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A Recap of Rheumatoid Arthritis

By: Mint Suetrong, Contributing Writer

Edited by: Olivia Storti, Editor; Name, Editor in Chief

Autoimmune diseases are caused when your immune system, designed to fight off pathogens and prevent you from getting ill, attacks your body instead. While autoimmune diseases are not frequently discussed, there are over 80 different variations of autoimmune diseases, and, collectively, they affect over 24 million people in the United States, according to the National Institute of Environmental Health Sciences (NIH). One example of an autoimmune disease is rheumatoid arthritis.

Rheumatoid arthritis (RA) is described as a systemic, chronic autoimmune and inflammatory disease, meaning that although the disease targets synovial tissue around your joints, the progression of the condition could lead to damage in other body systems such as the skin, eyes, lungs, heart and blood vessels. Although the cause of rheumatoid arthritis is still unknown, the National Health Society UK (NHS UK) suggests that possible triggers of certain risk factors such as infections, genes, hormones and smoking may play a role in the likelihood of developing RA, though none of which are proven as of the present.

Rheumatoid arthritis is caused when the body mistakenly produces antibodies that attack synovial tissue (tissue surrounding your joints),damaging nearby bones, cartilage, tendons, and ligaments. RA often targets many joints at once, most commonly in the hands, wrists and knees, resulting in inflammation, pain and stiffness in the early stages. Without proper treatment, joints may lose their shape and alignment or be destroyed.

Diagnosis of RA is difficult: many medical conditions can result in joint stiffness and inflammation, meaning the symptoms are not specific to RA. There is no definitive test for this disease, however, physical examinations by a GP (general practitioner), by X-rays and MRI scans of joint scans and blood tests such as an ESR (erythrocyte sedimentation rate) and a CRP (C-reactive protein) to assess inflammation levels and measuring rheumatoid factors (proteins that the immune system produces when it attacks body tissue) and anti-CCPs (antibodies produced by the immune system) can be used to help diagnose rheumatoid arthritis. The earlier the diagnosis, the better.

According to Healthline, 60% of people with inadequate treatment of RA are unable to work 10 years after the onset of symptoms. Although there is no cure for RA, early treatment and support through medicine, lifestyle changes and surgery could relieve pain, slow down or prevent joint damage and limit the impact of the condition. Two main types of treatment include using disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments.

DMARDs ease the symptoms and slow down the progression of RA by blocking the effects of chemicals released to damage your joints. Examples of DMARDs are methotrexate (an immunosuppressant, which hinders your immune system) and leflunomide. A short course of corticosteroids may also be given to alleviate pain. Common side effects include loss of appetite, feeling sick and headaches.

Biological treatments are given by injections and work by stopping particular chemicals from activating your immune system. Generally, they are taken in combination with DMARDs if they are not effective on their own. The side effects are usually mild but may include skin reactions at the site of the injection, feeling sick and headaches.

To relieve pain, painkillers such as paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen may be prescribed. In serious cases, a course of steroids, through tablets of prednisolone or direct injections into muscles and joints, may also be used. However, they are only used for short periods as long-term use can result in serious side effects such as osteoporosis (the weakening of bones), muscle weakness, and thinning of the skin. Janus kinase inhibitors (JAK inhibitors) are offered to patients who cannot take DMARDs or biological treatments or did not find them effective. They work by interfering with the JAK-STAT signalling pathway. Supportive treatments such as physiotherapy to improve fitness, muscle strength and flexibility of joints may also be used.

Patients with RA or other autoimmune diseases often report feeling frustrated and anxious due to the unpredictable nature of the condition as there are no cures and no way to determine when a flare-up will occur. When bottled up, these feelings can create fear, anger and resentment. The NHS UK suggests that speaking to others in a similar situation through support groups or calling the NRAS free helpline (0800 298 7650 from Monday to Friday, 9.30 am to 4.30 pm) or the Versus Arthritis free helpline (0800 5200 520 from Monday to Friday, 9 am to 8 pm) may help patients feel understood and provide some relief.

A common complication of RA is the carpal tunnel syndrome which is described as aching, numbness or a tingling sensation in the thumb, fingers and other parts of the hand. The use of splits or steroid injections can be used to control the symptoms and surgery may be required in severe cases. The progression of RA can lead to widespread of inflammation such as in the lungs or lung lining (leading to pulmonary fibrosis), in the tissue surrounding the heart (leading to pericarditis), in the eyes (leading to scleritis) and in blood vessels (known as vasculitis). Inflammation in blood vessels or heart tissue increases the risk of developing a cardiovascular disease (CVD) which may result in life-threatening problems such as a heart attack or stroke. The CDC suggests that an increase in physical activity (at least 150 minutes of activity per week - 30 minutes a day for 5 days of the week), stopping smoking, and maintaining a healthy weight can help patients manage rheumatoid arthritis and improve quality of life.

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