RHEUMATOID arthritis (RA) is a chronic, autoimmune disease that primarily affects the joints, leading to inflammation, pain, and potential joint damage. Unlike osteoarthritis, which is primarily caused by wear and tear on the joints, rheumatoid arthritis occurs when the body's immune system mistakenly attacks its tissues, specifically the synovium—the lining of the joints. Over time, this inflammatory process can cause joint deformities, loss of function, and widespread complications.
RA is an autoimmune disease, meaning that the body's immune system, which is designed to protect against harmful invaders like bacteria and viruses, begins to attack its healthy tissues. In RA, the immune system targets the synovium, the tissue lining the joints, leading to inflammation. This chronic inflammation can damage cartilage and bone, leading to joint deformities and disability if left untreated.
Although RA primarily affects the joints, it can also have systemic effects, impacting other organs and systems, including the lungs, heart, eyes, and blood vessels. This makes RA a potentially disabling and life-shortening disease if not properly managed.
RA tends to run in families, and certain genetic markers, such as the HLA-DRB1 gene, are associated with an increased risk of developing the disease. However, genetics alone does not account for the full risk of RA. In RA, the immune system mistakenly identifies the synovium as harmful and attacks it. This is thought to be triggered by environmental factors in genetically predisposed individuals. Some factors that may trigger or exacerbate RA include smoking, bacterial or viral infections, and exposure to certain chemicals. Smoking is one of the most significant environmental risk factors for RA, particularly for those with a genetic predisposition. Women are more likely than men to develop RA, with the disease commonly emerging between the ages of 30 and 60. This suggests that hormones, particularly estrogen, may play a role in the disease’s onset and progression.
The most characteristic symptom of RA is pain, swelling, and stiffness in the joints. The joints most commonly affected are the small joints in the hands, wrists, and feet, but larger joints like the knees, elbows, and shoulders can also be involved. People with RA often experience stiffness in the affected joints, particularly in the morning or after periods of inactivity. This stiffness can last for more than an hour in severe cases. Chronic fatigue is a common and often debilitating symptom of RA. This may result from the body’s ongoing inflammatory response or from the stress of living with a chronic illness.
RA often affects joints on both sides of the body. For example, if one wrist is affected, the other wrist will often be involved as well. Over time, chronic inflammation can cause joint damage, leading to decreased range of motion, difficulty performing everyday tasks, and eventual deformities, such as bent fingers or toes. Since RA is a systemic condition, individuals may experience symptoms outside of the joints, including fever, weight loss, anaemia, dry eyes, and lung or heart problems.
Although there is no cure for RA, a range of treatments can help control symptoms, prevent joint damage, and improve quality of life. Treatment typically involves a combination of medications, lifestyle modifications, and physical therapy.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) can help reduce pain and inflammation. Disease-modifying anti-rheumatic Drugs (DMARDs) can help slow the progression of RA by suppressing the immune system. Physical therapists can help RA patients improve joint mobility, strengthen muscles around the joints, and maintain independence in daily activities.
Regular, low-impact exercises like swimming, walking, and yoga can help reduce stiffness, improve joint function, and boost overall health. Maintaining a healthy weight reduces strain on the joints, especially weight-bearing ones like the knees and hips. A balanced diet rich in anti-inflammatory foods, such as omega-3 fatty acids (found in fish), can help manage inflammation. Some people with RA benefit from reducing their intake of processed foods and sugars. In advanced cases where joint damage is severe, surgery may be necessary. Options include joint replacement, tendon repair, or synovectomy (removal of the inflamed synovium).
Rheumatoid arthritis is a complex, autoimmune condition that can have a significant impact on both physical and mental well-being. Early diagnosis, a tailored treatment plan, and ongoing management are essential for improving outcomes and minimizing the effects of RA on daily life.
