Rheumatoid Arthritis (RA)


Rheumatoid Arthritis

Definition of Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is a chronic multi system disease of unknown cause. Through the prominent manifestation of RA is inflammatory arthritis of the peripheral joints, usually with a symmetrical distribution, its systematic manifestations include hematologic, pulmonary, neurological and cardiovascular abnormalities.

RA is a common disease having peaks incidence in 3rd to 4th decades of life, with 3-5 times higher preponderance in females. The condition has high association with HLA-DR4 and HLA-DR1 and familial aggregation. The onset of disease is insidious, beginning with prodrome of fatigue, weakness, join stiffness, vague arthralgias and myalgias. This is followed by pain and swelling of joints usually in symmetrical fashion, especially involving joints of hands, wrists and feet. Unlike, migratory polyarthritis of rheumatic fever, RA usually persists in the involved joint. Approximately 20% of patients develop rheumatoid nodules located over the extensor surfaces of the elbows and fingers.

About 80% of cases are seropositive for rheumatoid factor (RF). However, RF titres are elevated in certain unrelated diseases too such as in: viral hepatitis, cirrhosis, sarcoidosis and leprosy. Advanced cases show characteristic radiologic abnormalities such as narrowing of joint space and ulnar deviation of the fingers and radial deviation of the wrist. Other laboratory findings include mild normocytic and normochromic anaemia, elevated ESR, mild leucocytosis and hypergammaglobulinaemia. Extra-aricular manifestations infrequently produce symptoms, but when present complicate the diagnosis.

ETIOPATHOGENESIS OF Rheumatoid Arthritis (Causes and Pathogenesis)

Present concept on etiology and pathogenesis proposes that RA occurs in an immunogenetically predisposed individual to the effect of microbial agents acting as trigger antigen. The role of superantigens which are produced by several micro-organisms with capacity to bind to HLA-DR molecules (MHC-II region) has also emerged.

  • Immunologic derangement : A number of observations in patients and experimental animals indicate the role of immune processes, particularly autoimmune phenomenon, in the development of RA. These include the following:
    1. Detection of circulation autoantibody called rheumatoid factor (RF) against Fc portion of autologous IgG in about 80% cases of RA. RF antibodies are heterogeneous and consist of IgM and IgG class.
    2. The presence of antigen-antibody complexes (IgG-RG complexes) in the circulation as well as in the synovial fluid.
    3. The presence of other autoantibodies such as antinuclear factor (ANF), antibodies to collagen type II, and antibodies to cytoskeleton.
    4. Antigenicity of proteoglycans of human articualr cartilage.
    5. The presence of γ-globulin, particularly IgG and IgM, in the synovial fluid.
    6. Association of  RA with amyloidosis.
    7. Activation of cell-mediated immunity as observed by presence of numberous inflammatory cells in the synovium, chiefly CD4+ T lymphocytes and some macrophages.
  • Trigger events : Though the above hypothesis of a possible role of auto immunity in the etiology and pathogenesis of RA is generally widely accepted, controversy continues as regards the trigger events which initiate the destruction of articular cartilage. Various possibilities which have been suggested are as follows:
    1. The existence of an infectious agent such as mycoplasma, Epstein-Barr virus (EBV), cytomegalovirus (CMV) or rubella virus, either locally in the synovial fluid or systemic infection some time prior to the attack of RA.
    2. The possible role of HLA-DR4 and HLA-DR1 in initiation of immunologic damage.

Rheumatoid Arthritis

Few variant forms of Rheumatoid Arthritis

  1. Juvenile RA found in adolescent patients under 16 years of age is characterized by acute onset of fever and predominant involvement of knees and ankles. Pathologic changes are similar but RF is rarely present.
  2. Felty’s syndrome consists of polyarticular RA associated with splenomegaly and hypersplenism and consequent haematologic derangements.

Risk factors of Rheumatoid Arthritis

Doctors do not know what triggers the immune system to attack the joints in the boides of people with RA.

However, there are some factors that researchers know to increase the risk of being affected by the condition:

  • Sex : Women are at a greater risk of developing RA than men. A 2011 study found 1 in 12 women and 1 in 20 men developing RA in their lifetime.
  • Smoking : According to a 2009 study, there is strong evidence that smoking both increases the risk of developing RA and makes it progress more quickly.
  • Being overweight : A 2016 study found a link between obesity and a slightly increased risk of developing RA.

There are also some factors that researchers have found to decrease the risk of RA. These includes:

  1. Moderate alcohol consumption : Consuming alcohol moderately will reduce risk of RA.
  2. Breast-feeding : Women who breast-feed have a reduced risk of developing RA.

Symptoms of Rheumatoid Arthritis

  • Rheumatoid Arthritis affects joint lining, causing painful swelling over long periods of time, the inflammation associated with Rheumatoid Arthritis can cause bone erosion and joint deformity.
  • Anaemia, fatigue.
  • Joints : stiffness, swelling, tenderness/weakness.
  • Skin lumps or redness.
  • Dry mouth, flare.

Complications of Rheumatoid Arthritis

  1. Chest pain.
  2. Bumpy skin.
  3. Shoulder pain.
  4. Dry eyes.
  5. Difficulty breathing.
  6. Finger pain and redness.
  7. Weakness in the knee.
  8. Wrist numbness.
  9. Uneven stance in the ankles.
  10. Toe trouble.
  11. Constipation ulcers.
  12. Brain fog.
  13. Finger, toe abnormality.

Prevention of Rheumatoid Arthritis

  1. Smoking is a risk factor, since quitting smoking can be helpful.
  2. Lose the extra weight.
  3. Consume the best food that decrease Arthritis like ginger, broccoli, walnut, spinach, etc…

Treatment of Rheumatoid Arthritis

  1. Physiotherapy.
  2. Medication (anti-rhematic drugs)
  3. Surgery (Arthroplasty and joint replacement)

Some more related diseases can be found below :
Ischemic Heart Disease – http://pharmadiagnosis.com/ischemic-heart-disease/
Hypertension (High Blood Pressure) – http://pharmadiagnosis.com/hypertension-high-blood-pressure/
Jaundice – http://pharmadiagnosis.com/jaundice-icterus/
Tuberculosis – http://pharmadiagnosis.com/tuberculosis/
Gonorrhoea – http://pharmadiagnosis.com/gonorrhoea/

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