OVERVIEW, SYMPTOMS, & CAUSES

Overview of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic (long-lasting) inflammatory disease that mostly affects joints. RA causes pain, swelling, stiffness, and loss of function in joints. It is an autoimmune disorder because the immune system attacks the healthy joint tissues. Normally, the immune system helps protect the body from infection and disease.

Additional features of rheumatoid arthritis can include the following.

  • It affects the lining of the joints, which damages the tissue that covers the ends of the bones in a joint.
  • RA occurs in a symmetrical pattern, meaning that if one knee or hand has the condition, the other hand or knee does, too.
  • It affects the joints in the wrist, hands, feet, spine, knees, and jaw.
  • RA may cause fatigue, occasional fevers, and a loss of appetite.
  • RA may cause medical problems outside of the joints, in areas such as the heart, lungs, blood, nerves, eyes, and skin.

Fortunately, current treatments can help people with the disease to lead productive lives.

What happens in rheumatoid arthritis?

Doctors do not know why the immune system attacks joint tissues. However, they do know that when a series of events occurs, rheumatoid arthritis can develop. This series of events includes:

  • A combination of genes and exposure to environmental factors starts the development of RA.
  • The immune system may be activated years before symptoms appear.
  • The start of the autoimmune process may happen in other areas of the body, but the impact of the immune malfunction settles in the joints.
  • Immune cells cause inflammation in the inner lining of the joint, called the synovium.
  • This inflammation becomes chronic, and the synovium thickens due to an increase of cells, production of proteins, and other factors in the joint, which can lead to pain, redness, and warmth.
  • As RA progresses, the thickened and inflamed synovium pushes further into the joint and destroys the cartilage and bone within the joint.
  • As the joint capsule stretches, the forces cause changes within the joint structure.
  • The surrounding muscles, ligaments, and tendons that support and stabilize the joint become weak over time and do not work as well. This can lead to more pain and joint damage, and problems using the affected joint.

Who Gets Rheumatoid Arthritis?

You are more likely to get rheumatoid arthritis if you have certain risk factors. These include:

  • Age. The disease can happen at any age; however, the risk for developing rheumatoid arthritis increases with age. Children and younger teenagers may be diagnosed with juvenile idiopathic arthritis, a condition related to rheumatoid arthritis.
  • Sex. Rheumatoid arthritis is more common among women than men. About two to three times as many women as men have the disease. Researchers think that the female hormone estrogen may play a role in the development of the disease for some women.
  • Family history and genetics. If a family member has RA, you may be more likely to develop the disease.
  • Smoking. Research shows that people who smoke over a long period of time are at an increased risk of getting rheumatoid arthritis. For people who continue to smoke, the disease may be more severe.
  • Obesity. Some research shows that being obese may increase your risk for the disease as well as limit how much the disease can be improved.
  • Periodontitis. Gum disease may be associated with the risk of RA.

    Symptoms of Rheumatoid Arthritis

    Common symptoms of rheumatoid arthritis include:

    • Joint pain at rest and when moving, along with tenderness, swelling, and warmth of the joint.
    • Joint stiffness that lasts longer than 30 minutes, typically after waking in the morning or after resting for a long period of time.
    • Fatigue – feeling unusually tired or having low energy.
    • Occasional low-grade fever.
    • Loss of appetite.

    Rheumatoid arthritis can happen in any joint; however, it is more common in the wrist, hands, and feet. The symptoms usually happen on both sides of the body, in a symmetrical pattern. For example, if you have RA in the right hand, you likely also have it in the left hand.

    RA affects people differently. In some people, RA starts with mild or moderate inflammation affecting just a few joints. However, if it is not treated or the treatments are not working, RA can worsen and affect more joints. This can lead to more damage and disability. At times, RA symptoms worsen in “flares” due to a trigger such as stress, too much activity, or suddenly stopping medications.

    The goal of treatment is to control the disease so it is in remission or near remission, with no signs or symptoms of the disease.

    Rheumatoid arthritis can cause other medical problems, such as:

    • Rheumatoid nodules that are firm lumps just below the skin.
    • Anemia due to low blood cell counts.
    • Neck pain and dry eyes and mouth.
    • Rarely, inflammation of the blood vessels, the lining of the lungs, or the sac enclosing the heart.

    Causes of Rheumatoid Arthritis

    Researchers do not know what causes the immune system to turn against the body’s joints and other tissues. Studies show that a combination of the following factors may lead to the disease:

    • Genes. Certain genes that affect how the immune system works may lead to rheumatoid arthritis. However, some people who have these genes never develop the disease. This suggests that genes are not the only factor in the development of RA. In addition, more than one gene may determine who gets the disease and how severe it will become.
    • Environment. Researchers continue to study how environmental factors may trigger rheumatoid arthritis in people who have specific genes that also increase their risk. In addition, some factors such as bacteria, viruses, and gum disease may play a role in the development of RA.
    • Sex hormones. Researchers think that sex hormones may play a role in the development of rheumatoid arthritis when genetic and environmental factors also are involved. Studies show:
      • Women are more likely than men to develop rheumatoid arthritis.
      • The disease may improve during pregnancy and flare after pregnancy.
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