Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is the most common inflammatory arthritis in women and hence an important cause of potentially preventable disability. Many of the clinical features and management Strategies in RA are relevant across the spectrum of inflammatory joint disease. The typical clinical phenotype of RA is a symmetrical, deforming, small and large joint polyarthritis, often associated with systemic disturbance and extra-articular disease. The clinical course is usually life-long, with intermittent exacerbations and remissions and highly variable severity.

Causes

RA is an autoimmune disease. This means that certain cells of the immune system do not work properly and start attacking healthy tissues — the joints in RA. The cause of RA is not known. Yet, new research is giving us a better idea of what makes the immune system attack the body and create inflammation. In RA, the focus of the inflammation is in the synovium, the tissue that lines the joint. Immune cells release inflammation-causing chemicals. These chemicals can damage cartilage (the tissue that cushions between joints) and bone.

Other things likely play a role in RA as well. For instance, genes that affect the immune system may make some people more prone to getting RA.

Symptoms

The symptoms of rheumatoid arthritis are outlined below.

  • Pain

This is usually a throbbing and aching sort of pain. Often worse in the mornings and after you have been sitting still for a while. Pain is often felt while you are resting, not after activity.

  • Stiffness

Joints affected by rheumatoid arthritis can feel stiff, especially in the morning. Morning stiffness associated with a kind of arthritis called osteoarthritis usually wears off within 30 minutes of getting up. However, rheumatoid arthritis morning stiffness usually lasts longer than half an hour.

  • Warmth and redness

The lining of the affected joint becomes inflamed, causing the joints to swell, and become hot, tender to touch and painful.

Investigations

Laboratory tests for RA commonly look at:

  • Rheumatoid factor (RF)
  • Anti-citrullinated protein antibodies (ACPA) (including anti-cyclic citrullinated peptide [anti-CCP] and anti-mutated citrullinated vimentin [MCV] antibody tests)
  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • Antinuclear antibody (ANA)
  • Complete blood count (CBC)

Joint imaging

  • X-rays of your joints can help differentiate between different types of arthritis. A series of X-rays can also help show how your condition is progressing.
  • Musculoskeletal ultrasound may be used in the clinic to confirm the presence, distribution and severity of inflammation and joint damage. 
  • Magnetic resonance imaging (MRI) scans can help show what damage has been done to a joint.

Dietary Guideline

  • Eat a variety of foods: Eat from all 4 basic food groups (breads and cereals, fruits and vegetables, meats, and dairy) to obtain the needed forty-plus essential nutrients to maintain good health.
  • Maintain your ideal weight: Less weight equates with less strain on weightbearing joints. Less strain equates with less pain.
  • Avoid too much fat, saturated fat, cholesterol: Increased amounts of fat contribute to weight gain and obesity.
  • Eat adequate amounts of starch and fiber: Starches such as bread, rice, beans, pasta, and potatoes give the body energy. Fiber, the undigested portion of the plants we eat, adds bulk and helps with the process of elimination.
  • Avoid too much sugar: Sugar provides empty calories and little nutrition, contributing to excess weight gain.
  • Avoid too much sodium: Excess salt can contribute to high blood pressure and water retention.
  • Avoid alcohol: Alcohol can deplete the body of vitamins and minerals besides being high in calories. It also potentially can interact with medications for arthritis.

References