Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints.
While RA can affect any joint, the small joints in the hands and feet are more likely to be involved.
Inflammation can sometimes affect organs as well, for instance, the eyes, skin, heart or lungs.
The characteristic feature of RA is the joint involvement. The most common joints involved are – metacarpophalangeal, wrist, knee, shoulder, ankle, cervical spine, hip, elbow. The exact physiology is unknown.
But an external trigger (eg, infection, trauma) triggers an autoimmune reaction, leading to synovial hypertrophy and chronic joint inflammation. Genetic factors and immune system abnormalities contribute to disease propagation. CD4 T cells, mononuclear phagocytes, fibroblasts, osteoclasts, and neutrophils play major cellular roles in the pathophysiology of rheumatoid arthritis (RA).
Neck pain on motion and occipital headache are common manifestations of cervical spine involvement.
Limited motion or pain on motion and weight bearing are the hallmarks of hip involvement.
Instability may develop after progressive loss of cartilage and weakening of ligaments in case of knee involvement
People of all races are equally affected.
RA is three times more common in women. RA can begin at any age, but peak incidence is seen between 40 to 60 years of age.
The Denmark study also found a higher rheumatoid arthritis risk among women with pre-eclampsia, hyperemesis during pregnancy, or gestational hypertension.
• Joint stiffness it is most often worst in the morning. It may last for few hours to even the whole day
• Joint swelling, redness and tenderness
• Limited range of movement of joints
•Deformities of hands and feet
• Joint pains
• Loss of appetite
• Involvement of multiple joints at one time (polyarthritis)
• Symmetrical affection of joints
• Skin redness or inflammation
• formation of round, painless nodules under the skin (rheumatoid nodules)
• Inflammation of the lung (pleurisy)
• Dry eyes and mouth (Sjogren’s syndrome)
Physical examination looking for inflammation, swelling, difficulty in joint movement, a presence of rheumatoid nodules.
Common tests done to diagnose RA are as follows:
• RA factor test
• CBC (Complete blood count)
• X-ray of the joint
• ESR (Erythrocyte Sedimentation Rate)
• C-Reactive proteins (CRP)
• Synovial fluid analysis
Presence of anti- CCP antibodies
Tenosynovitis (defined as inflammation of the tendon and its enveloping tendon sheath ) and associated tendon rupture due to tendon and ligament involvement.
Muscle tenderness is not specific for RA.
• Medications include anti-inflammatory medicines, antimalarial medicines and corticosteroids.
• Surgery may include synovectomy (removal of the joint lining) or total joint replacement in extreme cases.
• Mind/body therapies may help with stress management. They can help improve sleep and pain perception.
• Cold compresses reduce joint swelling and inflammation. You can apply a cool compress or ice pack to the affected joint during an RA flare-up to help ease inflammation and pain.
• Heat compresses relax your muscles and stimulate blood flow.
• You can also use heat therapy by standing in the shower. Letting the warm water hit the painful area on your body may help ease the pain.
• A hot tub is a good way to relax stiff muscles
• Genetic, environmental, hormonal and infection are some of the factors for causing RA.
• Hyperprolactinemia may be a risk factor for RA.
• Psoriatic arthritis
• Sjogren syndrome
• Heart Disease
• Increased risk of heart attack with RA.
• The whole body feels stiff and sore as if beaten.
• Tenderness with swelling and occasional redness of the last joints of the fingers.
• Intense itching on the sides of the feet and hands, without any apparent cause.
• The whole body increases in weight and becomes puffy.
• The urine looks turbid and may deposit mucous or red sediment.
• The pains in the joints are acute and tearing in nature, with a paralytic weakness of the limbs and numbness and coldness of the surface.
The muscles feel sore, as if out of place.
• It is also useful in Chronic Rheumatism and is one of the remedies on which to depend in treating hereditary Rheumatism
• The symptoms usually extend from feet upwards.
• The patient is worse from warmth
Swollen joints, the pains are of a sharp stinging or tearing character and are accompanied by a feeling of soreness or of subcutaneous ulceration about the affected joint.
• It is indicated in Rheumatism, when the characteristic modality ( i.e., relief of symptoms by continued motion and aggravation on beginning to move) is present and when there is aggravation during damp weather or from dwelling in damp places.
It is esp. suitable for Rheumatism after exposure to cold or wet, particularly when one is overheated or perspiring.
• Restlessness, all the time.
The prominent projection of bones is sore to the touch, as for example the cheekbones.
• Rheumatic pains in the inter-scapular region.
• The patient cannot bear the least exposure to cool air
• It is indicated both in the Acute and Chronic Rheumatism, particularly the latter, when the inflammatory swellings ascend, i.e., they begin in the feet and extend up the body.
The pains are aggravation in bed and at night, and they may be erratic.
• Burning in the feet, which the patient uncovers.