Rheumatoid arthritis

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Chronic inflammatory disease that can affect several joints and whose cause is still unknown.

Which is?

Rheumatoid Arthritis (RA) is a chronic inflammatory disease that can affect several joints. The cause is unknown and affects women twice as often as men. It usually starts between 30 and 40 years and its incidence increases with age.

What are the symptoms?

The most common symptoms are arthritis (pain, edema, heat and redness) in any joint of the body, especially the hands and wrists. Lumbar and dorsal spine involvement is rare but the cervical spine is often involved. The inflamed joints cause morning stiffness, fatigue and with the progression of the disease, there is destruction of the articular cartilage and patients can develop deformities and inability to perform their activities of daily and professional life. The most common deformities occur in peripheral joints such as the fingers on a swan’s neck, fingers on a buttonhole, ulnar deviation and hallux valgus (bunion).

In addition to the joints, can others be affected?

Yes, but less commonly other organs or tissues such as skin, nails, muscles, kidneys, heart, lungs, nervous system, eyes and blood may show changes. The so-called Felty Syndrome (enlargement of the spleen, lymph nodes and fall of white blood cells in a patient with the chronic form of RA) can also occur.

How is the diagnosis made?

According to the American College of Rheumatology, the diagnosis of rheumatoid arthritis is made when at least 4 of the following criteria are present for at least 6 weeks:

  • Morning joint stiffness lasting at least 1 hour
  • Arthritis in at least three joint areas
  • Arthritis of the joints of the hands: wrists, proximal interphalangeal joints (mid-finger joint) and metacarpophalangeal joints (between fingers and hand)
  • Symmetrical arthritis (for example in the left and right wrist)
  • Presence of rheumatoid nodules
  • Presence of Rheumatoid Factor in the blood
  • Radiographic alterations: joint erosions or descalcifications located on radiographs of the hands and wrists.

Early diagnosis and immediate initiation of treatment are essential to control disease activity, prevent functional disability and joint damage, and return to the patient’s normal lifestyle as soon as possible.

What tests should be done?

Only the specialist doctor can assess which tests should be ordered for each patient. In the laboratory evaluation, the rheumatoid factor can be found in about 75% of the cases early in the disease. Antibodies against filaggrin / profilagrin and antibodies against cyclic citrullinated peptide (PCC) are found in the earliest stages of the disease but are more expensive. Evidence of inflammatory activity such as ESR and C-reactive protein correlates with disease activity. Imaging tests such as radiographs, ultrasounds, tomography, resonance, etc. can be requested by the rheumatologist after the evaluation of each clinical picture individually.

How is the treatment?

Drug treatment will vary according to the stage of the disease, its activity and severity, and should be more aggressive the more aggressive the disease. Anti-inflammatories are the basis of treatment followed by corticosteroids for the acute phases and drugs that modify the course of the disease, most of them immunosuppressive. More recently, immunobiological agents have become part of the therapeutic options. Treatment with anti-inflammatory drugs should be continued as long as inflammatory signs are observed or the patient has joint pain. The use of disease-modifying drugs should be maintained indefinitely. Drug treatment is always individualized and modified according to the response of each patient. In some patients, surgical treatment is indicated,

Physiotherapy and occupational therapy contribute to the patient’s ability to continue exercising the activities of daily living. Joint protection must guarantee the strengthening of the periarticular muscles and an adequate flexibility program, avoiding excessive movement. Physical conditioning, involving aerobic activity, resistance exercises, stretching and relaxation, should be encouraged by observing the tolerance criteria of each patient.

What about medical monitoring?

In rheumatoid arthritis, as well as in several other chronic rheumatic diseases, follow-up by the rheumatologist is essential and must be continuous. The intervals between appointments vary from patient to patient. In some cases, monthly assessments are necessary while in other cases, with less serious or controlled diseases, longer intervals between consultations can be established. Follow-up tests are often done to assess disease activity and side effects of medications. Only the doctor can decrease or increase the dose of medications, modify the treatment when necessary or indicate the rehabilitation therapy that is appropriate for each case.