Causes Of Rheumatoid Arthritis And Its Treatment
Rheumatoid arthritis is one of the most common forms of autoimmune diseases. It is a long-term, inflammatory disorder of the joints that causes damage and disability. It occurs when your body’s immune system does not act the way it should. Let's dive deep into the causes of rheumatoid arthritis and its management.
Typically, the immune system fights the toxins and infectious agents that are foreign to the body. But since RA is autoimmune, your immunity tends to work against yourself. Your immune system attacks the protective lining around the joints called synovium. When this happens, inflammation goes beyond control, resulting in joint pain, stiffness and swelling. While it is a joint problem, the damage does not always stay in the joints. In some circumstances, RA affects the heart, lungs, skin, nerves, kidneys and so on.
Causes Of Rheumatoid Arthritis
We do not know what exactly triggers rheumatoid arthritis. All we know is RA is an autoimmune disease resulting in joint inflammation and you lose your flexibility. We can categorize the causes of rheumatoid arthritis as modifiable and non-modifiable.
1. Modifiable Causes Of Rheumatoid Arthritis:
a. Smoking:
Smoking is one of the most prominent causes of rheumatoid arthritis that increases your risk with every puff you take. Smoking in the presence of small children can make them more prone to rheumatoid arthritis during their adulthood.
b. Obesity:
Excess body weight or obesity corresponds to an increased risk of RA and it also has the tendency to worsen the condition. People who are obese and diagnosed with RA have a higher risk of developing heart complications.
c. Stress:
A study conducted by Vincent Germain et al. suggests that stressful life events that cause psychological distress triggers the development of RA and its symptoms. High amounts of stress often leads to mental health problems like PTSD and depression. Since the stress system is more linked to the endocrine, nervous and immune system, stressful events contribute to significant inflammation.
2. Non-Modifiable Causes Of Rheumatoid Arthritis:
There are some factors which you can neither deny nor alter no matter what. They include age, gender, genetics and environmental exposure.
a. Age:
Although this disease has no age barriers, your risk of getting it increases with your age. If it occurs in children and adolescents, it is known as juvenile idiopathic arthritis.
b. Gender:
Women are more likely to suffer from this joint damage than men. Although it is not yet proven, it is speculated that the oestrogen hormone might be the triggering factor behind this. The hormonal changes are more erratic during pregnancy and menopause. Stress is another triggering factor that induces RA symptoms in women more than men.
c. Gene:
People born with specific genes are at a greater risk of rheumatoid arthritis. Even if your parents or immediate family members do not have this condition, if you carry genes like HLA class 2 genotypes, you are more likely to develop rheumatoid arthritis. The HLA genes help in distinguishing the body’s own proteins from those produced by bacteria, viruses and other toxins. any alteration that occurs in this gene induces the risk of autoimmunity.
d. Toxin exposure:
Though this can be slightly modified, you cannot predict when you can be exposed to environmental toxins. Accidental exposure to toxic substances in the environment like dust particles, bacteria and viruses trigger the risk of developing rheumatoid arthritis. Farmers and people who work in textile industries are at a greater risk of exposure to environmental toxins.
Treatment Of Rheumatoid Arthritis:
Pain and inflammation are the two major reasons a person with rheumatoid arthritis will struggle to move. The primary aim of treatment for rheumatoid arthritis is to reduce pain and inflammation and restore movement and retain joint functions. Immediate treatment can prevent joint damage in the long run.
Before treating you, your healthcare team will consider your age, joint involvement, occupation, knowledge of the disease, extent of joint damage and how regular you can visit the doctor for treatment.
1. Medications For Rheumatoid Arthritis:
a. Painkillers And Steroids:
As we discussed earlier, reducing pain and inflammation is the main goal of this treatment. Some of the highly effective painkillers and anti-inflammatory medications include aspirin, ibuprofen, celecoxib, naproxen and etodolac. These belong to the category called non-steroidal anti-inflammatory drugs (NSAIDs). These medications stop your body from releasing prostaglandins and eventually reduce pain.
