1st Revision: 
Overview
Rheumatoid arthritis (RA) is a disease that is characterized by inflammatory changes of the synovial tissue of joints, cartilage bone and of extra-articular sites including the heart, kidney, lung, digestive system, eye, skin, and nervous system.2,5 It is the most common inflammatory arthritis which occurs at any age but peaks between 30 to 50 years old.1
There are other rheumatic diseases that present with similar signs and symptoms which are namely Systemic Lupus Erythematosus (SLE), Sjögren’s Syndrome, Adult-Onset Scleroderma, Spondyloarthritis (SpA), Psoriatic Arthritis (PsA), polymyositis (PM).
A differential diagnosis will pinpoint the disease state you are suffering from. It is believed that dysregulated citrullination leads to the production of anti-citrullinated protein antibodies (ACPAs).5
Causes of rheumatoid arthritis
Rheumatoid arthritis is caused by your own immune system mistakenly attacking the cells in your joints. Genetic factors predispose some individuals to rheumatoid arthritis along with environmental factors such as smoking. These are known to increase the risk of developing swollen, stiff, and painful joints. The synovial cells proliferate in the joints to form pannus which destruct the cartilage causing bony erosions.
The release of proinflammatory cytokines along with tumor necrosis factor and interleukin- 6 drives the destruction further.
Signs and symptoms of rheumatoid arthritis
The signs of rheumatoid arthritis are;
- Joint pain,
- Joint swelling,
- Joint stiffness as well as,
- Inflammation around the body which is evidenced by redness
Gaining a score of greater than 6 based on the following aspects:
- 2 -10 large joints making 1
- 1-3 large joints corresponding to 2
- 4 to 10 small joints corresponding to 3
- greater than 10 joints correspond to 5
- The negative rheumatoid factor and ACPA correspond to 0
- Low positive rheumatoid factor and x3 ACPA correspond to 2
- The high positive rheumatoid factor and greater x3 ACPA corresponds to 3
- An abnormal erythrocyte sedimentation rate with an abnormal CRP corresponds to 1
- A normal erythrocyte sedimentation rate and CRP corresponds to 0
- A patient who also reports pain swelling and tenderness for greater than six weeks corresponds to 1
All the symptoms and laboratory findings correspond to a score.
The other symptoms to watch out for are weight loss, fatigue, and anemia.All Conclude that an individual has rheumatoid arthritis
Management and treatment for rheumatoid arthritis
The first-line medication for the treatment of rheumatoid arthritis is methotrexate. Where patients have other conditions such as liver disease, and kidney disease, Glucocorticoids can be used along with leflunomide, Antirheumatic drug therapy should also be started in order to stop the progression of the disease and further joint damage.
In order to manage the symptoms simple analgesia and nonsteroidal anti-inflammatory drugs should be taken. They are usually over-the-counter medications such as ibuprofen and paracetamol.
FAQs
How is rheumatoid arthritis diagnosed
Despite not being a specific marker for rheumatoid arthritis, the laboratory measurement of rheumatoid factor is important along with, C- Reactive protein, ESR, and ACPA.
Anti-citrullinated protein antibody (ACPA) is more specific for RA and is believed to play a role in disease pathogenesis.
Approximately 50 to 80 percent of persons with RA have rheumatoid factor, anti-citrullinated protein antibody, or both. Patients with RA may have a positive antinuclear antibody test result, and the test is of prognostic importance in juvenile forms of this disease.
C-reactive protein levels and erythrocyte sedimentation rate are often increased with active RA, and these acute phase reactants are part of the new RA classification criteria.16 C-reactive protein levels and erythrocyte sedimentation rate may also be used to follow disease activity and response to medication.
How can I prevent rheumatoid arthritis?
Rheumatoid arthritis can be prevented by focusing on not allowing pathological processes to begin, detecting and reducing risk factors to keep the condition under control. The other aspect is to introduce damage-limiting mechanisms and clinical prevention which reduces complications and the number of relapses. Screening individuals who are at risk will also ensure the levels of incidence and prevalence remain low,
Who are at risk of rheumatoid arthritis
Smokers, assigned female at birth(AFAB), and those with a family history of rheumatoid arthritis are at greater risk of developing this condition. Sex differential is less prominent as the individuals get older. Pregnancy is known to cause remission of rheumatoid arthritis.1
How common is rheumatoid arthritis
Rheumatoid arthritis has a prevalence of around one percent3 with increasing rates of obesity and aging populations, this put the immune system under strain and leads to idiopathic or genetic conditions presenting themselves more. When the joints are injured by other processes this can trigger the release of cytokines as well as self-modified self antigens.
When should I see a doctor?
You should visit a doctor when you notice any pain, tenderness, or joint swelling. The doctor will then refer you to a rheumatologist for further testing. It is important to act as soon as there are signs and symptoms of inflammation.
Summary
In conclusion, individuals who are diagnosed with rheumatoid arthritis should undertake therapy as soon as possible to ensure that they stop the progression of the disease to a more complicated state. Patients who are at risk of developing RA should be screened yearly to minimize the costs of treatment once the condition worsens. The history of the patients as well as laboratory findings should be reviewed so that patients make informed decisions on when to start or stop therapy.
References
- Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2011 Dec 1;84(11):1245-52. PMID: 22150658.8
- Giannini D, Antonucci M, Petrelli F, Bilia S, Alunno A, Puxeddu I. One year in review 2020: pathogenesis of rheumatoid arthritis. Clin Exp Rheumatol. 2020 May-Jun;38(3):387-397. doi: 10.55563/clinexprheumatol/3uj1ng. Epub 2020 Apr 23. PMID: 32324123
- Ngian GS. Rheumatoid arthritis. Aust Fam Physician. 2010 Sep;39(9):626-8. PMID: 2087776482
- https://www.nhs.uk/conditions/rheumatoid-arthritis/
- Radu AF, Bungau SG. Management of Rheumatoid Arthritis: An Overview. Cells. 2021 Oct 23;10(11):2857. doi 10.3390/cells10112857. PMID: 34831081; PMCID: PMC8616326.00
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