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Rheumatoid arthritis and the importance of early detection

rheumatoid arthritis man suffering
Rheumatoid arthritis is an autoimmune disease that affects joints and causes joint pain, inflammation, and damages throughout the body. (Photos: Envato Elements)
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May is rheumatoid arthritis (RA) awareness month. RA is a debilitating condition that can profoundly impact mobility and overall quality of life.اضافة اعلان

Globally, RA is estimated to affect 0.46 percent of the population. Regarding the prevalence of RA in Jordan, a 2011 study found that 0.36 percent of the Jordanian population has RA, consistent with global rates.

Although there is no cure for this condition, understanding the warning signs can allow for earlier detection and treatment, which can slow the progression of the disease and improve the odds of remission.

What is RA?

RA is an autoimmune disease — when the body’s immune system mistakes certain parts of the body for a foreign entity — that affects joints and causes joint pain, inflammation, and damages throughout the body.

In the case of RA, the body mistakes the structure between the bones known as cartilage as a foreign entity. Cartilage is a soft, flexible structure found in joints and acts as a cushion between two bones to absorb impact from daily activities and provide fluid movement.

Due to the body attacking the cartilage, it will eventually become withered and worn down, as well as inflamed, which is ultimately the cause of joint pain.



RA is a progressive disease which means that cartilage erosion will worsen over time. Although complete remission of the disease is often difficult, the progression of the disease can be slowed.

Symptoms of RA

Typically, RA progresses bilaterally, which means that symptoms mirror both on the left and right sides. In short, it is common for the same joint symptoms to occur on both sides of the body.

The most commonly affected joints are in the hands, wrists, and knees, but since RA is an inflammatory disease, it can also affect other organs and tissue all over the body, including the lungs, heart, and eyes.

Although RA is a progressive disease, it is also characterized by periods of minimal or no symptoms, followed by acute exacerbations known as flare-ups.

Symptoms of RA include pain or aching in more than one joint, stiffness in more than one joint, tenderness and swelling in more than one joint, and loss of function and deformities.

Throughout the body, it is also common to experience fatigue, low-grade fever (37.5–38.3 degrees Celsius), and loss of appetite.

Since early detection is key to avoiding excessive joint damage, it is important not to ignore any possible symptoms.

Diagnosing RA

Diagnosing RA poses a serious challenge due to the great variability in patients, especially those still in the early stages.

Most doctors follow the 2010 Rheumatoid Arthritis Classification Criteria to diagnose RA. This criterion is a comprehensive scoring of signs and symptoms, and a total score of six or more indicates RA.

The first category looks at which and how many joints are affected. The more joints involved and the smaller the joint, the higher the score. The second category is the duration of symptoms. Typically, an individual with RA will have symptoms for six or more weeks. Lastly, blood tests are used to help aid in diagnosing.

No single blood test can be used definitively, but several blood tests can help measure inflammation, which is commonly associated with RA.

Once a diagnosis of RA is made and treatment has begun, doctors will often use a score known as the Disease Activity Score (DAS), of which DAS28 is the most common.

The DAS28 indicates the severity of the disease at any given moment and is used to track the progression of the disease. DAS28 uses different factors such as lab data, patient feedback, and joint swelling or tenderness. By using a formula, a score between 0–9.4 is generated.

Generally speaking, treatment is considered effective if the DAS28 score is less than 3.2.

Complications

Due to the systemic effects of RA, complications are not limited to joints but can also increase the risk for many other diseases.

One of the most common complications of RA is permanent joint damage which can severely impair mobility. If left untreated, joints may become deformed and damage can occur to cartilage and nearby tendons or bones.

Similarly, this may also result in carpal tunnel syndrome, which is the compression of the nerve in the hand. This is often caused by inflammation and causes aching, numbness, or tingling in the hands or fingers.

It is also possible for those with untreated RA to develop subcutaneous nodules due to a lesion in the skin layers that result in protrusions visible on the surface of the skin.

In more severe and untreated cases, complications may occur in the lungs as interstitial lung disease, pulmonary fibrosis, or an increased risk of pneumonia.

In the cardiovascular system, those with RA are twice as likely to develop heart disease. In fact, coronary artery disease (ischemic heart disease) is the leading cause of death in those who have RA.

Renal failure is another serious complication of RA and is the third most common cause of death who have RA.

Causes and who is at risk

There is no single cause for RA, and it is currently believed that genetic and environmental factors both play a role in the development of RA.

In terms of genetics, certain genes known as HLA class II genotypes greatly increase the risk of developing RA. When combined with lifestyle and environmental factors, those with this gene type are at the highest risk.

Age and sex both play a role in developing arthritis. Females are 2–3 times more likely to develop RA compared to males. Additionally, the onset of RA is highest for those in their 50s.

However, the risk of developing RA increases in males with age, whereas the risk tends to plateau after menopause.

Many environmental factors can also contribute to developing RA. For those who smoke or are obese, the risk is increased. Additionally, a diet that consists of a high intake of sodium, sugar, red meat, and iron is also associated with an increased risk.

Treatment and management

There is no cure for RA, but treatment is focused on slowing the progression of the disease. The strategy for managing RA involves medication and has a huge emphasis on lifestyle changes.

Obesity increases the risk of developing RA and can also worsen symptoms for those who already have it. For this reason, low-impact exercises are highly recommended and serve a variety of functions.

For one, the lost weight helps reduce pressure on joints, and secondly, it will help improve range of motion and mobility.

Rest is also important in managing RA.

It is recommended that during flare-ups, you should rest and resume exercise and activity once symptoms subside. Additionally, getting plenty of sleep can also help reduce inflammation.

People have also found hot or cold compresses on joints to be beneficial. There is no evidence that one is better than the other and is based largely on personal preference.

Generally, cold compresses help with pain and inflammation, whereas warm compresses help with improving mobility and reducing stiffness.


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