What is Rheumatoid Arthritis (Inflammatory Rheumatism)? What are the Symptoms?

Rheumatoid arthritis, also known as inflammatory rheumatism, is a chronic autoimmune disease in which the immune system mistakenly attacks the cells lining the joints, causing inflammation, deformation, and functional problems. Common symptoms caused by rheumatoid arthritis are joint pain, swelling, stiffness, and loss of function. Rheumatoid arthritis, which can also affect other parts of the body, can be treated with lifestyle changes, physical therapy, medication, or surgery.

WHAT IS RHEUMATOID ARTHRITIS (INFLAMMATORY RHEUMATISM)?

Rheumatoid arthritis is an autoimmune disease that causes inflammation in the synovium tissues in the joint, causing pain, swelling, temperature increase, and stiffness in the joints. The joints most commonly affected by rheumatoid arthritis are the hands, wrists, feet, ankles, knees, shoulders, and elbows. Apart from small joints, it can also target organs or other joints. Symptoms include joint pain, stiffness, swelling, fatigue, or fever. Inflammatory rheumatism, one of the most common types of arthritis, causes pain and swelling, limiting the person’s movement in daily life. If left untreated, it can cause permanent damage to the joints.

WHAT ARE THE STAGES OF RHEUMATOID ARTHRITIS?

The development of rheumatoid arthritis is characterized by several stages, which vary from person to person. Most patients recognize the joint and physical changes that occur during these stages. Not all patients are expected to go through these stages, and the treatment methods to be applied at each stage also differ. The main goal of rheumatoid arthritis treatment is to control the disease activity and minimize any permanent damage that may occur.

Early stage rheumatoid arthritis: In this stage, patients with rheumatoid arthritis experience joint pain, swelling, or difficulty in movement. It is often accompanied by morning stiffness that persists for a certain period. At this stage, there is inflammation inside the joint. As a result, swelling of the joint may be noticeable. However, no damage to the bones is observed.

Mid-stage rheumatoid arthritis: This is the period when inflammation begins to damage the articular cartilage. In addition to symptoms such as pain and swelling, restriction in joint movements and loss of movement may be observed due to damage to the cartilage tissue. Accordingly, the range of motion in the joints may become limited.

Advanced stage rheumatoid arthritis: In this stage, damage develops not only in the cartilage but also in the bones. During this period, much more pain and swelling can be observed. Permanent damage to the bones, called erosion, is often associated. Some patients may develop deformities, muscle weakness, and loss of movement.

End-stage rheumatoid arthritis:  In this period, which is called the last stage of rheumatoid arthritis, permanent damage caused by the disease is at the forefront rather than inflammation in the joint. In this period, ongoing pain, swelling, and loss of movement can be observed in patients. There is usually a decrease in muscle strength. In addition to deformities due to damage to the joints, fusion development, which can be defined as the fusion of bones to each other and in which joint function disappears, can be seen.

In the course of rheumatoid disease, periods of low disease activity or so-called remission, in which symptoms are markedly reduced, can be observed, as well as phases called exacerbations, which worsen with very intense pain and clinical findings.

WHAT ARE THE SYMPTOMS OF RHEUMATOID ARTHRITIS (INFLAMMATORY RHEUMATISM)?

Symptoms of inflammatory rheumatism are pain, swelling, stiffness, and tenderness in the joints, as well as muscle pain. Symptoms of rheumatoid arthritis vary from person to person. The extent of involvement, age of onset, other concomitant diseases, clinical findings, and course have an effect on the course.

Symptoms of rheumatoid arthritis, a type of inflammatory rheumatism, are as follows:

• Tenderness, swelling, and pain in more than one joint
• Stiffness in the joints, usually in the morning or after inactivity due to non-use
• Involvement of the joints of the fingers and toes, wrist, and ankle joints
• stiffness in large joints such as elbow, shoulder, hip, and knee joints
• Fatigue
• Fire
• Appetite and weight loss
• Pain in the affected joints
• Limitation of movement
• Swelling in the joints
• Increased temperature and sometimes redness
• Stiffness, especially in the morning or after prolonged sitting

Rheumatoid arthritis can lead to general symptoms such as weakness, fatigue, loss of appetite, and, in some patients, fever.

WHAT CAUSES RHEUMATOID ARTHRITIS?

Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the synovium tissues in the joint, causing chronic inflammation. This causes the destruction and weakening of the bone tissue in the joint.

WHAT ARE THE RISK FACTORS FOR RHEUMATOID ARTHRITIS?

In rheumatoid arthritis, the underlying reasons why the immune system reacts and attacks the patient’s tissues are still under investigation. It is thought that certain genetic predispositions, personal characteristics, infection, immune system, tobacco use, and environmental factors may be effective in the development of rheumatoid arthritis.

Women are more likely to develop rheumatoid arthritis

Rheumatoid arthritis can occur at any age, but the risk of developing the disease increases with increasing age. Women are 2-3 times more likely to develop the disease than men.

Tobacco smoking

Medical studies have shown that smoking increases a person’s risk of developing rheumatoid arthritis and can worsen the disease. Smoking can significantly increase the risk, especially in patients who carry certain classes of genes. Patients with rheumatoid arthritis are therefore advised to stop smoking as soon as possible.

Being overweight and obesity

Overweight can also increase the development of rheumatoid arthritis. Studies examining the role of obesity in the development of this disease have shown that the more overweight a person is, the higher the risk of developing rheumatoid arthritis.

HOW IS RHEUMATOID ARTHRITIS (INFLAMMATORY RHEUMATISM) DIAGNOSED?

The diagnosis of people presenting with symptoms of rheumatoid arthritis is made by evaluating appropriate laboratory tests (e.g. RF, Anti CCP) and imaging methods (X-ray, ultrasonography, or MRI) together. Since the findings of inflammatory rheumatic diseases may show similarities, it would be the best approach to consult an experienced specialist physician or preferably a rheumatology department to clarify the diagnosis of rheumatoid arthritis.

HOW IS RHEUMATOID ARTHRITIS (INFLAMMATORY RHEUMATISM) TREATED?

Early recognition of rheumatoid arthritis and initiation of appropriate treatment as early as possible is the most important factor in the success of treatment, patient satisfaction, and prevention of possible complications. Lifestyle changes, abandoning habits such as smoking, losing excess weight with an appropriate diet, and doing the recommended exercises regularly are as important as drug treatments. Rheumatoid arthritis treatment includes:

• Drug treatment of rheumatoid arthritis usually involves the use of so-called disease-modifying antirheumatic drugs (DMARDs), which slow down the disease, control symptoms, and prevent joint deformity.
• Rheumatoid arthritis often requires the use of cortisone therapy for initial treatment and in some patients for longer periods. In each patient, the aim should be to be able to stop using cortisone treatment at the lowest possible dose and for the longest possible time. Various painkillers and anti-inflammatory drugs may also be used for pain control.
• The aim of rehabilitation in rheumatoid arthritis is to reduce the patient’s pain, maintain the range of motion of the joints, and prevent muscle atrophy, which is called muscle weakening, in a way to supports the drug treatments being used.
• Physiotherapy and rehabilitation are also important in rheumatoid arthritis. Physical therapy and rehabilitation treatments include movement restriction, i.e. immobilization, individualized posture adjustment, reducing the load on the joint by splinting when necessary, cold-hot water applications, and therapeutic exercises.
• The main aim of surgical treatments in rheumatoid arthritis is to relieve pain and improve function. The need for surgical treatment of rheumatoid arthritis is generally accepted as an indirect indicator of joint destruction and unsuccessful medical treatment, although surgical biopsy operations for diagnostic purposes may also be needed in some patients today.
• Surgical approach methods include preventive or therapeutic arthroscopy and synovectomy, therapeutic resection arthroplasty, arthrodesis, or total joint replacement.
• In addition, arthrodesis, which is the freezing of the joint and fixing it in a certain position, can be applied to joints such as the wrist, foot, or ankle in some patients. This procedure can be performed to relieve persistent joint pain that cannot be prevented by splinting and medication.

FREQUENTLY ASKED QUESTIONS ABOUT RHEUMATOID ARTHRITIS

What kind of disease is rheumatoid arthritis?

Rheumatoid arthritis is a chronic inflammatory disease caused by the immune system attacking the body’s own tissues. The immune system attacks the joints, leading to the thickening of the synovium and loss and damage to both cartilage and bone tissue through the release of certain enzymes and cytokines. In rheumatoid arthritis, tissue damage caused by the immune system attacking its own tissues causes long-term or chronic pain, deterioration in the natural shape and structure of the joint, and limitations in joint movements as a result of the tendons and ligaments around the joint being affected over time.

Is rheumatoid arthritis a genetic disease?

Although rheumatoid arthritis is not an inherited disease, certain genetic characteristics may increase the risk of developing the disease. Studies have revealed a number of genetic indicators that increase this risk. Carrying these genetic markers, which have been found to be associated with the immune system, chronic inflammation, and especially rheumatoid arthritis, does not necessarily mean that rheumatoid arthritis will develop.

What should patients with rheumatoid arthritis pay attention to?

