What is Rheumatoid Arthritis ? When we are talking about autoimmune disease it is not about one kind of disease. There are many different types of autoimmune disease or even a hundred. When the body senses danger from a virus infection, the immune system kicks into gear and attacks it. This is called an immune response. In our normal conditions, an immune response cannot be triggered against the cells of one’s own body. Sometimes, healthy cells and tissues are caught up in this response, resulting in autoimmune disease.1
Autoimmune diseases affect approximately 8% of the population, 78% of whom are women. The reasons for the high prevalence in women are unknown, but circumstantial evidence links autoimmune diseases with preceding infections.4 Autoimmune diseases are the third most common category of disease in the United States after cancer and heart disease; they affect approximately 5%-8% of the population or 14-22 million persons.2 Autoimmune diseases can affect virtually every site in the body, including the endocrine system, connective tissue, gastrointestinal tract, heart, skin, and kidneys. At least 15 diseases are known to be the direct result of an autoimmune response, while circumstantial evidence implicates >80 conditions with autoimmunity.3
Now, we want to discuss one of these autoimmune diseases called Rheumatoid Arthritis(RA). The global prevalence of RA between 1980 and 2019 was 460 per 100.000 population, with variations due to geographical location and study methodology.5
Rheumatoid arthritis (RA) is a disease of unknown origin, which is characterized by inflammatory(redness, swelling, pain, tenderness, heat, and disturbed function of an area of the body, especially as a reaction of tissue injury) changes of the synovial tissue of joints, of cartilage and bone and, less frequently, of extra-articular(means outside of or other than a joint)sites. Somehow people can’t make the difference between arthritis and rheumatoid arthritis. Whenever there’s joint pain, there must be rheumatoid arthritis, is a big NO.
The fact is not every arthritis was an autoimmune disease. For example: Rheumatoid arthritis and osteoarthritis both cause joint pain, stiffness and limited range of motion, but the two diseases are distinct in their root cause and treatment. RA is a complex disease that affects approximately 0,5% of the adult population worldwide, and occurs in 20-50 cases per 100.000 annually, mainly in women after their 40s.5
Sign & Symptoms
RA commonly involves multiple joints of both hands with morning stiffness that may last for several hours. It has symptom duration of fewer than six months is defined as early, and when the symptoms have been present for more than months, it is defined as established.6,7,8
There are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission. Sign and symptoms of RA include:9
- Pain or aching in more than one joint
- Stiffness in more than one joint
- Tenderness and swelling in more than one joint
- The same symptoms on both sides of the body (such as in both hands or both knees)
- Weight loss
- Fatigue or tiredness
An autoimmune disease like rheumatoid arthritis, something goes awry. Instead of protecting the body from infection or disease as it normally does the immune system attacks and destroys the body’s healthy tissue. When the disease affects many organs, as in lupus, it’s called a systemic autoimmune disease.
Researchers had found many mechanisms that cause the risk of RA. And here some characteristics that increase risk of having RA :9
- Age: RA can happen at any stage of your life, but likelihood increases with age. The onset of RA is highest among adults in their sixties.
- Sex: New cases of RA are typically two-to-three times higher in women than men.
- Genetics/inherited traits: there are specific genes that more likely this person will develop RA. These genes, called HLA /Human Leukocyte Antigen class II genotypes, can also make your arthritis worse. This risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
- Smoking: multiple studies show that cigarette smoking increases a person’s risk of developing RA and can make the disease worse.
- History of live births: women who have never given birth may be at greater risk of developing RA.
- Early life exposures: some early life exposures may increase risk of developing RA in adulthood.10 For example: one study found that children whose mothers smoked had double the risk of developing RA as adults.
- Obesity: Being obese can increase the risk of developing RA.
If there are some characteristics that can cause people to develop RA. Is there any characteristic that could be decreasing the risk???
YES, THERE IS IT.
