Rheumatoid Arthritis

Rheumatoid Arthritis or RA is an autoimmune disease. It typically presents with symptoms of pain, stiffness, swelling, and possible loss of function in the joints.

RA is the body’s natural immune system attacks the tissues surrounding the joints and this affects their ability to function properly. This condition to lead to damage of the bones and cartilage in the joints as well as weakening of the muscles, ligaments, and tendons connected to the affected joints.

RA can follow there different disease patterns:

Monocyclic: Have one episode which ends within 2-5 years of initial diagnosis and did not reoccur. This may result from early diagnosis and/or aggressive treatment.
Polycyclic: The levels of disease activity fluctuate over the course of the condition.
Progressive: RA continues to increase in severity and is unremitting

Risk Factors

The cause of RA is unknown. It is believed that RA is caused by a mixture of genetic and environmental exposures that lead to the development of the disease.

There is evidence that specific HLA class II genotypes are associated with increased risk. Most attention has been given to the DR4 and DRB1 molecules of the major histocompatibility complex HLA class II genes. The strongest associations have been found between RA and the DRB1*0401 and DRB1*0404 alleles.

Modifiable risk factors associated RA include reproductive hormonal use, tobacco use, diet, and microbial exposures.

Diagnosis and Testing

In an ideal situation RA will be diagnosed within the first 6 months of symptoms, this allows treatment to be started early enough to hopefully slow disease progress or halt the disease in its tracks. The reason this can be difficult is because early symptoms, such as weakness, fatigue, and muscle soreness, are non-specific to RA.

Treatment

The key to prevent disease progression and disability is early treatment of RA. The treatment combines relieving pain, reducing swelling, slowing or preventing joint damage, and improving joint function and over all wellbeing.

In the past, treatment of RA typically began with the use of non-steroidal anti-inflammatories (NSAIDs) or corticosteroids before the progression to non-biologic disease modifying anti-rheumatic drugs (DMARDs) and then further progression to biologic DMARDs if no relief.

Now it is recommended that non-biologic DMARDs be initiated within 3 months of diagnosis to reduce the disease activity and prevent irreversible joint damage.

The 2008 guidelines also recommend that treatment with DMARDs and biologic therapies should be accompanied physical and occupational therapy and anti-inflammatory pharmacologic interventions.

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Risk Factors

Diagnosis and Testing

Treatment

Resources

References