Rheumatoid Arthritis | Symptoms, Causes, Diagnosis & Treatment

Rheumatoid arthritis is an autoimmune and inflammatory condition in which the body's immune system attacks healthy cells, causing inflammation. It causes pain and inflammation in and around the joints and affects other body organs. Rheumatoid Arthritis usually begins in the feet and hands, although it can affect any joint. The joints on both sides of the body are commonly involved

More than one joint is affected in Rheumatoid Arthritis, symptoms remain the same on both sides of the body. It includes:

1. Pain
2. Stiffness
3. Inflammation and tenderness in the joint
4. Tiredness
5. Abnormalities in the functioning of joints
6. Fever
7. Weakness
8. Loss of appetite 
9. Weight loss
10. Fatigue

The following factors are responsible for causing Rheumatoid Arthritis.

1. Genetic Factors: HLA genes aid the immune system in identifying proteins made by the host and proteins produced by viruses and bacteria. Polymorphisms in the Human Leukocyte Antigen (HLA) genes result in Rheumatoid Arthritis.
2. Environmental Factors: Exposure to irritants and pollutants 

Risk Factors 

1. Age: Adults in their fifties are at the most significant risk of developing Rheumatoid Arthritis. 
2. Sex: Females are at more risk of developing Rheumatoid Arthritis when compared to Males.
3. Early Childhood Exposure:  Children whose mothers smoked during pregnancy have twice the risk of acquiring Rheumatoid Arthritis in their adulthood.
4. Diet: High sodium, sugar, red meat, and iron consumption have all been linked to an increased risk of acquiring Rheumatoid Arthritis.
5. Smoking:  People who smoke cigarettes regularly have a higher risk of acquiring Rheumatoid Arthritis.
6. Obesity: Obesity can raise the chances of developing Rheumatoid Arthritis.

To diagnose Rheumatoid Arthritis, a few blood tests and imaging scans can be performed.

1. Blood Tests: Theincludedes the following tests:
   1. Antinuclear Antibody Test: This test is performed to check levels of ANA antibodies.
   2. Rheumatoid Factor Test: The RF blood test checks for rheumatoid factor, a protein that causes arthritis. Autoimmune Diseases, like Rheumatoid Arthritis, are linked to high rheumatoid factors.
   3. Anti Citrullinated Peptide Antibody test (anti-CCP): This test looks for a Rheumatoid Arthritis-related antibody.
   4. Erythrocyte Sedimentation Rate: The ESR test is used to find the amount of inflammation.
   5. C-reactive Protein Test: Rheumatoid Arthritis is linked to high inflammatory marker levels.
2. Imaging Scans: Use of an X-ray or an MRI of a joint to determine what type of arthritis is present and track the progression

Medications used for the treatment of Rheumatoid Arthritis are as follows:

1. Non-steroidal anti-inflammatory drugs: These drugs decrease pain and swelling. It includes Ibuprofen, Naproxen, Aspirin.
2. Corticosteroids: It also helps in decreasing pain and swelling.
3. Disease-modifying antirheumatic drugs (DMARDs): These reduce the progression of disease by modifying the immune system. Drugs include Methotrexate, Hydroxychloroquine, Sulfasalazine, Leflunomide etc.
4. Janus kinase (JAK) inhibitors: If improvement is not noticed with DMARDs, JAK inhibitors are prescribed. Drugs include Tofacitinib, Baracitinib.
5. Biologics: The chemicals that cause inflammation in your joints are targeted by Biologics. Drugs include Anakinra, Rituximab, Certolizumab, Tocilizumab etc.

Surgeries

If the damage to the joint is severe then surgery  can be performed it includes:

1. Total Joint Replacement: In Total Joint Replacement the Hip and Knee are replaced.
2. Knee Replacement: Even after treatment with medication, if the pain persists in the knee, then knee Replacement Surgery is the best option to get relief.
3. Hip Replacement: Surgery is recommended if problems in bending, lifting a leg, or pain is noticed.
4. Arthrodesis: The removal of injured joints and the nearby bones are glued. This technique restricts movement while improving joint stability and reducing pain.
5. Tendon Repair: An incision across the damaged tendon's skin is made. The tendon's damaged or torn ends are stitched together. The graft is required if the tendon is damaged severely.
6. Synovectomy: The surgical removal of the synovial membrane (synovium) that lines a joint is referred to as synovectomy.