RHEUMATOID ARTHRITIS – How to proceed?

Understanding Rheumatoid Arthritis (RA)

Overview: Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disease that primarily affects joints but can extend to internal organs, such as blood vessels, lungs, skin, and eyes. Unlike other forms of arthritis, which may be due to wear and tear, RA is an autoimmune disorder in which the body’s immune system mistakenly attacks its own tissues, leading to joint inflammation and damage. The exact cause of RA remains unknown, but it is believed to result from a combination of genetic predisposition, environmental factors like exposure to certain microorganisms, and hormonal influences. Interestingly, RA is significantly more prevalent in women, occurring three to four times more often than in men, suggesting a link to sex hormones.

Current Statistics: Globally, the number of newly diagnosed cases of RA has been on a decline since 1955. In Slovenia, a study by the Slovenian Association of Rheumatic Patients revealed that approximately 16.1 new cases per 100,000 adults are diagnosed with RA annually. The average age of diagnosis is around 64 years, and while exact numbers of current patients are not well-documented, it is estimated that about 10,000 people in Slovenia live with this disease.

Main Symptoms of RA

• Joint Pain and Swelling: The hallmark symptom of RA is joint pain, typically starting in the small joints of the hands and feet. Swelling is usually the first observable sign and is often soft to the touch. The pain tends to be most severe in the morning and is associated with prolonged morning stiffness lasting more than an hour. As the day progresses and patients begin to move their joints, the pain and stiffness usually subside, although this relief is often temporary.

• Progression and Chronic Symptoms: Over time, if left untreated, RA can cause irreversible damage to joints and surrounding tissues. This can lead to significant limitations in daily activities, reduced quality of life, and loss of independence. Chronic RA often results in joint deformities, leading to increased pain with use, reduced mobility, muscle atrophy, and diminished physical strength. These deformities can make even basic tasks, like holding a cup or walking, challenging and painful.

Disease Progression and General Symptoms

Slow Onset: The disease usually begins gradually, with symmetrical inflammation affecting the small joints in the hands, wrists, and toes. The pain is often continuous and most intense in the early morning hours. Morning stiffness is a defining feature of RA and typically lasts longer than an hour, contributing to significant discomfort.

Early Diagnosis: Recent medical advancements have made it possible to diagnose RA within weeks of the first symptoms appearing. This early diagnosis is critical, as starting treatment promptly can slow the disease's progression and prevent severe joint damage. In some cases, patients may present with inflammation in just one joint at the time of diagnosis, making early recognition even more essential.

Other Symptoms: RA can be accompanied by general systemic signs such as fatigue, reduced appetite, and unintended weight loss. These symptoms contribute to an overall feeling of unwellness and can impact a person’s ability to carry out daily activities effectively.

Diagnostic Process

Clinical Assessment: The diagnosis of RA involves a thorough patient interview and physical examination. Physicians assess the number of painful and swollen joints and take note of the pattern of joint involvement. Symmetrical inflammation (affecting the same joints on both sides of the body) is a typical sign of RA.

Laboratory Tests: Blood tests can help support the diagnosis by detecting markers of inflammation, such as elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Additionally, the presence of rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies is common in RA patients.

Imaging: X-ray examinations at the onset of the disease may show soft tissue swelling but not yet any bone damage. Ultrasound or MRI scans are particularly valuable when physical examinations cannot confirm arthritis, as they can detect inflammation and early joint changes not visible on X-rays.

Treatment Approach

Early Treatment: Starting treatment within 12 weeks from the onset of symptoms is vital for preventing long-term joint damage and achieving better outcomes. Methotrexate is commonly the first line of treatment, known for its effectiveness in controlling inflammation and slowing disease progression. If methotrexate is ineffective or causes adverse side effects, biologic medications or newly developed targeted synthetic drugs may be prescribed.

Monitoring and Lifestyle Adjustments: The main goal of RA treatment is to achieve remission, which means the absence of signs and symptoms. Continuous monitoring of disease activity and regular adjustments to the treatment plan are essential for this. Beyond medication, lifestyle changes play a crucial role:

• Weight Management: Maintaining a healthy weight can reduce stress on joints and improve overall mobility.
• Exercise: Regular, low-impact exercise such as swimming or walking helps maintain joint function and muscle strength.
• Smoking Cessation: Quitting smoking can significantly improve treatment outcomes and reduce inflammation levels.

Conclusion

Rheumatoid arthritis is a complex condition that impacts not just joints but overall health. Early diagnosis, prompt treatment, and lifestyle adjustments can help manage symptoms and improve quality of life.

Acknowledgment: We extend our gratitude to the Slovenian Association of Rheumatic Patients for providing valuable information for this article.

For more information, visit: www.revmatiki.si