Rheumatoid arthritis

Autoimmune conditions such as rheumatoid arthritis occur when the body attacks its own cells, causing cell damage and inflammation. This can happen in flares and can be difficult to predict, although there may be some common triggers, including poor sleep, changes in treatment medication, infection, or stress on the body. In rheumatoid arthritis, the lining of your joints is affected, causing pain and swelling, but this can also lead to gradual erosion of the bone and deformity of the joint, leading to severe physical disability. Although any joint may be affected, the commonest ones involved are the small joints of the hands and feet.

You may also have more general symptoms like tiredness, poor appetite, and weight loss and it can also affect many organs such as the liver, kidneys, eyes, and skin. The severity of RA varies from person to person and it is typically a chronic (long-term) relapsing and remitting condition where there are periods where it flares up before settling down again. (There is usually no obvious reason why flares happen when they do but there can be months or even longer between each episode of RA).

Rheumatoid arthritis vs Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease characterised by the breakdown of cartilage, the smooth tissue that covers the ends of bones in a joint, leading to pain, stiffness, and reduced mobility. Unlike RA, which involves inflammation and autoimmune processes, OA is primarily a result of mechanical wear and tear on the joints over time.

Risk factors for OA include ageing, genetics, obesity, joint injury or trauma, and repetitive stress on the joints. OA most commonly affects weight-bearing joints such as the knees, hips, and spine, as well as the hands and fingers.

Symptoms of OA typically develop gradually and worsen over time, with pain and stiffness often worse after periods of inactivity or with movement. Diagnosis of OA is based on clinical evaluation, medical history, physical examination, and imaging studies (such as X-rays) to assess joint damage.

Treatment for OA aims to:

• relieve pain
• improve joint function
• prevent or slow further damage to the affected joints

This may include a combination of nonpharmacological interventions (such as exercise, weight management, physical therapy, joint protection techniques, and assistive devices), medications (such as paracetamol, NSAIDs, corticosteroid injections, and viscosupplementation), and surgical options (such as joint replacement or arthroscopy) for severe cases.

In summary, while RA and OA share some similarities in their presentation of joint symptoms, they are distinct conditions with different underlying causes, mechanisms, and treatment approaches.

Rheumatoid arthritis is an autoimmune condition, which is where your immune system attacks its own cells by mistake. In this condition your body attacks the cells that line the joints, leading to the symptoms mentioned above. Those at higher risk are people who smoke, have a family history of rheumatoid arthritis, and women also have a slightly higher risk compared to men but unfortunately in many cases of RA the exact reason why it develops is not known.

Your doctor will take a history and family history from you and they will perform an examination of your joints to assess any swelling, stiffness, or pain. They may arrange blood tests looking at specific inflammatory markers, markers of anaemia and rheumatoid specific markers that are helpful in the diagnosis. Imaging such as X-rays or more detailed MRI scans can also be done to look at the joints to assess them for any damage.

Unfortunately, there is no cure for rheumatoid arthritis but there are ways to manage symptoms.

Depending on the severity, some home, work, and lifestyle adjustments may need to be made to help you complete everyday tasks. This can be done with the help of an occupational therapist if needed, who can suggest adjustments and devices to help, and physiotherapists are also important team members in helping to keep your joints supple and active.

Painkillers and anti-inflammatory medication – such as ibuprofen or steroids - are usually taken during acute flares to manage the symptoms but long-term medication is often needed to help slow down the disease process and reduce the number of flare-ups. That is why early diagnosis is better, to reduce the chances of permanent damage. Long-term medication is divided into two classes known as; DMARDs (disease-modifying anti-rheumatic drugs) and biologics.

DMARDs (a common example being methotrexate) work on the chemicals released when your immune system attacks itself. These drugs block the immune system's damaging effects and reduce further damage from occurring. Biologics are given by injection either in combination with DMARDs or if DMARDs have not been effective. They work earlier in the process by stopping some of the chemicals that activate an immune response.

In some instances, if there is any significant joint damage, surgery may be considered to correct or improve the movement of the joint.