Rheumatoid arthritis is an unknown chronic inflammatory disease characterized by multiple arthritis. Initially, the synovium surrounding the joint is inflamed, but the inflammation gradually spreads to the surrounding cartilage and bones, causing destruction and deformation of the joint. It is a disease that can invade the whole body, such as anemia, dry syndrome, subcutaneous nodules, pulmonary fibrosis, vasculitis, skin ulcers, as well as joints as well as extra-joint symptoms.
As synovium in the joint becomes inflamed, leukocytes in the blood are collected into the joint, and as a result, joint fluid increases, causing pain as the joint becomes swollen. If such inflammation persists, inflammatory synovium tissues gradually grow and dig into bones and cartilage, deform the shape of the joint, and impediment to move the joint occurs.
Rheumatoid arthritis typically affects fingers, wrists, and toes joints from the beginning, and as the disease progresses, elbow joints, shoulder joints, ankle joints, and knee joints are also involved. Symptoms such as pain, stiffness, and swelling in these joints appear slowly over several weeks.
Symptoms of rheumatoid arthritis can be divided into prodromal symptoms, morning stiffness, joint symptoms, and non-joint symptoms, and can be examined as follows.
- Prodromal symptoms: In about 2/3 of patients, fatigue, loss of appetite, general weakness, ambiguous muscle and joint symptoms appear first, followed by synovium inflammation. These progenitor symptoms appear over weeks to months and are difficult to diagnose at this stage.
- Morning stiffness: Morning stiffness means that it becomes stiff and difficult to move after waking up in the morning or when the joint is in one position for a long time. In addition, it is characteristic to move better after a while. In rheumatoid arthritis, this type of stiffness lasts more than 1 hour.
- Joint Symptoms: An important characteristic of early rheumatoid arthritis is pain and swelling of the affected joint. Symptoms that are important for diagnosis are found in many hands, and rheumatoid arthritis invades the middle and palm of the fingers, and the joints of the fingertips tend not to invade well. The affected joint hurts when touched and movement is restricted, and erythema of the palm may accompany it. In addition, there is a disorder in bending the wrist back and a disorder in bending the fingers. Often, a fist cannot be clenched, and these symptoms are helpful in diagnosing as well as determining the activity and progression of the disease. The knee is the largest joint in our body, and it is not well invaded in the early stages of rheumatoid arthritis, but over the entire period, it is invaded in more than 80% of patients. The affected knee is swollen and tender, and joint fluid effusion is also evident. In addition, it can affect the elbow, foot and ankle, hip joint, spine, and jaw joint.
- Non-joint symptoms: Rheumatoid arthritis can affect many organs in addition to joints. The subcutaneous nodule is a hard nodule that appears on the elbow, fingers, pubis, and Achilles tendon. Anemia is also common, which is correlated with disease activity, especially joint inflammation. If systemic invasion occurs in the heart, lungs, eyes, nerves, liver, etc., the course of the disease and treatment results may be poor, especially vasculitis, amyloidosis, and pulmonary fibrosis. Symptoms of systemic involvement include fever, general weakness, and weight loss.
The exact cause of rheumatoid arthritis is not yet known, but autoimmune is known as the main mechanism. Autoimmunity is an abnormality in the immune system that protects the human body from the outside and rather attacks the human body. In general, genetic predisposition, bacterial or viral infection, etc. are thought to be the cause of rheumatoid arthritis. It is known to be more susceptible to onset after physical or mental stress. It is said that the incidence rate is high even in the early menopause, which is an example showing that rheumatoid arthritis is affected by hormones.
Organs related to rheumatoid arthritis
- Joints such as hands, wrists, feet, ankles, elbows, shoulders, and knees
- blood vessel
- Various other body parts
There is still no test method to reliably diagnose rheumatoid arthritis. Therefore, characteristic symptoms, blood test results, and radiological signs are synthesized and diagnosed at the doctor’s discretion.
Currently, rheumatoid arthritis is diagnosed when 4 or more of the following 7 items are satisfied and symptoms 1 to 4 persist for 6 weeks or more. Early rheumatoid arthritis tends to be diagnosed with an average of 9 months delay because symptoms are ambiguous.
- Morning stiffness: stiffness around the joints or joints lasts more than 1 hour
- Arthritis that appears in more than three areas: swelling and effusion are observed in three or more joints at the same time by a doctor’s consultation.
- Arthritis of the hand joint: swelling of one or more of the wrist, middle finger joint, and palmar joint
- Symmetric arthritis: Symptoms appear in the same joint on the left and right sides.
- Rheumatoid nodule: A subcutaneous nodule with protruding bones or touching on one side of a joint
- Rheumatoid factor positive in blood test
- Signs of bone erosion found on X-rays
The tests for rheumatoid arthritis include the following blood tests, liver function tests, kidney function tests, and rheumatoid factor tests.
- Rheumatoid factor test: Rheumatoid factor is positive only in 80% of patients with rheumatoid arthritis. In addition, 5% of normal people can come out as positive, so it is impossible to diagnose all rheumatoid arthritis just because the rheumatic factor is positive. However, people with high rheumatoid factors tend to have severe joint damage. The rheumatic factor does not necessarily decrease after treatment, so it is not tested again after diagnosis.
- General blood test, liver function test, kidney function test: Monitor for side effects of treatment or invasion of other organs.
- ESR (erythrocyte sedimentation rate), CRP (complement reaction protein): This is a blood test to evaluate the degree of inflammation, and it is common that the level is increased during inflammation.
No medication can completely cure rheumatoid arthritis.
Drugs used for rheumatoid arthritis include NSAIDs (nonsteroidal anti-inflammatory drugs) and steroids, antirheumatic drugs and TNF blockers. NSAIDs and steroids can alleviate the symptoms of the disease by reducing inflammation, but they do not inhibit progression. The earlier the antirheumatic drug treatment is started, the better the treatment outcome.
Recently, TNF (intermediate substance causing rheumatoid arthritis) blockers have been used for rheumatoid arthritis that does not respond to antirheumatic drugs.
- NSAIDs: Used to reduce pain and alleviate inflammation, but do not affect the course of the disease. The analgesic effect appears within 24 hours, but the anti-inflammatory effect appears after 7 days. The main reason why people with rheumatoid arthritis do not take NSAIDs for a long time is gastrointestinal disorders caused by drugs. To prevent this, drugs that protect the gastrointestinal wall are used together, or anti-inflammatory drugs with less side effects of the digestive system are used.
- Steroid: It has a very strong anti-inflammatory effect. Steroids have anti-inflammatory effects within 24 hours after taking them, improving symptoms. However, the course of the disease cannot be changed or cured. Rather, it is recommended to use a small amount for a short period of time as side effects may occur if the high dose is taken for a long time.
- Antirheumatic drugs: The reason why it is important to diagnose rheumatoid arthritis early is because the use of antirheumatic drugs in the early stages of the disease improves long-term results. Antirheumatic drugs are used to induce remission (a condition in which symptoms of the disease cannot be detected) or to slow the progression of rheumatoid arthritis. Examples of such drugs include methotrexate, sulfasalazine, leflunomide, and antimalarial drugs. If the response is not good even after 6 months of treatment, a combination therapy in which two or more drugs are administered together can be performed.
- TNF blocker: It is a drug that blocks the inflammatory response by blocking TNF, a representative intermediate substance that causes rheumatoid arthritis. In rheumatoid arthritis, which does not respond to existing antirheumatic drugs, it improves symptoms by more than 70%, and has the advantage of showing an effect faster than existing drugs. However, since it is expensive and has side effects such as activation of latent tuberculosis, it must be administered after consulting a specialist.
Progress and complications
The degree of rheumatoid arthritis varies greatly depending on the patient, from mild arthritis to major organ damage due to severe extra-joint involvement. In the affected joint, the synovium surrounding the joint and the film of the joint become thicker over time, and the motion of the joint is gradually restricted, so that fixed joint deformation may occur. Typically, untreated rheumatoid arthritis causes irreversible damage to the joint within 2 years. In case of invading major organs such as lungs, heart and kidneys other than joints, the course of the disease and treatment results are poor. Therefore, it is known that the overall mortality rate of patients with extra-joint symptoms increases by 5 times compared to patients without extra-joint symptoms. Patients with symptoms only in the joints have a lifespan similar to that of ordinary people.
The onset of rheumatoid arthritis cannot be prevented, but early diagnosis and appropriate treatment by a rheumatoid arthritis specialist can relieve symptoms and reduce joint deformity.
Daily Living Tips for Patients
- It is very important to educate patients to actively participate in treatment programs and take medications well.
- It is advisable to participate in the arthritis patient education program administered by each medical institution.
- Resting the joints can be expected to recover from inflammation.
- When symptoms worsen, it is recommended to increase the amount of rest and increase activity as the inflammation subsides.
- In the active period with severe arthritis, it is recommended to only exercise a weak degree, and as the inflammation subsides, perform active exercise to strengthen muscle strength.
- Depending on the type of exercise, joint damage may increase, so be careful.