Rheumatoid Arthritis Causes, Symptoms, Diagnosis, Treatment, Prevention, Diet, Home Remedies

Rheumatoid Arthritis Causes, Symptoms, Diagnosis, Treatment, Prevention, Diet, Home Remedies


What is rheumatoid arthritis?


Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in your hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues. In addition to causing joint problems, rheumatoid arthritis sometimes can affect other organs of the body — such as the skin, eyes, lungs and blood vessels.

Rheumatoid Arthritis Causes, Symptoms, Diagnosis, Treatment, Prevention, Diet, Home Remedies
Rheumatoid Arthritis

In some people with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments, causing deformity of the joints. Damage to the joints can occur early in the disease and be progressive. Moreover, studies have shown that the progressive damage to the joints does not necessarily correlate with the degree of pain, stiffness, or swelling present in the joints.

Rheumatoid arthritis is a common rheumatic disease, affecting approximately 1.3 million people in the United States, according to current census data. The disease is three times more common in women as in men. It afflicts people of all races equally. The disease can begin at any age and even affects children (juvenile rheumatoid arthritis), but it most often starts after 40 years of age and before 60 years of age. In some families, multiple members can be affected, suggesting a genetic basis for the disorder.

What causes rheumatoid arthritis?


The exact cause of rheumatoid arthritis is unknown. However, it is believed to be caused by a combination of genetic factors, abnormal immunity, environmental factors, and hormonal factors.

Normally, the immune system protects the body from disease. In rheumatoid arthritis, something triggers the immune system to attack the joints and sometimes other organs. Some theories suggest that a virus or bacteria may alter the immune system, causing it to attack the joints. Some people have a genetic or inherited factor that makes them more likely to develop rheumatoid arthritis.

What are the symptoms of rheumatoid arthritis?


Rheumatoid arthritis usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected.

The disease often begins slowly, usually with only minor joint pain, stiffness, and fatigue.

Joint symptoms may include:

  • Morning stiffness, which lasts more than 1 hour, is common. Joints may feel warm, tender, and stiff when not used for an hour.
  • Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.
  • Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.
Rheumatoid Arthritis Causes, Symptoms, Diagnosis, Treatment, Prevention, Diet, Home Remedies
Rheumatoid Arthritis

Other symptoms of Rheumatoid Arthritis include:


  • Chest pain when taking a breath (pleurisy)
  • Dry eyes and mouth (Sjogren syndrome)
  • Eye burning, itching, and discharge
  • Nodules under the skin (usually a sign of more severe disease)
  • Numbness, tingling, or burning in the hands and feet
  • Sleep difficulties
  • Tender, warm, swollen joints
  • Morning stiffness that may last for hours
  • Firm bumps of tissue under the skin on your arms (rheumatoid nodules)
  • Fatigue, fever and weight loss

When To Call A Professional


Tell your doctor if you experience any of the following:

  • Pain, stiffness, warmth, redness or swelling at the joints (of the wrist, fingers, neck, shoulders, elbows, hips, knees, ankles and feet)
  • Problems in symmetrical joints (both knees, for example)
  • Fatigue
  • Occasional fever
  • Pain or stiffness in the morning (lasting more than 30 minutes)

How does rheumatoid arthritis affect people?


Rheumatoid arthritis affects each individual differently. In most people, joint symptoms may develop gradually over several years. In other people, rheumatoid arthritis may progress rapidly. Other people may have rheumatoid arthritis for a limited period of time and then enter a remission (a time with no symptoms).

Who is affected by rheumatoid arthritis?


Rheumatoid arthritis affects more than 1% of the United States population. It is three to five times more common in women than men. It usually occurs between the ages of 20 to 50; however, young children and the elderly can also develop rheumatoid arthritis.

How is rheumatoid arthritis diagnosed?


The diagnosis of rheumatoid arthritis is based on a combination of factors, including:

Rheumatoid Arthritis Causes, Symptoms, Diagnosis, Treatment, Prevention, Diet, Home Remedies
Rheumatoid Arthritis - Results of x-ray

  • The specific location and symmetry of painful joints
  • The presence of joint stiffness in the morning
  • Presence of bumps/nodules under the skin (rheumatoid nodules)
  • Results of x-ray tests that suggest rheumatoid arthritis
  • Positive results of a blood test called the rheumatoid factor*
*Approximately 70% of people with rheumatoid arthritis have the rheumatoid factor antibody in their blood. The rheumatoid factor may be present in 5% of people who do not have rheumatoid arthritis. Other diseases can also cause the rheumatoid factor to be produced in the blood. A test called CCP antibody can sometimes help to determine whether the rheumatoid factor antibody is due to rheumatoid arthritis or some other disease. That is why the diagnosis of rheumatoid arthritis is based on a combination of several factors and NOT just the presence of the rheumatoid factor in the blood.