Patients diagnosed with rheumatoid arthritis should not only be aware of the treatment but also be patient as they have a chronic disease. It is very important to follow up on the disease regularly and at appropriate intervals and to continue the treatments without interruption. Rheumatoid arthritis patients are advised to make some changes in their daily lives and lifestyles.

In addition to the benefits of regular physical activity in fighting disease, it also reduces the risk of developing other conditions such as heart disease, diabetes, and depression. It is therefore ideally recommended that adults stay active by doing moderate physical activity such as walking, swimming, or cycling for 30 minutes a day, five days a week. Patients are also strongly advised to fight obesity by avoiding excess weight, to eat a healthy diet, and to quit smoking.

What precautions should patients with rheumatoid arthritis take during pregnancy?

It is recommended that women with rheumatoid arthritis receive the necessary counseling services before becoming pregnant and, if possible, plan to become pregnant when the disease is under control. Considering that some of the drugs used in the treatment of the disease are strictly forbidden to be used during pregnancy, it is very important to review the drug treatment before pregnancy, to determine the appropriate treatment plan and to evaluate the possible risks.

Observational studies have shown that the course of rheumatoid arthritis often changes during pregnancy. It has been reported that approximately 50% of pregnant women with rheumatoid arthritis have low disease activity, while 20-40% of patients with rheumatoid arthritis can achieve remission in the third trimester; however, exacerbations leading to a significant increase in rheumatoid arthritis activity can develop in approximately 20% of patients during pregnancy. In addition, in some patient series, it has been observed that the rate of postnatal disease exacerbation can reach 45%.

Do herbal medicines give successful results in the treatment of rheumatoid arthritis?

There is no herbal treatment that has been proven effective in the treatment of rheumatoid arthritis and has entered daily practice. However, there are many promising and ongoing herbal medicine research.

How should patients with rheumatoid arthritis eat?

The most appropriate diet recommended for patients with rheumatoid arthritis is the Mediterranean diet, which is low in saturated fat. The Mediterranean diet is a diet that includes plenty of fresh vegetables and fruit, more white meat such as fish and chicken meat, which are healthier, no frying and heavy meals, and protects cardiovascular health. It has been reported that a Mediterranean diet helps to improve the symptoms of the disease and suppress inflammation. The chronic inflammatory process caused by the disease may increase weight loss, muscle breakdown, and the associated protein requirement. Therefore, it is also very important that patients receive adequate energy, protein, and calcium requirements. Vitamin D is a very important vitamin for the musculoskeletal and immune systems. There are views that vitamin D deficiency in rheumatoid arthritis patients may be one of the causes of inflammatory rheumatism or may trigger disease attacks. For this reason, it is recommended that patients with inflammatory rheumatism benefit from the sun as much as possible and that patients with low vitamin D levels use appropriate vitamin D supplements in consultation with their physicians. Food or products containing omega 3, folic acid, and curcumin (turmeric) are among the additional food supplements recommended for rheumatism.

In addition, patients with rheumatoid arthritis are advised to avoid or minimize the consumption of fried meat and other fried non-meat products, sugar, refined carbohydrates, preservatives flavor enhancers, gluten, and alcohol.

Does rheumatoid arthritis occur in children?

Juvenile idiopathic arthritis (formerly known as juvenile-onset rheumatoid arthritis) is the most common inflammatory joint disease in children. There are forms defined depending on the number of joints involved and accompanying systemic symptoms such as fever and rash. The polyarticular form is considered similar to rheumatoid arthritis seen in adults. Symptoms such as pain, swelling, limitation of movement, and redness may develop in the joints. In the type of disease with systemic involvement, involvement of internal organs other than joints may be observed. In the oligoarticular form, uveitis (inflammation of the uvea of the eye) may develop. In all patients, it is important to perform the necessary examinations as early as possible and start treatment in terms of treatment success.

What should rheumatoid arthritis patients pay attention to in general and especially during the Covid-19 pandemic?

Considering the epidemic diseases that cause pandemics today, it is recommended that rheumatoid arthritis patients live by hygiene rules, pay attention to their self-care, especially dental hygiene, and stay away from environments and lifestyles that may threaten their health. Especially in this period of the Covid-19 outbreak, avoiding crowded and closed areas as much as possible, and completing their work as soon as possible by paying attention to the mask and distance rule in mandatory situations will reduce the risk of infection. During this period, it is very important to have regular medical check-ups and to update the medications used according to the patient’s health status. It should not be forgotten that all these precautions and recommendations will increase the success in the treatment of rheumatoid arthritis and provide a healthier and happier quality of life.