May 6, 2024 Author: Marta Cunha Rheumatoid arthritis is a chronic, autoimmune and multisystemic inflammatory disease that is characterized by promoting inflammation of the joints. There are several types of arthritis, with different causes. This autoimmune disease that mainly affects small joints interferes with the quality of life and daily life of patient. Although the cause of rheumatoid arthritis is not yet established, it is known that there is an abnormal reaction of the immune system against the joints. It is thought that it may result from an interaction between the individual genetic load (factors that increase individual susceptibility) and the environment (initiating or triggering factors), with loss of immunological tolerance. Its prevalence is about 1% in the Western population. Factors that increase individual susceptibility include sex, age, and family history: It affects women three times more than men; The risk increases with age, particularly after 50, with an average at onset of 30-40 years; It is more common when it occurs in a family member, but it is not a genetically transmitted disease. Triggering factors include: Excess weight; Excessive consumption of sugar and processed foods rich in carbohydrates; Tobacco consumption; Stress; Oral and digestive infections. Rheumatoid arthritis symptoms Symptoms of rheumatoid arthritis develop progressively. Usually, the small joints of the hands and feet are affected, progressively affecting the wrists, elbows, shoulders and knees. Joint symptoms are mainly: Joint erythema or redness; Heat, sensitivity and pain to touch; Edema; Stiffness. The pain can be persistent, but in most patients it predominates at night, causing nocturnal micro-awakenings. In the long term there is chronic fatigue with easy irritability and depressive symptoms. The pain is usually accompanied by joint stiffness, which is usually more pronounced in the first hours of the day and improves later. Over time, if left untreated, rheumatoid arthritis can result in characteristic joint deformity of the fingers (swan neck fingers), lack of strength and decreased functionality. Rheumatoid arthritis can also cause problems in various tissues and organs, including: Changes in bone mineral density with increased risk of fracture; Vision problems; Nodules under the skin; Respiratory difficulty with structural lung pathology. However, both the initial presentation, symptoms, severity, evolution and complications of the disease can vary from person to person. Diagnosis The following contribute to the diagnosis of rheumatoid arthritis: The history of symptoms and signs reported by the patient; Changes to the physical examination/anamnesis carried out by the doctor in consultation; The results of various lab tests and imaging exams. Whenever intense joint pain occurs, predominantly at night, associated with morning joint stiffness with limited mobility and function of the affected joints, medical care should be sought and as complete a history as possible should be reported. Sometimes, fatigue, especially in the morning, and unexplained joint swelling are key symptoms that raise suspicion. Rheumatoid arthritis treatment There is no cure for rheumatoid arthritis. However, it can be treated effectively, with a good prognosis for joint functionality and quality of life . The aim of treatment is: Control symptoms; Minimize irreversible joint injuries; Preserve joint function; Improve quality of life. A rheumatoid arthritis treatment plan may include: 1. Medicines In recent years, there has been a great improvement in the medications used to treat rheumatoid arthritis. There are new treatment strategies, with more effective use of existing disease-modifying medications; New medications have emerged that allow patients to have a normal quality of life, without pain or functional limitations. Medications that can be used to treat rheumatoid arthritis belong to several groups: non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARD), corticosteroids, biological agents. All with potential benefits and side effects and requiring close handling and monitoring by a trained professional. It is often necessary to combine several medications from different groups in different doses until the best option is found , due to an important interpersonal variability. Therefore, when choosing medications to treat rheumatoid arthritis, there are multiple factors to consider, including: Stage of the disease and characteristics of its evolution; Response to previous treatment and side effects; Individual needs and particularities, including comorbidities. 2. Lifestyle changes with the adoption of healthy habits, including: Healthy eating, choosing foods with anti-inflammatory characteristics (low in sugar and carbohydrates); Regular physical activity, focused on mobility and range of joint movements, as well as balance, strength and endurance; Do not smoke, specifically to reduce the risk of respiratory infections. 3. Physiotherapy and occupational therapy; 4. Cognitive-behavioral psychotherapy; 5. In severe cases, surgery to relieve pain and improve functionality. Multidisciplinary monitoring and a biopsychosocial approach are required in the follow-up of patients with rheumatoid arthritis. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