How is rheumatoid arthritis treated?


There are many different ways to treat rheumatoid arthritis. Treatments include medications, rest and exercise, physical therapy/occupational therapy, and surgery to correct damage to the joint.

The type of treatment prescribed will depend on several factors including the person’s age, overall health, medical history and severity of the arthritis.

Medications for Rheumatoid Arthritis


There are many medications available to decrease joint pain, swelling and inflammation and hopefully prevent or minimize the progression of the disease. These medications include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs – such as aspirin, ibuprofen or naproxen)
  • Corticosteroids (oral and injectable forms)
  • COX-2 inhibitors (celecoxib)
  • Disease-modifying anti-rheumatic drugs (DMARDs)* such as hydroxychloroquine, methotrexate, sulfasalazine, cyclophosphamide, and leflunomide
  • Biologic agents (such as infliximab, etanercept, adalimumab, anakinra, rituxamab, abatacept, certolizumab and golimumab)
*Some of these medications are traditionally used to treat other conditions such as cancer, inflammatory bowel disease, malaria, and organ transplant rejection. When these drugs are used to treat rheumatoid arthritis, the doses are significantly lower and the risks of side effects tend to be considerably less than when these drugs are used to treat cancer or other conditions.

When you are prescribed any medication, it is important to meet with your physician regularly so he or she can detect the development of any side effects.

Rest and exercise


A balance of rest and exercise is important in treating rheumatoid arthritis. During flare-ups (worsening of joint inflammation), it is best to rest the joints that are inflamed. This may be accomplished by the temporary use of a cane or joint splints.

When joint inflammation is decreased, guided exercise programs are necessary to maintain flexibility of the joints and to strengthen the muscles that surround the joints. Range-of-motion exercises should be done regularly to maintain joint mobility. Physical therapy and occupational therapy have also been found to be helpful.

Therapy


Your doctor may send you to a therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms.

Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a saw handle helps protect your finger and wrist joints. Tools such as buttonhooks can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.

Surgery


When bone damage from the arthritis has become severe or pain is not controlled with medications, surgery is an option to restore function to a damaged joint.

Prevention for Rheumatoid Arthritis


There is no known way to prevent arthritis because the exact causes are still unknown. However, there are ways to reduce the chance of severe joint damage after an rheumatoid arthritis diagnosis.

Home Remedies for Rheumatoid Arthritis


You can take steps to care for your body if you have rheumatoid arthritis. These self-care measures, when used along with your rheumatoid arthritis medications, can help you manage your signs and symptoms:

  • Exercise regularly. Gentle exercise can help strengthen the muscles around your joints, and it can help fight fatigue you might feel. Check with your doctor before you start exercising. If you're just getting started, begin by taking a walk. Try swimming or gentle water aerobics. Avoid exercising tender, injured or severely inflamed joints.
  • Apply heat or cold. Heat can help ease your pain and relax tense, painful muscles. Cold may dull the sensation of pain. Cold also has a numbing effect and decreases muscle spasms.
  • Relax. Find ways to cope with pain by reducing stress in your life. Techniques such as hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.

What about rheumatoid arthritis and pregnancy?


In general, rheumatoid arthritis often improves during pregnancy. It is commonplace for the rheumatoid joint inflammation to decrease and be minimized during pregnancy. Unfortunately, this reduction of joint inflammation during pregnancy is not usually sustained after delivery.

Medications that are commonly used to treat inflammation, such as nonsteroidal anti-inflammatory drugs including ibuprofen (Motrin, Advil), naproxen (Aleve), and others, are not used during pregnancy. Drugs that are used to stop the progression of rheumatoid disease, such as methotrexate (Rheumatrex, Trexall) and cyclosporine (Neoral, Sandimmune), are not used during pregnancy and also must be discontinued well in advance of conception because of potential risks to the fetus. Biologic medications are avoided during pregnancy when possible.

When rheumatoid arthritis is active during pregnancy, steroid medications such as prednisone and prednisolone are often used to quiet the joint inflammation. These medications do not adversely affect the fetus.

What are complications of rheumatoid disease?


Since rheumatoid arthritis is a systemic disease, its inflammation can affect organs and areas of the body other than the joints. Inflammation of the glands of the eyes and mouth can cause dryness of these areas and is referred to as Sjögren's syndrome. Dryness of the eyes can lead to corneal abrasion. Inflammation of the white parts of the eyes (the sclerae) is referred to as scleritis and can be very dangerous to the eye.

