Rheumatoid Arthritis: Causes, Symptoms & Treatment

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease primarily affecting synovial joints, causing joint destruction and systemic complications. The immune system mistakenly attacks the synovial lining of joints, causing inflammation, pain, swelling, and eventually cartilage and bone erosion. RA typically affects small joints symmetrically (both hands, both feet) and can involve other organs including the heart, lungs, and eyes.

The condition usually develops in middle-aged adults but can occur at any age.

Risk factors include:

• Female gender
• Family history of RA
• Genetic factors (HLA-DR4, shared epitope)
• Smoking
• Early menopause
• Nulliparity
• Environmental triggers (infections)

The exact trigger for autoimmunity remains unknown but likely involves genetic predisposition and environmental factors.

Symptoms typically develop gradually:

• Joint pain, swelling, and warmth
• Morning stiffness (lasting >1 hour)
• Symmetric joint involvement
• Fatigue and malaise
• Low-grade fever
• Weight loss
• Reduced hand grip strength

Systemic manifestations: vasculitis, pericarditis, interstitial lung disease, scleritis.

Diagnosis involves:

• Clinical features (symmetric polyarthritis)
• Rheumatoid factor (RF) testing
• Anti-CCP antibodies (more specific than RF)
• Elevated inflammatory markers (ESR, CRP)
• Imaging (X-ray, ultrasound, MRI)

First-line: Disease-modifying antirheumatic drugs (DMARDs):

• Methotrexate (gold standard)
• Sulfasalazine
• Hydroxychloroquine
• Biologic DMARDs (TNF inhibitors, others)

Combination therapy often used for better control.

Supportive care:

• NSAIDs for symptoms
• Corticosteroids (low dose, short-term)
• Physical therapy
• Occupational therapy
• Lifestyle modifications

While RA cannot be prevented, risk reduction includes:

• Smoking cessation
• Avoiding prolonged estrogen deficiency
• Regular physical activity
• Maintaining healthy weight
• Early intervention if symptoms develop

Seek evaluation for symmetric joint pain and swelling lasting more than 6 weeks. Rheumatology referral is recommended for diagnosis and treatment initiation. Regular monitoring assesses disease activity and treatment response.