Rheumatoid arthritis is a form of chronic inflammatory arthritis, predominantly involving small joints in the hand and the feet. It is due to inflammation in the joints, which causes significant joint swelling, pain and limited mobility of those joints. In rheumatoid arthritis, your immune function attacks your joint tissues (synovium) causing inflammation. If such inflammation is not well controlled, it could lead to chronic joint damage.
What causes rheumatoid arthritis?
The exact cause of rheumatoid arthritis is still unclear. It is considered to be multifactorial, which includes genetic risk factors and environmental triggers. Some of the known environmental triggers include smoking, exposure to silica dust and multiple other environmental risk factors. Cigarette smoking is considered to be the strongest environmental risk factor for rheumatoid arthritis. The primary problem in rheumatoid arthritis is immune attack of joint tissues called synovial lining. This leads to joint inflammation, and if untreated leads to joint damage.
What are the symptoms of rheumatoid arthritis?
As discussed earlier, the primary problem in rheumatoid arthritis is inflammation in the joints. It causes significant joint swelling, pain and difficulty using the joint. You could get severe morning stiffness lasting for few hours. The most common joints involved are small joints in the hand and the feet. Rheumatoid arthritis typically affects both sides of Your body. The symptoms of rheumatoid arthritis are typically worse in the morning, which improves with activity. Rheumatoid arthritis is a chronic condition, leading to continued joint symptoms. The symptoms fluctuate with intermittent worsening of symptoms, referred to as “arthritis flares”. During the time of such flares, you could have increased joint symptoms.
How is the diagnosis of rheumatoid arthritis made?
Rheumatoid arthritis is a clinical diagnosis, which means your symptoms and your doctors assessment including history and examination is the key in making the diagnosis. Your rheumatologist might order other tests to help support the diagnosis. These tests could include markers of inflammation which includes sedimentation rate (ESR) and C-reactive protein. These are non-specific blood markers but help support the diagnosis of rheumatoid arthritis. There are blood markers of RA, such as rheumatoid factor (RF) and anti-CCP. These are considered to be the markers of autoimmune problems and if present could lead to more severe disease. X rays of the involved joints help understand presence of joint damage.
How is rheumatoid arthritis treated?
There are two primary goals in the treatment of rheumatoid arthritis:
- Decrease the pain and symptoms of RA.
- Decrease the long-term complications such as joint damage and increased risk of heart disease.
The pain in rheumatoid arthritis is due to inflammation. Hence medication that decreases such inflammation could decrease your pain and other symptoms related to RA. Such medications include non-steroidal anti-inflammatories or a short course of corticosteroids.
For long term treatment, disease modifying anti-rheumatic medication also called DMARDs are used. These medications decrease your immune system which is attacking your joints. These mediations include: methotrexate, leflunomide, sulfasalazine, and hydroxychloroquine. These medications are taken regularly to decrease the symptoms of rheumatoid arthritis. They also reduce the long-term complications including joint damage. Untreated rheumatoid arthritis eventually leads to joint destruction, which is irreversible. Hence timely treatment of rheumatoid arthritis is essential to minimize such long-term complications. Adequate treatment of RA also decreases the risk of heart diseases.
What is methotrexate?
This is the most commonly used and effective medication to treat RA. This is also the oldest medication to treat RA. Methotrexate works by decreasing your immune function, which is attacking your joints. This is taken by mouth every week. It is not an everyday medication. Taking it every week helps decrease the side effects. Using vitamin supplement, Folic acid could further decrease the risk of side effects with methotrexate. Many of you might be worried that methotrexate is a chemotherapy medication. It was originally discovered as a chemo medication, but the way this medication is used by oncologists, or the cancer doctor is very different than how rheumatologists use this medication. This helps further minimize the side effects associated with methotrexate. Your rheumatologist will closely monitor blood tests (liver tests and blood counts) to make sure your body is tolerating methotrexate. With these precautions, methotrexate is well tolerated and is quite effective to manage the symptoms of rheumatoid arthritis. It is recommended to avoid alcohol while you are taking methotrexate to minimize liver related side effects.
Biologics:
The other group of medications that are used in the treatment of RA includes: biologics. These are a newer group of medications which are highly effective to manage rheumatoid arthritis. There are multiple classes of biologics, depending on how they change our immune function and decrease inflammation. If your rheumatoid arthritis symptoms are not well controlled with traditional disease modifying anti-rheumatic medications (DMARDs), your rheumatologist will provide you with the option of adding a biologic.
Biologics are newer medications which help effectively manage the symptoms of rheumatoid arthritis. Overall, these medications are very well tolerated, but require close monitoring by your rheumatologist. There are multiple medications within the class of biologics. Each class of biologics blocks specific molecules in the immune system and helps decrease inflammation and decrease the symptoms of RA.
Here are some of the classes of biologics used to treat RA:
- Anti-TNF group:
- Etanercept
- Adalimumab
- Certolizumab
- Golimumab
- infliximab
- IL-6 blockers:
- Tocilizumab
- Sarilumab
- T-cell blockers:
- Abatacept
- B-cell blockers:
- Rituximab
- JAK inhibitors:
- Tofacitinib
- Baracitinib
- Upadacitinib
- IL-1 inhibitor:
- Anakinra
If you’re showing symptoms of rheumatoid arthritis please seek help from our compassionate and highly qualified rheumatologist at Empowered Arthritis and Rheumatology Center, PLLC, located in Cary, NC.
