Rheumatoid Arthritis: Everything You Need to Know
Dr. Samuel Pegram
Rheumatoid Arthritis, might not be the most common arthritic conditions, it is most certainly one to be aware of. Contrary to initial thought, it’s actually an auto-immune disease that, if not addressed early, can cause long-term damage on the bones. It can start with minor discomfort in small joints, and when more severe, can aggravate the internal organs.
What Causes Rheumatoid Arthritis?
There are several answers, and none of them have been totally confirmed.
Like most auto-immune diseases, there’s a genetic component and then there’s an outside factor. We do know that patients with Rheumatoid have abnormalities on the short arm of their sixth chromosome– where they make certain receptors on their cells. This defines a population of patients who are more at-risk.
There are several theories in those patients with that genetic predispositions. There’s thoughts that they could be exposed to infection agents like viruses, particularly ones like CMV or Epstein-Barr.
There’s also thoughts that patients who are around certain chemicals have a greater risk of having Rheumatoid Arthritis, like silica, or those who smoke cigarettes.
Who is most at risk for Rheumatoid Arthritis?
Interestingly enough, 75% of people who have it are women, which is why we believe there’s a hormonal factor at cause.
In fact, most auto-immune diseases are significantly more prevalent in female populations. Lupus, even, is around 90% of women.
Primarily, there’s the genetic risk, and then the outside factor that could be any of the above mentioned components. There certainly appears to be some hormonal influences in these autoimmune conditions that are including Rheumatoid Arthritis.
How do you assess for Rheumatoid Arthritis?
Most auto-immune conditions including Rheumatoid Arthritis are multi-system illnesses. So, although we think of it as a disease of the joints– which it primarily is– some patients come to their opthamologist because of inflammatory changes in their eyes.
It can also cause enlargement of certain organs like the liver and the spleen, and even abnormalities in certain blood cells.
We’re always trying to differentiate when a patient is coming to us with joint pain, because although these symptoms are pretty rare since we get to patients so early, it still takes quite a bit of effort to differentiate between Rheumatoid Arthritis and Osteoarthritis.
To find out if a patient has it, we’ll begin by actually feeling for it. Most people think that diagnosis is from only laboratory diagnosis, but it’s actually a combination of laboratory data and clinical findings.
For example, patients with Rheumatoid Arthritis have a preference of their disease occurring in small joints that are closer to the wrist, whereas osteoarthritis has a preference for the more distal joints, which are closer to the fingernail and the base of the thumb, as well as much larger joints like knees, hips and back.
One of the key factors is that a patient can have rheumatoid factor in their blood, but not rheumatoid, and instead another illness like tuberculosis, hepatitis, or systemic lupus, to name a few.
The key takeaway from this is that: a proper Rheumatoid Arthritis diagnosis is found through both clinical findings and a laboratory diagnosis.
What’s the difference between Rheumatoid Arthritis and Osteoarthritis?
Osteoarthritis is by far the most common form of arthritis, in that it’s a gradual degeneration of cartilage, which is the shock-absorber on the end of the bones that make up the joint.
That’s why most people get that disease in their fifties and beyond. It’s like taking a chisel and chipping off pieces of the cartilage over many years.
Rheumatoid Arthritis, on the other hand, initially doesn’t have much to do with bone or cartilage. Rheumatoid is really a disease of the lining of the capsule that makes up the joint space. As inflammatory cells enter that capsule and proliferate, that lining gets thicker and thicker, almost like a tumor.
In fact, patients think that rheumatologists are super friendly, because we’re always feeling their hands, but what we’re really doing is feeling around for a spongy feeling within that joint space that tells us that there’s growth.
As those cells continue to proliferate within that capsule, they’ll attach themselves to their underlying structures, the bones, the cartilage, the ligament, or whatever’s underneath and begin to chew it away.
Saying that, Rheumatoid Arthritis is a much more aggressive form of arthritis, not just due to wear and tear, but due to a true inflammatory process underneath the skin that’s chewing away the substances.
What are usually the first steps in helping a patient with Rheumatoid Arthritis?
There are medicines for Rheumatoid Arthritis symptoms that help with pain, swelling and stiffness, and most importantly, there are medicines that are called DMARDs, or disease-modifying antirheumatic drugs. DMARDs are most important because they’re meant for preventing further bone destruction.
It’s fine for us to give patients anything from Ibuprofen to Neproxin, or even steroids. But if we only use them, our patient might feel better, but they still have a finger, knee, or elbow that’s not serving them.
The DMARDs are the key in Rheumatoid Arthritis prevention. They’re medicines to prevent the growth inside the joint capsule. The most commonly used one is called methotrexate, which is an old chemotherapeutic agent, but the newer medicines are even more powerful.
You might have heard them, because their advertisements are on television so frequently: Enbrel, Humira, Remicade, and a host of others. These biological agents have been the biggest advancement in the treatment of Rheumatoid Arthritis ever, because they not only prevent the progression of disease, but they also provide the opportunity of remission.
Here at APC, we’re involved in an Opioid Stewardship Program, where we promote safe usage of opioids when necessary. We strive for working with each of our patients with their own unique pain management needs, and always want to ensure we’re doing what’s best for their particular needs.
If someone thinks they may be suffering from Rheumatoid Arthritis, what should their first step be?
They should see a rheumatologist.
The earlier they can initiate disease modifying therapy, the greater their opportunity prevents things like bone destruction and crippling.
Unfortunately, we see a lot of patients who’ve gone to their primary care doctor who have received medicines that comfort the pain and allow them to persevere, but by the time they make it to us, they’re past the point of no return.
The sooner one can get an accurate diagnosis, the better.
What preventative measures can we take to avoid Rheumatoid Arthritis?
Rheumatoid is primarily passed down through genetics. Though you can’t run from your gene pool, there is also a combination of outside factors that can encourage it.
Patients who smoke are at a greater risk for the disease, because smoking encourages inflammation. Additionally, patients who are overweight because of poor dietary choices are at a greater risk because of similar reasons.
There are definitely social and self-care measures that help in preventing R.A. early on that can only help in avoiding inflammation, like eating well, exercising, and practicing self-care measures for the body and mind.
When it comes down to it, the key to detecting and treating Rheumatoid Arthritis is early diagnosis and treatment. If you do that, you’re on the right track to a good prognosis.