What is rheumatoid arthritis?

What causes rheumatoid arthritis?

Which joints are affected by rheumatoid arthritis?

What are the signs and symptoms of rheumatoid arthritis?

How is rheumatoid arthritis diagnosed?

How is rheumatoid arthritis treated?

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What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a condition that makes the joints in your body become inflamed, causing pain and stiffness. It is the second most common form of arthritis.

It is known as an auto-immune condition, which means that the immune system, the body's natural self-defence system, gets confused and starts to attack your body's healthy tissues. In rheumatoid arthritis, the main way it does this is with inflammation in your joints.

At the moment there is no cure for RA but, over the years, treatment for RA has advanced significantly giving many people a better outlook.

With the right medication, many people living with RA lead near-to-normal, active lives. Research shows that the sooner treatment for RA begins, the more effective it is likely to be.  

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What causes rheumatoid arthritis?

The exact causes of RA are unknown. We know that it is an autoimmune disease - where the immune system aggressively targets the body's healthy tissues and joints rather than germs and viruses. When the immune system targets healthy joints, the joints can become stiff and inflamed and cause pain.

Research to date suggests that certain genes in our body, which play a part in the immune system, are linked with RA. Having these genes doesn't mean you will definitely get RA, but it means you might have a tendency to develop it.

Researchers now think that something must trigger RA in people who have a tendency to develop it. There is no real evidence yet as to what those triggers are, but it's thought they might include stress, an infection or virus, smoking or hormonal changes in your body.

Smoking

Rheumatoid arthritis develops through a combination of genetic and environmental factors. Cigarette smoking is classed as an environmental factor and significantly increases the risk of developing the condition. Smoking can also weaken how well your medication works.

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Which joints are affected by rheumatoid arthritis?

RA varies a lot from person to person. It can affect almost any joint, the small joints of the fingers, thumbs, wrists, feet and ankles are most commonly affected. Knees and shoulders can also be affected and, less commonly, elbows, hips, neck, and other joints. Most people are affected in more than one joint. RA usually affects both sides of the body - not always at once, but usually within a short space of time.

In RA, your immune aggressively targets your joints and they become inflamed. The inflammation particularly affects;

- the synovial membrane (thin layer of tissue lining the inside of the joint)

- the tendon sheaths (tubes in which tendons move)

- the bursae (little sacs which hold fluid to coat the joint and help it move easily)

The joint swells and the inflamed tissues in the joint become stiff, painful and swollen. If the inflammation isn't tackled, it can damage the joints.

Much of this damage can happen in the first months and years of RA. This is why it is vital to get an early diagnosis so that you can get treatment before lasting damage is done.

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What are the early signs and symptoms of rheumatoid arthritis?

Although the symptoms of RA vary from person to person, the most common symptoms include;

- pain and swelling in the joints

- stiffness in the joints, particularly in the morning or after resting and lasting longer than 30 minutes

- redness or warmth in the joint

- inflammation around the tendons

Other symptoms;

- Fatigue (tiredness) and loss of energy

- Running a slight temperature

- A general feeling of being unwell, often described as like having the flu

- Loss of appetite

- Weight loss

- Anaemia

- Inflammation in other parts of the body such as the eyes

- Change in the way you walk and carry yourself

- Irritability

- Finding it difficult to do everyday tasks

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How is rheumatoid arthritis diagnosed?

There is no single test for RA and diagnosing it can be complicated. Your doctor will ask you about the difficulties you've been having, examine your joints and skin, and test your muscle strength. A physical exam will also look for signs such as warmth, swelling and pain in the joints.

It is important to be referred to a rheumatologist if you think you might have RA. Rheumatologists are experts in diagnosing and treating arthritis and other diseases that affect the joints, bones and muscles.

Early intervention is critical to a good outcome and to more effective treatment. The Irish Society of Rheumatology (ISR) recommends that a person going to their doctor with symptoms of RA should be seen within six weeks.

Blood Tests

It's likely your doctor will order a range of blood tests to help confirm RA. These blood tests will test for;

- Rheumatoid factor - an antibody found in 80% of people with RA. For many, though, this antibody is not present in the early stages

- Anti CCP - another antibody found in 60-70% of people with RA. If you test positive for this, you are more likely to develop RA

- Anaemia - your blood count

- CRP & ESR - blood protein and cell levels that measure how much inflammation or disease activity there is in your body

Blood tests are useful in diagnosing RA, however some people will have no signs of it in their blood results. Your doctor and healthcare team may talk about seropositive and seronegative arthritis.

