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RA CD UC AS PsO PsA

Rheumatoid Arthritis (RA)

  • About RA

    How do healthy joints work?

    • A joints is where two or more bones meet.
    • The ends of your bones are covered with a soft, slippery tissue called the cartilage. The cartilage allows the ends of your bones to move against each other smoothly. 1
    • The joint is surrounded by the synovium, which produces a small amount of fluid (called synovial fluid) that provides nurients for the cartilage and reduces friction between the bones. 1
    • The capsule is a tough outer layer surrounding the synovium. It provides strength to hold your joint in place. 1
    ra_img_1
    Cartilage:

    soft connective tissue that cushions the joints and helps the bones move smoothly

    Synovium:

    soft tissue that lines the inner surface of the joint

    Synovial fluid:

    also known as joint fluid, the synovial fluid contains nutrients to maintain the cartilage and reduces frection between the bones

    Joint capsule:

    structure that surrounds and holds the joint in place

    What happens in a joint affected by RA?

    Once affected by rheumatoid arthritis (RA), the synovium of the joints become inflamed. 1, 2

    The inflamed synovium becomes thickened and stretches the capsule, causing swelling and pain in and around the joints.

    If these symptoms continue, they can cause damage or loss of cartilage, bone erosion, and joint deformity. 1, 2

    ra_img_2
    Inflammation:

    the body's response to foreign and harmful substances, such as bacteria or viruses, or in some cases, self-antigens (symptoms of inflammation include heat, pain, redness, swelling)

    What causes RA?

    The exact cause of RA is unknown. It is thought that the symptoms of RA occur when your immune system acts abnormally. 3

    RA is associated with some risk factors including:

    • 1 Gender

      Overall, women are more likely than men to develop RA.
      However, older postmenopausal women have the same chance of developing the desease as men.

    • 2 Age

      While RA can occur at any age, it most commonly begins between the ages of 40 and 60.

    • 3 Family history

      If a member of your family has RA, you may have an increased risk of the disease.

    • 4 Other factors

      Cigarette smoking, exposure to hazardous substances, and obesity are associated with a higher risk of developing RA, as well as greater severity of the disease.

  • Symptoms

    What are the symptoms of RA?

    • RA mainly affects the joints.
      It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected. 4
      Hands, wrists, elbows, shoulders, knees, and ankles are most commonly affected sites.

    • Main symptoms affecting
      the joints include: 4

    • In addition to problems affecting the joints, you may experience a range of more general symptoms, such as: 4

  • Diagnosis

    How is RA diagnosed?

    Confirming the diagnosis may require a combination of symptoms, physical examinations, laboratory tests, and imaging tests (X-rays, ultrasound, or MRI scans). 5, 6

    Diagnosis of RA

    • Physical exam

      To check for sympotms and signs of RA

    • Blood test

      To check for specific substances indicative of RA

    • X-rays

      To examine damage of affected joints

    • MRI scans

      To determine the progression of RA through detailed images of the joints

    • Ultrasound

      To determine the severity of the disease through detailed images of the joints

    MRI (magnetic resonance imaging) scan:

    a type of scan that uses strong magnetic fields and radio waves to produce detailed images of inside the body

    Ultrasound:

    a type of scan that uses sound waves and their echoes to produce a picture of internal organs or masses

  • Treatment

    How is RA treated?

    The ultimate goal of RA therapy is to improve patient's quality of life by controlling inflammation to reduce pain, to prevent or delay joint damage, and to maintain maximum joint function.

    There are different drugs used for the treatment of RA. 7, 8

    • 1 Drugs that ease symptoms

      Non-steroidal anti-inflammatory drugs (NSAIDs) are available as over-the-counter tablets, and are used to help ease arthritis symptoms and pain.

    • 2 Drugs that slow disease activity
      • Corticosteroids

        Are quick-acting drugs that ease pain and slow joint damage.

      • Disease-modifying antirheumatic drugs (DMARDs)

        Can slow the progression of RA and save the joints from permanent damage.

      • Biologics

        Are a subset of DMARDs that target specific parts of the immune system causing joint damage. A biologic can slow, modify or stop the disease, even when other treatments haven't helped much.

    • 3 Surgery

      Whether surgery is necessary will be determined by your doctor after considering your symptoms, overall health, risk and benefits of surgery.
      Surgery may involve joint replacement or reconstruction.

  • Tips & FAQs

    Living with RA

    Having RA may involve making various adjustments in your daily life. You may need long-term treatment to control your symptoms and reduce joint damage. 9, 10

    • It is important to take your medication as prescribed, and let your doctor know as much as possible about your symptoms and condition by frequent communications. 9

    • Lack of exercise may stiffen your joints and weaken your muscles. It is important to keep a good balance between rest and exercise 9, 10

    • Although there is no specific diet for patients with RA, Mediterranean diet such as fish, vegetables, fruits, and olive oil may be helpful to control and reduce inflammation. 10

    Frequently asked Questions

    1. Isn’t RA just an “elderly” disease? 3, 11

    RA can affect people of all ages, male or female. While other forms of arthritis caused by joint erosion usually occur in older people, RA can occur even in children. Therefore, it is important to watch for signs and symptoms of RA even at an early age.

