Identifying RA Symptoms
For the past few weeks, you’ve awakened with swollen joints, the stiffness lasting for hours. The pain is mirrored in the joints of both hands and fingers, which feel tender and warm to the touch. You’re more tired than usual and don’t feel well in general. You may even be running fever or losing weight.
You’ve been ignoring these symptoms for a month in hopes they’ll go away, but it may be time to visit the doctor. Tenderness, warmth and swelling of the joints that persists for four to six weeks could be signs of rheumatoid arthritis (RA), a disease for which early detection and treatment can make all the difference.
“These are difficult to diagnose diseases because most people do not seek treatment early, and even if they see a physician, it usually takes six months to a year to diagnose,” says Dr. Vikas Majithia, a board-certified rheumatologist at the University of Mississippi Medical Center in Jackson.
What is RA?
Rheumatoid arthritis is primarily a joint disease. Where bones meet at a joint, the ends of the bones are covered with cartilage, a tough elastic tissue. The joint is surrounded by a protective capsule, which is lined with a tissue called synovium. This lining produces synovial fluid, that nourishes and lubricates the bones and cartilage in the joint.
RA is an autoimmune disease in which immune cells, including white blood cells, react against the joint lining and lead to the destruction of joints. In autoimmune disorders, the body’s immune system mistakenly attacks its own tissues. Inflammation resulting from these attacks causes the synovium to thicken, creating the swollen, puffy joints typical of rheumatoid arthritis. As the disease progresses, the synovium invades and destroys the cartilage and bone of the joint. The muscles, ligaments and tendons supporting the joint weaken and cannot function normally, leading to joint pain and damage.
The Importance of Early Diagnosis
“Studies suggest that damage starts very early,” notes Majithia. “It starts as soon as people start noticing pain and swelling of the joints, as early as two to four weeks, so it’s very important to try and diagnose it early. If [RA is] diagnosed early, it helps minimize damage to the ball and joint so they can keep normal function.”
If not controlled, rheumatoid arthritis can cause erosion of bones and cartilage along with significant joint destruction, which is irreversible. Most damage occurs within the first one to three years of rheumatoid arthritis and can indicate how patients will fare in the future, which underscores the importance of early diagnosis and treatment.
Diagnosis of rheumatoid arthritis is clinical, based on the patient’s complaints and what the doctor sees. The Medical College of Rheumatology’s criteria are used to help evaluate symptoms. Blood tests and x-rays can help confirm a diagnosis.
“Usually, the patient has five or more joints at one time exhibiting swelling, pain and warmth,” Majithia said. “Hand and feet joints are the most commonly afflicted, but any joint in the body can be affected.”
Often, multiple joints are affected at one time, and the disease is typically symmetrical, meaning that if symptoms occur in one hand, they are also present in the other. Rheumatoid arthritis is more likely if there has been ongoing inflammation or signs of inflammation for more than six weeks. In some patients, symptoms might come and go for a while before becoming persistent. The disease is much more common in women and in young women.
“The doctor can order lab tests which show inflammation and erythrocyte sedimentation rate [ESR, or sed rate] and C-reactive protein [CRP],” Majithia said. “Three out of four people who have RA have positive rheumatoid factor, or RF, and about two-thirds of patients have positive anti-CCP [cyclic citrullinated peptide] antibody. X-rays in the early stages are usually normal, but if the disease continues, then you can have problems with joint destruction and erosion.”
RA Treatment Options
In the past, over-the-counter medications like Aleve and Advil were used to help manage symptoms of rheumatoid arthritis. In the last twenty years, disease-modifying antirheumatic drugs (DMARDs) have been used increasingly with RA patients. “These medications have helped revolutionize treatment because not only do they make patients feel better, but they stop the progression of the disease,” Majithia said. The most commonly used DMARD is methotrexate, and others used include hydroxycholoroquine, sulfasalazine, leflunomide and azathioprine.
“Some newer treatments available for the last 10 years belong to a group of drugs called biologic agents,” Majithia said. “In rheumatoid and other arthritic disorders, inflammation is affected by molecular messengers. If we block them, we improve the symptoms and progression. Biologic response modifiers like Enbrel, Humira and a few others block tumor necrosis factor (TNF) and should be considered for any patients not responding to DMARDs. Other biologic agents are used to block other molecules, such as interleukin-1, B cells and T cells. New biologic agents are available each year,” said Majithia.
Treatments for rheumatoid arthritis do not differ according to which joints are involved. The medications are given by mouth or by injection, so all joints in the body are affected. “This is very important because rheumatoid arthritis is a systemic disease and affects other body parts,” Majithia said. “That’s why controlling it is so important for us.” Rheumatoid arthritis can affect multiple organs and organ systems, such as the heart, lungs, skin, immune system and blood system.
“Since we know joint damage comes very early on and know treatments keep it from happening, we use these agents to help improve not only the symptoms but also the damage,” Majithia said. “Studies have shown that if patients are treated early and aggressively with traditional DMARDs and biologic agents, either alone or in combination, and are able to achieve very good control of their symptoms, joint damage is low or zero. … If you’re a young person having persistent joint pain for four to six weeks, I urge you to visit your doctor. The earlier RA is diagnosed, [treatments] can help you have a normal life and normal functioning in society.”
Vikas Majithia, M.D., Rheumatologist received his medical degree in India, after which he completed his residency training in internal medicine at St. John Hospital and Medical Canter in Michigan. He received his fellowship training in rheumatology at the University of Mississippi Medical Center. He is board certified in rheumatology.