Rheumatoid Arthritis

25 July 2017

A chronic inflammatory and autoimmune disease (aseptic therefore noninfectious) characterized by flare-ups. Rheumatoid arthritis (or chronic arthritis) is the most common inflammatory disease in joints. Women are frequently more affected (aged 30 and 60, including those who reach menopause) than men. It rarely affects young patients (regardless of their gender).

The patient’s body produces specific antibodies that will attack the synovial membrane, i.e. the tissue that covers the inside of joints and which aims to produce the synovial fluid which allows the lubrication of joints for the proper functioning of the latter.

Classified as systemic (affecting multiple joints at the same time) the inflammation caused by rheumatoid arthritis will swell the joints and cause excessive production of synovial fluid which flows at the joint level. This ultimately leads to a distortion of the latter, the disease causing lesions in cartilage, tendons, ligaments, muscles and bones.

The most affected joints are those of the hands, wrists, knees and feet but some very aggressive forms can also affect organs such as the heart or the lungs.

Causes and symptoms of rheumatoid arthritis

Possible causes of rheumatoid arthritis

SThe medical community could point out only assumptions about the sudden or progressive disorder of the immune system and, by extension, the onset of rheumatoid arthritis.
Therefore, despite these uncertainties on the trigger or triggers, aggravating factors can be listed:

  • Genetics, the presence of the HLA-DRB1, HLA-DRB4 and PTPN22 antigens that have been identified in a significant number of patients with rheumatoid arthritis
  • Smoking (including passive smoking)
  • Air pollution (action of the micro particles in the air …)
  • Hormonal cause (hence a greater number of women who reach menopause)
  • Poor diet (overweight …)
  • Stress (due to divorce, as a consequence of someone’s death, inherent at work …)
  • Frequent child-bearing or contraceptives taken too early in the life of the patient having developed the disease

Symptoms of rheumatoid arthritis

Occurring in flare-ups (more or less severe depending on the individual) therefore with episodes where the symptoms are more discreet and even disappear. They will worsen and evolve over time especially if no treatment is implemented. The affected joints are essentially those of the hands and feet but the disease (as it develops) can also affect the hips, knees, shoulders, elbows, cervical vertebrae …
Therefore, we can distinguish a number of characteristic symptoms of this disease that eventually impair the use of the affected limbs:

  • Joints swelling, i.e. a characteristic edema that will affect the joints symmetrically, which means for example that both wrists will be affected at the same time. A characteristic redness will come with this swelling.
  • Bilateral and symmetric joints pain and stiffness experienced especially at the end of the night and when waking up, making it extremely difficult for the patient to get up. (The patient generally needs a good hour in the morning to “emerge”)
  • Severe fatigue coupled with weight loss due to loss of appetite
  • Fever during flare-ups

Please note that the deformations (which make the disease really debilitating for the future) can take many forms, depending on the part of the body they affect:

  • Hands look like camel humps and the skin is thinned
  • Mallet, gooseneck finger …
  • Wrist like a piano key
  • Feet that can take a triangular shape
  • Hammer toes, bent toes
  • Knees, hips, shoulders stiffen

A disease that has been existing for several years shows other additional symptoms such as:

  • An inflammation that spreads exponentially to other joints
  • It is harder and harder to move, to use his/her hands … because of the large deformations caused by the disease
  • Nodules under the skin
  • A disease spread to other organs (pleurisy in the lungs, Sjögren syndrome which causes dryness of the eyes and mouth, arteries damage, kidney damage, impairment of the heart valves …)

Diagnosis and treatment of rheumatoid arthritis

Tests that will confirm rheumatoid arthritis

The clinical symptoms that suggest the presence of the disease will be confirmed by a set of tests. The sooner rheumatoid arthritis is diagnosed, the better it is because it helps to stop the development of the disease by preventing the occurrence of other deformations, thus avoiding a real future disability of the patient.
So we will:

  • perform (it is essential) a blood test to highlight the inflammatory process that is characterized by a higher sedimentation rate than normal, by the presence of the rheumatoid factor and citrullinated anti- peptide autoantibodies (or CCP anti antibodies), by an increase in C-Reactive protein (PCR). The blood test is the most reliable examination to diagnose rheumatoid arthritis.
  • Carry out X-rays of all the painful joints. Radiographies will be performed at several stages of the disease to conduct strict monitoring of its evolution.
  • Perform an MRI if needed, as well as an ultrasound scan and perhaps even an analysis of the synovial fluid
Treatment of rheumatoid arthritis

The earlier it is diagnosed, the sooner the treatment begins and it is even more effective, in order to:

  • Control the disease and reduce joint problems already faced by the patient
  • To curb the development of the disease and all its consequences, particularly the deformation of the joints and, in the medium and long-term, the underlying disability if the treatment has not been implemented
  • To improve the patient’s quality of life through the reduction of symptoms (pain …) and of flare-ups

The treatments are based on:

  • Analgesics, corticosteroids (by injections / infiltration or not, injections are the most effective during flare-ups) and anti-inflammatory to relieve pain and reduce stiffness in the joints.
  • Immunosuppressants (methotrexate) to tackle the disease progression
  • Biological treatments or biotherapies
  • A last resort surgery (synovectomy, change of articulation)
  • Monitoring of physical therapy, occupational therapy
  • Monitoring a suitable diet

Regular medical monitoring of the affected patient is essential to closely follow the evolution of the disease and to adapt the drug treatment if needed.

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