Living With Rheumatoid Arthritis, From Diagnosis to Treatment
Rheumatoid arthritis is a chronic inflammatory autoimmune disease of unknown origin with a variable progression. It primarily impacts the joints but can also affect the internal organs. About 1.3 million adults in the United States are affected by rheumatoid arthritis. While most types of arthritis affect older adults, rheumatoid arthritis can affect people of all ages, including teenagers and even children. But initial symptoms appear more frequently in a person’s 40s or 50s. Rheumatoid arthritis affects women more commonly than men.
Rheumatoid arthritis begins gradually and grows more severe over time. In addition to joint pain, heart, lung and eye damage can result from the condition. But, many people can live long and healthy lives by keeping their symptoms under control.
The diagnosis is based primarily on the clinical appearance; this form of arthritis causes symmetrical swelling and pain in the small joints of the hands and feet. Fortunately, rheumatoid arthritis is treatable, and early drug therapy with a primary therapeutic agent is vial for a favorable outcome. To date, there is no cure for this condition, but treatments are available to ease pain and slow the progression.
Symptoms of Rheumatoid Arthritis
Early on when the condition first starts developing, people with rheumatoid arthritis tend to experience symptoms like:
- Weight loss
- Fatigue
- Appetite loss
- Muscle aches
- Weakness
- Stiffness in the morning or during periods of cold weather
- Pain in one or multiple parts of the body
- Red eyes
- Swollen glands
Patients may feel symptoms in one or multiple joints, including, but not limited to, their:
- Fingers
- Elbows
- Shoulders
- Ankles
- Knees
- Neck
- Toes
However, people can experience rheumatoid arthritis symptoms in all areas of the body.
As the condition progresses, rheumatoid arthritis may cause:
- Pain and swelling in the joints
- Pain and swelling in the muscles throughout other parts of the body
- Stiffness
- Limited range of motion
- Deformities
- Disfigurement
At this stage, people may have difficulties keeping up with their regular activities. While living with rheumatoid arthritis, your body is under tremendous stress, and it’s common to feel tired. Even getting through a day of work, school or parenting can be challenging. Many people also experience flare-ups, which are periods when the pain feels significantly worse or incapacitating.
Other common symptoms include:
- Anemia
- Vision problems
- Fevers
- Lung disorders
- Numbness
- Swelling
- Inflamed glands
Some people experience symptoms when they eat certain foods or engage in certain activities. You may be able to recognize risk factors and control your symptoms by monitoring and modifying your lifestyle.
If you have rheumatoid arthritis, you should keep up with regular blood tests to determine whether you’re at risk for possible complications. People who are diagnosed with rheumatoid arthritis can develop serious complications if their symptoms are left unmonitored or untreated. These complications include extreme pain and permanent disability. Many people who experience severe rheumatoid arthritis are unable to work or live active lives. But, a more significant number of people can remain healthy and active.
Causes of and Risk Factors for Rheumatoid Arthritis
A typical joint is made of muscle, bone, cartilage, tendons and joint capsules. Rheumatoid arthritis is a chronic condition that attacks these joint parts. Over time, bone and cartilage loss occur due to the stress placed upon the joint. The surrounding muscles can become swollen and degenerate over time if the condition progresses or continues without treatment.
There’s no known cause for rheumatoid arthritis. It’s an autoimmune disorder, which means that your body’s immune system perceives the cells in your joints as threats, similarly to how it reacts when detecting a pathogen, and subsequently attacks those cells in an effort to eliminate them. Some forms of autoimmune conditions are extreme, while others are more moderate and less severe. Other illnesses, genetic factors, or hormonal changes may trigger or complicate rheumatoid arthritis in any part of your body. In rare cases, people can develop rheumatoid arthritis as a result of an injury.
Rheumatoid arthritis is more common among women than men, and people of any age are susceptible. Most people start developing symptoms as older adults in their mid-40s. In some cases, affected children outgrow the condition by the time that they become adolescents or adults.
People with a family history of rheumatoid arthritis are a high-risk group, but it’s impossible to predict who will develop rheumatoid arthritis and which parts of their bodies will become affected. The most vital indicators for how the condition will progress involve your medical history. The condition is unique for everyone, so your doctor will assess your risks and prognosis based on existing patterns of the condition.
Diagnosing Rheumatoid Arthritis
A combination of tests can help diagnose rheumatoid arthritis. Your doctor will conduct tests based on your symptoms and medical history. In some situations, the doctor may need to conduct additional tests to find out how much joint damage has already occurred. You may need additional heart and neurological tests to determine an effective and personalized treatment plan.
