123 Rheumatoid Arthritis and its Treatments

Introduction

Rheumatoid arthritis is an autoimmune disorder where your immune system attacks your body’s tissues and creates chronic inflammation. This affects the lining of your joints, causing swelling that erodes the bone. Scientists estimate that about 1.5 million people, or about 0.6% of the US adult population, have rheumatoid arthritis. This autoimmune disease can occur in all races, ethnic groups and sexes. However, it is more likely to occur in women than in men. Rheumatoid arthritis most commonly occurs between the ages of 30 and 60. If it develops between the ages of 16 and 40, it is considered young-onset rheumatoid arthritis. On the other hand, if people develop symptoms after 60, it is considered later-onset rheumatoid arthritis. The most common signs and symptoms of Rheumatoid Arthritis are tender or swollen joints, joint stiffness, fatigue, fever and loss of appetite. It can be found in the fingers, hands, wrists, knees, ankles, feet and toes. In addition to affecting your joints, it can also affect your skin, eyes, mouth, lungs and heart. RA is typically diagnosed through physical exams, blood tests, image tests, and more. This chapter discusses rheumatoid arthritis in detail, emphasizing the need for early diagnosis and a comprehensive treatment plan that incorporates pharmacological intervention, lifestyle modifications, and therapies, all of which aim to improve patient quality of life.

Connection to STS

The topic of rheumatoid arthritis connects to science and technology because scientific research plays a crucial role in developing new treatment options and improving patient outcomes. Advances in understanding the underlying mechanisms of the disease have led to the creation of targeted biologic therapies that can better manage symptoms and slow disease progression. Ongoing studies continue to explore potential treatments, offering hope for more effective and personalized care in the future. This is connected to society because improved treatment options can significantly enhance the quality of life for individuals living with rheumatoid arthritis. As patients experience fewer symptoms and more manageable disease progression, they are able to maintain their independence and productivity, which can reduce healthcare costs and lessen the economic burden on families and communities. Additionally, these advancements contribute to increased awareness and understanding of the condition, fostering a more supportive and inclusive society.

Treatments for Rheumatoid arthritis

There are a variety of different treatment options for Rheumatoid arthritis. These include medications, lifestyle changes therapies, or even surgery. While there is no known cure for Rheumatoid Arthritis, treatment typically aims to reduce inflammation, manage pain, and slow the progression of the disease. This helps to minimize joint damage and improve physical function and quality of life. The most common treatment used is medications. The medications can be broken down into three types: non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and disease modifying anti-rheumatic drugs (DMARDs). Non-steroidal anti-inflammatory drugs (NSAIDs) are known for reducing inflammation, which reduces pain and improves function. Common examples of these are aspirin, ibuprofen, naproxen and more. High doses of these are typically necessary to decrease inflammation but once they are taken they can have an anti-inflammatory effect within hours. Gastrointestinal disturbance is the most common side effect but it can also impair renal function and increase blood pressure. Corticosteroids have both anti-inflammatory and immunoregulatory activity. They can provide rapid relief from pain and swelling, making them particularly useful during disease flares or when initiating treatment. They can be given orally, intravenously, intramuscularly, or can be injected directly into the joint. Some examples are prednisone, methylprednisolone and Medrol. While corticosteroids can be effective in controlling symptoms, they are typically prescribed at the lowest effective dose (5 to 10 mg daily) for the shortest duration necessary to minimize potential side effects. Side effects of taking these are weight gain, increased fat deposition around the face, redness of the face, increased blood pressure, increased blood sugar, and more. In many cases, corticosteroids are used in conjunction with disease-modifying antirheumatic drugs (DMARDs) to enhance overall treatment efficacy and maintain long-term disease control. Disease-modifying antirheumatic drugs (DMARDs) work by modifying the underlying disease process, rather than just treating symptoms, to slow down the progression of RA and prevent joint damage. The two types of DMARDs are traditional (synthetic) and biologic. Traditional (synthetic) DMARDs have been around for much longer than biologic DMARDs. These include Methotrexate, Sulfasalazine, Hydroxychloroquine, JAK inhibitors and more. Biologic DMARDs are much newer and were made using biotechnology. They target the specific molecules that cause inflammation in your joints. They are seen as more effective because they attack the cells at a more specific level. Biologics tend to work rapidly – within two to six weeks. These include TNF inhibitors, B-cell inhibitors, T-cell inhibitors and more. DMARDs are typically recommended to older patients before the other medications because they want to target the spots of inflammation as quickly and directly as possible. Lifestyle changes that help reduce some of the symptoms of rheumatoid arthritis include diet changes, regular exercise, adequate rest, stress reduction and more. Therapies that can help manage symptoms include physical therapy, occupational therapy, acupuncture, massage therapy and more. Surgery is only used to restore function to severely damaged joints. It can also be used if pain isn’t controlled with medication. Typically these are seen in the form of replacements like a knee or hip replacement.

