Rheumatoid Arthritis: Causes, Symptoms, Types & Tests

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily targets the joints, leading to pain, swelling, stiffness, and gradual joint damage. Unlike osteoarthritis, which is linked to wear and tear, RA occurs when the immune system mistakenly attacks healthy tissues, especially the synovium (lining of the joints). RA can affect people of any age, but it’s most common in adults between 30 and 60 years old, and it affects women more frequently than men. With timely diagnosis and treatment, people living with RA can manage symptoms and slow disease progression.

Rheumatoid Arthritis

Rheumatoid arthritis is defined as a systemic autoimmune disorder characterized by chronic inflammation of joints, leading to progressive joint damage and functional disability. The inflammation primarily affects the synovial membrane, causing it to thicken and produce excess fluid, which in turn damages cartilage and bone over time. RA isn’t limited to joints alone. It can also affect other parts of the body, including the lungs, heart, eyes, and blood vessels, classifying it as a systemic disease. Symptoms typically appear symmetrically—meaning if one wrist or knee is affected, the other often is too.

Causes of Rheumatoid Arthritis

The exact cause of RA is not fully understood, but several factors contribute to its development:

1. Autoimmune response:
RA results from an abnormal immune response where the body’s immune system attacks its own synovial tissues.

2. Genetics:
Certain genetic markers, particularly HLA-DR4 and HLA-DR1, increase susceptibility to RA.

3. Environmental factors:
Smoking is a well-established risk factor. Exposure to certain infections or pollutants might also trigger RA in genetically predisposed people.

4. Hormonal influences:
RA is more common in women, suggesting hormones may play a role in disease onset.

5. Other risk factors:
Obesity, chronic periodontal disease, and severe physical or emotional stress may also contribute.

Symptoms of Rheumatoid Arthritis

RA symptoms often begin gradually and vary in intensity over time. They can include:

• Joint pain and tenderness: Especially in small joints of the hands, wrists, and feet.
• Swelling and warmth: Joints often appear swollen and feel warm to the touch.
• Morning stiffness: Lasting 30 minutes or longer, which is a classic RA sign.
• Fatigue: Persistent tiredness or lack of energy.
• Reduced range of motion: Due to swelling and joint damage.
• Symmetrical symptoms: Both sides of the body are usually affected equally.
• Extra-articular symptoms: In severe cases, RA may also cause nodules under the skin, eye dryness, lung inflammation, or cardiovascular complications.

RA flares, periods when symptoms worsen, can alternate with remission, where symptoms may become mild or absent.

Types of Rheumatoid Arthritis

RA can present differently depending on disease progression and presence of specific antibodies:

1. Seropositive RA:

• Characterized by the presence of rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (anti-CCP) antibodies.
• Usually associated with more severe disease and extra-articular involvement.

2. Seronegative RA:

• RF and anti-CCP antibodies are absent.
• Symptoms are similar, but disease progression may be milder.

3. Juvenile rheumatoid arthritis (JRA):

• Occurs in children under age 16.
• Can affect growth and lead to unique complications.

Additionally, RA may be categorized based on disease stage:

• Early RA: Initial symptoms without major joint damage.
• Established RA: Ongoing inflammation with evidence of joint erosion.
• Advanced RA: Severe joint deformities and functional limitations.

Tests Used to Detect Rheumatoid Arthritis

Diagnosis of RA involves combining clinical evaluation with laboratory and imaging tests:

1. Physical examination:
A doctor checks joints for swelling, tenderness, and range of motion.

2. Blood tests:

• Rheumatoid factor (RF): Present in about 70–80% of people with RA.
• Anti-CCP antibodies: Highly specific for RA and often found in early disease.
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): Indicate inflammation levels.

3. Imaging tests:

• X-rays: Detect joint erosion and narrowing.
• Ultrasound and MRI: Identify early inflammation and soft tissue involvement.

4. Joint aspiration:
Analysis of synovial fluid can help rule out infections or other conditions.

Early and accurate diagnosis is crucial to prevent irreversible joint damage.

Conclusion

Rheumatoid arthritis is more than just joint pain—it is a lifelong autoimmune disorder that can affect various organs and impact daily life. While the exact cause isn’t fully understood, genetic predisposition combined with environmental and lifestyle factors plays a significant role.

Recognizing symptoms early, such as prolonged morning stiffness and joint swelling, can help individuals seek timely medical care. Modern treatments, including disease-modifying antirheumatic drugs (DMARDs), biologic agents, and physical therapy, have transformed RA from a disabling disease to a manageable condition.

Frequently Asked Questions (FAQ’s)

1. What is rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease where the immune system attacks the joints, leading to pain and inflammation.

2. Is rheumatoid arthritis the same as osteoarthritis?
No, RA is an autoimmune disease, while osteoarthritis is caused by wear and tear of joints.

3. Can rheumatoid arthritis affect other organs?
Yes, RA can affect the lungs, heart, eyes, and blood vessels.

4. At what age does rheumatoid arthritis usually start?
It commonly begins between ages 30 and 60 but can occur at any age.

5. Is rheumatoid arthritis hereditary?
Family history increases risk, but not everyone with genetic predisposition develops RA.

6. Can rheumatoid arthritis be cured?
There’s no cure yet, but treatments help manage symptoms and slow disease progression.

7. What is the role of diet in rheumatoid arthritis?
A balanced diet rich in anti-inflammatory foods may help reduce flare-ups.

8. How is rheumatoid arthritis diagnosed?
Through physical examination, blood tests (RF and anti-CCP), and imaging like X-rays or MRI.