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What are the Signs & Symptoms of Rheumatoid Arthritis?
Written by: James Gill BOst GOsC 6039. Registered Osteopath, Founder & Clinic Director
Medically Reviewed: Yannick Gracia, M.Ost GOsC 10475. Registered Lead Osteopath
What is Rheumatoid Arthritis?
Rheumatoid arthritis is a systemic autoimmune inflammatory disease which means that it affects a group of joints or organs or other body systems by a process in which the body’s immune system attacks itself causing inflammation and slow body distraction. Rheumatoid arthritis mainly affects the small joints of the fingers, wrists and feet and then it can progress to the elbow, shoulder, ankle and knee joints. Other parts of the body commonly affected are the skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow and blood vessels.
Rheumatoid arthritis is considered a relapsing and remitting inflammatory disease. This means that someone might suffer from flare ups with symptoms like joint stiffness, inflammation and pain during the relapsing period and then have minimal or no symptoms at all during the remitting period.
The synovium is a dense connective tissue that surrounds all joints of the human body, makes synovial fluid which lubricates joints and lets them move and slide smoothly and pain free. With rheumatoid arthritis the body sends antibodies that attack the synovium and make it swell up making the joint inflamed, hot, red and stiff.
Early rheumatoid arthritis is defined when there are consistent symptoms for less than six months. If past the six months, it still presents then it is considered established rheumatoid arthritis. Different types of rheumatoid arthritis include: Seropositive RA (testing positive for rheumatoid factor blood test), Seronegative RA (testing negative for rheumatoid factor blood test) and Juvenile idiopathic arthritis (JIA), seen in children of ages younger than 17 years old.
What are the signs & symptoms of Rheumatoid Arthritis?
The signs and symptoms of rheumatoid arthritis may vary between individuals however there are some standard clinical presentations often seen which include:
1st stage signs & symptoms (early RA phase)
- Bilateral (on both sides) & symmetrical small joint arthritis usually starting from the small joints of the hand and wrist progressing to the joints of the feet, elbow, knee and shoulder.
- Morning joint stiffness that usually lasts for more than 30 minutes and worse after periods of inactivity.
- Small joint swelling, redness and tenderness.
- Fatigue, loss of appetite, mild fever. These are collectively known as constitutional signs.
2nd stage signs & symptoms (established RA phase)
- Small joint swelling, redness, tenderness, joint deformity, decreased range of motion & stiffness.
- Loss of joint function and weakness.
- Rheumatoid nodules felt under the skin in areas such as the fingers, elbows and knees. These can feel like lumps under the skin.
- Positive rheumatoid factor (RF) blood test.
What are the common causes of Rheumatoid Arthritis?
The exact cause of rheumatoid arthritis is still unknown but scientific evidence suggests a combination of genetic, familial and environmental factors. Rheumatoid arthritis affects more middle-aged women than men in a ratio of 2:1. People with a positive family history are at higher risk of getting rheumatoid arthritis as there is a genetic link present. However, this link has not yet been fully understood.
Environmental factors and smoking can further increase the risk of rheumatoid arthritis. Finally, diet and a high consumption of red meat along with other foods, which can lead to obesity have shown a positive correlation to the presentation of rheumatoid arthritis.
How is Rheumatoid Arthritis diagnosed?
The first stage of the diagnosis of rheumatoid arthritis is based on the presenting symptoms which are analysed over a 6 week period. If the pattern of symptoms link with that of rheumatoid arthritis then the doctor will send for further blood tests. These blood tests will look for elevated levels of rheumatoid factor and inflammatory markers such as ESR and CRP, as well as looking for low iron levels (this may indicate that the patient is anemic). X-rays, ultrasound and MRI are used to track the progression of rheumatoid arthritis by looking at the levels of the joint distraction.
What are the treatment options for Rheumatoid Arthritis?
There are several different treatment approaches for rheumatoid arthritis. The earlier the diagnosis is made, the earlier the treatment will begin and the chances of the treatment to work increase. Treatment options include medication and physical therapy(such as chiropractic, physiotherapy and osteopathy) in the first stage followed by surgery in the later stages of rheumatoid arthritis, if required. LIfestyle modification can also help manage some of the symptoms better.
Medication
- Non-steroidal anti inflammatories (NSAIDs) : are used to reduce the inflammation of the joints and relieve pain.
