Rheumatoid Arthritis

By | 5 April 2021

What kind of disease is rheumatoid arthritis?

Rheumatoid arthritis (RA) is the most common inflammatory joint disease. It begins with the inflammation of the “synovium” tissue (membrane) that covers the inner surface of the joints and can damage the cartilage, bone, tendon (beam), and ligaments. The progressive disease can affect the internal organs as well as the joints. It usually involves more than one joint, is long-lasting (chronic), but there can also be long silent periods between attacks. This disease, the cause of which is not known exactly, can vary greatly from person to person. It is generally a disease of young-middle-aged adults and is seen 3 times more often in women than in men.

How is it different from other joint diseases?

The most important feature that distinguishes rheumatoid arthritis from other joint rheumatisms is some laboratory tests and which joints are involved. RA usually involves many joints of the wrist and hand, but the joints near the nails (excluding the thumb) are not very affected. In osteoarthritis (calcification) and inflammatory rheumatism due to psoriasis, on the contrary, these joints close to the nail get sick.

Elbow, shoulder, neck, jaw, hip, knee, ankle, and foot joints may also be involved in RA. Involvement in other parts of the spine other than the neck is rare. Usually, joints on both sides of the body get sick together. That is, if several joints in the right hand are swollen, there will likely be swelling and limitation of movement in the left-hand joints as well.

What is the cause of rheumatoid arthritis?

The immune system is impaired in RA. Our body perceives its own tissue as a foreigner and starts a war against it. Inflammatory cells accumulate in the joints and substances that will damage tissues (enzymes, antibodies, cytokines) are secreted from these cells. Do genes play a role?

RA is not a genetic disease that is passed directly from parent to child. However, susceptibility to RA can be passed on through genes. It has been shown that many patients with RA have a particular genetic marker called HLA-DR4.

Will the infection initiate rheumatoid arthritis?

Many researchers and physicians think that infection may play a role in the onset of RA, but it has not been proven. RA is not an infectious disease. It is assumed that a microbe that is very common in the environment causes the disease by disrupting the immune system in people with a predisposition to RA.

What are the symptoms of RA?

RA can vary greatly from person to person. Although joint findings show fluctuations in almost all patients, they continue in a chronic form. Some people have a milder course of the disease; there are attacks only from time to time. In some, it progressively destroys over time by watching a more severe course.

If you have RA, you will have warmth, swelling, sensitivity, redness, and pain in your affected joints. You may feel stiffness and difficulty in your joint movements, which are especially evident in the morning hours. We call this morning stiffness. The long duration indicates that your disease is active. You will find that you are generally getting better during the day. If your disease lasts for a long time, deformities may occur in your joints.

RA can cause general weakness, especially during attacks. Decrease in appetite, weight loss, sometimes mild fever, decrease in energy, anemia can be seen. In about 20% of the patients, hardness called “nodules” may develop in the areas of the body under pressure, under the skin. Although it can often be in the elbow, it can also be seen in other parts of the body and even in internal organs.

How is RA diagnosed?

Early diagnosis of RA is very important. Because starting treatment during this period keeps permanent joint damage to a minimum. For the diagnosis of RA, a detailed history and physical examination should be performed by the physician. Certain laboratory tests and x-rays may be ordered. The positivity of the test called “rheumatoid factor” supports the diagnosis. High erythrocyte sedimentation rate, low hemoglobin (anemia) are among the other laboratory findings. It should be noted that these tests are only indicative. The definitive diagnosis is made by evaluating the patient as a whole by the physician.

How is RA treated?

Currently, there is no cure for RA. The methods used are aimed at relieving pain, reducing or stopping inflammation and joint damage, and increasing the patient’s functions and quality of life.

Drug treatment in RA can be divided into 2 groups;
1. Short-acting drugs to relieve complaints; aspirin, nonsteroidal anti-rheumatic drugs, pain relievers, cortisone as needed.
2. Long-acting drugs; such as methotrexate, leflunomide, chloroquine-hydroxychloroquine, gold salts, cyclosporine, sulfasalazine, D-penicillamine, azathioprine, etanercept, infliximab, and adalimumab.

All of these drugs should be monitored at regular intervals; It has side effects such as low blood cells, kidney, and liver changes. Most of these effects are controlled by adjusting the drug type and dosage. The patient needs to be conscious of this issue.

The treatment is tailored to the patient; In this, the severity of the disease, accompanying health problems, and individual characteristics and needs are prioritized. Rest is the most important part of treating RA patients. It is recommended to rest the relevant joints, especially in acute flare periods. Apart from the acute period, balanced exercises when the patient is feeling well will benefit the patient.

Again, some simple tools called “splint” can be used to protect the functions of the joints and prevent their deformities. Splints are very effective in preventing deformities. You can also help prevent deformities by following some rules:

a. When doing work, be sure to use very large joints rather than small joints.

For example; When opening the door, push with your arm, not with your hand, or when opening the jar, open it with your hand, not with your fingers.
b. Try to distribute the load across multiple splices rather than a single joint.

For example; When lifting a book, hold it with both hands, not one, and lift it.
c. Try to use your joints in their most “natural” position. Avoid excessive bending and strain.
Surgery may be required in some patients to correct deformities, reduce pain, or make joints usable.

There is a need for close cooperation between the physician and the patient at all stages of treatment decisions.