Rheumatoid Arthritis Treated With Alternative Choice
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body.
The main symptoms of rheumatoid arthritis are joint pain, swelling and stiffness. It may also cause more general symptoms, and inflammation in other parts of the body.
The symptoms of rheumatoid arthritis often develop gradually over several weeks, but some cases can progress quickly over a number of days.
The symptoms vary from person to person. They can come and go, and may change over time. You may occasionally experience flares when your condition deteriorates and your symptoms become more severe.
Symptoms affecting the joints
Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.
Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this isn't always the case.
The main symptoms affecting the joints are outlined below.
The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.
Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.
Like joint pain, the stiffness is often more severe in the morning or after a period of inactivity. Morning stiffness associated with another type of arthritis called osteoarthritis usually wears off within 30 minutes of getting up, but rheumatoid arthritis morning stiffness often lasts longer than this.
Swelling, warmth and redness
The lining of joints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch.
In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints.
As well as problems affecting the joints, some people with rheumatoid arthritis experience a range of more general symptoms, such as:
- tiredness and a lack of energy
- a high temperature (fever)
- a poor appetite
- weight loss
Your immune system normally makes antibodies that attack bacteria and viruses, helping to fight infection.
If you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.
This causes the thin layer of cells (synovium) covering your joints to become sore and inflamed, releasing chemicals that damage nearby:
- cartilage – the stretchy connective tissue between bones
- tendons – the tissue that connects bone to muscle
- ligaments – the tissue that connects bone and cartilage
If the condition isn't treated, these chemicals gradually cause the joint to lose its shape and alignment. Eventually, it can destroy the joint completely.
Various theories of why the immune system starts to attack the joints have been suggested, such as an infection or virus being a trigger, but none of these theories has been proven.
Possible risk factors
There are a number of things that may increase your risk of developing rheumatoid arthritis, including:
- your genes – there's some evidence that rheumatoid arthritis can run in families, although the risk of inheriting the condition is thought to be low as genes are only thought to play a small role in the condition
- hormones – rheumatoid arthritis is more common in women than men, which may be because of the effects of the hormone oestrogen, although this link hasn't been proven
- smoking – some evidence suggests that people who smoke are at an increased risk of developing rheumatoid arthritis
Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there's no definitive test for the condition.
You should see your GP if you have these symptoms so they can try to determine the cause.
Seeing your GP
Your GP will carry out a physical examination, checking your joints for any swelling and to assess how easily they move. Your GP will also ask you about your symptoms.
It's important to tell your GP about all your symptoms, not just ones you think are important, as this will help them make the correct diagnosis.
If your GP thinks you have rheumatoid arthritis, they'll refer you to a specialist (rheumatologist).
Your GP may arrange blood tests to help confirm the diagnosis.
No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but a number of tests can show possible indications of the condition.
Some of the main tests used include:
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- full blood count
Read more about blood tests.
The full blood count measures your red cells to rule out anaemia. Anaemia means the blood is unable to carry enough oxygen because of a lack of blood cells.
Anaemia is common in people with rheumatoid arthritis, although having anaemia doesn't prove you have rheumatoid arthritis.
Rheumatoid factor and anti-CCP antibodies
Specific blood tests can help diagnose rheumatoid arthritis, but aren't accurate in everyone.
About half of all people with rheumatoid arthritis have a positive rheumatoid factor present in their blood when the disease starts, but about 1 in 20 people without rheumatoid arthritis also test positive.
An antibody test known as anti-cyclic citrullinated peptide (anti-CCP) is available.
People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody found to have rheumatoid arthritis has this antibody.
Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment.
A number of different scans may also be carried out to check for joint inflammation and damage.
These can help tell the difference between different types of arthritis and can be used to monitor how your condition is progressing over time.
Scans that may be carried out to diagnose and monitor rheumatoid arthritis include:
- X-rays(where radiation is passed through your body to examine your bones and joints)
- MRI scans(where strong magnetic fields and radio waves are used to produce detailed images of your joints)
Assessing your physical ability
If you have been diagnosed with rheumatoid arthritis, your specialist will carry out an assessment to see how well you're coping with everyday tasks.
You may be asked to fill in a questionnaire on how well you can do things like dress, walk and eat, and how good your grip strength is.
This assessment may be repeated later on after your treatment to see if you have made any improvements.