Development, diagnosis and treatment of rheumatoid arthritis

By Cristiano Antonino On Oct 29, 2022

Rheumatoid arthritis is a disease with an autoimmune imprint and unknown aetiology that causes pain, swelling, stiffness and loss of normal function of the affected joint

It usually affects symmetrical parts (if one hand or knee is affected, the other will soon be too) and very often wrists and hands, but can also affect other joints.

Each patient experiences different symptoms and seizures.

There are some who have crises for a few months, but then the disease disappears without having caused much damage.

Others experience long periods of crises alternating with long periods of remission; still others are forced to live with the disease for many years with a high degree of severity and a slow but inexorable progression towards joint damage and disability.

Typical symptoms of rheumatoid arthritis are swollen and painful joints, fatigue, occasional fever, generalised malaise, restricted movement, morning stiffness, and deformities in the hands and feet.

The cause, as mentioned above, is still unknown, but involves the immune system.

The disease can occur at any age, but it peaks between the ages of 25 and 55.

Development of rheumatoid arthritis

Healthy joints are covered by a joint capsule that protects the underlying bone.

This capsule is filled with synovial fluid, which serves to lubricate and nourish the cartilage itself and the bone.

In rheumatoid arthritis, the immune system attacks the synovial cells, causing a reaction (inflammation), called synovitis, resulting in the typical symptoms of arthritis: swelling, redness, pain.

As the disease progresses, the synovial cells, which have now become abnormal, invade and destroy the cartilage and bone of the joint.

This also affects the surrounding ligaments, tendons and muscles, which can no longer work normally, resulting in the pain and deformities typical of rheumatoid arthritis.

Other diseases linked to the onset of rheumatoid arthritis are pleurisy, resulting in shortness of breath, anaemia, due to the insufficient task of the bone marrow in producing red blood cells, rheumatoid vasculitis, which in turn causes skin ulcers, gastric ulcers, neuropathies, heart failure and infarction, pericarditis and myocarditis, resulting in congestive heart failure and accumulation of fluid in the lungs.

Diagnosis of rheumatoid arthritis

Rheumatoid arthritis can be difficult to diagnose in its early stages because there is no specific test that identifies the disease and because the symptoms may differ from person to person.

Moreover, the symptoms are in common with other rheumatic diseases and therefore, the disease could easily be mistaken for something else.

The doctor, therefore, will use a set of tools at his disposal to arrive at a correct diagnosis.

First of all, the interview with the patient in his or her description of the symptoms and the time of onset, the severity of the symptoms themselves and their progression over time is the standard starting point for making a diagnosis, combined with a careful physical examination of the joints, reflexes and muscles.

As for laboratory tests, the most common test is the rheumatoid factor, an antibody present in the blood of most rheumatoid arthritis patients.

Not all patients test positive for this test, especially if the disease has recently developed, and in some who test positive, however, the disease does not develop.

Other tests are the erythrocyte sedimentation factor, the white blood cell count, and the test for anaemia.

X-rays, on the other hand, are used to determine the damage to the joint; at first, they are not very useful, but they are later used to monitor the progression of the disease.

Finally, synovial fluid analysis may be useful.

There are several therapies to treat rheumatoid arthritis, but the aim is always the same: to reduce pain and inflammation, stop joint damage and improve patients’ quality of life

First of all, both rest and physical activity are important, and the two therapies should be alternated depending on the activity of the disease: rest when the crisis is on, physical activity when it is not.

A well-balanced diet also has its positive effects.

There is no single food that can positively affect the course and progression of the disease, but a diet rich in protein and calcium certainly helps.

Many patients take drugs to reduce pain or inflammation; the degree of severity of the disease, the patient’s general health condition, the results and undesirable effects of the prescribed drugs will make the doctor lean towards one or the other drug.

Typically, acetylsalicylic acid or other NSAIDs, rest and physical rehabilitation are prescribed and, if the disease worsens, stronger drugs may be prescribed later.

Surgery is instead reserved for patients with severe damage.

Surgery can reduce pain and improve the function of the affected joint, but should always be discussed to analyse the advantages and disadvantages.

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