Is rheumatoid arthritis genetic? Can anything “trigger” the disease? And what is the best way to treat it? We spoke to expert consultant rheumatologist Dr Vijay Hajela:
What are the typical symptoms of rheumatoid arthritis?
Rheumatoid arthritis typically causes pain and stiffness in the joints. The joints affected are usually the hands and feet, but it can also start in the knee or shoulder. The joints can feel warm and tender. Fatigue, different to normal tiredness and often described as like ‘having flu’, is also a common symptom.
This can affect your life in many ways. Initially, fatigue and joint pain or stiffness can be an inconvenience that interferes with work or ability to exercise. However, this can quickly progress to affect most activities of daily living such as going up and down stairs, preparing a meal, getting dressed and even washing and brushing teeth. Many people complain that they struggle to write or that their typing is dramatically affected due to swelling and stiffness affecting their hands. Most find that it takes them longer to get ready in the morning. On the whole, rheumatoid arthritis can have far-reaching effects.
Who is typically diagnosed with rheumatoid arthritis?
Rheumatoid arthritis can affect any age, although it is more common between the ages of 20-60. Women are three times more likely to develop rheumatoid arthritis than men.
Certain genes can increase the risk of developing rheumatoid arthritis but having the gene isn’t enough. For example, if one identical twin develops rheumatoid arthritis the other twin only has a 1:3 chance of developing it.
This suggests that there are important triggers. Cigarette smoking is known to increase the risk of developing rheumatoid arthritis and also influences its severity. There is increasing evidence that certain bacteria in the mouth or in the gut may have a role in triggering rheumatoid arthritis. People who develop rheumatoid arthritis have more frequently suffered stressful life events (e.g. divorce, bereavement or trauma) in the six months leading up to their diagnosis than the rest of the population . Finally, obesity probably increases the risk in younger women.
How is rheumatoid arthritis typically diagnosed?
In diagnosing rheumatoid arthritis we look at your history, do a clinical examination, and may also carry out blood tests and scans.
A detailed history is vital: not just to confirm the onset and nature of the pain, stiffness and swelling, but to help exclude other causes of these symptoms. For example, similar symptoms can follow certain infections or accompany other diseases such as Crohn’s disease, psoriasis or even cancer.
A thorough clinical examination should determine the distribution of tender and swollen joints, as well as checking for other conditions that might influence the diagnosis or choice of potential treatments.
The role of blood tests is to help confirm the presence of inflammation within the blood and may also detect diagnostic antibodies such as rheumatoid factor or anti-CCP.
Finally scanning the joints with ultrasound or MRI can show inflammation within the joints or in tendons around the joints and also checks to see if the arthritis has started to damage joint cartilage.
What treatment options are available to patients?
Early intensive treatment aimed at getting the disease fully into remission is the key. This has been shown to prevent progressive joint damage, keeps more people working and active, and gives them a higher quality of life five years later.
However, this takes strong medicines that act on the body’s malfunctioning immune system and this may come with side effects. But the risk/benefit overwhelmingly favours being bold. Effective treatment can be miraculous – as one lady commented ‘I was scared of the medication at first, but it has given me my life back’.
Most specialists start with two drugs, with one usually being methotrexate. These drugs take several weeks to work and so steroids are often used to give rapid relief in the first few weeks. If this regime is not effective enough then so-called biologic agents can be used. These are usually injectable drugs which are highly effective and well tolerated. Unfortunately, due to their high cost these drugs cannot be used as a first line treatment in the UK.
If you are affected by rheumatoid arthritis and would like to speak with a specialist, don’t hesitate to book an appointment with Dr Vijay Hajela.