Your guide to arthritis

Rheumatoid arthritis is more common than we think, affecting approximately 1% of people worldwide.

The disease is three times more common in women as in men. It affects people of all races equally. The disease can begin at any age and even affects children, but it most often starts after 40 years of age and before 60. In some families, multiple members can be affected, suggesting a genetic basis for the disorder.

Rheumatoid arthritis is an autoimmune disease that causes inflammation of the joints. Autoimmune diseases are illnesses that occur when the body’s tissues are mistakenly attacked by their own immune system. It’s a chronic progressive disease, causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet and ankles. The disease can also cause inflammation and injury in other organs in the body.

Because it can affect multiple organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease. While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms.

However, rheumatoid arthritis is typically a progressive illness that has the potential to cause significant joint destruction and functional disability. A joint is where two bones meet to allow movement of body parts. Arthritis means joint inflammation.

The joint inflammation of rheumatoid arthritis causes swelling, pain, stiffness, and redness in the joints. In some people with rheumatoid arthritis, chronic inflammation leads to the destruction of the cartilage, bone, and ligaments.

Causes

The exact cause of rheumatoid arthritis is unknown but viruses, bacteria and fungi are suspected. It is also believed to be genetically inherited (hereditary). Certain genes have been identified that increase the risk for rheumatoid arthritis. It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body’s own tissues. Environmental factors also seem to play some role.

The following factors may increase your risk of rheumatoid arthritis:

• Sex: more common is women.
• Age: can occur at any age, but it most commonly begins between the ages of 40 and 60.
• Family history: If a member of your family has rheumatoid arthritis, you may have an increased risk.
• Smoking: smoking can increase your risk of getting arthritis and it is also associated with greater disease severity.
• Environmental exposures: some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis.
• Obesity: People who are overweight or obese appear to be at higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.

Signs and symptoms

When the disease is active, symptoms can include fatigue, loss of energy, lack of appetite, low-grade fever, muscle and joint aches and stiffness. Muscle and joint stiffness are usually most felt in the morning and after periods of inactivity. This is referred to as morning stiffness.

Arthritis is common during disease flares (periods of increased disease activity). Also during flares, joints frequently become warm, red, swollen, painful, and tender. Early rheumatoid arthritis tends to affect your smaller joints first, particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

Can a diet cause or cure arthritis?

There is no special rheumatoid arthritis diet or diet “cure” for rheumatoid arthritis. Many years ago people thought tomatoes would aggravate rheumatoid arthritis. This is no longer accepted as true. There are no specific foods or food groups that should be universally avoided by individuals with rheumatoid arthritis.

Nevertheless, there are some home remedies that may be helpful, although these are not considered as potent or effective as disease-modifying drugs. Fish oils, such as in salmon, and omega-3 fatty acids supplements have been shown to be beneficial in some studies in rheumatoid arthritis.

This suggests that there may be benefits by adding more fish to the diet, such as in the popular Mediterranean diet. Supplements such as calcium and vitamin D are used to prevent osteoporosis (bone erosion) in patients with rheumatoid arthritis.

Folic acid is used as a supplement to prevent side effects of some medical treatments of rheumatoid arthritis. Alcohol should also be minimised or avoided in rheumatoid arthritis patients. The benefits of cartilage preparations such as glucosamine and chondroitin for rheumatoid arthritis remain unproven.

Benefits of exercise

Because impact loading the joints can aggravate inflamed, active rheumatoid arthritis and also be difficult when joints have been injured in the past by the disease, it is important to customise activities and exercise programmes according to each individual’s capacity.

Movement exercises that are less traumatic for the joints, including yoga and tai chi, can be beneficial in maintaining flexibility and strength, as well as lead to an improved general sense of well-being. Proper regular exercise is important in maintaining joint mobility and in strengthening the muscles around the joints.

Swimming is particularly helpful because it allows exercise with minimal stress on the joints. Splinting can also be beneficial. Wrist and finger splints can be helpful in reducing inflammation and maintaining joint alignment.

Devices such as canes, toilet seat raisers and jar grippers can assist in the activities of daily living. Heat and cold applications are modalities that can ease symptoms before and after exercise. Surgery may be recommended to restore joint mobility or repair damaged joints. It may be beneficial to see an orthopaedic surgeon if symptoms are severe.

Finally, minimising emotional stress can help improve the overall health in people with rheumatoid arthritis. Support and extracurricular groups provide those with rheumatoid arthritis time to discuss their problems with others and learn more about their illness.