Rheumatoid arthritis (RA) is a chronic symmetric polyarticular joint disease that primarily affects the small joints of the hands and feet. It may not only result in severe joint pain, it may also lead to joint deformations and ultimately to loss of function. The cause of RA is not completely understood. It involves genetic and environmental factors (especially smoking) and results in an activation of the immune system followed by articular inflammation.
Signs and Symptoms
The affected joints present with pain, swelling and tenderness associated with morning stiffness and loss of strength. The small joints of hands and feet are the most commonly affected, but larger joints like the shoulder and knee can also be involved. Synovitis can lead to damage of the articular cartilage and bone and to some characteristic joint deformities.
Physical examination of the affected joints combined with imaging techniques (ultrasonography, X-ray, magnetic resonance imaging) provide information on affected joints and articular damage. Differentiation with regard to other chronic inflammatory joint diseases is important. Rheumatoid factor and antibodies against anti-citrullinated protein (ACPAs) are important diagnostic and prognostic markers. Other organs may also be affected (skin, heart, blood vessels, lung, eye, nervous system).
The aims of treatment include the suppression of inflammatory activity and the progression of joint and bone damage through suppression of the overwhelming immune reaction. Glucocorticosteroids are used in the short-term for inflammatory flare-ups, while waiting for slow-onset drugs to take effect. Disease modifying anti-rheumatic drugs (DMARDs) are used as steroid-sparing agents. These drugs can not only provide pain relief, but also diminish or even completely block progressive joint damage. It has the best results when it is started early and aggressively. Biologic agents are used in patients with insufficient response to conventional DMARDs. These agents inhibit very specifically some inflammatory messengers or cells. Non-pharmacological procedures complement the therapeutic principles.
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