Causes, Symptoms, Risk-Factors and Treatments For Rheumatoid Arthritis Pain

Rheumatoid arthritis is a type of autoimmune disease in which the body’s immune system is attacking normal body tissues, particularly tissues that line the joint bilaterally. Rheumatoid arthritis is not limited to the joints alone, it can also affect some other systems of the body.

Studies have revealed that the actual cause of this autoimmune disease is not known yet, however, there are treatment options available for its management both medical treatment and lifestyle changes (1).

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is defined as a chronic inflammatory autoimmune disease characterized by symmetrical migratory polyarthritis that usually affects the hands and the feet. It is a systemic disease and usually leads to inflammation of the synovial membrane causing synovitis.

Rheumatoid arthritis can affect any joint so long the joint is lined by a synovial membrane. Being a systemic disease, it can affect other organs and systems of the body such as the heart, the eyes, and the skin. The flare usually more when it is affecting individuals with a family history or genetic susceptibility (2).

What’s Rheumatoid Factor?

Rheumatoid arthritis cannot be discussed without mentioning the rheumatoid factor. A rheumatoid factor test is a blood test usually carried out to determine the amount of rheumatoid factor present in the body.

An individual with an autoimmune disease will demonstrate a high level of rheumatoid factor in their bloodstream which does not automatically mean rheumatoid arthritis, a patient with another autoimmune disease such as Sjogren’s syndrome will also have elevated rheumatoid factor (3).

The Normal Joint Physiology

To understand what is happening in a joint with rheumatoid arthritis, it is also important to understand how normal joint works and what in a normal joint gets affected by rheumatoid arthritis.

The position where two or more bones meet is referred to as a joint. The presence of joints in the body permits us to move in different directions either laterally, medially, internally rotation or externally rotation, the knee joint for instance is one of the physiologically important joints in the body because it helps to bear the weight of the body, and it helps to stand properly.

The distal part of each bone is covered by cartilage, a tissue made up of smooth surfaces that help to keep the joints in place, and also permits movement without friction. In between the joint is the synovium which contains the synovial fluid, a thick slippery fluid that protects the joint. There is also the presence of tendons that helps to attach the bones to the muscles (4).

Pathophysiology Of Rheumatoid Arthritis

The pathophysiology of rheumatoid arthritis is still been studied according to researchers as it is currently not understood. In the presence of genetic susceptibility, the presence of a trigger such as infection or smoking will lead to an autoimmune reaction.

This autoimmune reaction will furthermore manifest as inflammation of the synovium and other joint tissues with other systemic manifestations.

Before full-blown rheumatoid arthritis occurs, there is a pre-rheumatoid phase of the disease that gradually progresses in different phases to actual and active rheumatoid arthritis.

In conclusion, chronic inflammation and hypertrophy of the synovium will lead to tissue destruction as well as the cartilage, ligaments, tendons, and vascular structures. Although the articular structures above are the primary areas of attack by rheumatoid arthritis, rheumatoid arthritis also affects other tissues (2).

Comparison Between Rheumatoid Arthritis And Other Articular Diseases

Rheumatoid arthritis should be compared with other articular diseases such as osteoarthritis and lupus for better understanding.

• – Rheumatoid arthritis vs lupus

Rheumatoid arthritis and lupus are commonly confused or misdiagnosed one for one because of their similarity in clinical manifestations. Rheumatoid arthritis and lupus are both types of autoimmune diseases in that they result from the body’s immune system attacking its normal cells.

The clinical features of rheumatoid arthritis and lupus often mimic each other. Symptoms like pain, joint stiffness, and swelling are not severe in patients with lupus and they occur slowly.

However, to differentiate lupus from rheumatoid arthritis, there are certain symptoms patients manifest that are specific to lupus alone, such as the butterfly rash also called malar rash, ulcers, skin rashes, low white blood cell count, and others.

Interestingly, both rheumatoid arthritis and lupus have no cure but they can be managed symptomatically for patient tolerance (5).

• – Rheumatoid arthritis vs osteoarthritis hand

A lot of studies have been ongoing comparing the manifestations of rheumatoid arthritis and osteoarthritis in the hand joints. Rheumatoid arthritis is a chronic autoimmune disease while osteoarthritis is an articular disease of wear and tear that occur as a result of joint overuse.

Studies have revealed that the metacarpophalangeal joint of the big finger in the hand is commonly affected in patients with rheumatoid arthritis. These patients are commonly present with swelling and stiffness of the joint.

In rheumatoid arthritis of the hand, distal interphalangeal joints of the hand and toes are usually spared. When rheumatoid arthritis is the joint junction between the ulnar and radius bone it usually manifests as wrist pain and tenderness. Rheumatoid arthritis has a predisposition to affecting the small joints first.

Unlike rheumatoid arthritis, osteoarthritis has an initial target for the big joints of the body. When the hand is affected, the index finger and the thumb are commonly affected. To studies, a patient who complains about osteoarthritis in the hand mostly complains of the affectation in their dominant hand (6).

Causes Of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic autoimmune disease that occurs as a result of the body’s immune system affecting its normal cells. However, the specific etiology of rheumatoid arthritis is not yet known.

In rheumatoid arthritis, inflammatory cells are sent by the immune system to the joint lining and other systemic areas of the body. The antibodies released caused the disintegration of the synovial cells and consequently led to inflammation. There is a release of chemical substances that will lead to the destruction of the cartilage, tendons, and ligaments.

If rheumatoid arthritis is not managed thoroughly early, it can lead to total joint destruction and misalignment of the joint (7).

Risk Factors Of Rheumatoid Arthritis

The following factors will increase the risk of predisposition to rheumatoid arthritis:

• – Age: anyone at any age is at risk of rheumatoid arthritis irrespective of the age of the individual. But commonly, it is commoner in the middle age group.
• – Sex: rheumatoid is more commoner in women than in the male gender.
• – Family history: family history is another strong risk factor for developing autoimmune disease. The presence of rheumatoid arthritis in any member of the family, especially the first-degree relatives is a risk factor for developing rheumatoid arthritis.
• – Smoking: Smoking cigarette increases the likelihood of developing rheumatoid arthritis, especially in people that are genetically predisposed to RA. Smoking also causes poor prognosis in such patients.
• – Obesity: being overweight or obese increases the risk of rheumatoid arthritis. Obesity is an associated high-risk factor for articular diseases (8).
• – Diet: excessive consumption of a diet rich in sugar, sodium, and red meat increases the risk of rheumatoid arthritis. Iron has also been traceable to the development of rheumatoid arthritis.
• – Early exposure: early exposure to triggers such as smoking in nursing mothers makes their children passive smokers, according to the center for disease control (CDC), such early exposure increases the risk of rheumatoid arthritis (7).

Joints Commonly Affected By Rheumatoid Arthritis

The following joints of the body are commonly affected in patients with rheumatoid arthritis and the patient can feel pain in the following areas:

• – Hands
• – Fingers
• – Toes
• – Feet
• – Elbow
• – Others are wrists, knees, and ankles (1).

Other areas of the body aside from joints affected by rheumatoid arthritis are:

• – Heart
• – Lungs
• – Eyes
• – Skin
• – Others are kidneys, vascular tissues, and salivary glands (8).

Rheumatoid Arthritis Elbow

Just as in other joints of the body, rheumatoid arthritis elbow joint will lead to the progressive and slow destruction of the joint tissues. In certain individuals, rheumatoid arthritis elbow manifests as a bulge-like swelling around the elbow due to the chronic effect of the inflammation on the joint.

When the first joint to be affected is the elbow, then the pain will start from the elbow joint progressively affecting other joints of the body such as the toes, hands, hip, and knee joint.

When the diagnosis is picked early, it will lead to rapid inflammation of the elbow joint tissues such as the synovium and the bursa causing synovitis and bursitis, which occurs when the fluid pads in the joints get inflamed. Continuous and uncontrolled edema from inflammation can cause the nerves around the joint to be compressed (9).

Symptoms Of Rheumatoid Arthritis

Rheumatoid arthritis is a chronic inflammatory disease, hence, common symptoms seen in the patients are the signs of inflammation and pains around the joint.

The symptoms reach the peak when the patient has flares and they subside or fade off in the time of remission when the patient is currently not under any attack.

Symptoms are commonly affected in joints of the wrists, hands, toes, and knee joints. Also, other tissues of the body can be affected such as the heart, the skin, the lungs, and the eyes (7).

The following are the main symptoms commonly manifested by patients with rheumatoid arthritis:

• – Joint pain
• – Edema of the joint
• – Joint redness
• – Differential warmth of the affected joint
• – Joint stiffness is worse after waking up from bed and can last for up to 30 minutes.
• – Joint/bone deviation, is commonly recorded in the ulnar bone. Rheumatoid arthritis ulnar deviation is characterized by the bending of fingers to the lateral side facing the pinky finger and the wrist towards the thumb.