Seropositive arthritis means your blood tests tested positive for CCP antibodies and a rheumatoid factor. This type tends to be more aggressive.

Seronegative arthritis means that your blood tests do not have a positive rheumatoid factor or show CCP antibodies. This type tends to be a little milder.

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How is rheumatoid arthritis treated?

Once your diagnosis is confirmed, there are many treatments that can ease your pain and increase your movement. Non-medication therapies such as physiotherapy, occupational therapy, physical activity and relaxation techniques can all be helpful in the treatment of RA. There is, though, a range of prescription drugs that are used to help people manage the disease.

It's a good idea to keep a diary of to include a record of symptoms, questions for clinic appointments, medications, history and blood results. A list of all medication including supplements, over the counter drugs and prescribed drugs by your healthcare team should be included.

Outcomes in RA have improved by the recognition of the benefits of early diagnosis and treatment. This has resulted in new treatment strategies that aim to prevent, or at least reduce, joint damage. This is sometimes referred to as "treat to target".

Dozens of drugs are used to treat RA and many people are prescribed a combination of them. The general aim when treating RA is to reduce joint inflammation and prevent long-term damage to the joints.

Disease Modifying Anti-Rheumatic Drugs (DMARDS - pronounced dee-mards)

The mainstay of drug therapy for RA is Disease Modifying Anti-Rheumatic Drugs (DMARDs), which tackle the causes of inflammation (pain swelling and stiffness) in the joints. DMARDs are important because they help prevent damage to the joint.

Your doctor will recommend a therapy that is best suited to your type and stage of arthritis, other medical problems and medications. Sometimes these drugs are given by injection.

Taking any medication carries some risk, which must be balanced against the potential benefits. It is important to recognise that the risk of joint damage and permanent disability is much greater than the risk of side effects from DMARDs to control the disease. When properly monitored, the vast majority of side effects are rare, and most are reversible by adjusting the dose or switching medications.

Biologic Therapies

Biologic therapies are a newer group of disease-modifying drugs that may be used if other DMARDs aren’t working well enough. These are given either by injection or through a drip into a vein.

This also includes a category of medicines called biosimilars. These drugs are follow-on versions of original biological medicines. They are independently developed after the patent protecting the original product has expired. Biosimilar medicines are intended to have the same mechanism of action as the original biological medicines and are designed to treat the same diseases as the innovator’s product.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs - en-saids) are a class of medications used to treat the pain and inflammation of arthritis. They act by blocking the inflammation that occurs in the lining of your joints. Although NSAIDs reduce the day-to-day inflammation and can be very effective in controlling pain and stiffness, they don't tackle the long-term effects of the disease.

Steroids

Steroids (properly known as corticosteroids and sometimes referred to as cortisones) can be effective in reducing inflammation. Most people with RA who need steroids are prescribed prednisolone (brand names include Deltacortril, Predsol) usually only for a short time. 

Steroids are often prescribed in the early stages of treatment in combination with DMARDs and are also useful in bringing the disease under control when RA is active.

Steroid injections

Steroids can also be injected into an inflamed joint, or into muscles to treat soft tissue conditions, such as tennis elbow. They can be injected directly into the veins during an arthritis flare-up. Injecting doesn't usually cause the same side effects as tablet steroids.

Your doctor might recommend steroid injections if your joints are particularly painful or your ligaments and tendons have become inflamed.

Painkillers (Analgesics)

Painkillers are drugs used to help reduce pain and are also called analgesics. Painkillers come in varying strengths and types. Some are available over the counter, while stronger painkillers are by prescription only.

There are a number of different types of painkillers;

1. Simple Non-opiod Painkillers

The most common type of painkillers, usually available over the counter e.g. paracetamol, ibuprofen 

 2. Compound painkillers

A combination of drugs used in one tablet e.g. co-codamol, which includes paracetamol and a low dose of codeine

3. Opiod Analgesics

These are stronger painkillers containing a higher dose of opiod than the other painkillers e.g codeine, tramadol, morphine

Painkillers are usually taken by mouth or given by injection. However, slow release painkilling patches, known as opiod patches, are also available though not widely prescribed.

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For more detailed information about rheumatoid arthritis, flare management, fatigue, physical activity, healthy eating and more, contact the Arthritis Ireland Helpline 1890252846/01-6618188 [email protected]  

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