Approximately 1% of the world population suffers from pain and limitations due to rheumatoid arthritis. In Brazil alone, there are, on average, 2 million people.
Pain, movement difficulties and changes in bone structure are just some of the symptoms and complications related to the disease.
However, those who think that the condition only happens to older people are mistaken. Despite having a direct relationship with aging, rheumatoid arthritis can also occur in children and adolescents.
Rheumatoid arthritis (RA) is a chronic, autoimmune and systemic disease characterized by inflammation of the joints.
It is not known exactly what triggers the change, but, like other autoimmune conditions, the body begins to be attacked by the defense cells themselves.
Gradually, the joints of the whole body (but mainly of the hands) are affected by inflammation.
The result is that pain, swelling and reduced mobility affect the patient.
Considered a systemic condition, over time, the disease can cause deformities in the structures and also affect other tissues and organs.
Changes caused by frequent inflammation can cause irreversible bone and joint damage, which can result in deformations that reduce the patient’s quality of life.
Because it is a systemic disease, inflammation can also occur in other places, such as around the heart, in the lung and even in the eyes.
There is still no cure, but rheumatoid arthritis can be controlled with antirheumatic drugs.
In general, conditions that affect joint structures ( rheumatism ) are attributed to older people.
However, rheumatoid arthritis is an autoimmune disease and, therefore, can manifest at any age, including children.
Still, aging is associated with the disease, which has a greater incidence from the age of 40.
In ICD-10, rheumatoid arthritis can be found under the code M05.
- M05 – Serum positive rheumatoid arthritis;
- M05.3 – Rheumatoid arthritis with involvement of other organs and systems;
- M05.9 – Serum positive rheumatoid arthritis, unspecified;
- M06.0 – Serum-negative rheumatoid arthritis;
- M06.9 – Rheumatoid arthritis, unspecified;
- M08.0 – Juvenile rheumatoid arthritis.
Rheumatoid arthritis can be subclassified in some types. Are they:
The rheumatoid factor is associated with lesions in different tissues and organs, but it is noteworthy that it is not the cause or determinant of rheumatoid arthritis.
When the exams detect the factor in the patient’s blood, the condition is considered to be serum-positive RA.
Most patients with rheumatoid arthritis have the positive type, but it is not the factor that determines the disease. This is because people without any alteration or rheumatic pathology may have levels of rheumatoid factor.
However, according to the Society of Rheumatology of Rio de Janeiro, patients with the positive type tend to have more severe symptoms and more impairment of health than those of the negative type.
In these patients, tests that detect rheumatoid factor are negative, even in the presence of symptoms. Therefore, the diagnosis is made mainly on the basis of laboratory and imaging tests.
Juvenile rheumatoid arthritis
Currently, the correct name for juvenile rheumatoid arthritis is juvenile idiopathic arthritis.
The condition affects children and adolescents up to 16 years old, and among all chronic arthritis, it is the most frequent in childhood.
In general, the disease is quite similar to that which occurs in adults (rheumatoid arthritis) and, likewise, the causes are not completely known, so it is called idiopathic.
Rheumatoid arthritis is an autoimmune disease, that is, it happens when the immune system gets confused and begins to attack the body itself.
It is not known exactly what triggers the alteration of the organism, but, among the possibilities, is the genetic inheritance.
The joint and point that connects the bones. Cartilage is a tissue that covers the extremities and protects each bone from friction.
In this region, there is also a synovial membrane, a very thin tissue that produces lubricants for the joints, preventing friction or difficulty in movement.
The patient with rheumatoid arthritis, for some reason, develops an inflammatory response that affects the joints, causing inflammation of the region, which generates pain, redness and swelling.
Then, defense cells enter the synovial tissue, causing other substances to accumulate in the joint tissue. This causes symptoms, such as swelling and pain.
Gradually, the synovial membrane becomes thicker and the cartilage undergoes progressive wear and can damage the bones, which weaken due to friction.
All of this mechanism is possibly triggered by an association of genetic predisposition and environmental factors.
