Rheumatoid Arthritis (RA): Symptoms, Causes & Treatment

What is it:

Rheumatoid arthritis (RA) is a chronic inflammatory auto-immune disease in which the immune system produces antibodies that attack healthy body cells, causing inflammation in the joints. It especially affects joints in the hands, feet, wrists and knees. In some cases, rheumatoid arthritis can also affect the skin, eyes, lungs, heart and blood vessels.

Joint affected by rheumatoid arthritis are found to have inflammation of their internal lining, causing symptoms such as chronic pain, swelling, difficulty holding objects or walking, and even deformity of the joint. Since this type of symptoms can greatly impact daily life, it's important that any suspicion of rheumatoid arthritis is checked by a rheumatologist who will run some tests to confirm the diagnosis.

Treatment for rheumatoid arthritis should always be oriented by a rheumatologist. It normally involves the use of medication and an anti-inflammatory diet. Physiotherapy sessions may also be beneficial in relieving pain and swelling in the joints, improving quality of life.  

Main symptoms

In its initial stage, rheumatoid arthritis produces some mild symptoms such as light pain or discomfort in the joints, which can start suddenly and worsen with time. 

Typical symptoms of RA usually happen in the more advanced stages of the disease, and include: 

• Intense pain and swelling of the joint;
• Pain in more than one joint;
• Burning sensation;
• Redness of the joint;
• Difficulty moving the affected joint, especially after waking up;
• Lumps in the joint;
• Weight loss;
• Fever;
• General weakness or fatigue.

Pain and swelling is frequently noted in the same joints of both sides of the body, such as the two hands or the two feet.

In addition, rheumatoid arthritis can also affect other parts of the body such as the eyes, heart, and lungs, causing very specific symptoms for each location, such as dry eyes, difficulty breathing or chest pain.  

How to confirm a diagnosis

RA diagnosis usually starts with a medical examination, in which the rheumatologist assesses the swelling, redness and temperature in the joints. The doctor may then evaluate the reflexes and muscle strength.   

Rheumatoid arthritis can be hard to diagnose, especially in the initial stage when symptoms aren't clear. It can also be confused with other diseases such as osteoarthritis or lupus. So, to confirm the diagnosis, the rheumatologist will also request blood tests, such as:

• Erythrocyte sedimentation rate (ESR): when it is high it indicates inflammation in the body;  
• C-reactive protein (CRP) test: helps to check the severity of the inflammation ;  
• Antinuclear antibody (ANA) test: checks the production of antibodies by the immune system;  
• Rheumatoid factor (RF): identifies the presence of a protein that the immune system produces when it attacks the body's own tissues;  
• Anti-cyclic citrullinated peptides (anti-CCP): helps to differentiate between rheumatoid arthritis and other types of arthritis. 

In addition, the doctor may also request an X-ray so to check the evolution of the condition, as well as an MRI scan and an ultrasound to assess the severity of rheumatoid arthritis. 

Ideally, the diagnosis of rheumatoid arthritis is confirmed within six months of symptom onset. It is important to reach a diagnosis as soon as possible in order to start treatment and slow down disease progression.

Possible causes

Rheumatoid arthritis is an auto-immune disease, which means that the immune system attacks the body's own healthy cells, in this case, joint cells.

The reason this happens is still unknown, but some factors have been linked to the development of this condition, such as age and gender. It is more common in women over 40, it happens more frequently when there are viral or bacterial infections, when there is a history of rheumatoid arthritis in the family, or when the person is obese or smokes. 

Treatment options

Treatment for RA should be supervised by a rheumatologist and normally includes the use of medication, specially during moments of crisis. This medications can include:

• Anti-inflammatory remedies such as ibuprofen or naproxen 
• Corticosteroids such as prednisone or prednisolone;
• Immunosuppressants such as methotrexate and sulfasalazine.
• Biological agents such as abatacept, adalimumab or infliximab.

In addition, physiotherapy is very important in the treatment of rheumatoid arthritis and includes the use of devices, hot water bottles, exercises, and techniques to mobilize joints and strengthen the muscles. These help prevent deformities and improve movement in the day-to-day life.  

Another important recommendation is to do an anti-inflammatory diet that includes foods, such as tuna, salmon, garlic, berries, citrus fruits, dark green vegetables and turmeric. this type of diet not only decreases inflammation, but it also helps to regulate the immune system. 

Possible complications

The main complications associated with rheumatoid arthritis are:

• Osteoporosis;
• Deformity of the joints;
• Progressive loss of joint function;
• Ruptured tendons or ligaments;
• Carpel tunnel syndrome, if arthritis is in the wrist;
• Instability of the spine, when the spine, hips, knees or ankle joints are affected;
• Frequent infections;
• Heart problems, such as pericarditis;
• Lung problems such as pleurisy or lung fibrosis;
• Blood vessel inflammation;
• Lymphoma. 

These complications arise mainly when rheumatoid arthritis is not treated properly. This is why it is important to have any joint issues assessed by a doctor.