Jeremy Alfred 
Rheumatoid arthritis is an autoimmune disorder in which the body’s immune system attacks the lining of the bones in some joints causing inflammation and destruction of bone and cartilage. As the lining between the bones (synovia) and cartilage deteriorates, bones rub against each other causing pain, swelling, stiffness, and a gradual loss of function in the affected joints. Autoimmune responses favor increased activity of osteoclasts that dissolve bones and decreased activity of osteoblasts that generate new bone material. Systemic and continued bone loss leads to systemic osteoporosis.
Areas affected by rheumatoid arthritis
Rheumatoid arthritis generally affects the smaller joints first, such as joints attaching the fingers to the hand or the toes to the foot. As the disease progresses, it can affect wrists, elbows, shoulders, hips, ankles, knees, spine, and jaw. Without treatment, the disease can progress and move beyond the joints. The patient’s heart, lungs, eyes, nerves, blood, or skin may become affected. Timely treatment can get the disease under control and help patients achieve a state of no symptoms (remission).
Rheumatoid arthritis generally occurs in symmetrical patterns. If one wrist is affected, the other wrist is affected too. However, the disease may not affect symmetrical joints with the same intensity. Testing over 200 patients with long-term rheumatoid arthritis in one foot, scientists found significant differences between the affected foot and the other foot in characteristics such as foot size and load-bearing capacity.
Symptoms of rheumatoid arthritis
Symptoms of rheumatoid arthritis include:
- Pain in usually symmetrical joints
- Swelling
- Tenderness
- Warm to touch
- Stiffness in the morning or after rest typically lasting over half an hour
- Loss of appetite
- Fatigue
- Occasional low-grade fever.
The symptoms may go away and return as a flare-up.
Risk factors for rheumatoid arthritis
Risk factor
Impact
Age
Rheumatoid arthritis can impact people of all ages including kids and teens. However, the risk increases with increasing age. The median age of disease onset is 45 for women and 50 for men.
Sex
Women are more likely to develop rheumatoid arthritis than men, possibly due to reproductive or hormonal factors.
Family history
Genetics can predispose a person to develop the disease. The risk of a person developing rheumatoid arthritis when they have a family member who has the disease is 0.8%. The risk in the general population is 0.5%. If an identical twin has rheumatoid arthritis, the risk of the other twin developing the disease is 12-15%. In non-identical twins, this risk is 4%.
Smoking
Smoking increases the risk of developing rheumatoid arthritis. The risk increases with the number of cigarettes smoked per day but persists even after the person stops smoking. Nonsmokers who were exposed to cigarette smoke as children have a 75% higher risk of developing the disease.
Obesity
Obesity causes chronic low-grade inflammation in the whole body. It increases the risk of developing rheumatoid arthritis. Being obese or overweight can also make the drugs for rheumatoid arthritis less effective. Obese patients with BMI > 30.0 kg/m2 were less likely to achieve remission from the disease, while the rates of remission were comparable between overweight (BMI 25.0–30.0 kg/m2), underweight (BMI < 18.5 kg/m2), and normal (BMI 18.5-25.0 kg/m2) patients.
Gum disease
Gum disease can trigger rheumatoid arthritis and also make medications less effective. The site of gum disease has been suggested to be one of the sites where rheumatoid arthritis first starts in the body. Treating gum disease can help improve a patient’s rheumatoid arthritis.
Treatment options
Treatment options for rheumatoid arthritis include medications and physical or occupational therapy.
Medications called disease-modifying antirheumatic drugs (DMARDs) can be effective in improving symptoms and achieving remission, especially when treatment starts in the early stages of the disease. Biologics that suppress specific components of the immune system can also help get the disease under control.
Patients may need occupational and physical therapy to relearn daily tasks that have become difficult due to the pain from rheumatoid arthritis. Physical therapists may also provide the patients with tools to simplify tasks such as opening twist tops.
Medicare Plan B partly covers physical and occupational therapy if a medical provider prescribes it. Depending on the plan, most health insurance companies also cover short-term physical and occupational therapy if it is deemed necessary by a medical care provider.
Lifestyle and Dietary recommendations
To reduce the risk of having or exacerbating rheumatoid arthritis, it can be helpful to quit smoking and get any existing gum disease treated.
A diet that reduces inflammation and is rich in prebiotics and probiotics is also recommended.
In their publication titled “Design of an anti-inflammatory diet (ITIS diet) for patients with rheumatoid arthritis”, Bustamante and colleagues present meal plans with foods rich in fiber and nutrients for those with rheumatoid arthritis.
The information provided in our blog posts is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
