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Rheumatoid Arthritis

Sydney Moretto

Boise State University

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Introduction

Rheumatoid arthritis is a chronic inflammatory autoimmune disease that causes

inflammation, stiffness, and loss of function in the joints. It is a slowly progressive disease but

once damage is done it can’t be reversed. Each case of rheumatoid arthritis is different, the

progression varies greatly from patient to patient. Rheumatoid arthritis is interesting and

important to know about because the cause of the disease is still unknown and there is no cure.

Due to the uncertainty of the cause of the disease, it is challenging to determine the exact

outcome.

Pathophysiology

Rheumatoid arthritis is caused by genetics and the result of the dysregulation of the

normal immune response. The development of inflammation in the joints that is a result from or

can be triggered by the dysfunction of the immune system. The body is affected due to

inflammation and the destruction of the joints (Porth, 2015). It is more frequent in those who

have close relatives with the disease. Rheumatoid arthritis is also more prevalent with the

advancement with age (Porth, 2015). Those who are diagnosed with the disease are highly

advised to stay away from smoking cigarettes. Smoking cigarettes is a big risk factor for the

development and severity of the disease (Porth, 2015).

Clinical Manifestations

There are both articular and extra-articular manifestations that are associated with

rheumatoid arthritis. Articular manifestations are characterized as being symmetric and

polyarticular, involving any diarthrodial joint (Porth, 2015). The joints in the fingers, wrists, and

toes are the most commonly affected by the disease. Larger joints like the ankles, knees, elbows

and shoulders become affected later with the progression of the disease (Porth, 2015). Patients
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will complain of joint pain, stiffness, and aching. Extra-articular manifestations are characterized

by having the articular manifestations that are listed and fatigue, weakness, anorexia, and weight

loss (Porth, 2015). The other symptoms are because of systemic inflammation. Patients will

complain of frequent stiffness and joint pain. Clinicians will be able to see ischemic areas in the

nail beds, subcutaneous nodules, eye lesions, and bone deviations (Porth, 2015).

Diagnosis

Rheumatoid arthritis is diagnosed by patient family history, laboratory testing, and

physical examinations. Diagnosis is done by using a chart created by the American College of

Rheumatology/ European League Against Rheumation (Porth, 2015). The intention of creating

the new chart is to try and diagnose Rheumatoid Arthritis earlier on in patients. The criteria in

the chart is based on the original criteria chart for diagnosing RA. Physical examination will

present inflammation, swelling, tenderness, and reduced motion of the affected joint. A lab

analysis of the synovial fluid helps detect RA early on (Porth, 2015). Rheumatoid factor and

anti-citrullinated peptide antibody are indicators of RA. The severity and activity of the disease

are correlated with RF levels (Porth, 2015). Patients with high RF levels are more likely to have

extra-articular manifestations. Detected early on in rheumatoid arthritis, the presence of ACPA is

a good indicator of having the disease (Porth, 2015). In later stages of RA, radiology can be used

for more specific evidence of joint changes due to the disease.

Vitamin D deficiency is also thought to be linked to rheumatoid arthritis. Vitamin D

plays many very important roles in the body. It enables normal mineralization of bone, is needed

for bone growth and remodeling for osteoblasts and osteoclasts, modulation of cell growth,

neuromuscular and immune function, and reduction of inflammation (Meena, Chawla, Garg,

Batta, & Kaur, 2018). An assessment was done to evaluate the correlation of Vitamin D and
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rheumatoid arthritis. The study showed results that 84% of participants with rheumatoid arthritis

had a vitamin D deficiency and only 34% of participants without RA had a Vitamin D deficiency

(Meena, Chawla, Garg, Batta, & Kaur, 2018). The assessment suggests that Vitamin D

deficiency is more common in patients with rheumatoid arthritis.

Management and Treatment

Since there is no cure for rheumatoid arthritis, treatment is critical to help slow the

progression of the disease. Education about the disease and the treatment options are important

in management of RA. The importance of education for the patient is critical because of the

long-term treatment that is required to help maintain and treat the disease. The overall goal is to

reduce pain, stiffness and swelling and to maintain mobility of the joints (Porth, 2015). Physical

lifestyle changes such as rest and therapeutic exercises are also used in the treatment of the

disease. Physical rest is important in helping relieve joint stress and pain of the affected joints.

Therapeutic exercises are used to help sustain muscle strength and motion of the joints (Porth,

2015).

The medications that are used in treating rheumatoid arthritis are aimed to slow the

progression of the disease and to reduce the signs and symptoms. Medications such as

Nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, glucocorticoids combined with

disease modifying antirheumatic drugs (DMARDs) are used for control of the symptoms

(Gallego-Galisteo, Villa-Rubio, Alegre-del Rey, Ma ́ rquez-Ferna ́ ndez, & Ramos-Ba ́ ez, 2012).

If those medications don’t work for treatment, it is replaced or combined with biological

medications (Gallego-Galisteo, Villa-Rubio, Alegre-del Rey, Ma ́ rquez-Ferna ́ ndez, & Ramos-

Ba ́ ez, 2012). Patients taking DMARDs require close monitoring since the medication can be
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toxic. To avoid long term side-effects, corticosteroid drugs are only used for short-term therapy

at a low dose in certain situations (Porth, 2015).

Prognosis

The progression of rheumatoid of arthritis varies greatly by patient to patient, so it is

difficult for doctors to predict a standard prognosis. With today’s technology and different

treatment options, many patients with RA are able to maintain a good quality of life. Most

common prognosis for RA patients: continued joint inflammation, progressive joint

deterioration, continued decline in mobility and range of motion, pain and stiffness that doesn’t

improve, and multiple joints being affected (Porth, 2015). Patients with rheumatoid arthritis are

at a higher risk of having atherosclerosis, cardiovascular disease, osteoporosis, and other minor

complications (Soltanzadeh-Yamchi, Shahbazi, Aslani, & Mohammadnia-Afrouzi , 2018).

Conclusion

The cause of rheumatoid arthritis is still uncertain making it such an interesting disease.

Also, there is no cure for the disease but only treatment that slows down the progression. The

progression varies between different cases making it even more unique to each person with the

disease. Getting treatment early on has a better outcome for a healthy quality of life. Our

advancements in medical technology have helped make progress in remission of the disease.

Hopefully the cause and prevention of the disease are in the near future.
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References

Gallego-Galisteo, M., Villa-Rubio, A., Alegre-del Rey, E., Ma ́ rquez-Ferna ́ ndez, E., & Ramos-

Ba ́ ez, J. (2012). Indirect comparison of biological treatments in refractory rheumatoid

arthritis. Journal of Clinical Pharmacy and Therapeutics, 301-307.

Meena, N., Chawla, S., Garg, R., Batta, A., & Kaur, S. (2018). Assessment of Vitamin D in

Rheumatoid Arthritis and Its Correlation with Disease Activity. Journal of Natural

Science, Biology and Medicine.

Porth, C. M. (2015). Essentials of Pathophysiology: Concepts of altered health states (4th ed.).

Philadelphia: Wolters Kluwer.

Soltanzadeh-Yamchi, M., Shahbazi, M., Aslani, S., & Mohammadnia-Afrouzi , M. (2018).

MicroRNA signature of regulatory T cells in health and autoimmunity. Biomedicine &

Pharmacotherapy, 316-323.