Understanding Rheumatoid Arthritis: Symptoms and Treatment

 

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

 

Symptoms of Rheumatoid Arthritis

The most frequent and prominent symptoms of RA, which typically begin slowly over weeks to months, are joint pain and swelling. The small joints of the hands and feet are usually affected first, then the larger joints.

Joints in the neck (cervical spine) may also be affected, but this is limited to that region. It does not affect the back (lumbar spine).

While it is common for individuals to have many small joint involvements, without treatment with disease-modifying anti-rheumatic medications (DMARDs), people with RA would experience joint damage, deformities, disability, and an increased risk of death. RA is a chronic, progressive disease. [2]

A defining feature of RA is stiffness, especially in the morning. Typically, symptoms appear gradually and mildly. [2]

 

Signs  of Rheumatoid Arthritis

At physical examination, the affected joint will hurt when moved or pressure applied, regardless of whether joint swelling is present.

Decreased grip strength in the hand is also present if there are several joints involved.

Warmth and redness in the joints are typically absent, and wrist involvement may manifest with pain on bending the wrist, simulating carpal tunnel syndrome symptoms.

Advanced chronic disease is characterised by the conventional physical findings of -

• Ulnar deviation (abnormal bending of fingers)

• Knuckle (Metacarpophalangeal) joint subluxation (hyperextension of fingers) 

• Swan neck deformity & Boutonniere deformity  (See figure 1). These are distinct deformities of RA

Figure 1: Hand showing appearance of Boutonniere and Swan neck deformities of fingers in rheumatoid arthritis.

 

 

Other advanced RA signs include:

• Reduced range of motion in the knees, elbows, and shoulders
• Hallux valgus (see figure 2) and other toe abnormalities. [2]
• Extra-articular rheumatoid nodules. They can develop over the patella, the Achilles tendons, the hand and foot joints, and pressure points such as the prominence of the elbow joint (olecranon).
• 5 to 16% of RA patients develop interstitial lung disease (ILD), which is linked to higher mortality and RA-specific autoantibodies. [2]

 

Impact of Rheumatoid Arthritis on Daily Life

Rheumatoid arthritis is not always simple to live with. One explanation is that the symptoms are frequently unpredictable; one never knows if they will become better or worse the next day.

It is not unusual to wake up in the morning with painful and stiff joints, which makes it challenging to get moving and begin the day. As the illness worsens, daily tasks including cleaning, cooking, laundry, gardening, and leisure activities may become difficult. But over time, a lot of people figure out ways to handle their everyday tasks more effectively.

The majority of people with RA manage to live independently. But having the support of friends and family is crucial. Additionally, they must comprehend the nature of the disease and the potential limits that come with it. [6]

 

Diagnosing Rheumatoid Arthritis

Clinically, patients with RA will complain to their doctor about,

• Morning stiffness in the joints

• Recent start of sore and swollen joints, and

• Generalised illness

Accurate and timely diagnosis is critical to the management of RA because, in up to 90% of cases, early detection can help to keep the disease in its tracks and prevent or significantly decrease the progression of the disease, irreversible joint damage, and disability. [7] 

The following conditions are typically considered for diagnosing your RA:

• Your symptoms and family history

• Your risk factor assessments

• What your doctor found when you were physically examined

• Your laboratory test results (e.g., increased blood CRP and ESR)

• Findings of your joint assessment following MRI and ultrasonography imaging scans [7]

 

Treatment 

There is no known cure for rheumatoid arthritis.

Different healthcare professionals frequently work together to manage rheumatoid arthritis, contributing to a personalised rehabilitation plan. Early detection and treatment can lessen disease progression, minimise symptoms, and prevent disability. The illness may go into be remission (i.e. relieved) under some circumstances.

Non-Medication (Conservative) 

Physical and Occupational therapies can both aid in preserving and enhancing your muscular strength and joint mobility, easing pain and enhancing your activities of daily living.

The use of assistive technologies, such as orthoses and self-care products may help to protect your joints from further harm and carry out important tasks on your own. [5]

Medications

Among the medications used to treat swelling, discomfort, and inflammation are -

• Non-steroidal anti-inflammatory medicines (NSAIDs) - e.g., aspirin, ibuprofen, naproxen, diclofenac).
• Glucocorticoids
• Disease-modifying anti-rheumatic drugs (DMARDs).
• Biological agents. These are used when basic DMARDs fail to produce desired relief.

Surgery

Orthopaedic surgery can help to relieve acute discomfort and restore movement in certain circumstances. Following surgery, rehabilitation is crucial to achieving the greatest results. [5]

 

Living with Rheumatoid Arthritis

• Lifestyle modifications

Depending on the severity of your pain and stiffness and the amount of joint damage you have, simple daily tasks may become more difficult or require more time to complete. In such condition; you may need to modify your daily routine or make lifestyle changes to help manage your condition.

• Self –care

Self-care is an essential part of day-to-day living and involves taking charge of your health and well-being with support from those involved in your care. [8]

Self-care aids you to keep in shape, preserve excellent physical and mental health, fend off disease and accidents, and take care of both minor and chronic problems.

• Diet and exercise

Not only is a good diet and regular exercise advised for everyone, but also for those with rheumatoid arthritis. They can lower your chance of developing several illnesses, such as heart disease and certain types of cancer.

Regular exercise can strengthen the muscles that support your joints, reduce stress, and maintain joint mobility. If you're overweight, exercise can also help you lose weight, which will relieve further load on your joints.

Finding a balance between exercise and rest is crucial, though. Inflamed joints will feel more comfortable with rest, but if you don't move, your muscles will weaken and your joints will tighten. [8]

 

Conclusion

In conclusion, learning and improving your knowledge of rheumatoid arthritis is essential for taking informed decision about the best way to manage your ailment, particularly in Africa where healthcare accessibility may differ. You can greatly enhance your quality of life when you identify your symptoms early, get medical help early, and making good lifestyle choices.
 

References

1. Adelowo O, Mody GM, Tikly M, Oyoo O, Slimani S. Rheumatic diseases in Africa. Nat Rev Rheumatol [Internet]. 2021 Jun 17(6):363–74. [Cited 2024 Aug 14]. Available from here.

2. Chauhan K, Jandu JS, Brent LH, Al-Dhahir MA. Rheumatoid arthritis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Last updated 2023 May 25. Available from here.

3. World Health Organization (WHO). Rheumatoid arthritis [Internet]. 2023 June 28. [Cited 2024 Aug 14]. Available from here.

4. NIH. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rheumatoid arthritis. Last reviewed Nov. 2022. [Cited 2024 Aug 14]. Available from here.

5. Mohammed A, Alshamarri T, Adeyeye T, Lazariu V, McNutt LA, Carpenter DO. A comparison of risk factors for osteo- and rheumatoid arthritis using NHANES data. Prev Med Rep. 2020 Nov 5;20:101242. doi: 10.1016/j.pmedr.2020.101242. Available from here.

6. NIH. National Library of Medicine. Rheumatoid arthritis: Learn More – Everyday life with rheumatoid arthritis. In: InformedHealth.org [Internet]. Last updated 2024 January 11. [Cited 2024 Aug 14]. Available from here.

7. Lin YJ, Anzaghe M, Schülke S. Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells. 2020;9(4):880. Doi: 10.3390/cells9040880. Available from here.

8. NHS.UK. [Internet]. Living with rheumatoid arthritis. Last updated 2023 March 8. [Cited 2024 Aug 14]. Available from here. 

 

 

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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