Rheumatoid arthritis

Rheumatoid arthritis, or RA, is a chronic autoimmune disorder. This means the body's immune system mistakenly attacks its own healthy tissues. While it primarily targets the joints, it is a systemic disease. This means it can affect many different parts of the body at once.

The condition causes joints to become warm, swollen, and painful. A common sign is stiffness that worsens after periods of rest. This morning stiffness is a prominent feature. It often lasts for more than one hour after waking up.

The disease works through a specific biological process within the joints. It begins when the immune system attacks the synovial membrane. This is the thin lining that surrounds the joint.

This attack leads to synovitis, which is inflammation of that lining. As the inflammation continues, the joint capsule becomes thick and swollen. This process can eventually damage the underlying cartilage and bone. This damage is known as erosion.

Over time, the destruction of the joint surface can lead to permanent deformities.

These deformities can take several distinct shapes depending on which joints are involved. One common type is the swan neck deformity. This involves hyperextension at one joint and flexion at another.

Another specific type is called the "Z-thumb" or Z-deformity. This gives the thumb a Z-like appearance due to joint shifting. In very severe cases, the condition is known as arthritis mutilans. This term describes the mutilating nature of the physical changes to the joints.

Medical history shows that humans have recognized this condition for a long time. The first formal description of RA was made in 1800. Dr. Augustin Jacob Landré-Beauvais provided this description in Paris. He lived from 1772 to 1840. The very name "rheumatoid arthritis" is actually based on Greek words. It translates to "watery and inflamed joints." Today, doctors use X-rays and laboratory tests to confirm a diagnosis. These tests help them distinguish RA from similar diseases like fibromyalgia or lupus.

Statistics show that RA is a widespread health issue. As of 2020, approximately 17.6 million people were living with the condition. In the developed world, it affects between 0.5% and 1% of adults. Each year, between 5 and 50 people per 100,000 develop the disease. Women are affected 2.5 times as often as men. Most people experience the onset of symptoms during middle age. In 2020, the disease was linked to 38,300 deaths. This was an increase from the 28,000 deaths reported in 1990.

Beyond the joints, RA can impact many other bodily systems. It affects the eyes, causing dryness or inflammation. It can also impact the lungs through conditions like lung fibrosis. The heart is also at risk, as RA increases the chance of a heart attack or stroke. Some people may also develop rheumatoid nodules in their skin.

These nodules are inflammatory reactions called necrotizing granulomas. They often appear over bony areas like the elbows or knuckles. Even the blood is affected, often causing a low red blood cell count known as anemia.

Treatment focuses on reducing inflammation and improving how a person functions. Doctors often prescribe pain medications and steroids to manage symptoms. To slow the actual progression of the disease, they use DMARDs. These are disease-modifying antirheumatic drugs, such as methotrexate. If standard DMARDs do not work, biological DMARDs may be used.

While effective, these biological drugs can have a higher rate of adverse effects. Physical tools like splints, braces, or assistive devices also help with daily movement. In some advanced situations, surgery may be used to repair or replace a joint.