Rheumatoid arthritis is the most common of the various forms of Rheumatism chronic inflammatory collectively known as “chronic arthritis.” It is part of what is called autoimmune diseases, diseases where immunity attacks the body of the person with the disease. It is also a system disease that does not always reach only the joints, but sometimes other areas of the body as well.
It causes inflammation of several joints at once, which swell, become painful and are limited in their range of motion. Without treatment, these joints tend to deform gradually over time. Rheumatoid arthritis most commonly affects the hands, wrists, knees and small joints of the feet. Over time, and sometimes early in the illness, the shoulders, elbows, neck, jaws, hips, and ankles can also be affected.
The evolution of rheumatoid arthritis is difficult to predict. In many cases, it develops in flares, interspersed with periods when symptoms subside or even disappear temporarily. As a rule, the disease tends to get worse, to reach and damage more and more joints. If not properly treated, arthritis can become very disabling in 20% of cases. However, in 10-15% of people who have recently, the disease may stop forever or for very long years, spontaneously, and more with recent treatments. And there is rheumatoid arthritis of relatively benign evolution.
Rheumatoid arthritis causes, symptoms and treatment
Rheumatoid arthritis affects 0.25% of the general population, and women three times more often than men 45. It is the most common chronic inflammatory rheumatism. Although the disease may appear at any age, the first symptoms usually occur around age 40 to age 60.
The rheumatoid arthritis is a disease self-immune: the immune system attacks the synovial membrane of joints, including the production of antibodies called “autoantibodies”. The synovial membrane lines the inside of our joints and its role is to manufacture a liquid, the synovial fluid allowing the lubrication of the movements. When it is attacked by autoimmune, this membrane thickens makes too much liquid that contains abnormal inflammatory enzymes, likely to attack the entire joint, cartilage, tendons and bone.
The disease is likely to be triggered by a combination of genetic, biological and environmental factors, particularly smoking.
In recent years, advances in genetics have detected more than 30 genetic factors involved in the development of polyarthritis 3. Only the involvement of certain genes, such as HLA-DRB1 and PTPN22, is clearly demonstrated. However, polyarthritis is not a “purely” genetic disease. It is estimated that the weight of genetics in the onset of arthritis is less than 30% 2.
The inflammation involved The symptoms of polyarthritis are due to an autoimmune reaction triggering abnormal inflammation within the joint. The inflammation first affects the synovial membrane, this membrane surrounding the joints (see diagram above). This membrane thickens, then lets out liquid and some elements of the blood in the joint, which explains the joint swelling. Then, progressively, in aggressive polyarthritis, inflammation damages the joint, cartilage, capsule, tendons, ligaments, muscles and bone, eroding the bone and damaging the joint more and more.
The evolution of rheumatoid arthritis is very variable from person to person. In the majority of cases, the disease gradually sets in over several weeks or months. The symptoms can also occur suddenly. The outbreaks of the disease are interspersed with periods of the improvement more or less long, ranging from a few weeks to a few years.
In 10 to 15% of people with rheumatoid arthritis for less than 3 to 6 months, the disease goes away on its own, permanently or, at least, for a very prolonged period (several months or years). However, despite this apparent cure, a new outbreak may occur.
As a general rule, the disease tends to become worse and affects more and more joints. Some forms of arthritis are very “aggressive” because they also affect organs like the heart, lungs, vessels or kidneys and can be life-threatening. Others can cause very rapid joint destruction, especially in the first 2 years (about 10% to 20% of polyarthritis). Conversely, there are “benign” forms that cause little pain and no joint deformity, even after several years. If they are not treated, however, it is considered that more than half of those affected will have a significant functional disability after 10 years. This often requires the cessation of professional activities.
It is important to get an early diagnosis of the disease to be able to benefit quickly from effective treatment. Current treatments can block the progression of the disease, thus avoiding handicaps.
There is no specific sign to say with certainty that it is rheumatoid arthritis. It is, therefore, necessary to take into account the signs described by the sick person, in particular, the presence of several joint swellings, pains, and their location, as well as fatigue.
There are also exams that go through a health scan that can give clues about the risk of arthritis and indicate inflammation:
- elevation of the sedimentation rate,
- increased C-reactive protein),
- increased autoantibodies (rheumatoid factors and/or anti-citrullinated protein antibodies.
The presence of rheumatoid factor in a person’s blood does not mean that they necessarily suffer from rheumatoid arthritis. This antibody is present in some healthy people and is also found in other diseases.
In the face of suspected rheumatoid arthritis, the medical assessment also includes X-rays of the hands, feet and other inflammatory joints to see typical signs early in the disease. Joint ultrasound or joint MRI can also be requested by the doctor.
A joint deformity may occur over time. For example, fingers are said to deform into “gooseneck” or “buttonhole” and toes, “hammer”. When not properly treated, the disease can result in a loss of dexterity. Simple gestures, such as turning a doorknob or holding a pencil, then become laborious. In rare cases, the disease becomes so disabling that it requires a wheelchair.
Rheumatoid arthritis is also often complicated by disorders outside the joints.
– Dryness in the eyes and mouth (Sjögren’s syndrome),
– Rheumatoid nodules, balls located under the skin often at the elbows or near the joints of the fingers,
– the lungs,
– attacks eyes,
attacks of the heart or vessels,
attacks of the nerves.
– infectious problems.
Fortunately, appropriate treatments, adopted early in the disease, can limit disability and joint destruction. In addition, by adopting a way of life that allows them to reduce the pain, the majority of the people reached manage to have a good quality of life.
- Of pain (or sensitivity) to the affected joints. The pains are stronger at night and in the early morning, or after a period of prolonged rest. They often cause a night awakening in the second half of the night. They can be continual and play a lot on morale.
- The swelling (edema) of one or, most often, several joints. As a rule, the damage is “symmetrical”, that is to say, that the same group of joints is touched on both sides of the body. It is often the wrists or joints of the fingers, especially those closest to the hand;
- Affected joints are also hot and sometimes red;
- A stiff morning joints, which persists for at least 30 to 60 minutes. This stiffness eases after the “rustling” of the joints, that is to say after having mobilized and “warmed up”. However, stiffness can return in the day, after a period of prolonged inactivity;
- Fatigue is very present in this disease, often from the beginning. It can be very disabling and difficult to understand for those around you. It is related to the autoimmune process and inflammation. It can be associated with a lack of appetite.
- Fever may be present during outbreaks of the disease.
Evolution of symptoms
- The more the disease progresses, the more difficult it is to use or move normally the affected joints;
- New joints can be affected;
- Small, hard (non-painful) bumps may form under the skin, especially at the back of the ankles (Achilles tendon), at the elbows and near the joints of the hands. These are “rheumatoid nodules” present in 10 to 20% of people with the disease;
- Depression, caused by pain, the chronicity of the disease, and any life changes it imposes, can occur.
Other symptoms (not affecting the joints)
In some people, the autoimmune process of rheumatoid arthritis can attack various organs in addition to joints. These forms may require a more aggressive therapeutic approach.
- A dry eye and mouth (Sjögren’s syndrome), present in about a quarter of people affected;
- An impairment of the heart, especially its envelope (called pericardium) which does not always cause symptoms;
- An impairment of the lungs or kidneys, which may also be related to or aggravated by the medication;
- Inflammatory anemia.
Rheumatoid arthritis Treatment
Extra virgin olive oil has anti-inflammatory and immunomodulatory properties that could be used in rheumatoid arthritis. Intervention studies in humans are however necessary.
Green tea and EGCG
Researchers have shown in an animal model that a compound of green tea can block the disease. “Existing drugs for rheumatoid arthritis are expensive, immunosuppressive and sometimes unsuitable for long-term use,” says Salah-Uddin Ahmed, a researcher who has worked on this project. This is why his team tested a molecule present in green tea, EGCG (epigallocatechin gallate), for its anti-inflammatory properties.
In an animal model for rheumatoid arthritis, the researchers found that the swelling of the ankles of animals that received EGCG for 10 days was remarkably reduced. EGCG targets TAK1 – a signaling protein involved in inflammation and tissue destruction in rheumatoid arthritis. These results suggest that it would be interesting in rheumatoid arthritis to regularly consume green tea or EGCG. Again, intervention studies are needed.
In an Australian study, researchers looked at the effects of fish oil in early-stage disease. Fish oil contains omega-3 fatty acids: eicosapentaenoic acid or EPA, and docosahexaenoic acid or DHA, which suppress the synthesis of inflammatory molecules, hence the idea of testing them as part of rheumatoid arthritis. Moreover, it has been shown that women who consume a lot of fish have a reduced risk of developing the disease.
Patients with rheumatoid arthritis were divided into two groups: the “fish oil” group received 5.5 g per day of EPA + DHA and the control group 0.4 g per day. All started concurrently with triple therapy with methotrexate, sulphasalazine, and hydroxychloroquine. Doses of triple therapy drugs have evolved with the response of patients. If triple therapy failed, patients received leflunomide.
After one year, 10.5% of patients in the “fish oil” group and 32.1% of control patients had started leflunomide, which is a sign of the failure of triple therapy. The remission rate was twice as high in the group that took the most omega-3s. Therefore, supplementation with omega-3s would slow the progression of rheumatoid arthritis, increase remission rates and limit drug use.
Turmeric is traditionally known for its anti-inflammatory properties, attributed to curcumin. Its effectiveness seems broad and has already been put forward against osteoarthritis. To test its effectiveness against the symptoms of rheumatoid arthritis, 45 patients were divided into 3 groups. They received twice daily, 500 mg of a complement of curcumin, 500 mg of a dietary supplement of turmeric and 50 mg of diclofenac (Voltaren) or 50 mg of diclofenac alone. The dietary supplement used as a particular formulation intended to improve the absorption of turmeric by the body, which is very weak naturally. This is an extract of micronized turmeric (an extremely fine powder) mixed in the essential oil of turmeric.
For eight weeks patients were followed up and their symptoms were assessed using standard questionnaires used for this disease and blood tests. The results show that even though all patients saw their symptoms decrease, it was the group that took turmeric alone that saw the greatest improvement and no side effects. Further studies are needed to confirm these first results.
This spice has anti-inflammatory properties, which have been demonstrated both experimentally and in clinical trials. A placebo-controlled study found that taking 4 capsules of 500 mg of cinnamon powder every day, women with rheumatoid arthritis experienced significant improvement in their symptoms.