Rheumatoid Arthritis: Symptoms, Causes and How to Cure It

Symptoms mainly affect the joints, but the disease can also adversely affect other parts of the body.

The main symptoms are:

• pain in one or more joints,
• stiffness of the affected joints, especially in the morning,
• joint tenderness and swelling,
• redness of the affected joints,
• fatigue, weakness,
• elevated temperature. ^[1]

Progressive polyarthritis can have long-term effects on the health of the heart, vascular system and respiratory system.

The worsening of symptoms is called a flare-up of progressive polyarthritis arthritis (relapse), and the resting phase of the disease is called remission. ^[2 ] If the flare-up lasts for weeks and is followed by spontaneous remission, patients have a better long-term prognosis.

If symptoms last for more than a year without improvement, the likelihood of severe joint changes (deformities, limitations of movement) increases. ^[3]

It is a painful disease that can damage your joints so much that you may have trouble squeezing your hand. Patients can sometimes barely get out of bed in the morning. Why does this diagnosis develop, how is it treated and how to live with it?

Rheumatoid arthritis – basic concepts

Rheumatoid arthritis, formerly known as progressive polyarthritis, is a chronic inflammatory disease that primarily affects the joints. Popularly and simplistically, people call it “rheumatism”.

Rheumatoid arthritis (RA) is an autoimmune disease in which the immune system attacks its own healthy tissues, which it mistakenly considers undesirable. ^[4] The result is inflammation, which in the case of RA affects the connective tissue in the joints. Inflammation can damage the joint so much that, in addition to pain and swelling, the joint deforms and movement is severely restricted. The joints most commonly affected are the hands, wrists, knees and ankles. ^[5]

• Symmetrical rheumatoid arthritis – the same joints on both sides of the body are affected, for example both knees or both wrists.
• Asymmetrical rheumatoid arthritis – the patient has problems on only one side of the body, for example, only the joints on the left hand are affected. ^[8]
• Seropositive rheumatoid arthritis – the most common type of RA, affecting up to 80% of patients with the disease.
  Autoantibodies (rheumatoid factor – RF and anti-citrulline antibodies known as ACPA) are present in the blood.
  The presence of rheumatoid factor usually means a worse prognosis for the disease.
  At the same time, the absence of rheumatoid factor does not automatically mean a milder course of the disease.
• Seronegative rheumatoid arthritis – patients with this type of RA do not have the above antibodies in their blood.

Although the symptoms of rheumatoid arthritis are very similar in seropositive and seronegative rheumatoid arthritis, there may be differences in pain intensity or response to different types of treatment. ^{[9] , [10]}

A combination of different procedures is used in the diagnosis of this disease.

• Physical examination – checking the condition of joints, joint pain, swelling or changes in skin colour.
• Blood tests – red blood cell sedimentation rate, CRP (both serve as an indicator of inflammation), blood count and antibody check (rheumatoid factor – RF, anti-citrulline antibodies – ACPA).
• Imaging methods – X-ray, magnetic resonance, ultrasound. ^[11]

The sooner a patient receives an accurate diagnosis, the sooner he or she can begin treatment to alleviate or halt the course of the disease. A favourable time horizon for diagnosis is considered to be 6 months from the onset of the symptoms. ^[12]

• RA affects more than 18 million people worldwide.
• Approximately 70% of the patients are women and 55% are over 55 years of age.
• Three-quarters of patients have a moderate to severe form of the disease. ^[13]

Therapy of RA is aimed at reducing inflammation and achieving remission. It is intended to relieve the symptoms of the disease, prevent damage to joints or internal organs and improve overall fitness. Ultimately, the goal of treatment is to minimize the risk of long-term complications of RA. ^[14]

Medication can be divided into several categories.

• Non-steroidal anti-inflammatory drugs – Relieves pain and inflammation, brings temporary relief.
• Corticosteroids – Dampen inflammatory processes, but long-term use has a number of side effects.
• Disease modifying drugs called DMARDs – They slow the progression of the disease and prevent severe joint damage.
• Biological treatment – This is used when other treatments have failed.
  Biological treatment of this disease uses various antibodies, proteins and other substances that aim to reduce the activity of the disease. ^{[15] ,[16]}

Non-pharmacological procedures are also used in the treatment of RA. Other methods than the use of drugs:

• Cold and warm compresses (heat relaxes stiff joints and tight muscles, cold helps with pain and swelling).
• Physiotherapy, exercise (regular movement can relieve pain and improve mobility).
• Orthotics, orthopaedic aids.

In the most severe cases, various surgical solutions are possible – for example, removal of the joint lining, tendon surgery or joint replacement. ^{[17] ,[18]}

Alternative or supportive treatments include various dietary supplements, acupuncture, massage or hydrotherapy. You can also try tai-chi, which is characterised by smooth movements that do not stress the joints, or yoga. Various relaxation techniques can also provide relief from painful sensations. ^[19]

Patients with RA should follow a healthy diet. If some important nutrients are lacking in the diet, they can be supplied to the body in the form of dietary supplements. Supplements can also be used to promote joint health or to relieve the symptoms of RA.
Popular ingredients in dietary supplements include:

• Omega-3 unsaturated fatty acids (can help fight inflammation, reduce swelling and stiffness, and benefit the cardiovascular system).
• Boswellia serrata (a plant that helps keep bones and joints in normal condition).
• Glucosamine and chondroitin (substances important for articular cartilage, support joint health).
• Curcumin (antioxidant with anti-inflammatory effects).^[20],[21]

Consult your physician before taking any dietary supplements to avoid interfering with the effect of the prescribed treatment.

This disease can have a negative impact on overall health and shorten life expectancy. This is due both to the disease itself, especially the severe damage to the joints, as well as the long-term use of corticosteroids and the increased risk of infection.

• According to an American clinical study, patients with RA live to an average age of 77 years, while healthy individuals live to 82 years.
• People with this disease are more likely to suffer from atherosclerosis (hardening of the arteries).
• The risk of heart disease-related death is up to 60% higher in patients with RA than in people without it.
• With the development of modern treatments for RA (biological therapy), the life expectancy of patients is increasing.
  Especially if patients follow their treatment carefully and maintain a healthy lifestyle. ^[22]

An interesting new development in research into the treatment of RA is the finding of scientists at the University of California who are looking at the possibility of influencing the immune system of patients. Scientists there have found that injecting all-trans retinoic acid directly into the joint can change the nature of the cells that cause the disease and make them disease-preventing cells. This approach could be tested in various clinical trials in the coming years. ^[23]