Rheumatoid arthritis is a chronic (long-lasting) disease that causes inflammation and deformation of the joints. Symptoms may come and go or change, but usually include joint pain, morning stiffness in them and limitation of movement. This condition can be controlled using a combination of treatment methods.
Rheumatoid arthritis is the second most common form of arthritis. It is three times more common in women than in men. Rheumatoid arthritis is found in all ethnic groups, climates and altitudes.
Rheumatoid arthritis is a consequence of changes in the body’s immune system, which (for unknown reasons) affect the soft tissues of the joints, causing inflammation, swelling and pain. If the process continues, damage to the cartilage and other soft tissues can lead to joint deformation.
In a healthy joint, the cartilage evenly covers the bone, acts as a pillow and allows the bones in the joint to glide smoothly over each other. The joint is contained in the joint capsule, which is lined with the synovial membrane (synovium). The synovial membrane produces synovial fluid, a clear fluid that lubricates and nourishes the joint. The surrounding muscles, tendons and ligaments support the joint, allowing it to move smoothly and without pain.
Rheumatoid arthritis causes inflammation and thickening of the usually thin synovium, which leads to the accumulation of synovial fluid and causes pain and swelling. In addition, the cartilage and bones inside the joint can be damaged and destroyed, which will lead to loss of function and deformation of the joint.
Rheumatoid arthritis can affect any joint in the body but usually affects small joints in the arms and legs. With the progression of the disease, other, larger joints can be affected. Joints are usually affected symmetrically (both the left and right sides of the body).
The condition can develop at any age, although, most likely, it will develop at the age of 25 to 50 years.
Signs and symptoms
Rheumatoid arthritis can develop gradually or very quickly. Signs and symptoms can vary greatly from person to person and can range from mild to very severe. Rheumatoid arthritis is characterized by periods of remission (absence of symptoms) and exacerbation (when symptoms are severe). Sometimes there is an obvious cause of exacerbation (physical or emotional stress, illness), but usually there is no obvious trigger. The course of the disease in each patient is individual and it is impossible to predict the development of the disease.
Fatigue can be one of the symptoms of rheumatoid arthritis for people who are difficult to cope with. Other symptoms may include:
- Joint pain (the main symptom in rheumatoid arthritis);
- Joint swelling (often accompanied by redness and fever in its area);
- Stiff joints (usually worse in the morning and after periods of rest);
- Muscle pain;
- Mild fever;
- Loss of appetite;
- Skin and nail changes;
- Anemia can also occur, often exacerbating a feeling of fatigue and a general feeling of ill health.
Since rheumatoid arthritis is a systemic disease (that is, it can affect the entire body), the symptoms may be similar to the presence of flu. Rheumatoid arthritis can cause problems with other parts of the body. They include:
- Inflammation of the blood vessels (vasculitis);
- Inflammation of the mucous membrane of the lungs or heart;
- Dry eyes and mouth.
About a quarter of people with rheumatoid arthritis develop small, hard, moving lumps under their skin called rheumatoid nodules. They usually appear under the skin around the joints and on the upper arms and legs. Rarely, rheumatoid nodules can occur on tissue membranes that cover the lungs and on the mucous membrane of the brain and spinal cord. Rheumatoid nodules usually do not cause any problems and usually do not require treatment.
Approximately one in six people with rheumatoid arthritis develops significant joint deformation as a result of damage to cartilage, bones and supporting structures such as ligaments and tendons.
Causes of arthritis
The causes of the disease can be different and depend on what kind of arthritis we are talking about. Reactive or infectious arthritis occurs when a bacterial, viral, or fungal infection enters the body. Inflammation of the joints can be a consequence of metabolic disorders, for example, with gout.
Also, the disease can develop due to a decrease in immunity or malfunctions in the immune system after a disease – in this case we will talk about rheumatoid arthritis. The hormonal system or the nerves may provide the person with rheumatoid arthritis. This is a chronic inflammation of the hands and feet. It is characterized by stiffness, swelling, hyperthermia, acute pain.
The joints can become inflamed after an injury or hypothermia — this causes osteoarthritis or traumatic arthritis. Such inflammation can appear after bruises, sprains, torn ligaments and other closed injuries, which result in hemorrhage in the joint. Open injuries can provoke acute purulent arthritis.
Dystrophic arthritis threatens those who eat improperly and receive not enough vitamins and minerals. Psoriatic arthritis affects people who have psoriasis. The joints swell and the fingers become like sausages.
Stages of arthritis
- I – the initial stage, in most cases it is asymptomatic, but signs of inflammation of the joint are visible on x-rays. There is some stiffness in movements and weakness when performing physical exertion. In the morning, it’s hard for a person to perform basic daily routines. If the patient at this stage consults a doctor, then the treatment of the disease is successful and painless;
- II – at this stage, the progression of inflammation and thinning of the joint tissue occurs, which leads to increased pain and the appearance of small wounds (erosions) on the heads of bones. The mobility of the joint is reduced, swelling and redness are formed at the site of the lesion, a characteristic crunch appears. If arthritis has affected the hip joint, then it becomes difficult for a person to move as before, and he or she begins to limp. In the case when the disease affects the shoulder joint, the patient feels pain even when raising his /her arm;
- III – disease at this stage acquires an acute form, obvious signs of deformation of the affected joint are visible on x-rays, it is difficult for the patient to perform daily self-care procedures. If the joints of the lower extremities are affected, it is difficult for a person to move, acute pains do not go away even when at rest. At this stage of the disease, the patient is enrolled in the first disability group. If arthritis of the third degree is not treated, then this can lead to even greater joint deformation and irreversible consequences;
- IV – the extreme stage of the disease, in which the destructive processes become irreversible, which leads to almost complete immobility of the affected joints, which implies that the patient can no longer move independently. A person with the fourth stage of arthritis feels constant pain, while painkillers do not guarantee a complete shutdown of the pain symptoms. Against this background, the patient is disturbed in the psycho-emotional state.
