Rheumatoid Arthritis (RA) is a chronic, systemic autoimmune disease characterized by persistent synovial inflammation of joints. Unlike osteoarthritis (caused by mechanical wear and tear), RA occurs when the body's immune system mistakenly attacks the synovial lining, leading to joint erosion, bone destruction, and articular deformity.
Symptoms of Rheumatoid Arthritis
- Symmetrical Joint Pain & Swelling: Tender, warm, swollen joints symmetrically affecting both sides of the body (e.g., both wrists or hands).
- Small Joint Predilection: Early involvement of Metacarpophalangeal (MCP) and Proximal Interphalangeal (PIP) joints of fingers and feet.
- Prolonged Morning Stiffness: Joint stiffness lasting longer than 30–60 minutes after waking up or prolonged inactivity.
- Systemic Symptoms: Chronic fatigue, low-grade fever, weight loss, and general malaise.
- Late Joint Deformities: Ulnar deviation of fingers, Swan-neck deformity, Boutonnière deformity, and rheumatoid nodules under skin.
Causes & Risk Factors
- Autoimmune Pathogenesis: Immune system produces autoantibodies (RF & anti-CCP) attacking joint tissue.
- Genetic Susceptibility: Strong association with HLA-DR4 gene alleles.
- Gender: 2 to 3 times more prevalent in women.
- Tobacco Smoking: Major environmental risk factor elevating disease severity and anti-CCP positivity.
- Obesity & Chronic Infections: Contributes to systemic pro-inflammatory cytokine burden.
Diagnostic Evaluation
- Rheumatoid Factor (RF) Blood Test: Positive in ~70–80% of RA patients.
- Anti-Cyclic Citrullinated Peptide (Anti-CCP): Highly specific blood biomarker (> 95% specificity) for early RA.
- Inflammatory Markers (ESR & CRP): Measures systemic inflammatory activity.
- Imaging (X-ray, Ultrasound, MRI): Identifies early synovial thickening, joint space narrowing, and marginal bone erosions.
Treatment & Clinical Management
- 1. Disease-Modifying Antirheumatic Drugs (DMARDs):
- Methotrexate: First-line anchor DMARD to slow progressive joint destruction.
- Leflunomide, Sulfasalazine, Hydroxychloroquine: Alternative or combination synthetic DMARDs.
- 2. Biologic & Targeted Synthetic Therapies: TNF-alpha inhibitors (Adalimumab, Etanercept), IL-6 inhibitors, or JAK inhibitors (Tofacitinib) for refractory RA.
- 3. Symptom Relief: NSAIDs (Ibuprofen, Naproxen) and low-dose Corticosteroids (Prednisone) for acute flare control.
- 4. Physical Therapy & Lifestyle: Low-impact exercises (swimming, cycling), anti-inflammatory omega-3 diet, joint splinting, and joint replacement surgery for end-stage destruction.
