နာတာရှည်အဆစ်ရောင်ခြင်း (Rheumatoid Arthritis)

Symptoms

Rheumatoid arthritis mainly affects the joints. It can cause problems in any joint in the body, although the small joints in the hands and feet are often the first to be affected.

Rheumatoid arthritis typically affects the joints symmetrically (both sides of the body at the same time and to the same extent), but this is not always the case.

Pain

The joint pain associated with rheumatoid arthritis is usually a throbbing and aching pain. It is often worse in the mornings and after a period of inactivity.

Stiffness

Joints affected by rheumatoid arthritis can feel stiff. For example, if your hands are affected, you may not be able to fully bend your fingers or form a fist.

Like joint pain, the stiffness is often worse in the morning or after a period of inactivity.

Morning stiffness that is a symptom of another type of arthritis, called osteoarthritis, usually wears off within 30 minutes of getting up, but morning stiffness in rheumatoid arthritis often lasts longer than this.

Swelling, warmth and redness

The lining of joints affected by rheumatoid arthritis become inflamed, which can cause the joints to swell, and become hot and tender to touch.

In some people, firm swellings called rheumatoid nodules can also develop under the skin around affected joints.

Additional symptoms

As well as problems affecting the joints, some people with rheumatoid arthritis have more general symptoms, such as:

• tiredness and a lack of energy
• a high temperature
• sweating
• a poor appetite
• weight loss

The inflammation that's part of rheumatoid arthritis can also sometimes cause problems in other areas of the body, such as:

• dry eyes – if the eyes are affected

• chest pain – if the heart or lungs are affected
  

Causes

Rheumatoid arthritis is an autoimmune condition, which means it's caused by the immune system attacking healthy body tissue. However, it's not yet known what triggers this.

Your immune system normally makes antibodies that attack bacteria and viruses, helping to fight infection.

If you have rheumatoid arthritis, your immune system mistakenly sends antibodies to the lining of your joints, where they attack the tissue surrounding the joint.

This causes the thin layer of cells (synovium) covering your joints to become sore and inflamed, releasing chemicals that damage nearby:

• bones
• cartilage – the stretchy connective tissue between bones
• tendons – the tissue that connects bone to muscle
• ligaments – the tissue that connects bone and cartilage

If rheumatoid arthritis is not treated, these chemicals gradually cause the joint to lose its shape and alignment. Eventually, it can destroy the joint completely.

Various theories of why the immune system attacks the joints have been suggested, such as an infection being a trigger, but none of these theories has been proven.

Risk Factors

There are several things that may increase your risk of developing rheumatoid arthritis, including:

• your genes – there's some evidence that rheumatoid arthritis can run in families, although the risk of inheriting it is thought to be low as genes are only thought to play a small role in the condition
• hormones – rheumatoid arthritis is more common in women than men, which may be because of the effects of the hormone oestrogen, although this link has not been proven

• smoking – some evidence suggests that people who smoke have an increased risk of developing rheumatoid arthritis
  

Diagnosis

Rheumatoid arthritis can be difficult to diagnose because many conditions cause joint stiffness and inflammation and there's no definitive test for the condition.

See a GP if you have these symptoms so they can try to determine the cause.

Seeing a GP

A GP will do a physical examination, checking your joints for any swelling and to assess how easily they move. The GP will also ask you about your symptoms.

It's important to tell the GP about all your symptoms, not just ones you think are important, as this will help them make the correct diagnosis.

If the GP thinks you have rheumatoid arthritis, they'll refer you to a specialist (rheumatologist).

Blood tests

The GP may arrange blood tests to help confirm the diagnosis.

No blood test can definitively prove or rule out a diagnosis of rheumatoid arthritis, but several tests can show indications of the condition.

Some of the main blood tests used include:

• erythrocyte sedimentation rate (ESR) – which can help assess levels of inflammation in the body
• C-reactive protein (CRP) – another test that can help measure inflammation levels
• full blood count – this test can be used to help rule out other possible causes of your symptoms as well as provide an indicator of your general health

The full blood count test can also be used to check if you have anaemia. Anaemia means the blood is unable to carry enough oxygen because of a lack of blood cells.

Anaemia is common in people with rheumatoid arthritis, although having anaemia does not prove you have rheumatoid arthritis.

Rheumatoid factor and anti-CCP antibodies

One blood test measures levels of rheumatoid factors in the blood. Rheumatoid factors are proteins that the immune system produces when it attacks healthy tissue.

More than half of all people with rheumatoid arthritis have high levels of rheumatoid factors in their blood when the disease starts, but about 1 in 20 people without rheumatoid arthritis also test positive.

A related blood test known as anti-cyclic citrullinated peptide (anti-CCP) test is also available. Anti-CCPs are antibodies also produced by the immune system.

People who test positive for anti-CCP are very likely to develop rheumatoid arthritis, but not everybody with rheumatoid arthritis has this antibody.

Those who test positive for both rheumatoid factor and anti-CCP may be more likely to have severe rheumatoid arthritis requiring higher levels of treatment.

Joint scans

Scans may be done to check for joint inflammation and damage.

These can help tell the difference between types of arthritis and can be used to monitor how your condition is progressing over time.

Scans that may be done to diagnose and monitor rheumatoid arthritis include:

• X-rays
• MRI (Magnetic resonance imaging)scans (where strong magnetic fields and radio waves are used to produce detailed images of your joints) 

Assessing your physical ability

If you have been diagnosed with rheumatoid arthritis, your specialist will do an assessment to see how well you're coping with everyday tasks.

You may be asked to fill in a questionnaire on how well you can do things like dress, walk and eat, and how good your grip strength is.

This assessment may be repeated after your treatment, to see if you have made any improvements.

Treatment Options

There's no cure for rheumatoid arthritis. However, early diagnosis and appropriate treatment enables many people with the condition to have periods of months or even years between flares. This can help them to lead full lives and continue regular employment.

The main treatment options include:

• medicine that is taken long term to relieve symptoms and slow the progress of the condition
• supportive treatments, such as physiotherapy and occupational therapy, to help keep you mobile and manage any problems you have with daily activities
• surgery to correct any joint problems that develop

Depending on how much pain, stiffness or joint damage you have, daily tasks may become difficult or take you longer to do. You may have to adapt the way you do everyday tasks.

When To See A Doctor

See a GP if you think you have symptoms of rheumatoid arthritis, so they can try to identify the underlying cause.