Rheumatoid Arthritis

Rheumatoid Arthritis


Rheumatoid arthritis (RA), an autoimmune disease, affects the joints of the hands, feet, wrists, elbows, knees, and ankles. This causes inflammation of the joints, thus leading to the thickening of the tissues that line the joints resulting in swelling and pain in and around the joints. The disease occurs at any age, but is more common in middle ageswomen.

RA progresses in 3 stages as follows:
There is a wide range of symptoms, which depend on the severity of the disease. Common symptoms include pain and stiffness early in the morning or after stillness, limited range of motion, cracking sound of joints in movement, mild swelling around a joint, loss of flexibility, and unbearable pain. OA affects the hips, knees, feet and fingers. OA symptoms hinder work, family life, and social life if not cared for.
Stage 1- pain, warmth, stiffness, redness in synovial joints and swelling of the joint.
Stage 2- Rapid growth of cells, which causes the synovium to thicken.
Stage 3- The inflammation of cells will release certain enzymes that damage the bone and cartilage, causing the joint to lose its shape and alignment.

Causes of RA
There are a few causes that are identified to lead to RA. One such causative agent is a common bacteria called Mycobacterium avium subspecies paratuberculosis (MAP) present in milk and beef. MAP can spread to humans through consumption of infected milk and beef.

Individuals with a certain genetic HLA shared epitope have a fivefold greater chance of developing RA than individuals without those markers. Other genes that are expected to be connected to RA include STAT4 gene which plays essential role in regulating and activation of the immune system; TRAF1 and C5 genes involved in chronic inflammation and PTPN22 gene associated with both the development and progression of RA.

Other causes for RA are obesity, cigarette smoking, air pollution, insecticides and occupational exposures to mineral oil and silica.

Symptoms of RA
RA starts with smaller joints in the fingers, hands and wrists, though it can start in any joint. Joint pain is symmetrical and hence if a joint hurts on the left hand the same joint in the right hand will also hurt.
Some basic symptoms related to RA are mentioned below:

  • Pain in the joints
  • Tenderness
  • Morning stiffness
  • Loss of movement in joint and joint deformity
  • Fatigue
  • Loss of energy
  • Lack of appetite
  • Dry eyes and mouth (Sjogren’s syndrome)
  • Numbness, tingling or burning in the hands and feet
  • Sleep disturbances

Diagnosis of RA
Till date there is no specific test to diagnose RA. The doctors rely on medical history and physical examination of the joints to diagnose RA. Examination of each joint for tenderness, swelling, warmth and painful or limited movement are some indications of RA. There are a few other laboratory tests that aid in the diagnosis of RA such as Rheumatoid factor (RF) test, anti-CCP antibody test, complete blood count (CBC), C-reactive protein, erythrocyte sedimentation rate (ESR), X-ray, ultrasound or MRI of the affected joint, and synovial fluid analysis.

Treatment for RA
Even though RA cannot be cured completely, there are some drugs and methods used to reduce the severity. One such method isthe use of scorpion venom called iberiotoxin, which blocks a potassium channel on certain cells of patients with rheumatoid arthritis. Fibroblast-like synoviocytes (FLS) grow and move from one joint to another secreting products that damage the joints. The scorpion venom blocks the potassium channels that trigger inflammation through these FLS. Thus, one of the hundreds of components in scorpion venom can reduce the severity of the disease.

Drugs that ease symptoms include NSAIDs such drugs as ibuprofen, ketoprofen, and naproxen sodium. For individuals at risk of stomach ulcers, celecoxib, a COX-2 inhibitor is prescribed. Corticosteroids like prednisone, prednisolone, and methyprednisolone are potent and quick-acting anti-inflammatory medications used in RA to bring under control the inflammation. Further, disease-modifying antirheumatic drug, tofacitinib, work to modify the course of the disease.

Stem cells and RA
Even though there are a lot of advancements in the treatment of RA, up to 50% of patients still fail to achieve a significant clinical response. Stem cells besides healing the damaged tissues have the unique ability to modulate the immune system so as to shut off pathological responses while preserving the ability to fight off disease. Mesenchymal stem cells induce the production of T regulatory cells, which protects the body against immunological self-attack, and also decreases pro-inflammatory cytokines IL-6 and TNF-α. Thus researchers are working with stem cells for the treatment of RA had showed gratifying results.