Rheumatoid arthritis is the most common inflammatory disease of the joints, characterized by erosive symmetrical polyarthritis in combination with systemic immuno-inflammatory damage to internal organs (lungs, liver, heart, peripheral nervous system, skin). One of the most severe and common inflammatory joint diseases. Rheumatoid arthritis is a common disease, occurring in all countries in about 1% of the total population.
Symptoms of rheumatoid arthritis
The main manifestation of the disease is pain and swelling in various joints, primarily in the joints of the fingers of the hands. Symmetrical affection of small joints of the hands and feet is characteristic. Pain increases with movement and at rest, there is morning stiffness, swelling, joint dysfunction. Over time, the process may involve the feet, ankle, knee, elbow joints. In some patients, on the contrary, the joints of the legs (knee, ankle), shoulder joints and only then – hands may be affected first. Chronic inflammation of a joint leads to destruction of articular cartilage and deformity of the joint, which in turn impairs its function – pain on movement and stiffness.
Causes of rheumatoid arthritis
At the heart of the disease is an inflammatory process that begins inside the joint. A certain factor gradually begins to stimulate the synovial articular membrane and an inflammatory reaction occurs. With the course of the disease, the neighboring structures are enlarged and destroyed.
The reasons why rheumatoid arthritis occurs are not truly known, even to date. Most likely, in order to provoke the development of the disease, a symbiosis of multiple factors is necessary. The most significant are:
- genetic predisposition: the hereditary factor is not a primary factor, so the presence of rheumatoid arthritis in a close relative does not mean that the children will be sick, but the risk is many times higher;
- immune defects: the body recognizes its tissues as “enemies” and the production of autoimmune antibodies that are aimed at destroying these structures;
- gender: women are more prone to developing this disease than men;
- foci of infection in the body: certain bacteria and viruses can cause an inflammatory reaction in the form of rheumatoid arthritis;
- smoking;
- stress: sometimes there is a rapid development of the disease after experiencing a strong shock.
In highly developed nations, rheumatoid arthritis affects an average of 1 in 100 people, with women having the disease more often. Arthritis usually begins to progress between the ages of 30 and 50, with occasional cases occurring earlier or later in life.
Treatment of rheumatoid arthritis
Treatment methods for rheumatoid arthritis have changed significantly in recent years due to the emergence of new effective drugs. Emphasis is now placed on the early use of disease-modifying drugs. Increasingly, these are achieving remission or low disease activity.
Successful treatment of rheumatoid arthritis means resolution of disease symptoms, good quality of life and maintenance of physical fitness. In addition to basic drug treatment, early initiation of rehabilitation and, in some cases, surgical treatment is important in this disease. Specific drugs are prescribed by a rheumatologist, taking into account the severity of the disease and its activity, prognostic indicators and contraindications to the use of certain drugs. It is important to work with your doctor to develop an effective treatment plan that includes regular visits and laboratory tests to evaluate the effectiveness and possible side effects of the medications used.
Pharmacologic treatment
Disease-modifying drugs play a fundamental role in the treatment of rheumatoid arthritis, as they not only relieve symptoms, but above all prevent joint destruction, allowing you to maintain physical fitness and function normally in your daily life. They should be used as soon as possible after diagnosis to prevent irreversible changes in the joints. However, these drugs do not provide a complete cure – after their withdrawal, the disease usually relapses.
Recently, innovative treatments for rheumatoid arthritis have also been joined by targeting synthetic drugs that inhibit inflammatory pathways, the advantages of which are oral administration. The effects of innovative drugs are seen somewhat more quickly, usually within 2-6 weeks. Glucocorticoids also quickly reduce arthritis symptoms and inhibit the process of their destruction, so they are often used at the beginning of the disease and during exacerbations. Because of the many side effects, the aim should be to reduce the dose as soon as possible and to use them for as short a time as possible. These drugs can also be injected directly into the joint.
Non-medication treatment
For all patients, in addition to the use of medication, the following points are very important.
- Psychological support. Remember that an illness that is often associated with pain and disability can also cause frustration, feelings of dependence on others, and even depression.
- Rest. Fatigue is a frequent symptom of rheumatoid arthritis, especially during its active period. Allow yourself to rest: a short afternoon nap can help you regain energy and improve your well-being.
- Physical activity. Patients often refuse any physical activity, which leads to reduced joint mobility, contractures and muscle weakness.
- Orthopedic equipment. Helps to relieve painful joints and cope with disability. These include canes, crutches, walkers, wheelchairs to facilitate mobility, hand, knee and ankle stabilizers to help maintain proper joint position, orthopedic shoe insoles to improve foot structure and relieve weight-bearing joints when walking.
- Adapting the environment to the disability. For example, specially adapted kitchen appliances, furniture, handles to help you stand up, an adapted car – these will help you function fully.
- Proper nutrition. Maintaining a healthy body weight. Both overweight and obesity should be avoided, as well as poor nutrition, which weakens the body and leads to muscle wasting. It is also important to provide your bones with the right amount of calcium and vitamin D, as rheumatoid arthritis greatly accelerates the development of osteoporosis.
- Quitting smoking increases the risk of developing a severe disease.
Regular physical activity prevents and even reverses some unfavorable joint changes. Exercises that increase range of motion and muscle strength, help to maintain joint mobility and stability, and exercises that improve overall performance (e.g. walking, swimming, cycling) are recommended. The exercise program should be designed by a physiotherapist and adjusted individually for each patient depending on the stage of the disease, the person’s condition and comorbidities.
Topical treatment of rheumatoid arthritis
Local treatment for rheumatoid arthritis is aimed directly at the affected joint. Its methods include puncture of the joint to decompress it from accumulated inflammatory fluid and administer anti-inflammatory drugs internally. These are procedures that remove the altered synovial membrane. There are different ways to perform them: surgical, chemical, or using a radioisotope. Various types of corrective and reconstructive procedures aimed at improving the structure and functioning of deformed joints and endoprosthetics, i.e. replacing the damaged joint with an artificial prosthesis, can also be attributed to such methods.
Conclusion
Rheumatoid arthritis is a complex disease that requires a comprehensive approach to treatment. Modern methods of therapy can significantly slow the progression of the disease, reduce inflammation and pain syndrome, and in some cases – to achieve remission. The key role is played by timely diagnosis and early initiation of treatment, including the use of baseline anti-inflammatory drugs, glucocorticoids and innovative drugs.
However, drug therapy is only part of successful treatment. Physiotherapy, lifestyle adaptation, regular physical activity and psychological support are of great importance. Patients need to monitor their diet, avoid bad habits and take into account the doctors’ recommendations on the load on the joints.
With the right approach and comprehensive treatment, many patients with rheumatoid arthritis can maintain an active lifestyle and avoid severe complications. It is important to remember that fighting the disease is an ongoing process that requires patience, discipline and close cooperation with doctors.
