Understanding Rheumatoid Arthritis: A Guide for Africans

By: Rukhsar Jabbar. M.Sc. Physiotherapy. Freelance Health Writer. Medical review by: The DLHA Team

Illustration showing rheumatoid arthritis process in hand joints. Click on image to enlarge. Credit: brgfx on Freepik

Highlights 

• Rheumatoid arthritis (RA) is a long-term inflammatory condition that mostly affects synovial joints and is frequently brought on by the combination of genes and environmental factors.

• The most frequent and prominent symptoms, which typically begin slowly over weeks to months, are joint pain and swelling. 

• RA primarily affects small peripheral joints, primarily in the hands.

• While there are several modifiable lifestyle factors linked to the condition (such as obesity and smoking) as well as non-modifiable ones (such as heredity, female gender, and age), the precise origins of the illness are still unknown.

• Clinically, patients with RA often complain to their healthcare providers with morning stiffness in the joints, and the recent start of sore and swollen joints along with generalised symptoms of illness. 

• There is no known cure for rheumatoid arthritis. Different healthcare professionals frequently work together to manage the condition, thereby contributing to a personalised rehabilitation plan.

Introduction

Rheumatic diseases are becoming a growing concern globally, but there's limited information from Africa, especially sub-Saharan Africa, where infectious diseases have historically been the main focus. As attention shifts to non-communicable diseases like rheumatic illnesses, their impact on health in Africa is becoming more evident. Although many patients with rheumatic diseases are seen in African medical facilities, the true extent of these conditions is unclear due to a lack of data. However, the burden of rheumatic diseases in Africa is likely higher than in other parts of the world. [1]

The blog aims to educate Africans about rheumatoid arthritis, its symptoms, and management strategies to improve awareness and enhance quality of life.

What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is a systemic autoimmune disease known for its inflammatory nature and extra-articular (joint) involvement.

An autoimmune disease (or misdirected defense) is a disease caused by the body being active in the wrong way by mistakenly attacking its own healthy cells. 

RA primarily affects the joints, starting with small joints and often progressing symmetrically to larger ones.

RA is usually triggered by a combination of genetic factors and environmental influences, like smoking.

RA can be acute or chronic or chronic with occasional acute flare up.

Early RA refers to symptoms lasting less than six months, while chronic RA has symptoms for more than six months. If not treated, RA can worsen over time, leading to increased illness and even death. [2]

Causes and Risk Factors

While there are several modifiable lifestyle factors linked to the condition (such as obesity and smoking) as well as non-modifiable ones (such as heredity, female gender, and age), the precise origins of the illness are still unknown. [3]

Certain risk factors increase your chance of developing rheumatoid arthritis. Among them are:

• Age - Rheumatoid arthritis can strike at any age, but as people age, their chance of getting the condition rises. Rheumatoid arthritis's related juvenile idiopathic arthritis can affect kids and early teens.

• Gender - Women experience rheumatoid arthritis at a higher rate than men. The disease affects women two to three times more frequently than males. Researchers believe that in certain women, hormonal and reproductive variables may contribute to the disease's development.

• Genetics and family history - You may be more susceptible to RA if you have a family member who has the condition. Several genetic variables marginally raise the chance of developing RA.

• Smoking. Long-term smokers had a higher chance of developing rheumatoid arthritis, according to research. Smokers may experience a more severe form of the disease.

• Being overweight - According to some studies, obesity may both raise your chance of developing the condition and reduce its potential for improvement.

• Periodontal disease. A history of gum disease and RA development may coexist.

• Lung conditions - Airway and lung disorders may be linked to RA development.[4]

How is Rheumatoid Arthritis different from Osteoarthritis?

Rheumatoid arthritis (RA) and osteoarthritis (OA) both affect the joints but have different causes.

RA is an inflammatory disease where the immune system attacks joint tissues, while OA is generally caused by wear and tear over time.

Both conditions are more common with age and occur more often in women than men. Among women, there's little difference in the rates of RA and OA between those of normal weight and those who are overweight, but both conditions are more common in obese women, especially those over 60.

RA is also more common in black individuals, while OA is more prevalent in white individuals, with Hispanics falling in between. [4]

Smoking increases the risk of RA in men, but in women, it significantly raises the chances of developing both RA and OA. Interestingly, smoking does not affect the rate of OA in men. Despite their different causes, it's surprising how much RA and OA have in common. [4]

Series of Events Leading to Rheumatoid Arthritis

The exact cause of the immune system attacking joint tissues in rheumatoid arthritis (RA) is unclear, but a combination of genetic and environmental factors likely triggers its onset.

The immune system may begin to malfunction years before any symptoms appear, often starting in other parts of the body before affecting the joints.

In RA, immune cells cause inflammation in the synovium, the inner lining of the joint. This inflammation becomes chronic, leading to a thickened synovium that causes pain, redness, and warmth in the affected joint.

As RA progresses, the thickened synovium invades deeper into the joint, eroding bone and cartilage. This process alters the joint's structure, stretching the joint capsule and weakening the tendons, ligaments, and muscles that support it. Over time, this leads to increased pain, joint damage, and difficulty using the affected joint. [5]

References

Related:

What Africans Need to Know about Osteoarthritis

Diagnosis and Treatment of Osteoarthritis

What is Frozen Shoulder? An Explainer for Africans

Understanding Neck Pain: Causes, Symptoms and Treatment

How to Deal With Joint Pains - Tips for Africans

Published: September 11, 2024

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