Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body, including skin, eyes, lungs, heart, nerves, and blood. This may result in a low red blood cell count, inflammation around the lungs, fever, low energy and inflammation around the heart. Often, symptoms come on gradually over weeks to months. The cause of rheumatoid arthritis is believed to involve a combination of genetic and environmental factors. The underlying mechanism involves the body's immune system attacking the joints. This results in inflammation and thickening of the joint capsule. It also affects the underlying bone and cartilage. The diagnosis is based on a person's signs and symptoms. X-rays and laboratory testing may support a diagnosis or exclude other diseases with similar symptoms. Other diseases that may present similarly include systemic lupus erythematosus, psoriatic arthritis, and fibromyalgia. The goals of treatment are to reduce pain, decrease inflammation, and improve a person's overall functioning. This may be helped by balancing rest and exercise, the use of splints and braces, or the use of assistive devices. Pain medications, steroids, and NSAIDs are frequently used to help with symptoms. Disease-modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine and methotrexate, may be used to try to slow the progression of disease. Biological DMARDs may be used when the disease does not respond to other treatments. However, they may have a greater rate of adverse effects. Surgery to repair, replace, or fuse joints may help in certain situations. Rheumatoid arthritis affects about 17.6 million people globally, as of 2020. This is 0.5–1% of adults in the developed world with between 5 and 50 per 100,000 people newly developing the condition each year. Onset is most frequent during middle age and women are affected 2.5 times more than men. It resulted in 38,300 deaths in 2020, up from 28,000 deaths in 1990. The first recognized description of RA was made in 1800 by Dr. Augustin Jacob Landré-Beauvais (1772–1840) of Paris. The term rheumatoid arthritis is based on the Greek words for watery and inflamed joints (from Ancient Greek ῥεῦμα (rheûma) 'flowing current', with arthritis derived from arthr- (meaning 'joint') and -itis (meaning 'inflammation')).
Signs and symptoms Rheumatoid arthritis (RA) is a chronic autoimmune disorder that can affect multiple organ systems. It mainly affects fluid filled connections between joints (synovial joints), causing inflammation, pain, and stiffness in the joints. RA also affects other organs in 20–40% of people. RA typically develops slowly and affects both sides of the body. Systemic symptoms such as fatigue, low-grade fevers and weight loss are also seen in RA.
Joints
The main symptoms of RA are joint pain, swelling, and stiffness, which are usually worst in the morning or after resting. Joint affected by RA are often tender when pressed or moved. Morning stiffness can last for several hours but gradually improves with movement and physical activity.This is different from osteoarthritis, where stiffness doesn't last as long. The symptoms of RA can make it difficult to perform everyday tasks, interfere with sleep, and reduce overall quality of life. RA usually develops gradually and often begins by affecting the small joints of the hands (metacarpophalangeal and proximal interphalangeal joints) and feet before spreading to larger joints. The condition can affect any joint, tendon, or bursa that contains synovial tissue, including the elbows, shoulders, ankles, knees, hips, and jaw. RA is polyarticular, meaning it affects multiple joints. Although RA usually affects the same joints on both sides of the body, this symmetry may not be present in the early stages. RA can be difficult to detect when it first develops because inflammation of the synovial membrane (synovitis) may not be visible early on. Signs of synovitis include soft, spongy swelling around a joint. Joint deformities are not seen early in the disease but can develop over time if RA is severe, chronic, or left untreated, and can potentially lead to significant disability. As the pathology progresses, the inflammatory activity leads to tendon tethering and erosion and destruction of the joint surface, which impairs range of movement and leads to deformity. The fingers may develop almost any deformity depending on which joints are most involved. Specific deformities, which also occur in osteoarthritis, include ulnar deviation, boutonniere deformity (also "buttonhole deformity", flexion of proximal interphalangeal joint and extension of distal interphalangeal joint of the hand), swan neck deformity (hyperextension at proximal interphalangeal joint and flexion at distal interphalangeal joint) and "Z-thumb." "Z-thumb" or "Z-deformity" consists of hyperextension of the interphalangeal joint, fixed flexion, and subluxation of the metacarpophalangeal joint and gives a "Z" appearance to the thumb. The hammer toe deformity may be seen. In the worst case, joints are known as arthritis mutilans due to the mutilating nature of the deformities.
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