat RA. The surgery may involve one or more of the following procedures:
Synovectomy means surgical removal of the membrane (synovium) that lines a joint. Synovectomy can be done on elbows, wrists, fingers, knees and hips.
Tendons are the soft, band-like tissues that joints muscles with bone. If the muscles contract, the tendons pull the bones and cause the joints to move. Inflammation and joint damage may cause tendons around your joint to weaken or rupture and a result you may feel pain and your movement becomes limited. Your surgeon may resolve this problem by repairing the tendons around your joint.
Arthrodesis refers to surgically fuse a joint to stabilize or realign a joint when a joint replacement isn’t an option. This operation gives the patient relief from pain
Prosthesis means replacing total joint with metal, plastic or ceramic device following a surgical procedure.
Diet for Rheumatoid Arthritis
Researchers found that certain foods are helpful to fight against RA. The two-third part of the diet of a patient with RA should come from plant based foods, such as- fruits, vegetables and whole grains and the rest of the diet should come from dairy products and lean sources of protein.
According to Ruth Frechman who is a registered dietitian and spokesperson for the American Dietetic Association the omega-3 fatty acids in fish oil are the most promising anti-inflammatory in food. It is very helpful to fight against the inflammation symptom of RA diseases. So, you should include cold-water fish, such as- herring, mackerel, trout, salmon and tuna in your diet plan.
Fish oil can provide you relief from tender joints and ease morning stiffness. If you want to try fish oil supplements, consult with your doctor to know about proper dosage because higher dosage may affect negatively. P
Fruits, vegetables and whole grain
Fruits, vegetables and whole grains are helpful to reduce inflammation. These help to lower levels of C-reactive protein (CRP) in the blood which is an indicator of inflammation.
- Tart cherries, strawberries, red raspberries, avocado, watermelon, grapes etc. are useful to reduce RA symptoms.
- Dark green leafy vegetables, sweet potatoes, carrots, red and green peepers, onion, garlic etc. are useful vegetables to treat RA symptoms.
- Gluten free (GF) brown rice, barley, rai, wheat, oat etc. are useful to reduce RA symptoms.
Extra-virgin olive oil
Extra virgin olive oil may also help to reduce inflammation, in the same way that a non-steroidal anti-inflammatory drug (NSAID) works.
Do Not Confuse Rheumatoid Arthritis with Osteoarthritis
Many people confuse rheumatoid arthritis with osteoarthritis (OA) because of similarity in their similar symptoms, but these two diseases are caused by different factors.
It was said earlier that rheumatoid arthritis is an autoimmune disease that causes joint malfunction due to inflammation. But osteoarthritis is a mechanical disease caused by the destruction of joints through wear and tear.