Rheumatoid Arthritis is a disorder of the immune system that affects multiple joints in the body, causing pain, stiffness and swelling of the affected joints. The commonly affected joints are the small joints of the hands, wrists, elbows, shoulders, knees, ankles and the toes. It can also affect other organs in the body like the eyes, skin, heart and lungs.
The body’s immune system which normally takes care of combating foreign bacteria, viruses and diseased cells in the body begins to attack the joints and their surrounding tissues leading to inflammation. Lacking an “off switch”, the continual attack by the immune system eventually causes damage to the joints. As the condition progresses, the inflammation, pain and stiffness of the joints tend to increase in severity, ultimately leading to joint deformity and a loss of function and mobility.
As Rheumatoid Arthritis is a disorder of the immune system and not due to “wear and tear”, patients can acquire Rheumatoid Arthritis at any age, though it occurs most commonly between the age of 25 and 40. It can and does occur in children. It affects both men and women, although women are 3 times more likely than men to develop the condition.
The first symptoms of Rheumatoid Arthritis are pain and swelling in the joints of the fingers and wrists accompanied by joint stiffness, especially in the mornings. The pain and stiffness can last for hours and usually involve the joints on both sides of the body.
Other symptoms include a low-grade fever, tiredness and loss of weight and appetite. These symptoms are related to the amount of inflammation present.
In advanced Rheumatoid Arthritis, much of the joint surface is destroyed leading to deformed joints.
Although scientists are not certain about the exact cause of Rheumatoid Arthritis, one can prevent the disabilities caused by Rheumatoid Arthritis through early diagnosis and treatment. A healthy balanced diet and moderate regular exercise is helpful. Quitting cigarette smoking is strongly advised.
Rheumatoid arthritis could cripple patients when the diagnosis is delayed or if patients do not take their medications and make lifestyle changes as advised by their doctors.
Scientific research shows that either a disorder in the body’s immune system or an overreaction to an unknown trigger like a virus infection can set off the condition. Once mobilised, the immune system targets the body’s own cells – hence the term “autoimmune disease”.
In the case of Rheumatoid Arthritis, the synovial membrane that covers the joints becomes the target of the immune system, leading eventually to the destruction of the bone and cartilage of the joints. The visible swelling and tenderness of the joints are due to increased fluid in the joint cavity and the thickening of the lining of the joint capsule, the results of on-going inflammation.
A family history with Rheumatoid Arthritis and environmental factors such as smoking are the risk factors.
Diagnosis is made from a detailed history and physical examination for signs of joint inflammation and comprehensive investigation.
Blood tests and X-rays are used to confirm the diagnosis. Blood tests include detection of the rheumatoid factor (RF) and anti-CCP antibody. Joint aspiration may be carried out and the fluid will be sent for special examination. This will help the doctor to differentiate between Rheumatoid Arthritis and other types of arthritis.
There is no cure for Rheumatoid Arthritis. Nevertheless, there are various treatment strategies focused on alleviating the symptoms, preventing further joint destruction, and regaining lost muscle strength and mobility.
When you are on medication for Rheumatoid Arthritis and you are preparing for an elective surgery, please consult your rheumatologist if any of your medication should be temporarily stopped.
When you are on medication for Rheumatoid Arthritis and you have undergone any surgery, please consult your rheumatologist if any of your medication should be reviewed. If your DMARDs, biologic agents, and small molecules for Rheumatoid Arthritis are stopped before surgery, these medication generally are safe to restart if there is no symptoms or signs of infection. Please consult your rheumatologist for your post-surgery care.