Rheumatoid Arthritis is a chronic inflammatory condition characterized by symmetric polyarthritis affecting the hands, feet, and any joint with a synovial membrane. Other organs that may be involved include the skin, eyes, heart, and lungs.
The cause of rheumatoid arthritis is unknown, but genetic, hormonal, immunologic, and environmental factors most likely play important roles. Disease outcome may be influenced by psychological, socioeconomic, and lifestyle factors.
Globally, it is estimated that around 3 in 10,000 people are affected by the disease annually. It usually affects people ages 35 to 50 years, with women thrice more likely to be affected than men. It is more prevalent in certain populations, such as Native American groups, and less prevalent among others, such as black people from the Caribbean.
People who have first-degree relatives with rheumatoid arthritis have a risk that is 2- to 3-fold higher for developing the disease. However, non-genetic factors also play an important role.
Signs and Symptoms
The hallmark characteristic of rheumatoid arthritis is persistent multiple joint inflammation that follows a symmetric pattern. It usually involves the hands and feet, but other joints lined with a synovium may be affected as well. The severity of symptoms may fluctuate, but chronic arthritis commonly results in progressive joint destruction, leading to deformity and significant loss of function. Patients usually complain about having difficulty carrying out activities of daily living, such as standing, walking, dressing, and personal hygiene.
Aside from joint deterioration, patients also experience other symptoms such as fatigue, morning stiffness, low-grade fever, and weight loss.
Physical examination reveals joint stiffness and tenderness, joint pain, swelling and deformity, and the presence of rheumatoid nodules.
In general, the small joints of both hands and feet are often affected symmetrically. Other joints affected include the cervical spine, shoulder, elbow, hip, ankle, and the temporomandibular joints.
There are no specific tests that define rheumatoid arthritis; instead, a combination of clinical and laboratory evaluations are necessary to confirm the diagnosis. Bone scans may help differentiate inflammatory from non-inflammatory features in joints with minimal swelling. Bone density measurements are useful for determining changes in the density of bone mineral to identify osteoporosis.
Other useful laboratory studies include identification of various markers in the blood, which help in the diagnosis. These markers include the following:
- Antinuclear antibody (ANA) assay
- C-reactive protein (CRP) level
- Erythrocyte sedimentation rate (ESR)
- Rheumatoid factor (RF) assay
- Anti−cyclic citrullinated peptide (ACCP) and anti−mutated citrullinated vimentin (AMCV) assays
No laboratory tests are specific for rheumatoid arthritis, but the presence of ACPA and RF increases the likelihood of rheumatoid arthritis as the diagnosis.
Optimal care consists of a combined approach that includes pharmacologic and nonpharmacologic treatments. Nonpharmacologic therapies include diet, exercise, massage, counseling, physical therapy, stress reduction, and, sometimes, surgery.
Pharmacologic or medication-based treatments include several classes of drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, immunosuppressants, and biologic disease-modifying antirheumatic drugs. Early treatment is the standard of care, which aims to slow down disease progression and to induce more remissions.
Surgical treatments for rheumatoid arthritis include synovectomy, tendon realignment, tenosynovectomy, arthrodesis, and reconstructive surgery of the joint or arthroplasty.
At American Infusion Centers we use the following drugs for rheumatoid arthritis: