Rheumatoid arthritis is one of the most common autoimmune diseases and many people suffer from its uncomfortable symptoms. It is discovered and introduced to the medical community for the first time in 1800 by a French doctor called Augustin Jacob. It occurs when the body’s immune cells (white blood cells) mistake the joint tissues for a foreign body and attack it. Although rheumatism is still used to indicate rheumatoid arthritis, many doctors no longer use it.
The patient’s Immune system for some reason gets confused and starts to attack his healthy tissue causing inflammation, pain, and long-term damage. When the irritated Immune system does not work properly, it develops new antibodies to attack the lining of joints called synovium which is responsible for reducing joint friction during articulation and has a major role in the smooth movement. Rheumatoid arthritis is a systemic disease, so it does not only affect small joints as in hand and feet but also affects different body organs.
Although Rheumatoid arthritis may affect all people regardless of their gender and age, it is more frequent among women as it is reported that women are three times more likely to get RA than men and this led to a theory that RA is related to female hormones. Researches estimate that 0.2-2% of women all over the world complain of rheumatoid arthritis. Middle-aged people (30-50 years old) are more presumably to get RA. However, people of all ages could get rheumatoid arthritis. People all over the world celebrate October 12 as world arthritis day in which they can raise awareness about rheumatoid and other arthritis diseases.
Recent statistics show that rheumatoid arthritis is less common in rural regions and Asian countries such as China and Indonesia and Australia, America, and northern Europe are found to record the highest numbers of rheumatoid arthritis cases in the world. USA reported cases of rheumatoid arthritis increase by 100,000 cases every year which makes 0.5 – 1.1% of its population suffer from RA. Individuals of different races have different probabilities of getting RA as Caucasians (white people) have the majority of incidence. Doctors assume that it is almost rare to see a black person with RA.
⇒ Now, let’s discuss causes of rheumatoid arthritis.
Causes of rheumatoid arthritis
Rheumatoid arthritis is considered an idiopathic (of unknown cause) disease as nobody knows for sure what causes the immune system to malfunction. However, Ongoing studies have been examining the potential risks of RA. Researchers have put some theories and most of them show that genetic factors play a major role in the prevalence of rheumatoid arthritis. International awareness of how badly RA affects people so many studies are being made about what may contribute to causing rheumatoid arthritis or worsening its symptoms.
Most doctors approved that rheumatoid arthritis is related to human genes and tend to run in families. the most frequent question regarding the previous point is “is rheumatoid arthritis hereditary?”, well there is not a RA causing gene, so it is not hereditary. Statistics show that the risk of getting rheumatoid arthritis increase if you are genetically related to a RA patient as If there is a family member with RA, the probability of getting RA increases by three folds to eight folds. Siblings have a 2 to 3 times higher risk of developing RA. Doctors have identified some genes in the human genome that may predispose their owner to rheumatoid arthritis, these genes may be functioning well in some people and regulate specific immune responses.
Researchers do not fully understand how these genetic markers interact with one another and lead to this immune disorder. The HLA (human leukocyte antigen) gene is accused to be the most significant genetic marker that causes RA. Despite the importance of the HLA gene in distinguishing between self-antigen (natural tissue) and invading foreign bodies in most people, it may mistake and develop immune disorders.
A less approved theory suggests that rheumatoid arthritis has a bacterial origin or caused by a virus that triggers RA, many researchers have dedicated their lives to trying to identify that agent, but they could not. Supporters of this theory claim that the immunity system at some point fails to differentiate between tissues of body joints and the invading pathogen. Other predisposing factors increase your chance of getting rheumatoid arthritis such as having other immune disorders especially type 2 diabetes mellitus. It is believed that the risk of developing rheumatoid arthritis if you are overweight or a smoker is substantially higher. It is hard to know for sure who will get RA. However, it is believed that RA may be caused by both genetic and environmental factors.
