Rheumatoid arthritis: symptoms, causes and treatment

By Cristiano Antonino On Jan 27, 2023

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Rheumatoid arthritis is a chronic inflammatory disease that affects the joints, but not only. In some people, it can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels

It is an autoimmune disease, i.e. it occurs when the immune system mistakenly attacks the body’s own tissues.

It affects the lining of joints, causing painful swelling that can sometimes lead to bone erosion and joint deformity.

It is precisely the inflammation associated with rheumatoid arthritis that can also damage other parts of the body.

The disease can also cause significant physical disability, but treatment options have improved in recent years.

Rheumatoid arthritis, what it is

Rheumatoid arthritis is an autoimmune disease, i.e. caused by an ‘error’ of the immune system, the body’s defence system.

Normally, the immune system helps to protect the body against infection and disease.

In rheumatoid arthritis, it, due to an abnormal functioning, does not attack the ‘enemies’ but the healthy tissues of the joints.

It produces, in fact, particular proteins, cytokines, which, through a series of reactions, cause inflammation of the joint and promote aggression against bones, cartilage and other connective tissues.

If no action is taken, over time, the synovial membrane (inner lining layer of the joint capsule) thickens and turns into inflammatory tissue that invades the entire joint and degrades joint, connective and bone tissue.

As a result, the bone can be progressively destroyed and the inflammation can spread to other joint structures, such as tendons and ligaments.

Over the years, the inflammation may gradually involve other organs including the heart, lungs, nerves, eyes and skin.

The causes of rheumatoid arthritis

Doctors do not know exactly what triggers the process behind the disease, although it seems likely that there is a genetic component: it is assumed that certain genetic alterations make some people more susceptible to certain environmental factors, such as infection with certain viruses and bacteria, which can trigger rheumatoid arthritis.

Factors that may increase the risk of suffering from this disease include:

gender: women are more likely than men to develop rheumatoid arthritis;
age: the disease can occur at any age, but most commonly starts in middle age;
family history: if a member of your family has rheumatoid arthritis, you have an increased risk of contracting the disease;
smoking: cigarette smoking increases the risk of developing the disease, particularly if the person has a genetic predisposition to its development. Smoking also appears to be associated with greater severity of the disease;
overweight: Overweight people appear to have a slightly higher risk of developing rheumatoid arthritis.

Rheumatoid arthritis, the symptoms

Rheumatoid arthritis manifests itself with certain signs and symptoms such as:

warm and swollen joints;
joint stiffness that is usually worse in the morning and after inactivity;
fatigue, fever and loss of appetite.

About 40% of people who have rheumatoid arthritis also experience signs and symptoms that do not involve the joints.

Areas that may be affected include the skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow, and blood vessels.

The signs and symptoms of rheumatoid arthritis can vary in severity and duration.

Periods of increased disease activity, called flare-ups, alternate with periods of relative remission, when swelling and pain fade or disappear.

Over time, rheumatoid arthritis can cause joints to deform and move out of place.

How rheumatoid arthritis begins

Early rheumatoid arthritis tends to affect smaller joints first, particularly the joints that attach the fingers to the hands and the toes to the feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders.

In most cases, symptoms occur in the same joints on both sides of the body.

Complications of rheumatoid arthritis

Rheumatoid arthritis increases the risk of developing

osteoporosis: rheumatoid arthritis, along with certain medications used to treat it, can increase the risk of osteoporosis, a condition that weakens bones and makes them more prone to fractures;
rheumatoid nodules, which are solid swellings of tissue that most commonly form around pressure points, such as the elbows. However, these nodules can form anywhere in the body, including the heart and lungs;
dry eyes and mouth: people who have rheumatoid arthritis are much more likely to develop Sjogren’s syndrome, a disorder that reduces the amount of moisture in the eyes and mouth;
infections: this disease and many of the drugs used to combat it can damage the immune system, leading to an increase in infections;
abnormal body composition: the proportion of fat to lean mass is often higher in people suffering from this disease, even in those with a normal body mass index (BMI);
carpal tunnel syndrome: if rheumatoid arthritis affects the wrists, inflammation can compress the nerve that innervates most of the hand and fingers, triggering carpal tunnel;
heart problems: this disease can increase the risk of having hardened and clogged arteries, as well as developing inflammation of the sac that encloses the heart;
lung disease: people with rheumatoid arthritis have an increased risk of inflammation and scarring of lung tissue, which can lead to progressive shortness of breath;
lymphoma: rheumatoid arthritis increases the risk of lymphoma, a group of blood cancers that develop in the lymphatic system.