Breastfeeding women: In a new study of over 7,000 older Chinese women published online today in the journal Rheumatology, breastfeeding especially for a longer duration is shown to be associated with a lower risk of rheumatoid arthritis (RA). Specifically, it showed that women who had breastfed their children were around half as likely to have RA, compared to women who had never breastfed.11
Diagnostic & Treatment
There is no specific test for diagnosis of RA. In 2010, the American College of Rheumatology and European League Against Rheumatism collaborated to create new classification criteria for RA. The 2010 new criteria rates on a scale from 0-10 points were assigned in four separate domains of signs and symptoms namely:1) joint involvement 2) serology 3) duration of symptoms 4) acute phase reactants. Patients are definitely diagnosed with RA if they score 6 or more points according to the following criteria. This criteria can be applied to any patient with and there is no explanation for synovitis which can not be attributed to other entities and there is no explanation for synovitis.13
Many rheumatic conditions can be diagnosed or suspected based on taking history and physical examination. Sometimes, diagnosis of RA maybe possible based on clinical grounds alone, nevertheless there are no disease-specific clinical features or laboratory tests to be diagnostic for RA.14 Early symptoms of RA may appear as vague pain with gradual appearance without classic symptoms of joint swelling or tenderness. Prolong duration of morning stiffness with arthralgia , or arthritis in a limited number of joints may be a clue for considering RA diagnosis.15
The therapy is complex and includes different classes of drugs with different routes of application but also non drugs interventions. The most important are patient education followed by exercise and physical and occupational therapy. Patient and the medical staff must go together to get the goal of the treatment. Because of an increased risk of coronary atherosclerosis, efforts should be made to reduce risk factors such as smoking, hyperlipidemia , hypertension, and obesity. To relieve pain and swelling fast and to gain control of the inflammation, glucocorticoids are used widely in acute disease flares either orally or as joint injections .16 Oral glucocorticoid is for short-term use (up to 3-4 month) only should be tapered to prevent side effects as soon as possible.17 To control inflammation in the long run, Disease Modifying Anti-Rheumatic Drugs (DMARD) to spare glucocorticoid are needed.
- https://www.hopkinsmedicine.org/health/wellness-and-prevention/autoimmune-disease-why-is-my-immune-system-attacking-itself. Access: 24 June 2021
- National Institutes of Health Autoimmune Disease Coordinating Committee Report 2002. Bethesda (MD): The Institutes; 2002.
- Rose NR An immunology primer. In: Morton CC, Fagan T, editors. Proceedings from Sex Differences in Immunology and Autoimmunity, Society for Women’s Health Research, Boston, MA, 8 Nov 2001. Washington: Society for Women’s Health Research; 2002. p. 7–9.
- Women and Autoimmune Diseases. DeLisa Fairweather, Noel R. Rose. Emerg Infect Dis. 2004 Nov; 10(11): 2005–2011. doi: 10.3201/eid1011.040367. PMCID: PMC3328995
- Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C. The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. Rheumatol Int. 2021 May;41(5):863-877. doi: 10.1007/s00296-020-04731-0. Epub 2020 Nov 11. PMID: 33175207.
- Carbone F, Bonaventura A, Liberale L, Paolino S, Torre F, Dallegri F, Montecucco F, Cutolo M. Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents. Clin Rev Allergy Immunol. 2020 Feb;58(1):1-14.
- Cai Q, Xin Z, Zuo L, Li F, Liu B. Alzheimer’s Disease and Rheumatoid Arthritis: A Mendelian Randomization Study. Front Neurosci. 2018;12:627.
- Voigt A, Seipelt E, Bastian H, Juche A, Krause A. [Improved early diagnostics of rheumatic diseases : Monocentric experiences with an open rheumatological specialist consultation]. Z Rheumatol. 2018 Nov;77(9):844-849
- Rheumatoid Arthritis. Access: https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html.
- Colebatch AN, Edwards CJ. The influence of early life factors on the risk of developing rheumatoid arthritis. Clin Exp Immunol. 2011;163(1):11-16. doi:10.1111/j.1365-2249.2010.04263.x
- Oxford University Press (OUP). “Breastfeeding is associated with a lower risk of rheumatoid arthritis, according to a new study.” ScienceDaily. ScienceDaily, 7 January 2014. <www.sciencedaily.com/releases/2014/01/140107093037.htm>.
- Pradeepkiran, Jangampalli Adi. Insight of rheumatoid arthritis risk factors and associations. Elsevier: Journal of Translational Autoimmunity. https://doi.org/10.1016/j.jtauto.2019.100012. August 2019.
- 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative.Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JM, Hobbs K, Huizinga TW, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G. Arthritis Rheum. 2010 Sep; 62(9):2569-81.
- Heidari, Behzad. “Rheumatoid Arthritis: Early diagnosis and treatment outcomes.” Caspian journal of internal medicine vol. 2,1 (2011): 161-70.
- Emerging trends in diagnosis and treatment of rheumatoid arthritis.. Birch JT Jr, Bhattacharya S. Prim Care. 2010 Dec; 37(4):779-92, vii.
- Kohler M.Birgit, Gunther Janine, Kaudewitz Dorothee, Martin Lorenz-Hanns. Current Therapeutic Options in the Treatment of Rheumatoid Arthritis. J. Clin. Med. 2019, 8(7), 938; https://doi.org/10.3390/jcm8070938
- Hoes, J.N.; Jacobs, J.W.G.; Boers, M.; Boumpas, D.; Buttgereit, F.; Caeyers, N.; Choy, E.H.; Cutolo, M.; Silva, J.A.P.D.; Esselens, G.; et al. EULAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann. Rheum. Dis. 2007, 66, 1560–1567.