Symptoms of rheumatoid arthritis
Rheumatoid arthritis is known to affect small joints as hands or feet on both sides of the body. Arthritis patients complain from many uncomfortable symptoms which make their daily activities so hard. Autoimmune disorders as rheumatoid arthritis affect all body systems so its symptoms are not limited to joints. RA is an Inflammatory disease, so it is usually accompanied by abnormal homeostasis and an irritated immune system. Physicians and orthopedic surgeons divide rheumatoid arthritis symptoms into usual and unusual symptoms, they always consider both types while diagnosing.
Usual symptoms are those which are reported frequently by rheumatoid patients and we will sum them up into seven main symptoms.
- Joint pain and tenderness are the patient’s first complaint. Almost all Rheumatoid arthritis patients suffer from chronic joint pain ranging from mild to severe and it is exaggerated by movement. The first episode of pain comes with no warning and lasts for about two hours. Fortunately, these waves of pain could be controlled by analgesics.
- Some patients experience fatigue and flu-like symptoms days before feeling joint pain. Delocalized muscle numbness and periods of inactivity are said to be the earliest signs of rheumatoid arthritis
- Stiffness of the joints and inability to articulate smoothly. The knee joint is the most affected joint by this symptom and it always gets worse after waking up in the morning or after making effort. Flexing and extending the joint may help reduce its stiffness.
- Limited joint movement is a major barrier for rheumatoid arthritis patients as they could not perform many exercises. Massaging the muscles surrounding the joint is believed to widen the range of its articulation.
- Swelling and redness are the most common results of acute joint inflammation. These symptoms unlike how they look like, are not serious and often do not last for more than two weeks.
- Joint deformity which is considered a complication of uncontrolled rheumatoid arthritis appears as hard painless nodules under the skin. Unfortunately, deformities in bones of the joint could not be fixed by medications and doctors may recommend joint replacement surgery.
RA can also affect other organs throughout the body and cause problems in them and usually untreated rheumatoid arthritis can have serious consequences and much damage to these organs. Unusual symptoms of rheumatoid arthritis are believed to be its complications or resulted from the interaction between body organs and the irritated immune system. We will cover them into:
1) Rash
A rash is an inflammatory condition characterized by the presence of itchy painful small red dots on a localized part on the skin. A rash mostly results from vasculitis which is inflammation of the small blood vessels supplying the skin. Rheumatoid patients are more likely to get their skin irritated and develop rashes due to the flared up immune system. Rheumatoid patients are more likely to get rashes as well as rheumatoid papules than normal people. In severe cases, the skin covering the affected joint may have ulcers. A rash is not a common symptom and affects a small percentage of patients as it is believed that 1% of RA patients will have rashes. Rashes can appear on any part of the skin but it occasionally reported on the fingertips and skin covering joints.
2) Cardiovascular diseases
Cardiovascular diseases are reported to be a probable consequence of untreated rheumatoid arthritis. Many cardiologists believe that rheumatoid arthritis patients are significantly more likely to develop heart problems such as congestive heart failure (CHF). Rheumatoid has become one of the most serious cardiovascular risk factors. Recent studies have estimated that the risk of experiencing a heart attack for RA patients is almost twice more than that for normal people.
The relation between rheumatoid arthritis and cardiovascular disorders are not fully clear. However, many doctors claim that the irritated immune system develops antibodies against the pericardium (layer covering the heart) leading to inflammation in the cardiac tissue. It is assumed that patients with rheumatoid arthritis cannot exercise or do their daily activities, so they are more susceptible to getting obese which increases their risk of developing a cardiac disease. Rheumatologists always recommend managing chronic diseases to control RA symptoms.
3) Osteoporosis
Osteoporosis is a degenerative condition in which bone loss gradually it’s mass. chronic inflammation resulted from rheumatoid arthritis affects bones surrounding the joint as well as the synovium. Osteoporosis is painless and has no noticeable manifestations, so patients occasionally get diagnosed with it after a sudden fracture. Rheumatoid arthritis is one of the most common causes of secondary osteoporosis, therefore RA patients are more likely to lose bone density. Unfortunately, thin and brittle bones may take a long period to restore their normal density.
