Arthritis refers to inflammation of the joints, but in this module the main focus is Rheumatoid Arthritis (RA), a chronic autoimmune condition that affects joints and can also impact the whole body.
🧬 What is Rheumatoid Arthritis (RA)?
Rheumatoid arthritis is a long-term autoimmune disease where the immune system mistakenly attacks the synovium (lining of the joints).
This causes:
- Inflammation
- Pain
- Swelling
- Progressive joint damage
🧠Pathophysiology
- Immune system attacks synovial membrane
- Synovium becomes thick and inflamed
- Formation of pannus (abnormal tissue growth)
- Cartilage and bone are gradually destroyed
- Leads to deformity and loss of function over time
⚠️ Key Characteristics of RA
- Symmetrical joint involvement (both sides of body)
-
Usually starts in small joints first
- Fingers (PIP, MCP)
- Toes (MTP)
- Morning stiffness lasting more than 1 hour
-
Systemic symptoms:
- Fatigue
- Weight loss
- Low-grade fever
🧪 Diagnosis
Blood tests:
- Rheumatoid Factor (RF) – positive in many cases
- Anti-CCP antibodies – highly specific for RA
- ESR / CRP – raised inflammation markers
💊 Pharmacological Treatment
Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
- First-line treatment within 3 months of diagnosis
Examples:
- Methotrexate (most common)
- Leflunomide
Biologic DMARDs (for severe cases):
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Infliximab (Remicade)
Other medications:
- Corticosteroids (e.g. prednisone) for inflammation control
⚠️ Methotrexate requires monitoring of:
- Liver function
- Kidney function
- Alcohol intake must be avoided
🧘 Non-Pharmacological Management
- Rest during flare-ups
- Gentle exercise to maintain mobility
- Heat therapy for stiffness
- Cold therapy for pain/swelling
- Splints or braces for joint support
- Physiotherapy for function and movement
⚖️ RA vs Osteoarthritis (OA)
| Feature | Rheumatoid Arthritis (RA) | Osteoarthritis (OA) |
|---|---|---|
| Cause | Autoimmune | Wear and tear |
| Symmetry | Symmetrical | Often asymmetrical |
| Type | Inflammatory | Degenerative |
| Morning stiffness | > 1 hour | < 30 minutes |
| Common joints | Small joints (hands, feet) | Weight-bearing + DIP joints |
| Systemic effects | Yes | No |
⚠️ Complications
- Joint deformity
- Loss of mobility and function
- Anaemia (not responsive to iron therapy)
- Increased risk of cardiovascular disease
- Secondary autoimmune conditions (e.g. Sjögren’s syndrome – dry eyes and mouth)
📌 Key Summary
- RA is a systemic autoimmune disease
- It mainly affects small joints symmetrically
- Causes chronic inflammation and joint destruction
- Diagnosed using RF, anti-CCP, and inflammation markers
- Treated with DMARDs, biologics, and supportive therapies
- Early treatment helps prevent long-term disability
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