Other symptoms experienced by people with rheumatoid arthritis are:

• – Fatigues, demonstrated by extreme tiredness and generalized body weakness
• – Anorexia, lack of appetite
• – Weight loss
• – Hyperpyrexia, a very high fever
• – Excessive sweating
• – Eye dryness, usually from inflammation
• – Chest pain
• – Rheumatoid nodules, this is a form of lump usually seen under the skin of the affected joints. Although not always painful, some patients elicit tenderness on palpation of the nodules.
• – Most often than not, when rheumatoid arthritis occurs, it is usually bilaterally more than just one part of the body, although not all the time (4).

Diagnosis Of Rheumatoid Arthritis

As much treatment is important in making a patient with rheumatoid arthritis feel better, it is also important to make a good diagnosis that will guide the treatment. A specialized physician called a rheumatologist is often in charge of caring for patients with rheumatoid arthritis.

Diagnosis entails a detailed medical history, examination, laboratory, and imaging studies.

• – Medical history: A detailed history of the joint symptoms is very important when it started if it is recurrent, the level of severity of the pain, what the patient has done to get relieved the pain, and if there is a family history of similar symptoms in the family or a family history of rheumatoid arthritis.
• – Examination: On examination, the doctor can notice swelling around the joint, the presence of differential warmth or redness, difficulty moving the limbs, and tenderness of the joint on palpation.
• – Blood tests: blood tests are usually done to check for antibodies, infectious agents, and the presence of rheumatoid factor to further ascertain the diagnosis. The following blood tests are done:

1. a) Rheumatoid factor: rheumatoid factor is commonly seen in a patient with rheumatoid arthritis and other autoimmune diseases. Another type of antibody commonly seen is a cyclic citrullinated peptide in the majority of patients with rheumatoid arthritis.
2. b) ESR (Erythrocyte sedimentation rate): ESR is usually done to confirm the presence of an ongoing inflammatory process. C-reactive protein can also be done alongside ESR still for the same purpose.

• – Imaging studies: this includes an x-ray, CT scan, or MRI. These tests are usually done to check the bones, joints, and surrounding soft tissues. Erosion is the major usually checked for. Rheumatoid arthritis x ray hand will show the affected small joints, and how bad it is and can also help to know when the treatment is winning (10).

7 Treatments For Rheumatoid Arthritis Pain

The treatments for rheumatoid arthritis symptoms include the use of medication and lifestyle changes. People with RA have the option to first try diet and lifestyle changes to reduce pain and rheumatoid arthritis symptoms at their own. If pain relief is not experienced, they may want to see a licensed physician for prescription medicines that may help reduce pain and stiffness associated with joint damage.

Medications

In the treatment of rheumatoid arthritis, the physician will use some or most of these medications in the management of the patient:

1. 1. Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are commonly used with caution and prescription in rheumatoid arthritis patients in the treatment of pain and inflammatory symptoms.
2. 2. Steroids: steroids can also be prescribed by the doctor to treat pain and reduce the symptoms felt by the patient.
3. 3. (DMARDs): DMARDs is an acronym for disease-modifying antirheumatic drugs. The drug works by reducing the disease progression of rheumatoid arthritis and they can do this by inhibiting the immune response of the body.
4. 4. Biologics: Biologics are new generational drugs often referred to as modified DMARDs. Instead of blocking the immune system of the patient like DMARDs will do, biologics work against inflammation by slowing down the systemic inflammatory reaction.

Lifestyle changes

The following lifestyle changes will help to improve the quality of life of patients with rheumatoid arthritis:

5. Exercise as recommended by an Occupational Therapist. Proper rest.

6. Anti-inflammatory diets such as foods rich in omega-3 fatty acids to reduce inflammation.

7. Hot or cold compress as prescribed by the physician, similar to occupational therapy (7).

References:

1. 1. https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis
2. 2. https://emedicine.medscape.com/article/331715-clinical
3. 3. https://www.mayoclinic.org/tests-procedures/rheumatoid-factor/about/pac-20384800
4. 4. https://www.versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/
5. 5. https://www.webmd.com/rheumatoid-arthritis/ra-lupus-difference
6. 6. https://www.medicinenet.com/rheumatoid_arthritis_vs_osteoarthritis_hands/article.htm
7. 7. https://www.healthline.com/health/rheumatoid-arthritis#diet
8. 8. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
9. 9. https://www.healthline.com/health/advancing-rheumatoid-arthritis/rheumatoid-arthritis-in-elbow#impact-on-elbow
10. 10. https://www.arthritis.org/diseases/rheumatoid-arthritis