Figuring out rheumatoid arthritis
Rheumatoid arthritis causes pain, swelling and stiffness in the joints. In this article, Professor Antoni Chan, Consultant Rheumatologist, explains rheumatoid arthritis, how it occurs, and how it can be managed.
Rheumatoid is an inflammatory joint condition that affects the lining and cartilage between the joints. It affects 1% of the population and is an autoimmune disease. An autoimmune condition is due to a combination of genetic and environmental factors that starts attacking the lining of the joints and cartilage tissue, deteriorating it. Due to the loss of the joint lining and cartilage tissue, causes the bones to rub against each other, which leads to pain, inflammation, deformity, and stiffness.
It differs from other types of arthritis like osteoarthritis and arthritis after an injury – rather, rheumatoid arthritis is a generalised or systemic condition and it can progress to affect other organs and tissues.
Common additional symptoms include chest pain when breathing, fatigue, dry eyes and mouth, and limb numbness.
What causes rheumatoid arthritis?
There is no conclusive cause for rheumatoid arthritis. However, there are factors that can make individuals more likely or more susceptible to developing it.
One of the biggest factors is genetics, where a family history of the disease or other autoimmune conditions increases the chances of developing rheumatoid arthritis. However, environmental factors are significant too, such as smoking, diet and obesity.
Prior infections can also trigger a wayward immune system response against cartilage.
Flare-ups can be triggered by stress, poor oral hygiene, smoking cigarettes, changes in weather, and fatigue.
What treatment is available for rheumatoid arthritis?
The symptoms of rheumatoid arthritis can lessen and intensify over a period of time. As rheumatoid arthritis is uncurable at this present time, treatment instead focuses on reducing the progression of the condition and flare-ups, providing access to support and resources, and maximising the patient’s comfort and mobility.The aim is to achieve remission of the condition.
Treatment plans are formulated to achieve this goal, requiring the commitment of both the healthcare providers and the patient.
Medications like antirheumatics, anti-inflammatories, steroids, and biologics are often utilised:
- Disease-modifying anti-rheumatic drugs (DMARDs): these work by controlling the immune system cells from attacking the jointsCommon DMARDs include methotrexate, sulfasalazine, and leflunomide.
- Non-steroidal anti-inflammatory drugs (NSAIDs): these can be used to alleviate pain while also reducing inflammation. Common NSAIDs include ibuprofen, naxopren, and diclofenac.
- Steroids: mostly used for short-term relief of pain and stiffness, these can come in the form of oral tablets or injected into the joints or muscles.
- Biological treatments: administered as injections, they are often taken with DMARDs when they have not been proven to be sufficient. They work by repressing the immune system response. Biologics include anti-TNF agents such as Adalimumab, Infliximab, Etanercept, Certolizumab and Golimumab.
Aside from medications, patients may also benefit from physiotherapy, which can improve muscle strength and joint flexibility.
This includes joint protection techniques, stretches, heat and cold treatments, splints and braces.
In very severe cases of rheumatoid arthritis, surgery can be done to reduce pain or fix deformation,. Joint replacements may be carried out in advanced rheumatoid arthritis with the aim of reducing pain and improving joint mobility.
Professor Antoni Chan sees and treats patients with rheumatoid arthritis. Please book an appointment with him if you would to have a review of your joint symptoms.