Rheumatoid Arthritis (RA) - A Chronic Autoimmune Disease - Types, Symptoms, Causes, Effects, and Treatment.

Rheumatoid Arthritis is a progressive chronic autoimmune disorder causing inflammation in joints, hands, legs, etc., and results in painful deformity and immobility, especially in fingers, wrists, feet, and ankles, the immunity attacks the healthy tissues of the body and damages a wide variety of body systems like skin, lungs, heart, and blood vessels. In severe cases, RA causes painful swelling in organs. If the inflammation with Rheumatoid Arthritis exists for a long time, it may cause bone erosion and joint deformity.

Here are a few early signs of rheumatoid arthritis in our body.

Symptoms:

Symptoms of Rheumatoid Arthritis vary from person to person, and the symptoms change from day to day. Intensified attacks of the immune on the healthy tissue of our body are called flare-ups and inactive periods, and in case of less noticeable symptoms, it is called remission.

1. Morning Stiffness: This is an early sign of arthritis. Stiffness lasts for a few minutes in the mornings and is a common sign of arthritis. It can worsen the condition over a while if not treated in time.
2. Minor Joint Swelling: Mild inflammation in joints causes your joints to appear larger than usual, and the swelling is associated with the warmth of the joints.
3. Numbness and tingling: Inflammation of tendons (a fibrous connective tissue that attaches muscle to bone) and ligaments create pressure on the nerves that cause a burning sensation, numbness, and tingling in your hands called Carpel Tunnel Syndrome.
4. Joint stiffness and pains:
   Pain: In the early stages of RA, the focus body points are fingers and wrists. Pain penetrates knees, feet, ankles, or shoulders followed by tenderness while at rest or during the movement.
   Stiffness: Stiffness shows up suddenly and gradually and affects multiple joints over one or two days.
5. Fatigue: Unusual tiredness shows up as a symptom before the outset of any other symptoms by weeks or months that are vague and a few times accompanied by illness or depression. The feeling of malaise, eye discharge, chest pain while breathing, loss of appetite, sleeping difficulty, weight loss, hard bumps of tissue under the skin on your arms. Consult your doctor immediately if you experience these early symptoms, and do not neglect them as they can cause serious health issues.

What causes Rheumatoid Arthritis?

In the case of RA, your immune system mistakenly sends the antibodies to the lining of your joints and attack the tissues around the joints, and the thin layer of the cells (synovium) that cover the joints become sore and inflamed, that releases the chemicals which damage the

• Bones
• Tendons: Tissue that connects bones to muscle.
• Cartilage: A stretchable connective tissue between bones.
• Ligaments: The tissue that connects the bone and cartilage.

Genetics:

Your genetics is a significant risk factor for rheumatoid arthritis. It is because of variants in human leukocyte antigen (HLA) genes, especially the HLA-DRB1 gene. HLA genes produces the protein that distinguishes the proteins produced by the body and proteins produced by the foreign invaders (viruses and bacteria).

Hormones:

It is seen more in women than men. Research say hormonal imbalance causes the chronic disorder though this finding is practically not proved.

Smoking:

As few shreds of evidence prove smoking has increased the risk of evolving Rheumatic Arthritis.

Types of Rheumatoid Arthritis:

The RA type is identified by the presence and absence of an autoantibody or protein produced by the body that attacks the immune system, referred to as the rheumatoid factor.

There are three types of RA:

1. Rheumatoid Factor Positive (Seropositive) RA: If your blood tests positive, that means there is a presence of a protein called rheumatoid factor or antibody anti-cyclic citrullinated peptide (anti-CCP), and your body is producing an immune reaction to your normal tissues.
2. Rheumatoid Factor Negative (Seronegative) RA: If the protein called rheumatoid factor and anti-CCP is absent in the blood, it is referred to as Seronegative, but they still have RA.
3. Juvenile Rheumatoid or Idiopathic Arthritis (RA): This RA is seen in kids under age 16 and causes joint pain, stiffness, swelling, fever, swollen lymph nodes, and rashes. Complications: improper growth, joint damage, eye inflammation, etc.

Stages in Rheumatoid Arthritis:

There are four distinct stages of RA determined based on radiologic findings and disease progression.
Four stages are:

Stage 1:
Early (Initial) stage:

• Patients may not have many symptoms except for stiffness in the early mornings.
• The stiffness and pain might be in small joints like hands, knees, and feet symmetrically, which improves and gets better with movement.
• The antibodies are present in the blood before the symptoms develop in patients.

Stage 2: Moderate Progression:
Swelling worsens, and antibodies develop:

• The body starts making up antibodies, and the joints start swelling.
• It causes inflammation in the lungs, eyes, skin rashes, and also affects heart health.
• Lumps called rheumatoid nodules also develop in elbows.

Stage 3:
Severe progression:

• The inflammation becomes severe and damages the joint bones and cartilage.
• The joints at this stage get twisted, deformed, and the fingers become contorted and puts pressure on the nerves causing nerve pain.

Stage 4:
Terminal Progression:

• The joints no longer work due to abnormal stiffening and immobility of joints due to the fusion of joints.
• Patients should undergo surgery to heal or repair the joint damage.

Triggering factors of RA:

Experts or researchers have not yet ruled out the actual reason for the cause of Rheumatoid Arthritis.
However, the below factors trigger RA:

1. Family history of RA
2. Obesity or Overweight
3. Age at diagnosis
4. RA- genes - human leukocyte antigen class 2 genotypes.
5. Mental stress, trauma, child birth, and infections.

How to know if your RA is progressing?

If your RA is worsening, your joints will shout out of pain and increases swelling. There are a few non-joint symptoms that worsens RA.

Treatment for RA:

There is no cure for RA, but treatment in the early stages and proper lifestyle can reduce the chances of RA and risk of joint damage:

Medications:

The medications depend on the severity and longevity of your symptoms:

1. NSAIDs: Non-steroidal anti-inflammatory drugs relieve pain and reduce inflammation.
2. Steroids: Corticosteroid medicine reduces or slows joints damage, inflammation, and pain.
3. Biologic agents: These are biological response modifiers. These are more effective when integrated with conventional DMARD
4. Targeted Synthetic DMARDs: Synthetic DMARDs are classified into conventional DMARDs and targeted DMARDs.
5. Therapies: If the condition is not serious, then your doctor might refer you to a physical therapist for tips and exercises to help your joints relax and become flexible.
6. Surgery: Here are a few surgeries that your doctors suggest to repair and restore your joint’s health, reduce pain and improve infections.
   • Tendon repair: Tendons that loosen or are ruptured around the joints due to inflammation are repaired in the surgery.
   • Joint fusion: Fusion of joints is to realign or stabilize the joint pain in joint replacement surgery.
   • Synovectomy: Removal of inflamed lining of the joint is to reduce the joint pain and improve flexibility.
   • Total Joint replacement: All the damaged parts of your joints are removed and replaced by a prosthesis made of plastic and metal.

How to prevent RA progression?

Here are a few tips to stay away or reduce the risk and progression of RA in your body:

• Quit smoking
• Lose extra weight
• Exercise regularly.
• Limit exposure to environmental pollutants.

Key Take-Away:

Despite of many studies on how RA develops in the body, it is still unclear whether these autoantibodies could contribute to disease pathogenesis. However, studies are being conducted on genetic and environmental risk factors for a better understanding and prevention of RA.