Types of arthritis
- Rheumatoid. This is a systemic inflammatory disease related to polyarthritis since inflammation affects the cartilage and bone tissue symmetrically (in parallel). With rheumatoid arthritis, the patient’s immune system perceives its own tissues as extraneous and infects them, as a result of which the disease flows into a chronic form, and if treatment is postponed, the inflammation affects large joints. This type is more common in women than in men;
- Reactive. The main factor provoking the development of reactive arthritis is infection. Pathology manifests itself against the background of recently transferred diseases and reduced immunity, mainly pathogens penetrate through the reproductive or digestive systems. The causative agents of infection include bacteria of various types: chlamydia, ureaplasma, mycoplasma, dysentery bacillus, salmonella, typhoid fever, etc. More often, cases of reactive arthritis are found in the male population;
- Traumatic. The provoking factor in the development of traumatic arthritis is the presence of joint injuries. Microcracks resulting from regular excess load lead to an inflammatory reaction. This type is diagnosed in athletes and people whose activities are associated with heavy manual labor (builders);
- Gouty. Arthritis developing on the background of gout. This disease occurs due to impaired protein metabolism and deposition of uric acid salts in the body. Gout is diagnosed in people with a sedentary lifestyle, consuming fatty foods and alcohol in large quantities, as well as in people suffering from diabetes or obesity;
- Psoriatic. The chronic form of arthritis, which is provoked by the presence of psoriasis and the lack of proper treatment, and this, in turn, leads to the fact that the disease affects not only the skin but also the joints. Psoriatic arthritis affects large and small joints, the classic version of the lesion is the distal interphalangeal joints of the hands and feet;
- Degenerative-dystrophic arthritis. In view of various factors, cartilage tissue is gradually worn out and destroyed, which leads to a change in the shape of the joint and the appearance of bone growths. There are two types of this arthritis: endocrinopathic, which is caused by a thyroid disease and hormonal changes in menopause. And osteoarthritis, which is provoked by a violation of metabolism in the cartilage, starts the process of destruction of the cartilage.
There is no single test that diagnoses rheumatoid arthritis. In the initial stages, it can be difficult to distinguish rheumatoid arthritis from other forms of inflammation of the connective tissue, such as gout, systemic lupus erythematosus, fibromyalgia and others. To diagnose rheumatoid arthritis, the doctor usually does the following:
- Collection of anamnesis (complete medical history, including any family history of rheumatoid arthritis);
- Discussion of current symptoms;
- Physical assessment, for example: joints, skin, internal organs;
- X-ray and / or MRI;
- Blood tests.
Two types of blood tests are usually used to diagnose rheumatoid arthritis:
- Immunological tests. These tests measure blood protein and antibody levels, including a protein called rheumatoid factor (RF), antinuclear antibodies (ANA), and sometimes other antibodies. Rheumatoid factor is present in 80% of people with rheumatoid arthritis;
- Markers of inflammation. Blood tests can be performed to evaluate the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Typically, both markers are elevated in people with rheumatoid arthritis, and they can be a good indicator of the degree of the disease.
Complications of arthritis are diverse and are largely determined by the disease that triggered its development. A common complication for all arthritis is ankylosis of the affected joints and their deformation. A pathological distortion of the shape of the joint occurs, the patient cannot normally make movements, as a result mobility as a whole suffers. With arthritis of the joints of the hand, the patient cannot normally take a spoon in his/her hand, manipulate objects, and lose the ability to self-service, which is the cause of disability. With arthritis of the joints of the legs, the patient cannot bend the affected limb, as a result, the ability to move independently is lost.
The treatment of arthritis will take a lot of time, it should be complex – the task is not only to relieve pain but also to eliminate inflammation and the very cause of the disease.
- Use of non-steroidal anti-inflammatory drugs that relieve pain and reduce inflammation; steroid drugs (injections of hormones in the joint), which are prescribed in case of severe and acute pains; cytostatics – these antitumor drugs stop the growth, development and division of cells.
- Be sure to review your physical activity, nutrition, start taking vitamins and chondroprotectors. It is recommended to undergo physiotherapy, to engage in physical therapy.
- Doctors prescribe a low-calorie diet for arthritis, a balanced intake of carbohydrates, fats, and proteins. Food should be steamed or baked. You can eat fish, meat, dairy products, vegetables, fruits, chicken, eggs. Lentils, peas, beans, bananas are especially recommended. Animal fats should be replaced with vegetable fats.
- It is prohibited to consume broths, mushrooms, offal, cauliflower, sorrel. You should also avoid the consumption of strong tea and coffee, fast food, chips, muffins, jams.
Early stages of arthritis are treatable.
To protect yourself from this dangerous disease and avoid prolonged and painful treatment, you should protect your health from youth. The recommendations that doctors give are as follows:
- Keep to a balanced diet that is rich in calcium, vegetables, and fruits. Eliminate animal fats — cholesterol sources — from your menu. Limit your intake of sugar, sugary sodas, sweets;
- Watch the weight. Overweight affects joints.
- Get rid of bad habits – give up smoking and alcohol;
- Do not sit or stand long in one position.