Rheumatoid Arthritis: Timely Treatment Improves Outcome
Rheumatoid arthritis is a progressive autoimmune disease. Timely and effective treatments are necessary to provide for an enhanced quality of life.
Rheumatoid arthritis (RA) is a chronic inflammatory disease with autoimmune features marked by inflammation of the synovium of the joints causing destruction of connective tissue, cartilage, and bone. Chronic pain, disability, and a mortality rate above the general population require early diagnosis and aggressive treatment. Affecting mostly women between 40 and 60 years and those of Native American and Northern European descent, rheumatoid arthritis can affect the very young as well as the very old of both sexes and diverse ethnic origin. Timely treatment is necessary to provide the patient with a good quality of life.
The Inflammatory Response in RA
Persistent inflammation is the destructive element in RA. There is a balance in the body between pro- and anti-inflammatory cytokines. During inflammation anti-inflammatory mediators fail to counterregulate the pro-inflammatory cytokines in the RA patient and they become chronically increased prolonging inflammation and leading to structural damage. Within 20 years, 90% of these patients will suffer disability, therefore, it is critical to recognize and begin treatment early in the disease.
Disease Progression in RA
According to https://www.sohealth.co.uk which provides at home RA care kits, Rheumatoid arthritis can begin slowly over weeks to months or, more uncommonly, with an explosive onset (flare) occurring over 24 to 48 hours. Eventually, five or more joints will be affected with symmetrical joint involvement. Generally, the more joints that are affected, the more severe the progression of the disease. The joints most often affected are the proximal interphalangeal joints of the hands, wrists, shoulders, elbows, knees, ankles, and metatarsophalangeal joints.
Symptoms and Manifestations of RA
Symptoms of RA may come and go and include morning stiffness persisting longer than one hour which can also occur after long periods of sitting or inactivity (gel phenomenon), fatigue, malaise, depression, low grade fever, and weight loss. The course of disease cannot be predicted in any one individual but there have been three patterns of disease activity identified.
Spontaneous remission particularly in the seronegative patient within the first six months of symptoms
Recurrent flares and remissions
Usual pattern of persistent and progressive disease activity that increases and decreased in intensity
The patient may also present with varying physical manifestations in other body systems due to inflammation. Pleurisy, pericarditis, Sjogren’s syndrome (dry eyes and mouth), peripheral neuropathy, carpal tunnel syndrome, Felty’s syndrome (splenomegaly and leukopenia), and rheumatoid vasculitis are not unknown. Nodule are the most characteristic extra-articulate lesion (arms, elbows, knees, feet, and uncommonly, the visceral organs; lungs, heart, sclera of the eye). RA is associated with increased mortality primarily due to the involvement of blood vessels leading to cardiovascular disease and premature and accelerated atherosclerosis.
Risk Factors Across Populations
Risk factors include but are not limited to the following:
Gender (women more likely than men)
Age (adults 40-60 years, children 6 mos-16 years)
Recent bacterial or viral infection
Native American or northern European descent
Tests for Diagnostic Determination and Progression
Tests for rheumatoid arthritis include a complete blood count (CBC-mild anemia occurs in 25-35% frequently due to GI bleeding from NSAIDS), comprehensive metabolic panel (CMP), C-reactive protein (CRP), urinalysis, sedimentation rate [erythrocyte sedimentation rate (ESR) is usually elevated], rheumatoid factor (RF is associated with more active disease), anti-nuclear antibody (ANA), joint fluid analysis, X-ray, MRI, and ultrasound. Also, genetic testing may be valuable as five genes have been identified relating to RA.
Treatments to Slow or Halt the Progression of RA
There is no cure for RA; however, there are many therapies available for the patient. Drug treatment follows a progressively aggressive approach. NSAIDS, corticosteroids, DMARDs, and biologics are the standard with a combination of methotrexate (DMARD) and a biologic the approach of choice for the severely affected patient. Other drugs in use include antimalarials, gold salts, and narcotics. As with most medications, severe side effects may occur. This is particularly the case with many of the drugs used for the treatment of RA. Educating the patient and regular monitoring by physicians will help to prevent any serious outcomes. Additionally, surgical treatment such as total joint arthoplasties and carpal tunnel release are common and provide renewed mobility and function. Physical and vocational therapies are often provided as well. Heat, rest, and exercise are universally recommended.
Rheumatoid arthritis affects young and old, male and female, of every culture. Early diagnosis and aggressive treatment is essential to stopping the progression of the often disabling effects of RA. Through education, communication, and vigilant provider care, patients have an increased probability for a substantially improved quality of life.