4) Lung diseases
Lung diseases are considered complications of rheumatoid arthritis. Fortunately, few RA patients experience pulmonary diseases. recent studies estimated that 10% of rheumatoid patients will develop pulmonary fibrosis. Pulmonary disorders resulted from chronic inflammatory diseases as rheumatoid arthritis include pulmonary nodules, Pleurisy (inflammation of layer covering lungs), and interstitial lung disease. Rheumatologists say that prolonged joint inflammation double the risk of getting lung disease which may interfere with normal breathing.
5) Anemia
Anemia is reported as a common condition in patients with rheumatoid arthritis. Anemia is defined as a lack of hemoglobin carrying oxygen due to a decrease in the number of red blood cells (RBCs). Anemia is manifested with frequent dizziness and continuous fatigue. It is believed that anemia in RA patients is resulted in long-term inflammation, as chronic inflammation interferes with red blood cell production in bone marrow leading to declining in their count.
6) Depression
Depression is the least common symptom among the previously mentioned ones. Rheumatoid arthritis patients are mostly unable to do their daily activities properly due to joint pain and stiffness therefore they may experience a change in behavior and loss of interest. Physical and mental conditions are significantly correlated so patients with RA are twice more likely to develop neuropsychiatric symptoms.
- Untreated rheumatoid arthritis will not only cause joint pain and dysfunction but also it will affect other organs leading to systemic diseases. it is said, with no clear evidence, that smoking and drinking alcohol may relieve joint pain and reduce its stiffness. The earlier you manage arthritis, the easier it will be treated. Late staged rheumatoid arthritis is much harder to be treated and occasionally leads to limited choices of treatment. Statistics show that uncontrolled rheumatoid arthritis increase mortality rate, they also show that cardiovascular diseases and secondary infections are the most common cause of death of RA patients.
Diagnosis of rheumatoid arthritis
Rheumatoid arthritis as well as other autoimmune diseases are not easy to diagnose. Doctors may find difficulty in diagnosing especially in its early stage because there are not certain criteria to follow in diagnosing. Rheumatoid arthritis shares many symptoms with other inflammatory diseases so rheumatologists should consider not to get mistaken with them. People should take into consideration that early diagnosis help significantly in avoiding osteoporosis, joint erosion, and many irreversible complications. Then, how doctors diagnose rheumatoid arthritis? Doctors usually more than one method to diagnose accurately, these methods include:
1) Physical examination
Physical examination is the most important and critically indispensable method of diagnosis. Doctors always examine the affected joint carefully, he observes its range of motion and degree of tenderness to evaluate the state of damage. The patient’s good presentation of the symptoms guides the doctor greatly. The degree of pain and joint deformity help rheumatologist determine the stage of arthritis. Physicians depend primarily on the clinical manifestations and his observation to limit the probable disorders considering the most common ones.
2) Patient’s family medical history
The patient’s family medical history is extremely important especially in diagnosing rheumatoid arthritis. Rheumatoid arthritis is majorly believed to run in families and is caused due to genetic factors. If you have a family member who has rheumatoid arthritis, your risks of developing RA is increased by three folds. People should consider that the closer they are to the patient with RA, the more they are susceptible to getting rheumatoid. Having a relative with RA is not confirmative proof that you will develop arthritis. Doctors usually ask patients questions about their family medical history, but if he did not, do not hesitate to tell him whether you have a relative who has RA or not.
3) Blood and urine tests
Patients may be asked for blood and urine tests by their doctors. Physical examination is usually not enough to make a precise diagnosis, so doctors may refer you to the lab to get tested. Although there is not a specific test that confirms whether patients have or have not rheumatoid arthritis, there are other tests that may indicate the presence of inflammation or immune disorder. A blood sample is drawn from your vein by a nurse or a health care professional and sent to a lab to perform the following tests:
- Complete blood count (CBC) test is done to measure the number of blood cells especially white blood cells (WBCs) which represent immune response against pathogens and self-tissue in case of autoimmune disease. Rheumatoid arthritis patients are reported to have an elevated number of WBCs which attack small joints and cause inflammation. CBC is relatively cheap, and most doctors ask their patients to do it.