Rheumatoid inflammation of the lung lining (pleuritis) causes chest pain with deep breathing, shortness of breath, or coughing. The lung tissue itself can also become inflamed, scarred, and sometimes nodules of inflammation (rheumatoid nodules) develop within the lungs. Inflammation of the tissue (pericardium) surrounding the heart, called pericarditis, can cause a chest pain that typically changes in intensity when lying down or leaning forward. Rheumatoid arthritis is associated with an increase risk for heart attack.

Rheumatoid disease can reduce the number of red blood cells (anemia) and white blood cells. Decreased white cells can be associated with an enlarged spleen (referred to as Felty's syndrome) and can increase the risk of infections. The risk of lymph gland cancer (lymphoma) is higher in patients with rheumatoid arthritis, especially in those with sustained active joint inflammation. Firm lumps under the skin (rheumatoid nodules) can occur around the elbows and fingers where there is frequent pressure. Even though these nodules usually do not cause symptoms, occasionally they can become infected. Nerves can become pinched in the wrists to cause carpal tunnel syndrome. A rare, serious complication, usually with longstanding rheumatoid disease, is blood vessel inflammation (vasculitis). Vasculitis can impair blood supply to tissues and lead to tissue death (necrosis). This is most often initially visible as tiny black areas around the nail beds or as leg ulcers.

Rheumatoid arthritis diet and other treatments


There is no special diet or diet "cure" for rheumatoid arthritis. One hundred years ago, it was touted that "night-shade" foods, such as tomatoes, would aggravate rheumatoid arthritis. This is no longer accepted as true. Fish oil has been shown to be beneficial in some short-term studies in rheumatoid arthritis. The anti-inflammatory effects of curcumin in dietary turmeric, an ingredient in curry, may be beneficial in reducing symptoms of rheumatoid arthritis.

The benefits of cartilage preparations for rheumatoid arthritis remain unproven. Symptomatic pain relief can often be achieved with oral acetaminophen (Tylenol) or over-the-counter topical preparations, which are rubbed into the skin. Antibiotics, in particular the tetracycline drug minocycline (Minocin), have been tried for rheumatoid arthritis recently in clinical trials. Early results have demonstrated mild to moderate improvement in the symptoms of arthritis. Minocycline has been shown to impede important mediator enzymes of tissue destruction, called metalloproteinases, in the laboratory as well as in humans.

The areas of the body other than the joints that are affected by rheumatoid inflammation are treated individually. Sjögren's syndrome (described above, see symptoms) can be helped by artificial tears and humidifying rooms of the home or office. Medicated eyedrops, cyclosporine ophthalmic drops (Restasis), are also available to help the dry eyes in those affected. Regular eye checkups and early antibiotic treatment for infection of the eyes are important. Inflammation of the tendons (tendinitis), bursae (bursitis), and rheumatoid nodules can be injected with cortisone. Inflammation of the lining of the heart and/or lungs may require high doses of oral cortisone.

Proper regular exercise is important in maintaining joint mobility and in strengthening the muscles around the joints. Swimming is particularly helpful because it allows exercise with minimal stress on the joints. Physical and occupational therapists are trained to provide specific exercise instructions and can offer splinting supports. For example, wrist and finger splints can be helpful in reducing inflammation and maintaining joint alignment. Devices such as canes, toilet seat raisers, and jar grippers can assist in the activities of daily living. Heat and cold applications are modalities that can ease symptoms before and after exercise.

Surgery may be recommended to restore joint mobility or repair damaged joints. Doctors who specialize in joint surgery are orthopedic surgeons. The types of joint surgery range from arthroscopy to partial and complete replacement of the joint. Arthroscopy is a surgical technique whereby a doctor inserts a tube-like instrument into the joint to see and repair abnormal tissues.

Total joint replacement is a surgical procedure whereby a destroyed joint is replaced with artificial materials. For example, the small joints of the hand can be replaced with plastic material. Large joints, such as the hips or knees, are replaced with metals.

Finally, minimizing emotional stress can help improve the overall health in people with rheumatoid arthritis. Support and extracurricular groups provide those with rheumatoid arthritis time to discuss their problems with others and learn more about their illness.

Is there hope for people with rheumatoid arthritis?


Yes. Although there is not yet a cure for rheumatoid arthritis, there are many effective methods available for decreasing the pain and inflammation, and slowing down the disease process. Early diagnosis and effective treatment is of great importance.

Extensive research is in progress to determine the cause of rheumatoid arthritis and the best method of treatment.