This post was written by Deya Obaidat, MD, Parkview Rheumatology.
Rheumatoid Arthritis (RA) is a chronic autoimmune condition that mainly affects the joints. However, it can have systemic involvement of different organs. The cause of RA is related to our immune system. For someone with the disease, the immune system mistakenly recognizes their own tissue as an outside tissue, causing chronic inflammation in these areas. It’s unclear what exactly triggers this condition, but we think that there is a combination of genetic and environmental factors that play a role.
Symptoms
The symptoms of RA vary depending on the severity of the disease and organ involvement. Most patients typically have pains mainly around the smaller joints (knuckles, fingers, wrists, elbows, toes and ankles), but can also have pains in bigger joints (knees, shoulders and hips).
Usually, those pains are more bothersome early in the morning, and they ease up gradually through the day. The pain is typically associated with morning stiffness that lasts for more than an hour before it gets better. Affected joints are typically swollen and tender to the touch.
Diagnosis
The diagnosis of RA requires a combination of symptoms and signs that would suggest the disease, along with blood work which includes inflammatory markers, Rheumatoid Factor (RF) and cyclic citrullinated peptide (CCP). Imaging studies like X-rays, ultrasound or MRI for the involved joints can show changes that can also be helpful for distinguishing RA.
Is it hereditary?
There is evidence of an increased risk of having RA in people who have a family history of the disease. We also have evidence that the presence of some genes can increase the risk of having RA. However, there is no clear inheritance pattern that we know of. So having the disease doesn’t necessarily mean passing it on to the next generation.
Treatment
We have a lot of treatment options available for RA patients, especially with the introduction of biologics in the last couple of decades. The choice of the medication is usually individualized according to the patient’s severity of symptoms and other comorbidities.
In some patients, a combination of medications can be used for treatment as well. Those medications will work on modulating the immune system to improve RA symptoms. Those medications can be given by mouth, injections that can be done at home or infusions that can be done in infusion centers.
Flare ups
We usually attribute flare ups to overexertion, weather changes, missing medications, stress or infections. However, sometimes we are unable to find a particular reason for a flare up.
Exercise
Patients with RA are encouraged to exercise. After controlling the inflammation, we want the patient to continue to be active to maintain strength of the muscles and maintain range of motion of the joints.
Osteoarthritis vs Rheumatoid Arthritis
Osteoarthritis is a condition that can present similar to RA because it involves the smaller joints. Sometimes it can be difficult to differentiate between them, even for physicians.
Osteoarthritis likes to involve the bigger joints (knees, hips, shoulders, lower back) more than RA, but still can involve smaller joints as well (base of the thumb and joints in the fingers). The pain with osteoarthritis is usually worse with movement and better with rest, and the morning stiffness associated with it usually lasts less than 30 minutes.
Cure
As of now, there is no cure for RA. The goal with this chronic condition is to achieve remission or low disease activity with the use of different medications early in the disease course to prevent permanent damage to the joints.
Sources
1. Bullock J, Rizvi SAA, Saleh AM, Ahmed SS, Do DP, Ansari RA, Ahmed J. Rheumatoid Arthritis: A Brief Overview of the Treatment. Med Princ Pract. 2018;27(6):501-507. doi: 10.1159/000493390. Epub 2018 Sep 2. PMID: 30173215; PMCID: PMC6422329.
4. Ross C. A comparison of osteoarthritis and rheumatoid arthritis: diagnosis and treatment. Nurse Pract. 1997 Sep;22(9):20, 23-4, 27-8 passim; quiz 39-41. doi: 10.1097/00006205-199709000-00003. PMID: 9314163.