- C-reactive protein (CRP) is also a common test which doctors ask for to measure the degree of inflammation. C-reactive protein is made by the liver and excreted in response to inflammation. Unfortunately, C-RP is not specific to rheumatoid arthritis, therefore doctors cannot rely on in diagnosing. Rheumatologists use the CRP test not only for diagnosing but also in evaluating drug’s effectiveness and potency.
- Rheumatoid factor test is the newest among the previous tests. Rheumatoid factor (RF) is an antibody that contributes to attacking healthy joint tissue. The rheumatoid factor test is considered the most accurate test in diagnosing rheumatoid arthritis as its specificity is estimated to range from 60% to 80%. More than 75% of adult patients with a rheumatoid factor are reported to have an elevated level of rheumatoid factor in their blood. The more elevated the RF level is in the blood, the worse is the condition of rheumatoid arthritis. RF test is also used in evaluating drug medications’ effectiveness.
- Erythrocyte (red blood cell) sedimentation rate is the least used test to measure the degree of inflammation. ESR test involves putting a certain quantity of blood in a test tube and measure the amount of precipitated red blood cells after one hour. RBCs tend to descend and precipitate more in case of inflammation. Erythrocyte sedimentation rate (ESR) is normally up to 22mm/hr for men and 29mm/hr for women.
- Urine test is used as an additional test. Some rheumatologists ask patients to have a urine test to measure the amount of uric acid to distinguish between rheumatoid arthritis and gout. Gout symptoms are similar to RA, but gout is characterized by elevated uric acid. Doctors exclude gout if uric acid level is normal in the urine.
4) Imaging
Diagnostic imaging tests are frequently used to allow physicians to have a closer look at the damaged organ. There are several types of imaging tests; each of them is sensitive to a certain type of body tissues. The captured images by these imaging techniques provide information and show indications of inflammations, erosion, and joint deformities. Imaging tests help rheumatologists greatly evaluate the severity of rheumatoid arthritis and monitor the progression of patients’ conditions. Rheumatologists usually look for swelling, erosion of bones forming the joint, and fractures in the captured picture. We will cover the most asked for imaging tests in diagnosing rheumatoid arthritis:
- X-rays imaging test is well known to be used as a basic diagnostic method by many specialists. X-rays imaging test involves passing x-rays through the body and being absorbed by joint tissues at different rates giving them different exposures. Standard x-rays test is cheap and almost available in all hospitals, so rheumatologists usually prefer it in judging bone density and intactness. Although the x-rays test is an excellent method in observing the deterioration of the bony parts of joints, it is less effective in detecting the earliest signs of immune disorders. Rheumatoid arthritis patients often do not have to get an x-ray test unless their bones are impaired and eroded.
- Magnetic resonance imaging (MRI) has been used in diagnosing rheumatoid arthritis. MRI technique is more advanced than x-rays imaging. MRI scan involves using strong magnets to produce clear images of internal organs. Radiologists consider MRI superior in imaging soft tissues and observing fluid accumulation. rheumatologists use MRI to detect abnormalities in the soft tissues like muscles, tendons, and synovium of joints. It is believed that doctors can rely on MRI to detect early signs of RA including inflammation and swelling. MRI test is not considered the first option in diagnosing rheumatoid arthritis because it is relatively expensive and is not available in all hospitals. Patients complain sometimes from the loud noise of the scanner during having MRI.