Although it is not yet known to indicate whether there is a determining factor, some conditions are associated with the possibility of rheumatoid arthritis to manifest. Are they:
People who have the genetic markers are 10 times more likely to develop rheumatoid arthritis. That is, having a close relative with the disease can increase the risk of developing it.
Experts believe that some infectious agents, such as viruses and bacteria, are related to the disease and act as triggers in people with predisposition.
Although rheumatoid arthritis can occur in young people, including children, aging is a risk factor.
In general, the joints suffer common wear and tear of age. Therefore, the fabric becomes more fragile.
For every man with rheumatoid arthritis, there are 3 women who suffer from the same problem.
Other risk factors
Although poorly understood, there are some risk factors associated with the development of RA. Some of them are:
- Smoking: It is believed that smoking can trigger the disease, especially in those who already have a genetic predisposition.
- Hormones: Experts believe that hormonal factors are linked to the disease, which explains the higher incidence in women and the fact that many pregnant women show clinical improvements without further explanation.
- Exposure to substances: People who have spent a lot of time exposed to substances such as silica and asbestos are more likely to develop autoimmune diseases, including rheumatoid arthritis.
- Obesity: Overweight or obese people seem to be more likely to develop RA due to joint overload.
The first symptoms of RA are usually subtle, such as pain in the joints of the hands and feet. The patient may have trouble performing simple tasks such as opening pots and turning doorknobs, or even feel pain in their feet when walking after getting out of bed in the morning.
Pain and inflammation
Inflammation causes leukocytes (defense cells) to enter the joints, accumulating substances at the site.
In general, they follow a symmetrical pattern, that is, when there is an inflammation in the right hand, most likely, there is one in the left hand as well.
As there is an increase or concentration of cells and substances, the region becomes swollen.
This swelling causes the synovial tissue to stretch, making nerve endings more sensitive and painful.
The pain can be constant and with different intensities, depending on each patient.
Joint swelling and redness
The swelling occurs due to inflammation of the joints. Cells accumulate in the synovial layers and distend the site.
The redness, on the other hand, is due to the defense cells migrating to the joint region. As the body needs to send more blood to the site, blood vessels dilate in order to supply circulatory demands.
The stiffness of the joints is closely related to pain and, often, the patient has the ability to move the region completely.
That is, the inflammation makes the region sensitive, causing pain and discomfort. Gradually, the patient himself limits his movements in order to avoid discomfort.
As there is a distension of the synovial layers, gradually, the joints start to become unstable.
Cartilaginous tissue begins to degenerate and, as a result, causes changes in bone joints, causing structures, such as fingers, to become crooked.
The formation of rheumatoid nodules can also occur, which are subcutaneous nodules from 2mm to 5cm in size, located mainly around joints.
These lesions are usually hard and asymptomatic, but can develop infections and ulcerations.
Fatigue and intense tiredness
In general, 40% of patients with rheumatoid arthritis experience extreme fatigue and tiredness . The condition may be the result of muscle impairment, which causes a reduction in strength and physical conditioning.
In these cases, the condition is aggravated because, as the patient feels pain, difficulty in getting around and fatigue, there is a tendency to reduce or avoid the exercises, aggravating the reduction in conditioning.
Symptoms such as:
- Lack of appetite;
- Cold sweat.
The most appropriate professional to diagnose rheumatoid arthritis is the general practitioner and the rheumatologist .
There is no specific test for RA, so the diagnosis depends on the manifestation of signs and symptoms, as well as laboratory and imaging tests.
According to the Guidelines for the Diagnosis and Treatment of Rheumatoid Arthritis, the patient must present at least 4 of the 7 items below:
- Morning stiffness: stiffness in the joints and muscles for at least 1 hour after waking up.
- Arthritis in three or more areas: inflammation in three or more joint areas, which presents abnormal fluid accumulation (edema) in the soft parts or joint fluid leakage;
- Arthritis of the joints of the hands or wrists;
- Symmetrical arthritis: inflammation of the same joints on both sides of the body simultaneously;
- Rheumatoid nodules: nodules under the skin, located on bony prominences, on extensor surfaces or in regions close to the joints (justarticular region);
- Serum rheumatoid factor (RF): group of antibodies present in the blood of most people with RA;
- Radiological changes: Appearances of joint erosions or descaling in radiographic examinations.