- Steroids: corticosteroid medication is used during flare ups to reduce acute stage inflammation and pain. However due to some side effects steroid medication is prescribed and used with caution.
- DMARDs: this medication contains antirheumatic drugs that slow down the progression of rheumatoid arthritis and are often used alongside NSAIDs.
- Biologic agents: these are a new generation of DMARDs that have been extensively tested and have shown positive results in the past years.
Physical Therapy
- Physical therapy such as osteopathy, chiropractic , physiotherapy, clinical Pilates and yoga are often used in order to maintain a good muscle tone and flexibility of the joints. Some therapists will look more into the advice part for the management of rheumatoid arthritis by educating the patients about how to deal with daily essential living tasks.
Surgery
- Surgery is only used if the arthritis has progressed enough to damage the joints and prevent the individual from performing their daily tasks. Surgery often involves removing any inflammation and thickened synovial membrane, repairing damaged tendons due to the prolonged inflammation and fusion of joints for stability as this cannot be maintained due to tendon damage. Only in severe cases will a total joint replacement be recommended. If surgery is necessary your rheumatologist and orthopedic surgeon will work to explain the correct type of surgery for your needs along with the risk and benefits towards each type of surgery.
Lifestyle Modifications
- Low impact exercises such as swimming, cycling, Pilates and yoga can help maintain muscle strength and mobility of the joints. These forms of exercises will also increase blood flow and the removal of waste products, toxins and inflammation from the body.
- Ice therapy regular times during a day can help prevent or at least decrease the levels of inflammation.
- Contrast water therapy/contrast bath therapy is the alteration of hot and cold compresses applied onto the muscles and joints. This therapy can be used to decrease inflammation but most importantly it is used to increase blood flow and remove any toxins and waste products.
- An anti-inflammatory diet can help decrease the levels of inflammation and therefore the symptoms of rheumatoid arthritis. Foods high in Vitamin A, C and E and omega-3 include: Fatty fish (tuna, salmon etc.), green vegetables (spinach, broccoli, celery), peppers, avocado, mushrooms, turmeric, ginger, virgin olive oil, dark chocolate, cherries, berries and green tea. Speak to your healthcare specialist to find out more information on how diet can help with your symptoms.
How long does Rheumatoid Arthritis last?
Can Rheumatoid Arthritis be prevented?
Due to the genetic factors behind the cause of rheumatoid arthritis this condition cannot be prevented. However, as there are numerous environmental and lifestyle factors that can make someone more prominent at developing rheumatoid arthritis, there are several things that can be done to potentially reduce the likelihood of it developing. As discussed earlier, lifestyle changes including diet, smoking, levels of exercise and obesity can help prevent the development of RA to a certain extent.
As mentioned above RA cannot be entirely prevented however, coping mechanisms and support with daily tasks can help to improve the lifestyle of the individual.
- Cooperating and working in partnership with your doctor can help you understand and have more control over what is happening to your health.
- Knowing your limits and never trying to exceed them can help you keep on top of things, whilst preventing excess fatigue and weakness.
- Allowing your social environment to know what you are capable of and what not so they can act when needed and give you the support you might require from time to time.
- Keeping stress levels to a minimum can help the autoimmune system to stay strong whilst also helping your mental health.
What are the best exercises for Rheumatoid Arthritis?
- Swimming is a full body exercise that puts minimal impact on all the joints of the body and can be done at any age.
- Pilates is another type of strengthening and stretching exercise that can be tailored to the individual’s needs.
- Yoga uses gentle stretches to help maintain good health and mobility of the muscles and joints respectively. Again, the intensity and difficulty can be tailored to the individual’s needs.
- Cycling puts almost no impact on the joints of the hand that are most affected by RA, thus allowing people to still anaerobically exercise and maintain good health.
- Tai chi is often used by individuals suffering from RA as it uses gentle movements and stretches along with controlled and deep breathing, which help maintain a good health and mobility of the joints and bring the stress levels down.
Do I need to go to the GP or visit my local hospital?
If rheumatoid arthritis symptoms start to appear and you have a positive family history of RA it is better to speak to your GP. This way the right examination and possible diagnosis will be made, and an early treatment plan can be formed to help prevent symptoms getting worse and slowing down the progression of RA.
Physiotherapy
Offers rehabilitation to all major systems of the body, including neurological, respiratory and cardio-vascular
Osteopathy
Primarily treats the musculoskeletal system of the body
Chiropractic
Deals primarily with spinal manipulation
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