Rheumatoid Arthritis
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a progressive disease which causes chronic inflammation of the joints. It generally affects the smaller joints in the body such as fingers, thumbs, wrists, feet and ankles.
However, the systemic nature of the condition means that it can also affect the body as a whole. RA is one of a group of conditions classified as autoimmune diseases, where the immune system attacks the body’s own tissues, specifically the synovium, the tissue that surrounds joints.
Who is affected?
Over 4.6 million Canadian adults (one in six Canadians aged 15 years and older) report having arthritis. By 2036, this number is expected to grow to an estimated 7.5 million Canadian adults (one in five).
Although RA can occur at any age, the disease most commonly begins between the ages of 40 and 60. Women are three times more likely to be affected than men.
How is it caused?
Doctors are still unable to pinpoint the exact cause of RA. It is thought that genetic, environmental and hormonal factors play a role.
People with specific genes are at an increased risk of developing RA, but having a gene that predisposes to RA does not always lead to the development of the disease.
Many scientists believe there are environmental factors that can trigger the development of RA in susceptible individuals. These triggers, which lead to the immune system attacking the healthy synovium, are thought to be bacterial and/or viral.
How is RA diagnosed?
Diagnosis of RA is not always easy, since initial symptoms may be subtle and occur gradually, and early-stage RA shares a number of symptoms with other musculoskeletal diseases.
There is also no one clear way to diagnose RA, so the physician has to rely on a combination of medical history, physical examinations and laboratory tests. The two kinds of laboratory tests used to aid diagnosis are blood tests and x-rays or imaging techniques.
Early diagnosis is important as joint damage begins to occur in the first two years of the disease or less.
What are the symptoms of RA?
Symptoms of RA may come and go and vary in severity from patient to patient. The main symptoms are:
- Joint stiffness
- Joint pain
- Swelling of joints
- Redness and warmth around the joints
- Reduction in mobility
- Appearance of nodules or lumps under the skin
- Deformity of joints.
Patients often experience symmetrical symptoms, whereby any symptoms felt on one side of the body are reflected in the same joints on the other side.
These symptoms often lead to permanent damage of joints and bones. As this damage occurs, patients may find their movement becomes more restricted, and this can lead to difficulty in undertaking even the simplest everyday tasks such as combing hair, turning a doorknob or taking a walk.
RA patients are also at a higher risk of developing other conditions, in particular heart disease and stroke. There is no explanation for this, however lack of exercise and mobility are risk factors for developing many of these other conditions.
As there is currently no cure for RA, treatment goals centre on disease management. Treatment is aimed at:
- Controlling disease progression
- Providing pain relief and reducing swelling
- Preventing joint damage and deformity
- Maintaining function of the affected joints and preventing disability
Depending on the level of severity and stage of the disease, several different types of drug therapies may be used in monotherapy or combination:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Analgesic drugs
- Corticosteroids
- Disease modifying antirheumatic drugs (DMARDs)
- Biological therapies