Blood Tests: Your doctor will conduct a variety of blood tests when diagnosing rheumatoid arthritis. The main reason for this is that a variety of underlying conditions can produce rheumatoid arthritis symptoms. The doctor will check your kidney function, liver enzymes, blood iron status and immune system and will pay particular attention to tests that indicate the presence of lupus, liver damage, hemochromatosis, Still’s Disease and Sjögren’s syndrome. Blood tests measure an antibody called rheumatoid factor (RF). The test is very general; it can indicate other conditions in which RF is present.
Rheumatoid Factor Test: Rheumatoid factor (RF) is an antibody, which is a type of protein. The majority of people with rheumatoid arthritis have positive RF test results. Fewer than one-fourth of rheumatoid arthritis patients will test negative for RF. This result is called seronegative. The opposite can also occur: People may have a positive RF test even when they don’t have rheumatoid arthritis.
Anti-CCP Antibody Test: Anti-cyclic citrullinated peptide antibody (anti-CCP) is a blood test that doctors use to diagnose rheumatoid arthritis. Most doctors conduct an anti-CCP antibody test in conjunction with an RF test to obtain more conclusive and precise results. Anti-CCP antibodies are antibodies, like RF, that are present in people with rheumatoid arthritis. This test is effective in diagnosing rheumatoid arthritis in people who don’t test positive for RF.
Joint Fluid Analysis: Doctors perform synovial fluid analyses to diagnose the reason for joint inflammation, pain and swelling. This type of test can help diagnose rheumatoid arthritis and rule out other inflammatory conditions that produce similar symptoms. The test can diagnose crystal formation, gout, lupus and osteoarthritis.
Usually, joint fluid contains glucose, proteins, white blood cells and red blood cells. In the presence of a degenerative condition, abnormalities will show up. Normal synovial fluid is clear, dense and slightly beige in color. An abnormality will cause the joint fluid to look less dense, cloudier or red if there is blood in the fluid. Doctors might also check to see whether glucose levels are high or low or whether proteins indicate a bacterial infection. High amounts of uric acid may be a symptom of gout.
Scans: X-rays can help diagnose advanced stages of rheumatoid arthritis by revealing degeneration and abnormalities in joints. If you’ve been diagnosed with rheumatoid arthritis, you may need to undergo regular scans to determine the progression of the disease.
Similar Conditions: Sometimes, rheumatoid arthritis can be challenging to diagnose because other conditions present with similar symptoms. Conditions that are similar to rheumatoid arthritis include:
- Crystal-induced arthritis, which mainly affects the joints and is often diagnosed using joint fluid tests
- Osteoarthritis, which can result from advanced age or injury
- Lupus, which can be identified using blood tests
- Lyme disease, which is caused by a bacterial infection from a tick bite and can be diagnosed via blood tests
- Gonococcal arthritis, which can affect the tendons around the wrist
Based on your symptoms, your doctor may want to test for various conditions using a blood test or joint fluid test. For diagnostic and treatment purposes, you must maintain an accurate record of your symptoms. There are more than 100 different types of arthritis that can potentially cause symptoms similar to rheumatoid arthritis.
Treatments for Rheumatoid Arthritis
Rheumatoid arthritis requires consistent medical care. Physical therapy and medications are available to slow the disease’s progression and keep symptoms under control. If left untreated or unmonitored, the disease can cause your joints to degenerate. As a result, you might develop permanent joint pain. Early drug therapy with a basic therapeutic agent, such as the following, is crucial for a favorable outcome:
- Disease-modifying antirheumatic drugs (DMARDs). DMARDs can slow rheumatoid arthritis progression and are the basis of rheumatoid arthritis therapy. The most common DMARD is methotrexate.
- NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and reduce inflammation.
- Steroids. Corticosteroids help alleviate joint pain and swelling.
- Biologic agents. This newer class of DMARDs is also known as biologic response modifiers. An example is adalimumab (Humira).
You might also require physical therapy, exercise or surgery. Without treatment, long-term joint damage or organ failure may occur.
If you experience symptoms of rheumatoid arthritis, consult your doctor for a determination about whether you’re at risk. If you have a fever and have already been diagnosed with rheumatoid arthritis, you should immediately consult a medical professional. Because your immunity is low, you might have trouble fighting possible infections. You may need to adjust your treatment or take supplemental medications as well.
Resource Links:
https://www.rheumatology.org/Portals/0/Files/2008%20RA%20Recommendations.pdf
https://pubmed.ncbi.nlm.nih.gov/21413195/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266846/
https://bmcrheumatol.biomedcentral.com/articles/10.1186/s41927-019-0090-7
https://ard.bmj.com/content/79/6/685
