Rheumatoid arthritis

Rheumatoid arthritis is a chronic debilitating disease that affects between 0.3 and 0.8 per cent of the world population according to the WHO.

Often starting at between 20 and 50 years of age, 300,000 patients in France suffer from it, and several thousands of new cases are reported every year. Women are more affected than men.

Within 10 years of the disease manifesting itself, more than 50 per cent of patients are unable to hold a full-time job. It limits the movements of the subjects with the disease in 80% of cases, and 25% are unable to perform everyday tasks.

Rheumatoid arthritis: a debilitating disease

Rheumatoid arthritis (RA) is characterised by inflammation and progressive destruction of the joints. As a reminder, inflammation is a mechanism that enables the body to defend itself against chemical, toxic and microbial attacks. In the case of rheumatoid arthritis, this inflammation is excessive and continuously overexpressed, resulting in painful symptoms in the joints, causing irreversible lesions.

RA progresses by way of inflammatory attacks whose duration and intensity vary. Over time, complications appear, making it difficult for the patient to carry out simple everyday tasks.

In most cases, when the patient with RA suffers an acute attack of their illness, the patient manifests the following symptoms:

Pain in the joints that can be continuous during the attack and have consequences on the patient’s state of mind.
Swelling of one or several joints.
Stiffness of the joints in the morning lasting between 30 and 60 minutes. This stiffness can reoccur if the patient stays still for too long.

Apart from the physical aspect, RA affects the daily lives of the patient in several ways. The patient suffering from the pathology has difficulty using their hands, suffers from fatigue, preventing them from perform certain everyday activities, leading to a feeling of frustration.

Other non-articular manifestations may occur in severe rheumatoid arthritis. Early diagnosis and treatment are necessary to limit the risk of extra-articular manifestations that can affect the vessels and the heart, kidneys , and lungs.

How does rheumatoid arthritis start?

Rheumatoid arthritis usually begins gradually, attacking different joints. It can also occur suddenly, when several joints become inflamed at the same time.

The inflammation is in most cases symmetrical and affects the joints on both sides of the body in a uniform manner. The inflammation most often starts in the following joints: wrists, hands, feet, toes, fingers.

Rheumatoid arthritis can also affect other limbs: shoulders, elbows, ankles and knees.

Rheumatoid arthritis: a debilitating disease

RA progresses by way of inflammatory attacks whose duration and intensity vary. Over time, complications appear, making it difficult for the patient to carry out simple everyday tasks.

In most cases, when the patient with RA suffers an acute attack of their illness, the patient manifests the following symptoms:

Pain in the joints that can be continuous during the attack and have consequences on the patient’s state of mind.
Swelling of one or several joints.
Stiffness of the joints in the morning lasting between 30 and 60 minutes. This stiffness can reoccur if the patient stays still for too long.

The radiological assessment

The radiological assessment consists of taking X-rays of the feet, wrists or hands depending on the areas affected. Taking these pictures at the beginning of the disease makes it possible to follow its evolution.

The early diagnosis of rheumatoid arthritis will allow the treatment to be set up quickly and to avoid joint damage.

What causes rheumatoid arthritis?

The origin of rheumatoid arthritis is still unknown. Several hypotheses have been put forward and can be classified into 2 main parts: genetic factors & environmental factors.

Genetic factors

There are genes that predispose to rheumatoid arthritis but they are not observed in all patients. It is also possible to find these markers in healthy subjects. Thus, the presence or absence of these genes does not allow a definitive diagnosis to be made.

Environmental factors

Certain lifestyle factors can be the cause of rheumatoid arthritis. Smoking, emotional shocks, obesity, poor dental hygiene...could favour its appearance.

How does Rheumatoid arthritis create joints lesions?

Rheumatoid arthritis causes inflammation of the synovial membrane. The synovial membrane plays a major role in the proper functioning of the joint since it secretes a liquid intended to lubricate the joint and nourish the cartilage.

The inflammation of the synovial membrane causes a thickening and an abnormal secretion of the synovial fluid in the joints. This phenomenon will gradually lead to the destruction of the joint structures:

The bone around the joint are demineralized
The cartilage are damaged and thinner
The ligaments and tendons are weakened and can tear

Medical monitoring of rheumatoid arthritis

Once the diagnosis of rheumatoid arthritis has been confirmed, a system for monitoring the disease's progress will be put in place. The DAS28 score is an index that integrates different clinical criteria allowing the rheumatologist to evaluate the state of the disease at a precise moment.

The DAS28 is an essential indicator to monitor the evolution of the disease but also to judge if the patient is responding to his treatment or not.

DAS 28 Scale

DAS greater than 5,1 = high activity
3,3 < DAS28 > 5,1 = Moderate level of activity
2,6 < DAS28 > 3,2 = Low activity

Other criteria must be integrated by the rheumatologist, such as the HAQ score, which is designed to evaluate the impact of the disease on daily life (getting up, getting dressed, eating, walking, etc.).

Dialogue between the rheumatologist and the patient is also essential in order to consider other therapeutic scenarios if the current treatment does not work. Patients with rheumatoid arthritis should not hesitate to tell their doctor about all the difficulties they are experiencing on a daily basis.

Rheumatoid arthritis on a daily basis

Waking up un the morning
People with rheumatoid arthritis may wake up with stiffness in their joints. It may take several hours for the stiffness to go away and the joints to start working again.

Fatigue
Patients suffering from polyarthritis experience fatigue. There are several reasons for this: pain due to inflammation, waking up at night, and muscular fragility. In order to fight against this condition, patients are strongly advised to practice a regular physical activity adapted to the disease

Pain
Rheumatoid arthritis is a painful disease. Its intensity varies throught the day. This has an impact on the patient's mood and morale. Treatments are available to reduce or eliminate flare-ups and control joint destruction in order to help patients manage the symptoms of their disease.

Flare-ups
In most cases, when a patient with RA experiences an acute attack of the disease, he or she suffers from the following symptoms

Continuous pain in the affected joints during the attack that can affect the patient's psyche.
Swelling of one or more joints.
A morning stiffness of the joints lasting from 30 to 60 minutes. This stiffness can reappear when the patient is immobile for too long.

If not under control by treatment, the disease progresses, making the use of the effected joints complicated for the patient.

Lifestyle and rheumatoide arthritis

In addition to treatment, it is important for patients to adapt a lifestyle that will help them better manage their disease.

The link between diet and rheumatoid arthritis activity has not been scientifically proven and to date, no diet can stop the progression of the disease. On the other hand, adopting a balanced and varied diet improves the quality of life of patients (weight loss, pain management, etc.)

Physical activity is strongly recommended. However, it must be adapted according to the stage of the disease and must be supervised by a doctor or a physiotherapist.