# Rheumatoid Arthritis --- **Rheumatoid arthritis** or **RA** is a form of [[joint#Problems with Joints|arthritis]] where the joints become inflamed due to the body being under chronic inflammation due to an [[autoimmune disorder]], specifically a [[type III hypersensitivity]] reaction. Unlike [[osteoarthritis]], RA systemic, progressive and cannot be treated with surgery. A lot of the symptoms mimic those of [[chronic stress]], because its pretty similar. The immune system of those with RA attack the [[synovial joint|synovial joints]], which wears down the cartilage between the bones, leading to bone-on-bone contact, which can even fuse together. In RA we also see a "pannus invasion" of the synovial membrane move in between the bones. ![[arthritis.png]] ## Risk Factors There are both genetic and environmental factors for developing rheumatoid arthritis. - family history - bacterial/viral illness - pollution - [[smoking]] ## Signs & Symptoms The symptoms of rheumatoid arthritis are often vague, especially at first. Usually it starts with **inflammation**, **pain** and **stiffness** in the small joints of the hands hands and then moves up and effects the shoulders, the knees, even the jaw. Joints are also sometimes **spongy** because of the pannus formation. Unlike osteoarthritis, RA affects joints bilaterally and symmetrically, and cause **deformities** which leads to **loss of function**. Sometimes there are the formation of **rheumatoid nodules**, which can pop up over bony prominences and can be very tender. They can also creep into the subcutaneous space. Other systems can be effected, which can cause **nerve** and **muscle damage**. Other systemic symptoms include: - lymph node swelling - fever - fatigue - weight loss ## Diagnostic Tests - Rheumatoid Factor - This measures [[antibody|IgG]] and [[antibody|IgM]]. - IT's not specific to RA, an dhas a high rate of false results, so by itself is not diagnostic but a good pointer - ESR - CRP - CBC - X-rays - ultrasound - MRI ## Treatment Rheumatoid arthritis is a progressive disease that doesn't have a cure, so treatment involves slowing the progression and relieving the symptoms - managing inflammation - cold and heat - managing fatigue - getting the right amount of rest - not too much to avoid deconditioning - good quality [[sleep]] - good [[nutrition]] - maximizing mobility - PT/OT - assistive devices Surgical interventions can be used to relieve symptoms, but it is not curative. In some cases they can remove some inflamed synovium or perform a total [[joint replacement]]. Medicines that can be used for RA are: - [[NSAIDs]] - [[glucocorticoids|glucocorticoids]] - [[DMARDs]] (disease-modifying antirheumatic drugs) ___