Rheumatoid Arthritis: From Symptoms to Treatment

Rheumatoid Arthritis: From Symptoms to Treatment

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, leading to damage of cartilage and bone. The disease typically affects multiple joints, especially the small joints in the hands and feet.

Causes and risk factors:

• The exact cause of RA is unknown, but it is believed to be due to a combination of genetic, environmental, and immune factors.

• Factors that can increase the risk of developing RA include:

• Infections: Epstein-Barr virus (EBV), parvovirus

• Genetic predisposition: Individuals with a family history of RA are at a higher risk.

• Environmental factors: prolonged cold and humid weather

• Age and gender: Women over 40 are at a higher risk.

• HLA-DR4: a gene related to the immune system

Clinical manifestations:

• Joint involvement:

• Small joints: proximal interphalangeal joints, metacarpophalangeal joints, wrists, elbows

• Large joints: knees, ankles, metatarsophalangeal joints

• Damage usually appears symmetrically on both sides.

• Earliest affected joints:

• Wrist joints (50-60%)

• Metacarpophalangeal joints, knees (10-15%)

• Joint deformities:

• “Windswept” hand

• “Swan neck” deformity

• “Boutonniere” deformity

• Other symptoms:

• Morning stiffness: stiffness lasting longer than 1 hour

• Swelling, warmth, redness, and pain in the joints

• Rheumatoid nodules under the skin

• Fatigue, weakness

• Weight loss

Diagnosis:

• Laboratory tests:

• Rheumatoid factor (RF): detected by the Waaler-Rose test, positive when values are above 14 IU/ml.

• Anti-CCP: appears early and has prognostic value regarding the potential for joint damage.

• X-ray:

• Soft tissue swelling around the joints

• Loss of mineral content in the bone ends

• Narrowing of the joint space

• Bone erosions: specific sign

• Staging: based on the degree of damage on X-ray according to Steinbroker:

• Stage 1: loss of bone mineral content at the bone ends.

• Stage 2: bone erosions, bone cysts, mild joint space narrowing.

• Stage 3: significant joint space narrowing, irregularity, partial joint fusion.

• Stage 4: severe joint fusion and deformity, subluxation, joint axis deviation.

• Ultrasound and magnetic resonance imaging (MRI): help detect synovitis.

• Diagnostic criteria for RA:

• According to ACR 1987: need to meet at least 4/7 criteria.

• According to ACR/EULAR 2010: total score ≥ 6 points.

Differential diagnosis:

• Juvenile rheumatoid arthritis: often seen in children under 26 years old, acute migratory arthritis, history of pharyngitis, positive ASLO.

• Systemic lupus erythematosus: has skin, kidney, neurological symptoms…

• Osteoarthritis: damage often in weight-bearing joints, without systemic symptoms.

• Gouty arthritis: presents with acute swelling and pain in the great toe joint.

• Scleroderma: thickening and hardening of the skin.

• Pierre Marie syndrome: ankylosing spondylitis.

Treatment:

• Treatment goals: control symptoms, reduce joint damage, improve quality of life.

• Medications:

• Corticosteroids: used during flares or while waiting for DMARDs to take effect.

• High-dose, short-term for attack.

• Low-dose, long-term for maintenance.

• Disease-modifying antirheumatic drugs (DMARDs): treat the underlying disease, slow down disease progression.

• Conventional DMARDs: antimalarials (hydroxychloroquine), methotrexate, sulfasalazine.

• Biologic DMARDs: etanercept, adalimumab (anti TNF alpha), tocilizumab (anti IL6), rituximab (anti B cell).

• Intra-articular corticosteroid injections: reduce local swelling and inflammation, used during flares.

• Physical therapy: strengthen joint function.

• Surgery: to correct joint deformities, joint replacement.

Notes:

• Treatment of RA is a long-term process that requires close monitoring by a physician.

• Use medications as prescribed by your doctor, do not self-medicate.

• Maintain a healthy diet, exercise regularly, and keep a positive attitude to enhance your health.

In conclusion, RA is a chronic disease that can cause severe joint damage. Early and proper treatment can effectively control the disease and improve quality of life for patients.