Rheumatoid arthritis is a chronic, systemic autoimmune disease that most commonly affects joints, but can also affect internal organs. Although it is an inflammation of several joints, the disease can also affect other organ systems, especially the blood vessels, lungs, skin and eyes. The cause of the disease is unknown, but there are probably several causes: genetic factors, environmental factors (microorganisms) and sex hormones, as the disease occurs three to four times more often in women. The number of newly diagnosed patients with this disease in the world has been declining since 1955. According to a recently published study by the Slovenian Association of Rheumatic Patients, 16.1 new patients per 100,000 inhabitants over the age of 18 are diagnosed with the disease in Slovenia every year. The mean age of patients at diagnosis was 64 years. There are no exact data on the number of patients with rheumatoid arthritis, it is estimated that there are about 10,000.
The main symptoms of rheumatoid arthritis
The main symptom of rheumatoid arthritis is joint pain, and the first sign joint swelling. Joint pain is most pronounced in the morning, and is usually accompanied by prolonged morning stiffness. Later on, during the day, when patients move their joints, the problems usually decrease. Swellings of the joints are soft. Patients with chronic rheumatoid arthritis, especially if left untreated, may develop permanent and irreversible damage to the joints and joint tissues, which, even when the inflammation is completely subdued, can significantly interfere with daily activities, reduce quality of life and jeopardize the patient’s independence. Deformed joints cause pain that worsens with overload. Due to the deformations, the joints can become less mobile, the joint muscles decay, and physical strength is reduced.
The progress of the disease
The onset of the disease is usually slow. The disease is characterized by symmetrical inflammation of the small joints of the hands, wrists and toes. Joint pain is constant and it worsens in the early morning hours. It is accompanied by morning stiffness, which usually lasts longer than an hour. Recently, when the diagnosis can be made as early as a few weeks after the onset of the first symptoms, the patient may have inflammation in one joint “only” at the time of the diagnosis. General signs such as fatigue, loss of appetite and weight may also be present. There are no diagnostic criteria for diagnosing rheumatoid arthritis. In addition to a thorough interview with the patient and a physical examination, including an accurate assessment of the number of painful and swollen joints, laboratory tests help in making the diagnosis.
X-ray examination at the onset of the disease shows soft tissue swelling. Ultrasound examination of the joints is important especially when physical examination cannot entirely confirm arthritis. In order to be able to treat patients with rheumatoid arthritis, we need to:
– diagnose as soon as possible and start treating with medications that change the course of the disease straight away after the diagnosis, if possible within 12 weeks from the onset of the problem. As stated by the Slovenian Association of Rheumatic Patients, the treatment usually starts with methotrexate. If the medication is not effective enough or side effects occur, patients should be treated with biologic medications. Recently, targeted synthetic drugs that change the course of the disease have become available;
– monitor disease activity and adjust the treatment in order to achieve the main goal of the treatment – remission of the disease (i.e. the absence of signs and symptoms). Furthermore, adjustment of the patient’s lifestyle plays an important role. The possibility of achieving remission is increased with losing weight when overweight, regular exercise and quitting smoking.
WE WOULD LIKE TO GIVE A BIG THANKS TO THE SLOVENIAN ASSOCIATION OF RHEUMATIC PATIENTS FOR ALL THE INFORMATION FOR THIS ARTICLE.