Rheumatoid arthritis is a chronic inflammatory disease that typically affects the small joints of the hands and feet. Unlike a typical degenerative phenomenon, rheumatoid arthritis affects the joint capsule, causing painful swelling that can ultimately lead to bone erosion and joint deformities. Rheumatoid arthritis is an autoimmune disease that occurs when the immune system mistakenly attacks its own tissues. In addition to causing joint problems, it can also affect the entire body (fever, fatigue, and numerous complications). Rheumatoid arthritis is much more common in women than in men and usually occurs between the ages of 40 and 60.
Symptoms
Swollen, tender, and warm joints, morning stiffness that can last for several hours, presence of "bumps" (rheumatoid nodules) under the skin, fatigue, fever, and weight loss. Early rheumatoid arthritis tends to affect the smallest joints (especially the wrists and the joints connecting the toes to the feet). As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips, and finally to the shoulders. In most cases, symptoms occur in the same joints on both sides of the body. Signs and symptoms of rheumatoid arthritis can vary in intensity and may even come and go. Periods of increased disease activity alternate with periods of relative remission (when swelling and pain fade or disappear).
Causes
Rheumatoid arthritis occurs when the immune system attacks the synovial membrane lining the joint capsule. The resulting inflammation makes the synovial membrane thicker and thicker. Eventually, they invade and destroy the cartilage and bone in the joint. The tendons and ligaments that hold the joint together are then weakened and loosened. Gradually, the joint loses its shape and alignment. The trigger for this inflammation is unknown. It seems that a genetic component is one of the risk factors. Thus, the presence of certain genes would make one more sensitive to environmental factors (infection by certain viruses and bacteria) that can trigger the disease.
Risk factors
- Gender. Women are more likely to develop rheumatoid arthritis than men.
- Age. Rheumatoid arthritis can occur at any age, but it most often begins between the ages of 40 and 60.
- Family history. If a family member has rheumatoid arthritis, you may have an increased risk of developing the disease.
- Smoking. Smoking increases the risk of rheumatoid arthritis in some people. Quitting smoking can reduce your risk.
Complications
Osteoporosis. Rheumatoid arthritis itself, combined with certain medications used to treat it, can increase the risk of osteoporosis, a disease that weakens bones and makes them more prone to fractures.
- Carpal tunnel syndrome. If rheumatoid arthritis affects the wrists, inflammation can compress the nerve that supplies most of the hand and fingers.
- Heart problems. Rheumatoid arthritis can promote hardening of the arteries, as well as inflammation of the membrane surrounding the heart.
- Lung diseases. People with rheumatoid arthritis have an increased risk of inflammation and scarring of lung tissues. This makes them thinner and more fragile, triggering the onset of respiratory difficulties (progressive shortness of breath).
Conventional treatments
There is no cure for rheumatoid arthritis. Medications can reduce inflammation in the joints to relieve pain and prevent or slow joint damage. Occupational therapy and physiotherapy can be helpful in learning to protect the joints. When joints are severely damaged by rheumatoid arthritis, surgery may be necessary.
1. Medications
Many medications used to treat rheumatoid arthritis have serious side effects. This is why doctors prescribe medications with the fewest side effects, depending on the progression of the disease.
Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Side effects may include ringing in the ears, stomach irritation, heart problems, liver and kidney damage.
Corticosteroids (or corticosteroidal anti-inflammatories) help reduce inflammation and pain, and slow joint damage. Side effects may include bone weakening, cataracts, weight gain, and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of decreasing and then stopping treatment after stabilizing the situation.
Disease-modifying antirheumatic drugs (DMARDs). These medications can slow the progression of rheumatoid arthritis and spare joints and tissues from permanent damage. Side effects vary but may include liver damage, bone marrow damage, and serious lung infections.
Immunosuppressants. These medications work to regain control of the immune system. These drugs can increase sensitivity to infections.
TNF-alpha inhibitors. TNF-alpha is an inflammatory substance produced by the body. TNF-alpha inhibitors are useful for reducing pain and morning stiffness while limiting localized swelling. Possible side effects include an increased risk of serious infections, heart failure, and certain cancers.
2. Physical therapy
Occupational therapists and physiotherapists teach exercises to help keep joints flexible. The therapist may also suggest new ways to perform daily tasks. For example, if the fingers are painful, it is possible to learn to pick up an object using the forearm. Some functional accessories can make daily life easier to avoid stressing painful joints in order to maintain autonomy.
3. Surgery
If medications fail to prevent or slow joint damage, surgery may be considered to repair damaged joints and tendons (such as replacing damaged joints with prosthetics, for example). At the level of small joints (toe or finger), arthrodesis, which fuses two joints, can put an end to pain.
4. An adapted lifestyle
It is important to take care of your body, especially if you are taking long-term medication.
By adopting an anti-inflammatory diet that focuses on fatty acids, omega-3s, and alkaline foods (fruits and vegetables, legumes, nuts, and plant proteins).
By engaging in physical activity to strengthen muscles around the joints and fight fatigue. Start with walking, then try swimming, for example. Discuss this with your doctor beforehand.
By using the relaxing and anesthetic properties of heat and cold. Heat can help relieve pain and relax sore muscles. Cold can alleviate the sensation of pain by reducing muscle spasms.
By taking the time to relax. Find ways to cope with pain by reducing stress in your life. Techniques such as hypnosis, guided imagery, deep breathing, and muscle relaxation can be used to control pain.
Alternative medicines
Some complementary treatments have shown promising results for rheumatoid arthritis: evening primrose, borage, and black currant seed vegetable oils contain a type of fatty acid (gamma-linolenic acid or GLA) that can relieve pain and morning stiffness. Similarly, fish oil, rich in omega-3 fatty acids (EPA and DHA), is useful for reducing chronic inflammation. Tai Chi helps relieve daily stress. This movement therapy involves gentle exercises combined with deep breathing. It proves useful for reducing pain in cases of rheumatoid arthritis. Choose a competent instructor to avoid making false movements that could aggravate the pain.