Overview

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the joints, causing pain, swelling, stiffness, and eventual joint damage. Unlike osteoarthritis, which results from wear and tear, RA occurs when the immune system mistakenly attacks healthy joint tissue. This inflammatory process can lead to joint deformity and disability if left untreated. RA commonly affects the small joints of the hands and feet, but it can also involve other joints and organs, including the skin, eyes, lungs, and heart. It is more prevalent in women and typically develops between the ages of 30 and 60, although it can occur at any age.

Causes

The exact cause of rheumatoid arthritis remains unknown, but several factors are believed to contribute to its development. A combination of genetic predisposition, environmental triggers, and immune system dysfunction plays a central role. Specific genes, especially HLA-DR4 and HLA-DR1, have been linked to an increased risk of RA. Environmental factors such as smoking, exposure to certain infections, and hormonal changes can also trigger the onset of the disease in susceptible individuals. Additionally, the immune system's abnormal response results in chronic inflammation that damages the synovial membrane lining the joints.

Symptoms

Rheumatoid arthritis typically presents with a range of symptoms that can vary in severity and progression. Common symptoms include:

• Joint pain and tenderness: Most often affects the small joints of the hands, wrists, and feet.
• Swelling and warmth: Inflamed joints appear swollen and feel warm to the touch.
• Morning stiffness: Stiffness lasting more than 30 minutes after waking up is characteristic of RA.
• Fatigue: Persistent tiredness and low energy levels are common.
• Fever: Low-grade fevers may occur during disease flare-ups.
• Weight loss: Unintentional weight loss can accompany chronic inflammation.
• Joint deformities: In advanced cases, joints may become visibly deformed due to prolonged inflammation and damage.
• Extra-articular symptoms: Some patients experience complications affecting the eyes (dry eyes), lungs (inflammation), skin (rheumatoid nodules), and cardiovascular system.

Diagnosis

Diagnosing rheumatoid arthritis involves a combination of clinical evaluation, laboratory tests, and imaging studies. Physicians consider a patient's medical history, symptom patterns, and physical examination findings to identify joint involvement and inflammation. Common diagnostic steps include:

• Blood tests: Elevated inflammatory markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), rheumatoid factor (RF), and anti-cyclic citrullinated peptide (anti-CCP) antibodies help support the diagnosis.
• Joint imaging: X-rays, ultrasound, or MRI scans may reveal joint erosion, synovial thickening, and inflammation.
• Physical examination: Assessment of joint tenderness, swelling, and range of motion.
• Classification criteria: The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) classification criteria are often used to confirm RA diagnosis.

Treatment

The goal of rheumatoid arthritis treatment is to reduce inflammation, relieve symptoms, prevent joint damage, and improve quality of life. Early intervention is crucial to limit long-term complications. Treatment options include:

• Medications:
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Help reduce pain and inflammation.
• Corticosteroids: Provide quick relief during flare-ups but are used cautiously due to side effects.
• Disease-modifying antirheumatic drugs (DMARDs): Such as methotrexate, are the cornerstone treatment to slow disease progression.
• Biologic agents: Target specific immune pathways (e.g., TNF inhibitors, IL-6 inhibitors) to control inflammation in moderate-to-severe RA.
• Janus kinase (JAK) inhibitors: An oral treatment option that blocks inflammatory signaling pathways.
• Physical therapy: Exercises and therapies to maintain joint flexibility and strength.
• Lifestyle modifications: Regular exercise, balanced diet, weight management, and smoking cessation help manage RA symptoms.
• Surgical options: In severe cases, joint replacement or reconstructive surgery may be necessary to restore function.

Prognosis

Rheumatoid arthritis is a lifelong condition, but with early diagnosis and effective treatment, many patients can achieve significant symptom control and maintain a good quality of life. Advances in biologic therapies and personalized treatment strategies have improved the long-term outlook for RA patients. However, some individuals may experience periods of remission and flare-ups. Without proper management, RA can lead to joint deformity, functional impairment, and increased risk of cardiovascular disease. Regular follow-up with a rheumatologist, adherence to treatment plans, and lifestyle adjustments are essential for optimizing outcomes and minimizing complications.