- Ultrasound imaging test is a well-known and commonly used diagnostic method in the last two decades especially in Europe and the USA. Rheumatologists believe that the ultrasound imaging technique is a reliable tool in diagnosing arthritis. The ultrasound technique involves using a machine called a sonogram emits high-frequency sound waves leading to the formation of a clear picture of internal organs. Ultrasound imaging is painless and safe as it does not involve using radiation. Ultrasound as well as MRI tests are approved to detect early signs of rheumatoid arthritis as both of them are sensitive to soft tissues. Unlike MRI, ultrasound imaging test could be done without previous preparation and for everybody which speed up the process of diagnosis. The use of an ultrasound technique for investigating rheumatoid arthritis is currently increasing as ultrasound proved its effectiveness in revealing the degree of the inflammation and tissue damage.
Treatment of rheumatoid arthritis
Rheumatoid arthritis patients frequently seek a permanent cure or the magic pill for this disorder while there is no such thing. Rheumatoid is an idiopathic (of unknown cause) disorder, so doctors cannot treat RA patients by eliminating its cause. Many doctors say that there is no direct cure for rheumatoid but otherwise, they recommend different pharmacologic and nonpharmacologic methods of treatment. RA patients should consider setting realistic goals for their therapy. Symptomatic treatment is the major pathway for rheumatoid patients. Rheumatologists’ main concern is reducing inflammation and remission of rheumatoid symptoms. Clinical studies show that controlling rheumatoid by the proper type of therapy is the key to reducing further consequences. Patients with early-staged rheumatoid have several options for treatment including medications, physical therapy, lifestyle changes, and surgery.
Rheumatologists may rely on medications in treating rheumatoid patients. It is believed that medications play a major rule in slowing down disease progression and preventing serious complications. So, what are the best medications for rheumatoid arthritis? We will cover the most used drugs:
1) Non-steroid anti-inflammatory drugs (NSAIDs)
Non-steroid anti-inflammatory drugs are the first line of treatment for patients with mild to moderate rheumatoid arthritis. NSAIDs approved its efficacy in reducing inflammation and act as prophylactic medications to relieve and prevent symptoms during flare-ups. NSAIDs may not be potent enough in relieving symptoms of moderate to severe rheumatoid. Although Rheumatologists usually give NSAIDs to relieve pain and limit joint damage, they do not recommend them for long term treatment because of their side effects. Most of the NSAIDs cause stomach irritation and increase patient’s risk of getting stomach ulcers so doctors usually give PPI drugs to prevent damage to the stomach lining. Celecoxib (Celebrex) is the safest and effective NSAID in treating rheumatoid arthritis.
2) Disease-modifying antirheumatic drugs (DMARDs)
Disease-modifying antirheumatic drugs are used to interfere with the mistaken inflammatory response against joint tissues. DMARDs are believed to be the standard class of medication to treat rheumatoid arthritis as they make noticeable improvements in early and late staged rheumatoid. Although DMARDs are not considered part of symptomatic treatment, they help relieve the pain and reduce morning stiffness. DMARDs may not seem to be effective in the first week so rheumatologists always advise patients to keep taking them. Although most of the disease-modifying antirheumatic drugs proved their effectiveness, they may cause serious adverse effects such as hair loss, bone marrow depression, and different infections. Doctors often prefer hydroxychloroquine (Plaquenil), methotrexate (Trexall), and Leflunomide (Arava) in treating rheumatoid arthritis.
3) Biologics
Biologics are the newer generation of DMARDs. Biologics are genetically engineered protein to act like natural proteins and attach to the antibodies attacking joint tissues leading to reducing inflammation. Biologics as well as DMARDs are considered immunosuppressive drugs which make RA patient more susceptible to infections. Unlike DMARDs, biologics are more specific and block certain inflammatory responses. Most rheumatologists do not give biologics unless DMARDs pharmacologically fails and can not cause any progress. RA patients who take biologics should consider that their risks of getting infected by opportunistic bacteria such as TB are higher than normal people. The most commonly used biologics are Humira (adalimumab), Enbrel (etanercept), Remicade (infliximab), and Rituxan (rituximab).
