Rheumatoid arthritis (RA) is a long-lasting 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. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.
Onset is most frequent during middle age and women are affected 2.5 times as frequently as men. The term rheumatoid arthritis is based on the Greek for watery and inflamed joints.
CAUSES
Rheumatoid arthritis occurs when your immune system attacks the synovium — the lining of the membranes that surround your joints .The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint.The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.
RISK FACTORS
Your sex. Women are more likely than men to develop rheumatoid arthritis.
Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
SIGNS AND SYMPTOMS
RA primarily affects joints, but it also affects other organs in more than 15–25% of individuals.
Joints – Most commonly involved are the small joints of the hands, feet and cervical spine, but larger joints like the shoulder and knee can also be involved.
RA typically manifests with signs of inflammation, with the affected joints being swollen, warm, painful and stiff, particularly early in the morning on waking or following prolonged inactivity. Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for more than an hour. 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 suffer from almost any deformity depending on which joints are most involved. Specific deformities, which also occur in osteoarthritis, include ulnar deviation, boutonniere deformity (also “button hole deformity”, flexion of proximal interphalangeal joint and extension of distal interphalangeal joint), 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.”Spindling of fingers” of hand occurs due to swelling of the PIP but not DIP joints. “Piano key movement” of the ulnar styloid occurs due to inflammation around the ulnar styloid and tenosynovitis of extensor carpi ulnaris.
Skin – The rheumatoid nodule, which is sometimes in the skin, is the most common non joint feature . Several forms of vasculitis occur in RA. A benign form occurs as microinfarcts around the nailfolds.
Lungs – Fibrosis of the lungs is a recognized response to rheumatoid disease.. Pleural effusions are also associated with RA. Another complication of RA is Rheumatoid Lung Disease.
Kidneys – Renal amyloidosis can occur as a consequence of chronic inflammation
Heart and blood vessels – People with RA are more prone to atherosclerosis, and risk of myocardial infarction (heart attack) and stroke is markedly increased. Other possible complications that may arise include: pericarditis, endocarditis, left ventricular failure, valvulitis and fibrosis
Other
Eyes – The eye can be directly affected in the form of episcleritis or scleritis..
Liver- Liver problems in people with rheumatoid arthritis may be due to the underlying disease process or as a result of the medications used to treat the disease.
Blood – Anemia is by far the most common abnormality of the blood cells which can be caused by a variety of mechanisms.
Neurological – Peripheral neuropathy and mononeuritis multiplex may occur. The most common problem is carpal tunnel syndrome caused by compression of the median nerve by swelling around the wrist..
Constitutional symptoms – Constitutional symptoms including fatigue, low grade fever, malaise, morning stiffness, loss of appetite and loss of weight are common systemic manifestations seen in people with active RA.
Bones – Local osteoporosis occurs in RA around inflamed joints. It is postulated to be partially caused by inflammatory cytokines. Cancer
The incidence of lymphoma is increased in RA, although it is uncommon
HOMOEOPATHIC MANAGEMENT
Homoeopathic medicines can reduce the frequency , duration and severity of the attacks and delay the onset of complications. In advanced stages where deformity of the joints have occurred , homoeopathy can help to ease the pain . it also helps in reducing the joint stiffness and pain .