Early Identification of Rheumatoid Arthritis

Early Identification of Rheumatoid Arthritis

1. What is Rheumatoid arthritis

Rheumatoid arthritis is a classic rheumatic disease that affects 0.5%-1% of the overall population. In India, the prevalence has been estimated to be around 0.7%. Rheumatoid arthritis is often thought to be a condition related to old age, though this isn’t always the case. The average onset is between the ages of 30 and 60 and women seem to have a higher predilection for this disease at a younger age than men.

Rheumatoid arthritis (RA), inflammatory arthritis characterized by symmetric polyarticular inflammation of the synovium, typically of the small joints of the hands, wrists, and feet. Inflammation and the consequent destruction of synovial joints is the hallmark of RA. This inflammation results in pain and stiffness can lead to progressive joint damage resulting in deformities and loss of function.

While inflammation of the tissues around the joints and inflammatory arthritis are characteristic features, the disease can also cause extra-articular inflammation and injury in other organs in the body. Because it can affect multiple organs of the body, rheumatoid arthritis is referred to as a systemic illness and is seldom called rheumatoid disease.

It can affect organs, such as the heart, the lungs, or other tissues like muscles, cartilage, and ligaments. Associated organ damage contributes to severe disability in these patients. Additionally, chronic inflammation secondary to RA can lead to an increased risk of cardiovascular disease and changes in bone metabolism. RA patients in contrast to the general population have a 40% increased risk of mortality; this risk is primarily attributed to the increased incidence of cardiovascular disease.

2. What causes Rheumatoid Arthritis

The etiology of RA is unknown, but genetic factors are associated with the condition and its severity, and multiple environmental and lifestyle factors have been shown to be associated with its development. Of the several factors, genetics (HLA-DRB1) gene, which encodes a “shared epitope,” has a major influence on the development of RA, with the strongest risk seen in first-degree relatives.

Environmental, dietary, and lifestyle factors associated with rheumatoid arthritis risk include
• Infectious aetiology include Epstein-Barr virus, Mycobacterium tuberculosis, Escherichia coli, Proteus mirabilis, retroviruses, and parvovirus B19
• Exposure to tobacco smoke (Cigarette smoking increases the risk of developing RA, particularly in cases of genetic predisposition to the disease)
• Occupational dust (silica)
• Air pollution
• High sodium, red meat, and iron consumption
• Obesity
• Low vitamin D intake and levels

3. When to visit a doctor

The treatment protocol for any existing disease condition is that the earlier they are diagnosed; the better it is in terms of prognosis. Rheumatoid arthritis, in general, can be difficult to diagnose in its early stages as the initial signs and symptoms mimic those of many other diseases.

In people with autoimmune conditions like RA, warning signs that necessitate therapeutic assistance are
• Fever, severe chills, or inexplicable pain or swelling in the joints
• Pain and stiffness that lasts for more than 30 minutes, even after prolonged rest
• Tender, stiff joints that are red or warm to touch
• Joint inflammation frequently affecting the wrist and finger joints nearest to the hand
• Joint pain that limits movement impairing the quality of life of the individual.
• Episodes of joint pain recurring within a short duration of time
• Symptoms lasting for years with frequent flare-ups and remissions

Early diagnosis and adequate treatment by the rheumatologist can help slow down or prevent this joint damage. A frequent and an early visit are associated with greater improvements in pain and functional disability over a period of time.