    2. Will I pass on RA to my children? 12, 13

    Family history of RA is one of the strongest known risk factors for developing RA. The risk of an individual passing on RA to his or her child is about 1-3%, so a parent having RA does not necessarily mean the child will be born with RA. You should consult your doctor or genetic counsellor to assess the possible risks.

    3. Does having RA increase the risk of heart disease? 11, 14

    Patients with RA are at increased risk of heart disease due to complications. Since RA is an autoimmune disease that affects the immune system by causing inflammation in the joints, it may cause damage to the blood vessel lining and plaque builds up. Therefore, having RA doubles the risk of most heart problems, including heart attack, stroke, and atherosclerosis.

    4. How is rheumatoid arthritis different from osteoarthritis? 15
    • Rheumatoid arthritis

      Characteristic

      Osteoarthritis

    • Overall age

      Age

      After age 40

    • Lack of autoimmune, heredity or life style

      Risk factors

      Aging & overuse

    • Small joints such as hands, foot, wrist, elbow, shoulder, or ankle

      Location of joint pain

      Weight-bearing joints, such as knees, hips, and finger joints

    • Usually medications

      Treatment

      Medication, surgery, or physical therapy

    See your doctor if you experience any of the following: 16-18

    • Pain that is sharp, stabbing, and constant
    • Pain that causes you to limp
    • Pain that lasts more than 2 hours after exercise or gets worse at night
    • Pain or swelling that does not get better with rest, medication, or hot or cold packs
    • Large increases in swelling or if your joints feel “hot” or are red

    Note: It may be helpful to keep a medical diary noting effective drugs, side effects, severity of symptoms, flare-ups, and remissions.

References

1. Arthritis Research UK. What is rheumatoid arthritis. Available at: http://www.arthritisresearchuk.org/arthritisinformation/conditions/rheumatoid-arthritis/what-is-rheumatoid-arthritis.aspx Accessed November 2019.

2. Arthritis Foundation. What is rheumatoid arthritis. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php Accessed November 2019.

3. Mayo Clinic. Rheumatoid arthritis. Symptoms and causes. Available at: http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/dxc-20197390 Accessed November 2019.

4. NHS Choices. Rheumatoid Arthritis - Symptoms. Available at: http://www.nhs.uk/Conditions/Rheumatoid-arthritis/Pages/Symptoms.aspx Accessed November 2019.

5. NHS Choices. Rheumatoid arthritis – Diagnosis. Available at: http://www.nhs.uk/Conditions/Rheumatoid-arthritis/Pages/Diagnosis.aspx Accessed November 2019.

6. Arthritis Foundation. Rheumatoid arthritis diagnosis. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/diagnosing.php Accessed November 2019.

7. Arthritis Foundation. Rheumatoid Arthritis Treatment. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/treatment.php Accessed November 2019.

8. Mayo Clinic. Rheumatoid Arthritis – Treatment. Available at: http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/treatment/txc-20197400 Accessed November 2019.

9. NHS. Living with Rheumatoid arthritis. Available at: https://www.nhs.uk/conditions/rheumatoid-arthritis/living-with/ Accessed November 2019.

10. Arthritis Foundation. Rheumatoid arthritis self care. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/self-care.php Accessed November 2019.

11. Arthritis Foundation. 10 Things to Know About Rheumatoid Arthritis. Available at: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/articles/living-with-ra.php Accessed November 2019.

12. Frisell T, Saevarsdottir S, and Askling J. Nat Rev Rheumatol. 2016;12:335-43.

13. Arthritis Research UK. What are the chances of my child having arthritis?. Available at http://www.arthritisresearchuk.org/arthritis-information/daily-life/pregnancy-and-arthritis/what-are-thechancesof-my-child-having-arthritis.aspx Accessed November 2019.

14. Arthritis Foundation. Arthritis Comorbidities. Available at: https://www.arthritis.org/living-with-arthritis/comorbidities/ Accessed November 2019.

15. Osteoporosis and Arthritis: Two Common but Di erent Conditions. Available at: http://www.niams.nih.gov/health_info/bone/Osteoporosis/Conditions_Behaviors/osteoporosis_arthritis.asp Accessed November 2019.

16. Rheumatoid Arthritis(RA). Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Farthritis%2Fbasics%2Frheumatoid.htm Accessed November 2019.

17. How you can prevent chronic disease. NCCDPHP. Available at: https://www.cdc.gov/chronicdisease/about/prevent/index.htm Accessed November 2019.

18. Physical Activity for Arthritis. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/arthritis/basics/physical-activity-overview.html Accessed November 2019.

Abbreviations

DMARD, disease-modifying antirheumatic drugs; MRI, magnetic resonance imaging; NSAIDs, non-steroidal anti-inflammatory drugs; RA, rheumatoid arthritis; SC, subcutaneous