Rheumatoid arthritis causes pain, swelling and stiffness in the joints. We’ve asked one of our top rheumatologists Dr Gerald Coakley about the possible causes of the condition, whether it can be mistaken for another autoimmune disease and what might trigger flare ups.
What's the main cause of rheumatoid arthritis?
Despite many decades of intensive research in genetics and immunology, we still do not know what causes rheumatoid arthritis, although we know a lot more about disease mechanisms than we used to and have far more effective treatments as a result.
It is clear that there is a genetic component related to various genes involved in our immune systems. There are several environmental factors that make rheumatoid arthritis more likely and more severe, the most important of which is smoking. It is possible that infections trigger rheumatoid arthritis in susceptible individuals, although there is no particular infectious agent that has yet been found responsible.
Years ago, people did not distinguish clearly between the various types of inflammatory and non-inflammatory arthritis and tended to refer to all musculoskeletal aches and pain as ‘rheumatism’. For this reason, when people think they have a family history of rheumatoid arthritis, we usually probe some more to find out whether or not that diagnosis was correct.
Is it related to other autoimmune diseases? Are there similar autoimmune diseases with the same symptoms?
Rheumatoid arthritis is one of several types of inflammatory arthritis. Rheumatologists use this term to distinguish immune-mediated arthritis from other, more common types of musculoskeletal problems. These may include osteoarthritis, simple low back pain, fibromyalgia, and ’soft tissue’ problems like tennis elbow or frozen shoulder, which are not caused by an autoreactive immune system.
Other types of inflammatory arthritis include that related to the skin condition psoriasis (psoriatic arthritis), another related to inflammatory bowel conditions Crohn’s disease and ulcerative colitis (colitic arthritis), and the inflammatory spinal condition ankylosing spondylitis.
Rheumatoid arthritis can also resemble or overlap with a group of conditions that rheumatologists call connective tissue diseases - lupus, Sjögren’s syndrome, and the inflammatory muscle condition myositis fall into this group. While rheumatoid arthritis can affect organs and tissues other than the joints, multiple systems or organ involvement in connective tissue diseases is very common. These conditions need particularly meticulous evaluation and monitoring.
Because there is a wide range of possible causes of inflammatory arthritis, it is important to seek the opinion of a rheumatologist if you think you might have rheumatoid arthritis because the treatment differs widely depending on the correct diagnosis.
What triggers flare ups?
Rheumatoid arthritis is a condition that naturally waxes and wanes, varying between remission and flares. With effective treatment, however, it is usually possible to get the condition into good control with low disease activity and, in many cases, into sustained remission over years.
Many flares of arthritis simply reflect the natural history of rheumatoid arthritis - it can flare up for no identifiable reason. There are common triggers, however, which many of our patients tell us about. Forgetting to take medication is an important factor, and the treatments we currently have only work if taken at the prescribed interval. If that is interrupted for whatever reason, then a flare up will be a common result.
Stress is also very important. Clearly it is impossible to avoid stress altogether as it is part of life, but we do see flare ups with stressful life events like bereavement, moving house or work stress. Maintaining a healthy approach to handling stress is important for people with rheumatoid arthritis.
That means trying to avoid things that appear to relieve stress in the short term but actually add to it longer term such as smoking, relying on alcohol or other forms of addiction. Instead, regular gentle exercise, cultivating hobbies, and pursuing relaxation for its own sake through yoga, meditation and the like can help.
Do not hesitate to book an appointment with Dr Coakley if you’re worried that you’re living with symptoms of rheumatoid arthritis.