In addition, items 1 to 4 must be present for at least 6 weeks.
Some tests may be essential for the diagnosis of rheumatoid arthritis. Between them:
The blood test can help the doctor to identify if there are rheumatoid factor (RF) antibodies and cyclic citrullinated anti-peptide antibodies (anti-CCP), which are present in the bloodstream of most patients with rheumatoid arthritis.
Other checks that can be made with the blood sample are the erythrocyte sedimentation rate (ESR) and active protein C, which indicate the presence of inflammation in the body.
Tests such as X-rays and MRIs are used to check the condition of the joints.
The appearance of erosions, descaling and other deformities can reinforce the diagnosis.
Synovial fluid analysis
It consists of taking a sample of synovial fluid from an inflamed joint, which can help rule out other causes for arthritis.
Using a puncture in the joint, called arthrocentesis, a small amount of material was removed. The procedure is similar to an ordinary blood collection, only located in some joint.
No . RA is a chronic disease and, to this day, there is no known cure for the condition. However, there are treatments that can keep it under control and thus reduce symptoms.
As it is a condition capable of generating mobility problems, treatment must be multidisciplinary in order to control the disease, relieve discomfort, stabilize the condition and restore autonomy to the patient.
The patient can be guided to the use of medications that relieve pain and reduce inflammation, in addition to drugs considered to modify the course of the disease.
Although it is difficult to remit symptoms completely, this type of medication shows good results to avoid worsening the condition.
Physical exercises guided by a physiotherapist can prevent loss of mobility and relieve pain
Stretching prevents the tendons from being shortened by inactivity, just as the use of orthoses can help maintain the functionality of the joints that have suffered deformities.
The occupational therapist can help the patient maintain his autonomy through adaptations of spaces and objects, in addition to assisting the mobility of joints with kinesiotherapy techniques.
In addition, the professional is very important if it is necessary to use orthoses or accessories that facilitate the maintenance of the patient’s daily activities.
When drugs are ineffective and fail to prevent damage to the joints, surgical procedures can be performed to repair and restore joint function.
Some surgeries that can be performed are:
- Synovectomy: Procedure that removes the inflamed part of the synovial membrane, preventing damage to the cartilage. It can be done on the knees, elbows, wrists, fingers and hips.
- Tendon repair: Recurrent inflammation and damage can cause ruptures or even loosening of the tendons. A surgeon may be able to repair these tendons to the joints, so that the movement is regained.
- Total arthroplasty: In this procedure, the damaged parts of the joint are removed and replaced with a metal and plastic prosthesis. This prosthesis, when properly cared for, can last up to 20 years before an exchange is necessary.
- Arthrodesis: When there is no possibility of total arthroplasty, arthrodesis becomes a last resort and consists of the fusion between the two bones, permanently eliminating the joint. It is usually done when there is no other way to relieve the pain felt in the joints.
Drug treatment is aimed at reducing inflammation and preventing deformities. There are 4 classes of drugs used to treat RA and the doctor will choose the most appropriate one according to the severity of the case. Are they:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Relieve the symptoms of arthritis, treating inflammation. They serve as a palliative because they offer many risks and side effects in the long run. In addition, they are not able to prevent deformities. They reach their maximum effect between 2 and 4 weeks of use.
Some of the most used anti-inflammatory drugs are:
- Ibuprofen ;
- Naproxen .
Reduce inflammatory processes and relieve symptoms. Like NSAIDs, they do not prevent deformities and are indicated at the beginning of treatment for quick relief of symptoms. Often, it is administered simultaneously with anti-inflammatory drugs. The most used substance in these cases is prednisone .
Disease-modifying antirheumatic drugs (DMARDs)
They reduce inflammatory processes, thus preventing the progression of the deforming disease. They are immunosuppressive drugs, that is, they weaken the immune system, so their use must be monitored by a doctor. The effects are felt only after weeks or months of treatment.