What tests are done for rheumatoid arthritis

If there is persistent discomfort and swelling in the joints, it is a good idea to consult your doctor, who may then refer you to a specialist in rheumatology and/or orthopaedics.

Rheumatoid arthritis can be difficult to diagnose in its early stages because the first signs and symptoms are similar to those of many other diseases and can be misleading.

There is no blood test or physical finding to confirm the diagnosis.

During the physical test, the doctor will check the joints for swelling, redness and heat.

The specialist may also check reflexes and muscle strength and request blood tests: in fact, people with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, also known as sed rate) or C-reactive protein (CRP) level, which may indicate the presence of an inflammatory process in the body.

Other useful blood tests are those for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. The doctor may then recommend an X-ray and/or MRI scan to monitor the progression of the situation over time.

Rheumatoid arthritis, treatments

Unfortunately, there is no definitive cure for rheumatoid arthritis, but clinical studies indicate that remission of symptoms is more likely when treatment starts early with disease-modifying anti-rheumatic drugs (DMARDs).

Today, physicians have several pharmacological treatments available: the types of drugs recommended by the physician for the individual case will depend on the severity of the symptoms and the time of onset of the disease.

The most commonly used are:

non-steroidal anti-inflammatory drugs (NSAIDs), which can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen and naproxen sodium. Stronger NSAIDs are only available on prescription. Side effects may include stomach irritation, heart problems and kidney damage;
steroids: corticosteroid drugs, such as prednisone, reduce inflammation and pain and slow down joint damage. Side effects may include bone thinning, weight gain and diabetes. Doctors often prescribe a corticosteroid to quickly relieve symptoms, with the aim of gradually tapering off the drug;
Conventional DMARDs: these drugs can slow the progression of the disease and save joints and other tissues from permanent damage. Common DMARDs include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine. Side effects vary, but can include liver damage and severe lung infections;
Biological agents: also known as biological response modifiers, they represent a new class of DMARDs that includes abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, sarilumab and tocilizumab. Biological DMARDs are generally more effective when combined with a conventional DMARD, such as methotrexate. These types of drugs may increase the risk of infection;
targeted synthetic DMARDs, such as baricitinib, tofacitinib and upadacitinib, which can be used if conventional DMARDs and biological drugs have not been effective. Higher doses of tofacitinib may increase the risk of blood clots in the lungs, serious cardiac events and cancer.

When surgery is needed

If medication fails to prevent or slow down joint damage, your doctor may recommend surgery to repair damaged joints, reduce pain and improve mobility.

Surgery for this form of arthritis may involve one or more of the following procedures

synovectomy, to remove the inflamed lining of the joint (synovium). It can help reduce pain and improve the flexibility of the joint;
tendon repair: inflammation and joint damage can cause loosening or rupture of tendons around the joint, so it may be necessary to repair them surgically;
joint fusion, which may be recommended to stabilise or realign a joint and to relieve pain when joint replacement is not an option;
total joint replacement: during joint replacement surgery, the surgeon removes the damaged parts of the joint and inserts a prosthesis.

The doctor may refer the person to a physiotherapist or occupational therapist to learn specific exercises that help keep the joint flexible.

The therapist may also suggest new ways to perform daily activities that help protect the joints, for example, picking up an object using the forearms.

In some cases, it is helpful to use assistive devices that avoid further stressing painful joints, such as a kitchen knife with a handle that helps protect finger and wrist joints and button hooks that can facilitate dressing.

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