4) Analgesics and painkillers
Analgesics and painkillers are occasionally used to ease pain and help overcome periods of rheumatoid flare-up. Paracetamol (novaldol – panadol) is considered a drug of choice to relieve mild to moderate rheumatoid pain because it acts centrally with no peripheral action. Unfortunately, paracetamol is hepatotoxic and may cause liver impairment so it is contraindicated to patients with liver diseases. Corticosteroids are potent analgesics therefore they are used to relieve the severe pain of acute rheumatoid. Cortisone and other forms of corticosteroids should be used under the supervision of a healthcare provider because they may cause weight gain and increase the risks of infections.
5) Healthy diet
A healthy diet and balanced nutrition are believed to be important in treating rheumatoid arthritis. Although there is no clear evidence of how an unhealthy diet contributes to getting your symptoms worse, doctors always recommend having a balanced diet. Neither doctors nor nutritionists have put a specific diet plan for rheumatoid patients however balanced nutrition is believed to be the key to treatment. Here are some tips on how to have a healthy diet:
- make sure to cover most of the necessary elements and vitamins in all of your meals.
- try to make room for healthy food and make dietary changes stepwise.
- eat foods reach in calcium and vitamin D to avoid osteoporosis and bone thinning.
- vitamin B supplements may be necessary to keep your nerves functioning well.
- add omega-3 fatty acids to your diet by eating salmon, tuna, herring, and mackerel.
- eat a lot of greens especially those rich in fibers
- avoid foods that may trigger joint inflammation and make your condition worse.
- avoid processed food such as baked and fast food.
- cut down on the amount of sugar in your diet.
- avoid high-fat dairy products and canned food containing gluten.
6) Physical therapy
Physical therapy is so important for rheumatoid patients at any stage. Rheumatologists always motivate their patients to set up a light workout plan to improve their joint flexibility. Frequent exercising does not only enhance joint mobility and strengthens your muscle but also it improves your mental state and boost your mood. Rheumatoid patients are known to have higher risks of developing cardiovascular diseases, so doctors always advise them to practice running to avoid developing cardiac diseases and to lower their blood pressure. Physical therapists can help you create an exercise plan and tell you what the most efficient and suitable exercise for your diseased joints.
Choose gentle exercises and do not put too much pressure on your joints. Doctors usually recommend walking, running, and swimming to improve your cholesterol level and to make your heart stronger. Rheumatoid patients should warm up before doing the exercises and should not push themselves too hard especially when you’re just getting started. If you have a muscle spasm, you should apply hot compresses on it to stimulate blood flow and help the muscle relax. Therapeutic massages may also be useful to reduce stiffness and reduce fatigue. Rheumatoid patients should always remember to stick to the plan to get improved as soon as possible.
Surgeries
Joint surgery is usually the last option of treatment. Rheumatoid arthritis patients do not consider having joint until they found that their medications cannot make any progress on their own. Late staged rheumatoid patients always from unbearable and severe pain, so they find joint surgeries their last resort. Joint surgery is a major operation for RA patients so they should talk to their doctor to know more about it and work together to ensure the best outcome. The percentage of success of joint surgeries is relatively high as these surgeries often restore the ability of movement and help eliminate rheumatoid symptoms dramatically.
Patients with late-stage rheumatoid arthritis usually have one of the following operations:
- Total knee replacement is believed to be the most effective procedure to cure rheumatoid. Surgeons replace your whole joint or the most damaged part with a prosthetic piece. Surgeons do not recommend this kind of surgery except for patients with a severely damaged joint. The inserted prosthetic part usually lasts unworn for 15 to 20 years, so some patients may need to replace them once throughout their lifetime.
- Tendon repair operation could be necessary for patients whose tendons ruptured due to the surrounding inflammation. Tendons are the terminal parts of muscles attached to the bones which are critically important in joint movement. This surgery may involve lying in bed for several days followed by weeks of rehabilitation.