The doctor may prescribe, among others:
- Hydroxychloroquine ;
- Methotrexate ;
- Penicillamine ;
- Azathioprine ;
- Leflunomide ;
- Cyclosporine .
Biological response modifiers
This is the newest class of medication to treat rheumatoid arthritis. Its action focuses directly on inflammatory mediators and cells involved in arthritis.
The drugs are obtained through biotechnology, have an immunosuppressive effect and their side effects can be more serious than the other classes of drugs. They are used exclusively in cases in which the disease does not respond to conventional treatment.
Some drugs belonging to this class are:
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Rheumatoid arthritis should always be followed up clinically, with trained professionals, following therapeutic guidelines.
However, some actions can be taken at home to help improve symptoms. They should always be done together, without replacing medical advice.
Among the options are:
Teas, in general, have relaxing properties and can assist in the well-being of the patient.
The hot drink can reduce anxiety and agitation, causing the patient to control the emotional state. As a consequence, there may be a reduction in the perception of pain.
Especially drinks that contain anti-inflammatory properties, like chamomile, can help.
Hot compresses can help reduce inflammation, promoting muscle relaxation.
Gradually, it is possible to notice improvements in stiffness and difficulties in movement. But cold compresses can also be effective in reducing swelling.
The ideal is to talk to the doctor so that, together, the best times and time for applying compresses are established.
Cushions and pillows
Using comfort in favor of the patient is an effective measure to reduce the impact of rheumatoid arthritis pain.
Upon waking up, the patient usually perceives the stiffest joints. Therefore, using comfortable pillows and pillows can help during sleep.
It is also possible to place pillows along the body to make it more aligned, avoiding aggravating the pain.
The limitations that rheumatoid arthritis brings can make living with the disease difficult, both physically and psychologically.
Still, there are several resources and tips for the patient to guarantee a good quality of life.
It is normal for people with RA to end up developing depression , since the disease causes severe pain that seems to have no end, in addition to creating feelings of loss and incapacity.
For this, it is important that the patient also receives psychological treatment.
One way to maintain joint functions for a longer time is to perform light physical exercises on a daily basis.
While physiotherapy sessions may take place a few times a week, it is also important that the patient maintains a home exercise routine.
To formulate this routine, you can ask for help from a physical therapist or occupational therapist.
There is no specific diet for people with rheumatoid arthritis, however, having a balanced and nutritious diet helps to keep the weight stabilized, which helps in reducing pain in the joints of the hips, legs and feet.
To relieve pain, a hot or cold compress can be applied. Heat helps to relax sore muscles, just as ice can numb the area.
Clothes and shoes
The use of appropriate clothes and shoes helps to facilitate the patient’s daily life.
The fabrics must be comfortable and suitable for the patient, avoiding limiting movements or compressing the joints (for example, very tight pants).
Adaptation of environments
The shower is one of the most dangerous places for people with RA, since the slippery floor can easily cause falls. It is recommended to use non-slip mats and, if necessary, waterproof chairs suitable for bathing.
Bathtubs are not recommended for use without supervision, as the patient may have trouble getting in or out of it.
In addition, some patients may suffer from limited movement and need help in the kitchen.
For this, there are equipment suitable for the disabled, which can help to open pots, cans, bottles, among others.
When it comes to reaching the most used utensils, an occupational therapist can help to redesign the kitchen in order to make the patient’s life easier.
Some patients may have problems on the beach, due to UV radiation, heat, as well as inflammation and pain can get worse, for example.
Places like countryside, mountains or hot springs are great travel options, where the patient can maintain their care routine, in addition to the possibility of other beneficial exercises, such as, for example, swimming in heated pools.
Many of the complications related to rheumatoid arthritis are known as extra-articular manifestations (that is, in addition to the involvement of the joint), although they are caused by the disease.
In addition, the medications used in the treatment often weaken the immune system, making it easier to contract infections and other diseases.
Because it is a systemic condition, inflammation can attack other organs and tissues in the body, causing several serious complications.
Check out the main extra-articular manifestations below:
Dryness is one of the main symptoms related to the eyes. As lubrication also helps to protect the organs, the patient with rheumatoid arthritis is more prone to infections.
