Rheumatoid Arthritis

Signs of RA include symmetrical joint distribution, rheumatoid nodules, tenderness with warmth and swelling over affected joints usually involving hands and feet. The joints normally involved with RA include small joints of hand, wrists, feet, elbows, shoulders, knees, and ankles.

Symptoms of RA include joint pain and stiffness for more than 6 weeks, may also experience fatigue, weakness, low grade fever, loss of appetite, muscle pain, and joint deformity (generally seen late in the disease). Stiffness is typically worse in the morning, and lasts more than 30 min. Movement normally improves pain and lack of exercise can lead to chronic inflammation, loss in range of motion, muscle atrophy, weakness, and deformity. Ongoing inflammation can affect the body’s systems such as eyes, mouth, skin, lungs, blood vessels, and blood.

RA can be hard to diagnose because there is no one test that can diagnose it and symptoms can be similar to other kinds of joint diseases. To diagnose rheumatoid arthritis, doctors use medical history, physical exam, x-rays, and lab tests. Joint radiographs can help detect RA early on by showing joint space narrowing or erosions. While labs results commonly seen in RA include a detectable rheumatoid factor (RF), Anti-cyclic citrullinated peptides/protein antibodies (anti–CCP/ACPA), elevated WBC count, and anemia.

Goal of therapy is to improve or maintain functional status, and quality of life by taking away pain, swelling, and slowing down progression of joint damage.

General approach to treat RA includes pharmacologic and non-pharmacologic with emphasis on aggressive treatment early to prevent irreversible joint damage/disability. Less active disease may be treated with oral agents as monotherapy while high disease activity is treated with combination therapy and biologics. Treatment for rheumatoid arthritis may involve lifestyle changes, medication, surgery, or alternative therapies.

Non-pharmacological therapy include rest to relive stress on inflamed joints and prevents further joint destruction, OT/PT can provide skills and exercise to increase or maintain mobility, weight reduction can also alleviate stress on inflamed joints, and finally surgery which is reserved for patients with severe disease.

Pharmacologic therapy includes disease modifying anti-rheumatic drugs (DMARDs) such as methotrexate, hydroxychloroquine, sulfasalazine, and lefunomide. Biologics like TNF inhibitors (adalimumab (Humira), etanercept, infliximab) or non-TNF biologics (abatacept (Orencia), anakinra, rituximab).

Normally a combination of Pharmacologic and non-pharmacologic is used for best possible outcome.

RA and OA are often confused, although both are affecting the joints they are in fact very different. OA effects articular cartilage, causing damage and joint space narrowing from loss of cartilage. This damage leads to synovial inflammation and osteophyte formation.

OA increases with age, and progresses slowly over years while RA progresses quickly and can happen at any age. OA is asymmetrical while RA is symmetrical. OA causes limited motion, and effects mainly hands, hips, knees and or spine (multiple joint involvement). With OA pain is exacerbated with motion, and stiffness in affected joints lasting less than 30 min while in RA pain is relieved with motion, and stiffness lasts more than 30 minutes. OA has no lab markers distinguishing diagnosis, while RA has specific lab markers. Treatment is also different, OA is mainly treated with NSAIDs or steroids, while RA requires DMARDs and Biologics.