- Synovectomy is a surgical operation in which the surgeon removes the damaged tissues of the synovium. Synovial tissues and fluid which are responsible for reducing joint friction, are believed to be the most affected part of rheumatoid inflammation.
- Arthrodesis surgery which is known as joint fusion is a common operation for rheumatoid patients. This procedure includes removing cartilage and fusing bones of the joint manually when patients could not have a joint replacement.
Types of rheumatoid arthritis
Rheumatologists divide rheumatoid arthritis into two main types: seropositive and seronegative rheumatoid. This classification is based on the seropositivity (presence of rheumatoid factor (RF) and cyclic citrullinated peptides) of the blood tests of rheumatoid patients. The purpose of this classification is to detect the response of rheumatoid patients to medication, but many doctors do not rely on this classification in choosing the course of treatment.
What are the differences between seropositive and seronegative rheumatoid arthritis?
1. seropositive rheumatoid arthritis (RA)
Seropositive patients are found to be about 60-70% of rheumatoid patients. Statistics show that rheumatoid patients who have tested positive for rheumatoid factor are more likely to experience extra-articular symptoms. Recent studies reported that seropositive patients would have tested positive RF if they were tested 5 to 10 years before the development of rheumatoid symptoms. Neither Seropositivity nor any blood test proves a bad prognosis. Seropositive rheumatoid is more easily diagnosed so it is managed earlier.
2. seronegative rheumatoid arthritis (RA)
Seronegative patients are estimated to be about 35 -40% of rheumatoid patients. Seronegative patients who test negative RF are harder to be diagnosed than seropositive patients. Rheumatoid factor (RF) is considered an important indication for RA. The absence of rheumatoid factor from patients’ blood may lead to a misdirected diagnosis. Doctors may mistake seronegative RA with osteoarthritis or gout. It is believed that seronegative rheumatoid arthritis has a mild course with fewer complications than seropositive rheumatoid. Extra-articular manifestations of seronegative patients are less reported by rheumatologists.
Rheumatoid arthritis vs osteoarthritis
Many people usually get confused and cannot differentiate between osteoarthritis and rheumatoid arthritis. Both disorders affect joints and have many similar manifestations. RA and osteoarthritis are the most common forms of joint diseases.
Rheumatoid arthritis is caused by a malfunctioning immune system that attacks normal joint tissue, while osteoarthritis is a degenerative disease caused by the gradual wearing of joint cartilage over several years Rheumatoid is reported to be more common in people aged between 25 – 45 years. Osteoarthritis is more common in senile people whose bodies cannot regenerate worn-out cartilage. Rheumatoid arthritis certain cause is still unknown while mechanical friction between the bones of the joint is the main cause of osteoarthritis.
RA and osteoarthritis share many similar symptoms as both lead to joint pain, swelling, and stiffness. osteoarthritis symptoms develop gradually over time, while rheumatoid symptoms start as a flare without previous signs or warnings. Rheumatoid usually affects small joints such as hands and feet while osteoarthritis usually affects weight-bearing joints which carry much weight such as the knee joint.
Rheumatoid arthritis vs gout
Gout is an inflammatory disorder characterized by increased uric acid levels in the blood. The cause of gout is mostly increased protein breaking down (catabolism) while rheumatoid is an autoimmune disorder with an unknown cause. Gout as well as rheumatoid arthritis affect small joints. The most affected joint of gout is the metatarsophalangeal of the big toe, so rheumatoid affecting the big toe is usually mistaken with gout. Doctors always ask patients to have CBC (complete blood count) or urinalysis to measure the amount of uric acid in the body fluids and to determine whether it is gout or RA.
The precipitated uric acid crystal in body joints causes an inflammatory response against joints like inflammation of rheumatoid arthritis. Swollen, red, and painful joints are noticed in both disorders. Attacks of gout and rheumatoid are exaggerated in the morning and after doing exercises. Unlike rheumatoid, the inflammation of gout does not affect tendons and ligaments.