Risk Factors and Complications

Rheumatoid arthritis (RA) is a chronic autoimmune condition that primarily affects the joints and presents several risk factors and potential complications. Women are significantly more likely to develop RA than men, and while it can occur at any age, it is most commonly diagnosed in middle-aged individuals. A family history of the disease also increases the risk, along with lifestyle factors such as smoking and obesity. Complications of RA can be serious and include a higher likelihood of developing osteoporosis, rheumatoid nodules, and dry eyes and mouth. Additionally, individuals with RA face increased risks for infections, carpal tunnel syndrome, heart problems, lung disease, and lymphoma. These complications underscore the importance of early diagnosis and effective management of the condition.

Missing Voices

Unfortunately, medications for this autoimmune disease can be pretty expensive. Even with the help of insurance, patients can spend thousands of dollars annually on the care that they need. This means that some people who would really benefit from treatments like these are unable to access them because of the price. This financial burden can lead to feelings of hopelessness and anxiety as patients struggle to manage their health without the necessary medications. The stress of choosing between essential treatments and other basic needs can take a significant emotional toll, leading to a diminished quality of life. For many, the inability to afford proper care not only affects their physical well-being but also weighs heavily on their mental health. A potential solution to the problem could be programs like Remistart that help pay for remicade treatment. This is a program that you have to apply to and be eligible for, however, if accepted they help pay for your treatment. Although not everyone will be treated with remicade, there are likely other programs out there that could help pay for other treatments. These programs could also be created to help people afford their medications.

Conclusion

In conclusion, rheumatoid arthritis (RA) presents a complex challenge that significantly impacts the lives of millions worldwide. This autoimmune condition not only causes debilitating joint pain and inflammation but also affects various aspects of physical and emotional well-being. Throughout this chapter, we have explored the multifaceted nature of RA, including its symptoms, diagnosis, and the variety of treatment options available. Current treatment strategies encompass a range of approaches, from pharmacological interventions—such as disease-modifying antirheumatic drugs (DMARDs) and biologics—to physical therapy and lifestyle modifications. While these treatments can substantially improve the quality of life for many patients, barriers such as high costs, limited access to care, and variability in response to treatment underscore the need for a more equitable healthcare system. Ultimately, by recognizing the complexities of rheumatoid arthritis and striving for comprehensive, accessible care, we can work towards improving the lives of individuals impacted by this chronic condition.

References

Elena Nikiphorou, Hannah Jacklin, Ailsa Bosworth, Clare Jacklin, Patrick Kiely, Disease impact of rheumatoid arthritis in patients not treated with advanced therapies; survey findings from the National Rheumatoid Arthritis Society, Rheumatology Advances in Practice, Volume 5, Issue 1, 2021, rkaa080, https://doi.org/10.1093/rap/rkaa080

Mayo Foundation for Medical Education and Research. (2023, January 25). Rheumatoid arthritis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

Pavlov-Dolijanovic S, Bogojevic M, Nozica-Radulovic T, Radunovic G, Mujovic N. Elderly-Onset Rheumatoid Arthritis: Characteristics and Treatment Options. Medicina. 2023; 59(10):1878. https://doi.org/10.3390/medicina59101878

Prasad, P., Verma, S., Surbhi et al. Rheumatoid arthritis: advances in treatment strategies. Mol Cell Biochem 478, 69–88 (2023). https://doi.org/10.1007/s11010-022-04492-3

Rheumatoid arthritis (RA): Causes, symptoms & treatment faqs. Cleveland Clinic. (2024, August 15). https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis

NIH. (2016). Rheumatoid arthritis. Handout on Health. https://permanent.fdlp.gov/gpo72222/Handout%20on%20Health%20%20Rheumatoid%20Arthritis.htm

Rheumatoid arthritis physical therapy in Manhattan & Brooklyn, NYC. Physical Therapists NYC. (2022, December 23). https://www.physicaltherapistsnyc.com/physical-therapy-services/rheumatoid-arthritis/

Rheumatoid arthritis treatment options. Johns Hopkins Arthritis Center. (2020, April 14). https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/

Saklaine, M. (2023, November 8). The role of ppis in conjunction with NSAIDs. EduGonist. https://www.edugonist.com/the-role-of-ppis-in-conjunction-with-nsaids/

AI acknowledgement

This chapter has been authored with the assistance of Microsoft Copilot, an artificial intelligence platform.