What is arthritis?

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Rheumatoid arthritis is a chronic inflammatory autoimmune disease that attacks the joint tissues of a person whose immune system, instead of protecting the body from external agents such as viruses and bacteria, is abnormally activated against it. In this case, the antibodies affect our synovial membrane, the inner lining of the joint capsule, which reacts to the inflammation by increasing in volume and giving rise to the synovial cloth. 

Symptoms of rheumatoid arthritis

In most cases, rheumatoid arthritis presents with painful, swollen, hot, and red joints, with or without prolonged morning stiffness. The disease is symmetrical. That is, it usually affects the same joints on both sides of the body simultaneously.

The first joints affected are usually hands, feet, and wrists, but large joints such as shoulders, knees, elbows, etc., can also be affected. Joint involvement may be preceded, rarely, or associated with systemic manifestations, such as fever, fatigue, weight loss, muscle aches, and skin redness.

In any patient with pain in the wrists and small joints of the hands and feet, swelling of 3 or more joints persistent for more than 12 weeks, and stiffness on awakening for more than 30 minutes, rheumatoid arthritis should be suspected, and a rheumatologist consulted.

How arthritis is diagnosed: what tests to do

In case of suspected rheumatoid arthritis, the doctor will prescribe simple blood tests, which will look for all those signs of an ongoing inflammatory process. About 70% of patients with rheumatoid arthritis have elevated rheumatoid factor (RF) levels in the blood. The sedimentation coefficient and the anti-cyclic citrullinated peptide (anti-CCP) are also high. It is also possible to measure the increase in ESR – an inflammatory index that measures the speed with which red blood cells settle on the bottom of the tube – of the C reactive protein (CRP) and the decrease in hemoglobin (index of anemia.

The early diagnosis of the disease is fundamental. The so-called “window of opportunity,” an initial period of illness, corresponds to the first three months from the onset of symptoms. Particularly sensitive to the action of anti-rheumatic drugs modifying the course of the disease (DMARDs). In fact, the therapy is started in the early stages. There are greater chances of remission and better clinical results.

Treatment of the arthritis

If arthritis is not treated correctly or does not respond to treatment, chronic inflammation can lead to cartilage destruction, bone erosions, and deformities. In patients with severe rheumatoid arthritis, other organs and systems may also be affected, with an increased risk of cardiovascular, infectious, hematological, gastrointestinal, and respiratory complications, which have been recognized as the most likely causes of premature death in patients rheumatoid arthritis.

There are several drugs to control the disease. They are used for anti-inflammatory drugs (NSAIDs), corticosteroids,anti-rheumatics, and immunomodulators (so-called DMARDs).

Then there are the biological drugs used in cases where the therapy with DMARDs is no longer effective. Biological drugs are made from living organisms, unlike synthetic drugs, produced through chemical processes.