Inflammation may occur in the sclera, white part of the eyes. The condition generates pain and redness.
Uvea is one of the layers of the eye, which participates in the correct blood supply to the retina (another layer of the eyes). Thus, uveitis is the inflammation of that layer, causing redness and changes in vision.
People with RA are 2.5% more likely to develop cardiovascular disease than the general population.
The heart can also be affected by rheumatoid arthritis. Prolonged inflammation can cause the accumulation of fatty plaques in the blood vessels.
Gradually, plaques reduce blood flow and can block arteries.
The pericardium is a membrane that surrounds the heart and participates in blood control, preventing accumulations of the substance from occurring in the heart.
Rheumatoid arthritis can cause inflammation in this tissue, causing pain and difficulty in breathing.
Nerve compression and carpal tunnel syndrome
As a result of joint inflammation, the nerves may suffer compression and result in changes in sensitivity.
Thus, numbness, tingling, reduced strength and movement of arms, hands and legs can occur.
Among the nerves that can be affected is the median nerve, located in the carpal canal, in the region between hand and forearm.
Interstitial lung disease (ILD)
In general, changes in the functioning or structure of the lungs due to rheumatoid arthritis are common.
Even though, many times, they do not represent risks or manifest symptoms, some afflictions can generate risks to the patient.
Among the most common conditions is interstitial lung disease, which designates a group of changes capable of affecting the lungs, causing prolonged inflammation and damage to the functioning of the organs.
The bronchi (tubes that take the air to the lungs) may suffer dilations and have their functioning compromised due to rheumatoid arthritis.
These dilations become permanent and lead to the destruction of structures, causing mucus to accumulate in the lungs.
Accumulation of fluid may occur in the pleura, which is a layer of lining of the lungs.
This accumulated liquid triggers coughing , shortness of breath, pain and respiratory changes.
On average, anemia affects between 30% and 70% of patients with rheumatoid arthritis. The causes are diverse and can be related to digestive impairment or side effects of medication use
Over time, the bones of patients with rheumatoid arthritis may become weak and damaged.
Due to the reduction of cartilage (a layer that prevents friction between bones), the extremities begin to suffer injuries, which can cause erosion and bone fragmentation.
The chance of developing lymphoma, cancer in the lymphatic system, is greater in patients with rheumatoid arthritis.
The disease has no cure and the prognosis is directly related to the speed at which treatment begins.
That is, the sooner the diagnosis occurs, the better the chances of controlling and stabilizing the disease.
There is no way to prevent rheumatoid arthritis.
Maintaining healthy habits, a routine of physical activities and a balanced diet are the best ways to take care of your health as a whole.
In addition, if there are cases in the family, it is important to pay attention to consultations and medical follow-up.
One of the characteristics of rheumatoid arthritis is the irregularity or alteration of bone structures:
From the exams, the changes are very clear:
Since small joints in general are quite affected:
Rheumatoid arthritis retires?
If the disease is in an advanced stage, compromising the patient’s professional life, yes .
It is important to remember that there are a number of complications involved in rheumatoid arthritis and they can harm the patient’s life.
As the complications are, in general, irreversible, when the disease severely affects the daily life, it is possible to ask the INSS for retirement due to disability.
The process requires medical expertise, which will check the conditions of the applicant, through examinations and consultation. Once the limitations and progression of the disease are verified, retirement is granted.
Why is rheumatoid arthritis an autoimmune disease?
Autoimmune diseases are all those that result from an immunological alteration in which the body attacks its own cells and healthy tissues. In rheumatoid arthritis, the immune system affects the synovial membrane, causing inflammation in one or more joints in the body.
What foods are bad for rheumatoid arthritis?
A balanced and healthy diet is especially important for patients with rheumatoid arthritis. In general, it is recommended that the patient reduce the sodium intake, which includes putting less salt in the food and decreasing the consumption of processed products, in addition to reducing fried foods and the use of refined sugar on a daily basis.
The ideal is to choose foods with anti-inflammatory, antioxidant and nutritious properties.
The best way to prevent the progression of the disease is information and diagnosis as early as possible.
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