Signs and symptoms of rheumatoid arthritis
Rheumatoid arthritis is an inflammatory joint disorder which is intermittent. Anyone can be affected. Patients suffer particularly from their fingers and hands under swollen, aching and deformed joints. With consequent medication, complications of the disease can be prevented in many cases. Read all the important facts about rheumatoid arthritis.
Rheumatoid arthritis (RA) is also referred to as (primary) chronic polyarthritis. It is an inflammatory joint disease. Particularly the small joints on the hands and feet are affected.
Rheumatoid arthritis is the most common inflammatory joint disease in the world. About two-thirds of the patients are female. Although rheumatoid arthritis can occur at any age, most patients are aged between 55 and 75 years of age.
Ten percent of patients have a first-degree relative who also has rheumatoid arthritis. The likelihood that identical twins will develop both is about 15 to 20 percent.
Special forms of rheumatoid arthritis
There are some special forms of rheumatoid arthritis:
Caplan syndrome: Rheumatoid arthritis in combination with a silicosis. Caplan syndrome typically occurs among workers in the coal mining industry.
Felty syndrome: Felty syndrome is a severe course of rheumatoid arthritis, mainly affects men. In addition to joint inflammation, the spleen is swollen and the number of white blood cells (leukocytes) and platelets (thrombocytes) diminished.
Late onset rheumatoid arthritis: Late onset rheumatoid arthritis is a common condition. It breaks out only after the age of 60 and often affects only one or a few large joints. In addition, there are often general symptoms such as fever, loss of weight, and and muscular atrophy.
Juvenile rheumatoid arthritis: Juvenile rheumatoid arthritis is one of the most common chronic diseases in childhood. Their causes are mostly unclear. It is assumed that a-partially undetected-bacterial infection strongly activates the immune system. As a result, the body’s own tissue is destroyed (auto immune reaction).
Systemic arthritis: Still is a sub-form of juvenile rheumatoid arthritis and affects not only the joints, but also other organ systems such as the liver or spleen. The prognosis of this disease is unfavorable.
Rheumatoid arthritis symptoms
Rheumatoid arthritis begins with unspecific symptoms like:
- Slight fever
- Severe feeling of the muscles
Many patients then think of a flu infection or a sports injury. Typical rheumatoid arthritis symptoms show up only in the further course. This includes pain and swelling of the small joints on the fingers and feet, as a rule on both hands or feet at the same time (symmetrical infestation). Above all, a strong hand pressure triggers severe pain in the patients.
In addition, patients complain that they feel their joints are stiff in the morning. Rheumatoid arthritis can also lead to circulatory disorders of individual fingers. Later, larger joints can be affected, such as the elbow, shoulder and knee joint, or the upper cervical spine. The finger joints as well as the thoracic and lumbar spine are not normally affected in rheumatoid arthritis.
Other rheumatoid arthritis symptoms
Rheumatoid arthritis can also attack other structures besides the joints.
- Carpal tunnel syndrome: Narrowing of the median nerve on the wrist due to thickened, inflamed tendons
- Irritation of the ulnar nerve at the elbow
- Baker’s cyst: Fluid accumulation in the knee, which can affect the bending
- Rheumatic nodules: knotted structures that form in the subcutaneous fat tissue along the tendons or at pressure points
- Sicca syndrome (secondary Sjögren’s syndrome): Functional disorder of the salivary glands
Rheumatoid arthritis can also affect the internal organs. Possible consequences are:
- Cardiac valve disorders
- Pulmonary infarction (pleurisy)
- Hepatic fibrosis (liver fibrosis)
- Renal insufficiency
Rheumatoid arthritis causes and risk factors
The exact cause of rheumatoid arthritis is still unknown. However, there are different theories of the disease. On the one hand, the heredity seems to have an influence. For this reason, the rheumatoid arthritis is frequently found in families.
In addition, many patients have similarities in HLA genes. HLA stands for “Human Leukocyte Antigen”. The HLA proteins can mark cells as body-borne or body-free.
Thus, the immune system knows which cells (body foreigners) are to be attacked and which are not (body-specific). However, certain changes in the HLA genes can cause this distinction to no longer work and the immune system attacks the body’s own structures (auto immune reaction).
Studies have shown that around 70% of rheumatoid arthritis patients carry the HLA gene DR4 / DRB1. In the healthy population, only about 25 percent of people have this gene variant.
Another possible cause of rheumatoid arthritis is environmental influences in the sense of infections or allergies. It is possible that pathogens such as herpesviruses or rubella viruses are the cause of the disease. Smoking and overweight may also contribute to the onset of the disease if further risk factors are present.
How is rheumatoid arthritis diagnosed?
Most rheumatoid arthritis patients initially look for their family doctor. The nonspecific symptoms at the beginning of the disease are often misinterpreted as harmless influenza infections. If rheumatoid arthritis is already known in your family, your GP will refer you to a rheumatologist.
With a lot of experience and expertise, rheumatologist can make the right diagnosis and initiate the necessary therapy.
In order to diagnose a rheumatoid arthritis, the doctor first asks you in detail about your medical history (anamnesis). Possible questions are:
- Does anyone in your family suffer from rheumatism?
- When are the complaints worst?
- Which joints are affected?
- Have you noticed other symptoms besides joint pain?
Next, your doctor will examine you. In doing so, he examines your fingers and wrists, for example, and checks their mobility.
Blood testing for rheumatoid arthritis
A blood test is also important for the diagnosis, because rheumatoid arthritis can alter nonspecific blood values in the sense of an inflammatory reaction:
- Increased CRP (C-reactive protein)
- Strongly accelerated BSG (blood reduction rate)
- Decreased Hb (hemoglobin)
- Increased coeruloplasmin
- Increased α2 and γ band in electrophoresis
- Anemia (blood loss)
Laboratory values that may indicate rheumatoid arthritis are the rheumatoid factor, anti-CCP antibodies and other autoantibodies.
Imaging techniques for rheumatoid arthritis
Imaging procedures help in the diagnosis and the determination of the disease stage. Radiographs of hands and feet show changes in the joints resulting from rheumatoid arthritis especially in the advanced stage. For example :
- Narrowing of the joint gap
- Joint dislocations
Other imaging techniques that can help diagnose rheumatoid arthritis include:
- Magnetic resonance tomography (MRI)
Similar diseases as rheumatoid arthritis
As already mentioned, there are many diseases associated with joint complaints. Therefore, it is important to distinguish rheumatoid arthritis from these diseases. These include:
- Ankylosing spondylitis
- Psoriatic arthritis
- Polymyalgia rheumatica
- Sjogren’s syndrome
- Systemic lupus erythematosus (SLE)
- Rheumatic fever