Rheumatoid Arthritis (Inflammatory Rheumatism): Causes, Symptoms, Treatment

Rheumatoid arthritis, commonly known as inflammatory rheumatism, is one of the significant chronic inflammatory diseases that directly affects a person's quality of life. It is typically seen in adults between the ages of 30 and 50. Although factors such as smoking, stress, infection, hormonal changes, and gender are known to be associated with the disease, genetic factors are primarily responsible for its onset. Early diagnosis directly influences the course of the disease and the patient's response to treatment. Therefore, having accurate knowledge about rheumatoid arthritis and being able to recognize the symptoms and signs at an early stage is extremely important. You can find detailed information in the continuation of our article.

What is Rheumatoid Arthritis and What Causes It?

Rheumatoid arthritis, also known as inflammatory rheumatism, is a chronic inflammatory collagen tissue disease that typically affects small joints in the hands, wrists, feet, and ankles, as well as the joints in the knees and elbows, and, less frequently, the shoulders and hips. Although important symptoms and findings related to the disease are seen in the joints, other parts of the body are also considered at risk for inflammation.

The condition emerges from inflammation in the synovial fluid sacs located in the joint structures of the body, leading to tissue destruction in these areas. Due to the complex interactions between these cell groups, the disease progresses over time. Based on the severity of the symptoms, the disease is classified into four stages:

• Stage 1: Inflammation of the synovial fluid in the joints is still in its early stages, and there is no restriction on daily activities.
• Stage 2: As synovial inflammation increases, pain and limited movement occur in the affected joint areas, but the symptoms are not severe enough to interfere with daily activities.
• Stage 3: Inflammation in the joints increases, and patients may have difficulty performing daily tasks or work, leading to partial dependency.
• Stage 4: At this stage, joint limitation reaches its most severe form, and the person becomes completely dependent, unable to carry out even basic daily tasks.

Rheumatoid arthritis is a progressive disease, and transitions between stages can occur rapidly. Since the exact cause of the disease is not fully known, individuals of all age groups are considered at risk. However, certain risk factors, such as genetics, age, infection, immune system functioning, smoking, and family history, are known to contribute to the development of rheumatoid arthritis. In this regard, rheumatoid arthritis is considered an autoimmune disease with an unknown exact cause. Like other autoimmune diseases, rheumatoid arthritis develops in genetically predisposed individuals due to the abnormal functioning of the immune system, which leads the body to react against its own healthy tissues, causing damage in these tissues. A series of reactions initiated by the immune system results in joint and other collagen tissue damage.

What Are the Symptoms of Rheumatoid Arthritis?

Rheumatoid arthritis has a gradual onset, meaning the first symptoms typically appear weeks or even months after the disease begins.

The initial signs noticed by the individual are swelling, stiffness, and pain in the joints. The hand, wrist, foot, and ankle joints, as well as the knee and elbow regions, are frequently affected. In the early stages, general body fatigue, widespread muscle pain, mild fever, and abnormal weight loss may also be observed. Temperature, swelling, and pain may occur in the ligaments and muscle tissues surrounding the joint areas.

The disease often shows bilateral involvement in small joints like the hands and feet. As a result, individuals with affected hand joints may experience a rapid decline in hand skills, and those with affected foot joints may experience foot pain even after taking a few steps.

As the disease progresses, in addition to small joint groups, joint structures in the knees, elbows, hips, and shoulders may also be affected, and symptoms such as movement limitation, pain, and swelling may appear.

Muscle stiffness, often referred to as morning stiffness, is a significant symptom associated with rheumatoid arthritis. The person may experience stiffness lasting more than an hour in the joints when waking up or after long periods of inactivity.

Complications of Rheumatoid Arthritis

Swelling in the wrist area can put pressure on the nerves in that region, leading to carpal tunnel syndrome, characterized by numbness and loss of sensation in the hand.

In advanced stages of the disease, significant deformities may develop, especially in the fingers of the hands and feet, as well as in the root joint structures.

In cases of arthritis affecting the knee area, a cyst filled with joint fluid (Baker's cyst) may develop in the space behind the knee.

In severe stages of the disease, joint inflammation can turn into widespread body inflammation, which may cause inflammatory infections in vital organs such as the heart and lungs. This is considered one of the most important complications of rheumatoid arthritis.

When the disease lasts more than 10 years, there is an increased risk of inflammation in the blood vessel walls. This can lead to serious circulation problems, particularly gangrene in the fingertips and wounds in the lower parts of the body.

How is Rheumatoid Arthritis Diagnosed?

There is no single diagnostic test that can definitively diagnose rheumatoid arthritis. Therefore, the diagnosis is usually made based on a combination of several important data points. Key indicators of rheumatoid arthritis include:

• Stiffness and tightness in specific joint areas that lasts at least 1 hour, occurring in the morning
• Soft tissue tenderness and swelling seen in three or more joints
• Joint inflammation in the wrists, fingers, and the body part of the hand
• Symmetric inflammation affecting both hands or both feet simultaneously
• Painless, non-tender rheumatoid nodules or lumps under the skin
• Positive rheumatoid factor (RF) autoantibodies
• Typical radiological findings of rheumatoid arthritis

If at least 4 of these findings are present simultaneously and the patient's complaints persist for at least 6 weeks, a diagnosis of rheumatoid arthritis can be made.

Treatment Methods for Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that cannot be completely cured, as it continues throughout life. However, effective treatment strategies applied at the right time can help control the symptoms of the disease, and current medication options and advanced treatment strategies can achieve complete remission.

The preferred types of medications for treatment include non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid medications, and disease-modifying anti-rheumatic drugs (DMARDs). NSAIDs and corticosteroids are used to treat symptoms, while DMARDs and other biological agents are applied to directly treat the disease. In addition to medication, physiotherapy is also considered one of the most effective treatment methods. When determining the appropriate medication for the disease, several personal factors are taken into account, including the patient's age, overall health status, the presence of accompanying diseases, the severity of rheumatoid arthritis symptoms, and the overall course of the disease. Therefore, effective treatment for the disease should always be personalized, and medical treatment should be supported by auxiliary treatments such as diet and exercise.