What
is rheumatoid arthritis?
Rheumatoid
arthritis (RA) is an chronic autoimmune disease which causes marked
inflammation of the joints. The body's own immune system attacks the
synovial membrane (the tissue lining of the joint), leading to
inflammation and pain as well as swelling and stiffness (See Figure
1).
Figure
1: Diagram showing difference between a healthy joint and RA
(http://www.aihw.gov.au/rheumatoid-arthritis/about/)
The
synovial membrane is usually very thin, and produces the fluid to
lubricate and nourish the joint tissue. However, in RA the synovial
membrane becomes thick and inflamed, resulting in unwanted tissue
growth which may lead to bone erosion, irreversible joint damage and
permanent disability. RA usually affects the smaller joints, most
often the joints in the hands, and also the feet, but can also affect
the larger joints in the knees and hips. As a systemic disease, it
affects the whole body and can also lead to problems with the heart,
respiratory system, nervous system and eyes.
What
causes RA?
The
precise cause of RA is not well understood, although it is known that
there is a strong genetic component, contributing to 50-60% of the
risk for developing RA. Smokers and people who have a family history
of RA also have a higher risk of developing the disease.
Who
gets RA?
According
to the Australian
Institute of Health and Welfare, approximately 407,900
Australians (approximately 2% of the total population) have RA, based
on self-reported data from the ABS
2014-15 National Health Survey. RA can affect anyone at any age
although is most common in those over 65 years, and has a slightly
higher prevalence in women (1.7%) compared to men (1.4%). Over an ~10
year period between 2005-06 and 2014-15, there was a 59% increase in
the rate of hospitalisation due to RA, primarily due to female
patients.
Symptoms and limitations caused by
RA
The most common symptoms of RA include
joint pain, swelling, stiffness and tenderness, and usually affect
the same joint on both sides of the body at once. Systemic symptoms
may include fatigue, fever, weight loss, anaemia, inflammation of the
eyes or lungs, and subcutaneous nodules (bumps under the skin).
Quality of life can be severely
affected for people with RA. Even in the early stages of disease,
severe limitations may occur, which then worsen over time. The cause
of the most severe limitation is most commonly reported to be joint
damage in the wrist. There is also a high
prevalence of anxiety, depression and low self-esteem amongst
people with RA.
Another major consequence of this
condition is work
disability, with only 80% of patients being able to continue work
2 years after disease onset, and 68% at 5 years.
Diagnosis of RA
RA is diagnosed through a physical
examination of your symptoms by your doctor and various tests
including blood tests for inflammation and for rheumatoid factor, as
well as x-rays to look for joint damage. During the early stages of
disease these tests may come up negative, and your symptoms may be
similar to other types of arthritic disease. Hence it can be
difficult and time-consuming to diagnose RA, and if your doctor
suspects you are affected you should be referred to a specialist
known as a rheumatologist.
Treatment for RA
Currently there is no cure for RA,
however there has been dramatic improvements in treatment of RA over
recent years which are particularly helpful for people in the early
stages of the disease. Treatment depends on your symptoms and their
severity, and your rheumatologist may need to trial several different
treatments in order to determine which one will work best for you.
Treatment options may include:
- Regular exercise
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroid medications
- Disease-modifying anti-rheumatic drugs (DMARDs)
- Biological DMARDs such as tumour necrosis factor medications
Useful
resources
AIHW
Arthritis
WA
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