Rheumatoid arthritis affects joints in both hands, wrists and knees. The Singapore General Hospital (SGH) Department of Rheumatology and Immunology provides the facts.
Information provided by the
Department of Rheumatology and Immunology from Singapore General Hospital (SGH), a member of the
SingHealth group.
What is rheumatoid arthritis (RA)?
Rheumatoid arthritis (RA) is the most common autoimmune rheumatic disorder and affects around one per cent of the population, which is equivalent to about 45,000 people in Singapore.
In the case of rheumatoid arthritis, the synovial membrane that covers the joints becomes the target of the immune system’s attack leading eventually to the destruction of the bone and cartilage of the joint. The visible swelling and tenderness of the joints is due to increased fluid in the joint cavity and the thickening of the lining of the joint capsule.
RA is a systemic disorder that can affect other organs in the body like the eye, the skin, the heart and the lungs. The commonly affected joints are the small joints of the hands, wrists, elbows, shoulders, knees, ankles and the toes.
What causes rheumatoid arthritis (RA)?
Scientific research shows that either a disorder in the body’s immune system or an overreaction to an unknown trigger like a virus infection can set off the condition. Once mobilised, the immune system targets the body’s own cells – hence the term “autoimmune disease”.
Lacking an “off switch”, the continual attack by the immune system eventually causes damage to the joints. As the condition progresses, the inflammation, pain and stiffness of the joints tend to increase in severity, ultimately leading to deformity of joints and a loss of overall mobility.
Who is at risk of rheumatoid arthritis (RA)?
Rheumatoid arthritis (RA) affects all races and 75 per cent of patients are female. The age at which RA most frequently begins is 20 to 45 years.
Having a family history with rheumatoid arthritis and environmental factors such as smoking and hormonal changes during pregnancy are also risk factors.
How to prevent rheumatoid arthritis (RA)
Although it remains unclear the exact cause of rheumatoid arthritis (RA), a person can prevent the disabilities caused by RA through early diagnosis and treatment.
A healthy balanced diet and moderate regular exercise is also helpful. RA will only cripple patients if the diagnosis is delayed or if patients do not take their medications as instructed or continue to smoke.
Symptoms of rheumatoid arthritis (RA)
The first symptoms of rheumatoid arthritis are:
Pain and swelling in the joints of the fingers and wrists
Accompanied by joint stiffness (especially in the mornings). The pain and stiffness last for hours and usually involve joints on both sides of the body.
As the disorder progresses, the joints will become warm, tender and painful throughout the day, accompanied by body stiffness.
Other symptoms include
In advanced rheumatoid arthritis, much of the joint surface is destroyed leading to deformed joints.
Diagnosis of rheumatoid arthritis (RA)
In order to diagnose rheumatoid arthritis (RA) accurately, a doctor must evaluate the patient and will usually also perform blood tests and x-rays. Blood tests include detection of the rheumatoid factor (RF) and anti-CCP antibody.
If the joints are swollen especially at the knee, joint aspiration may be carried out and the fluid will be sent for special examination. This will help the doctor to differentiate between infective, degenerative or inflammatory joint disease.
It is very important to diagnose RA as early as possible as research has shown that prompt treatment improves the chance that the patient's joints and organs will remain healthy and will not be permanently damaged.
Referral to a rheumatologist (a specialist doctor who looks after patients with rheumatic disease) is often helpful for confirmation of RA and its treatment.
Treatment for rheumatoid arthritis (RA)
Treatment aims to alleviate the symptoms of RA, prevent further joint destruction, and help patients regain lost muscle strength and mobility.
1) Medication
Upon confirmation of the diagnosis of rheumatoid arthritis (RA), the attending doctor will determine the type of medication suitable for the patient based on individual requirements.
Examples of medications used to treat RA are:
NSAIDs (non-steroidal anti-inflammatory drugs) like diclofenac acid, or COX-2 inhibitors, are often prescribed to reduce pain, swelling and stiffness that result from rheumatoid arthritis.
However, these drugs will only reduce the symptoms and will have no effect on the progression of the disorder. Reducing pain and swelling are important as they make you more comfortable.
Depending on the severity and progression of the disorder,
DMARDs (or disease-modifying antirheumatic drugs) are often prescribed.
These include hydroxychloroquine (Plaquenil), methotrexate, sulphasalazine and leflunomide (Arava). Low dose steroids may be used. Steroids can also be injected directly into a joint to relieve pain and swelling. However, steroids cannot be used in the long term, especially in high doses because they have significant side-effects.
There is now a
new group of drugs called biologic agents which can control the disease quickly and effectively. They are given as injections and are very expensive. Not all rheumatoid arthritis patients are suitable for or need such drugs. Your doctor is the best judge on which drugs to use.
2) Exercise
Once the inflammation is under control, it is necessary to rebuild the muscles and ligaments weakened by the arthritis.
Exercise helps to rebuild muscle strength which can aid to stabilise the joint. While some sports which stress the joints excessively are not suitable, recovering patients should aim to keep fit as much as possible. It is important not to exercise the acutely swollen and painful joints. Your physiotherapist is the best person to ask for advice.
3) Surgery
In some cases, surgery may be necessary to correct joint deformity or to replace a completely destroyed joint.
How is rheumatoid arthritis (RA) different from osteoarthritis (OA)?
Although rheumatoid arthritis (RA) and
osteoarthritis (OA) sound similar in the sense that they are both arthritis, the causes are different.
RA arises from the body’s immune system attacking its own tissues, while primary osteoarthritis is caused by “wear and tear” of the joints.
Their symptoms, long term effects and treatment for both conditions are also very different.
Ref: G25 (ed)
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Rheumatoid Arthritis (RA): Other Complications That May Occur
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