Rheumatoid arthritis can affect any joint in the body but usually affects the small joints in the hands and feet before any of the larger joints such as hips, knees, shoulders and elbows are affected. Joints are usually affected symmetrically (both the left and the right side of the body).
The condition can develop at any age, though it is most likely to develop between the ages of 25 and 50 years. Rarely, children under the age of 16 can develop a form of rheumatoid arthritis known as juvenile rheumatoid arthritis or Still’s disease.
Signs and symptoms
Fatigue can be one of the most difficult symptoms of rheumatoid arthritis for people to manage. Other symptoms may include:
- Pain in the joints
- Swelling (often accompanied by warmth and redness) of the joints
- Stiffness in the joints (generally worse in the mornings and after periods of rest)
- Muscle pain
- Mild fever
- Loss of appetite (with resulting weight loss)
- Changes to the skin and nails
- Anaemia can also occur, often compounding the feeling of fatigue and the feeling of being generally unwell.
Because rheumatoid arthritis is a systemic condition (ie, it can have an effect on the whole body) symptoms may be similar to having the flu. Rheumatoid arthritis can cause problems with other parts of the body. These include:
- Inflammation of the blood vessels (vasculitis)
- Inflammation of the linings of the lung or the heart
- Dryness of the eyes and mouth.
Approximately one in six people with rheumatoid arthritis will develop significant joint deformity as a result of damage to the cartilage, bones and supporting structures such as the ligaments and tendons.
Genetic (inherited) factors:
The condition appears to run in families, which suggests that genetic factors may influence its development.
It is possible that rheumatoid arthritis is triggered by the abnormal response of the body’s immune system (autoimmune response) to some infections.
Changes or deficiencies in certain hormones may be involved in the development of rheumatoid arthritis.
There is no single test that diagnoses rheumatoid arthritis. In its initial stages it may be difficult to distinguish rheumatoid arthritis from other forms of connective tissue inflammation, such as gout, systemic lupus erythematosus (SLE), and fibromyalgia. In order to diagnose rheumatoid arthritis a doctor will usually undertake the following:
- A full medical history, including any family history of rheumatoid arthritis
- Discussion of current symptoms
- Physical assessment eg: of the joints, skin, reflexes and muscle strength
- X-rays and/or MRI scans
- Blood tests.
These tests assess levels of proteins and antibodies in the blood, including a protein called rheumatoid factor (RF), antinuclear antibodies (ANA) and sometimes other antibodies such as anti-CCP. Rheumatoid factor is present in up to 80% of people with rheumatoid arthritis.
Blood tests to assess erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be performed. It is common for both markers to be elevated in people with rheumatoid arthritis and they can be a good indicator of the extent of the condition.
Treatment for rheumatoid arthritis is aimed at treating the symptoms. Goals of treatment are to:
- Reduce pain
- Reduce inflammation
- Minimise and/or prevent joint damage
- Maximise joint movement.
Common types of medications used to treat the symptoms of rheumatoid arthritis include:
Non-steroidal anti-inflammatory drugs (NSAIDs)
These medications work by treating pain and inflammation.
These medications eg: prednisone, work to reduce pain and inflammation, and are more powerful than NSAIDs.
Disease modifying antirheumatic drugs (DMARDs)
These medications, which are used to treat moderate to severe rheumatoid arthritis, slow the progression of the disease helping to prevent permanent joint damage. Types of medications in this category include methotrexate, leflunomide, hydroxychloroquine and sulphasalazine. Methotrexate is considered by many to be the anchor drug in managing severe rheumatoid arthritis.
A range of physiotherapy treatments are used to reduce pain, improve movement, strengthen muscles, and maintain independence.
EXERCISE AND REST
A balance should be reached between exercise and rest. When the disease is active more rest may be appropriate. Rest will help reduce fatigue, pain and inflammation. Exercise is important to increase muscle strength, decrease joint deformities and stiffness, and to maintain mobility. A physiotherapist can recommend an appropriate exercise regimen.
CARE OF JOINTS
Joint protection and work simplification methods can be effective in decreasing joint pain and fatigue. An occupational therapist or physiotherapist can give advice on these. The use of splints or joint-sparing devices such as zipper pullers or long-handled shoehorns may be suggested.
When pain is severe or deformities disabling, and especially when medications fail to prevent or slow joint damage, surgery to repair damaged joints may be indicated. Commonly this involves hip and knee joint replacements but it may be necessary to perform other joint replacements. The repair of tendons and removal of an inflamed synovium (synovectomy) may also be required.
Some people find therapies such as meditation and relaxation techniques helpful in managing symptoms. The anti-inflammatory effects of some fish oils may also be beneficial.
Arthritis New Zealand
Freephone 0800 663 463
Mayo Clinic (2016). Rheumatoid arthritis (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/home/ovc-20197388 [Accessed: 25/07/17]
Smith, H.R. (2017). Rheumatoid arthritis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/331715-overview?src=refgatesrc1 [Accessed: 25/07/17]