Another type of painkillers indicated for RA is opioid analgesics like codeine, tramadol, etc. These medications effectively reduce pain but they are not routinely recommended as their side effects outweigh the benefits.
Steroids are recommended for only a short period of time. During inflammation, a component of white blood cells called eosinophils increases rapidly. Steroids work by reducing the action of eosinophils to reduce inflammation. However, do not stop taking this medicine abruptly. discuss with your doctor if you are facing side effects and feel you need to stop taking steroids. your doctor will slowly taper the dose before stopping them completely.
b. Disease Modified Anti Rheumatoid Drugs (Dmards):
The main aim of using DMARDs is to stop the disease from progressing. lymph cancer is one of the consequences of rheumatoid arthritis and DMARDs help reduce the risk of developing lymphoma. These medications take weeks to months to start working. They work by reducing the release of inflammatory mediators in the body to avoid joint disability and destruction.
Methotrexate, Hydroxychloroquine and Sulfasalazine are highly preferred drug modified antirheumatic drugs. Biological DMARDs like tocilizumab are also effective in cases when traditional DMARDs do not work.
Gold salts like aurothioglucose, auranofin, gold sodium thiomalate, D-penicillamine are also frequently used to treat rheumatoid arthritis.
Immunosuppressants like Cyclosporine, Chlorambucil, Azathioprine stop the immune system from attacking your joints. These are recommended in severe or advanced rheumatoid arthritis.
c. Other Medications
Leflunomide is a new medication added to the regimen of rheumatoid arthritis management. You can take this medicine with or without methotrexate. It is effective in relieving your symptoms and preventing joint damage. however, watch out for side effects like high blood pressure, stomach upset, liver damage, lung problems, etc.
d. Tumour Necrosis Factor
Medications like etanercept, infliximab, adalimumab, etc are recommended if other treatment methods do not work. They work by inhibiting cells that produce inflammation in the body and provide rapid relief from the symptoms.
2. Physical Therapy:
Physical therapy helps with managing pain and other uncomfortable symptoms. seek professional guidance from a physiotherapist to understand suitable exercises to make you more flexible and fit.
a. Surgery:
Surgery is the last option left to treat rheumatoid arthritis. It is often indicated in severe and aggressive rheumatoid arthritis where other treatment methods are not effective.
b. Joint Replacement:
Medically referred to as arthroplasty, this surgical procedure is indicated in severe arthritis of the hand. It involves replacing the problematic joint with an artificial joint. The artificial joint may consist of metal, plastic, silicon rubber or tissue from other parts of your body. This procedure reduces pain and improves movement of joints. It is often recommended for older adults who are not much physically active.
c. Joint Fusion:
Joint fusion is fusing two bones into a single bone in place of the diseased joint. As a result, the patient has one large bone and no joints. This surgery is recommended only in advanced rheumatoid arthritis because once the procedure is over, the joints cannot move.
Ways To Manage Rheumatoid Arthritis At Home
Apart from your visits to the physician for treatment, you also need to follow a disciplined lifestyle and incorporate self-care practices to maintain a good quality of life.
When you are feeling overwhelmed, alternate between physical activity and rest. Low impact aerobic activities like walking helps boost your muscle strength and keeps your joints flexible. Through regular physical activity, you can maintain your body weight and reduce the strain on your joints.
Fish oils and omega 3 supplements are useful to manage short-term symptoms. Calcium and vitamin D supplements help prevent osteoporosis. Supplementation with folic acid can alleviate side effects of methotrexate.
Rheumatoid arthritis can be stress-inducing and enable feelings of anxiety and depression. Periods of intense stress are natural with any new diagnosis but you have to remember that the stress only worsens your condition. Seek help from a mental health practitioner and discuss your symptoms and feelings with them to find a solution that works for you.
