What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic disease marked by inflammation of the joints, most often affecting the hand joints and both sides of the body at the same time.

In a healthy joint, the tissue lining the joint (called the synovial membrane or joint synovium) is very thin and produces fluid that lubricates and nourishes joint tissues. In rheumatoid arthritis, the immune system attacks the synovial membrane, causing inflammation, pain, swelling and stiffness. The synovial membrane becomes thick and inflamed, resulting in unwanted tissue growth. As a result, bone erosion and irreversible joint damage can occur, leading to permanent disability [1].

Normal joint compared to rheumatoid arthritis joint diagram

Rheumatoid arthritis is a systemic disease, affecting the whole body, including the organs. This can lead to problems with the heart, respiratory system, nerves and eyes. Its cause is not well understood although there is a strong genetic component. Genetic factors are estimated to contribute 50-60% of the risk of developing rheumatoid arthritis [2].

People's quality of life can be severely affected by rheumatoid arthritis. Functional limitations arrive soon after the onset of the disease and worsen with time. Joint damage in the wrist is reported as the cause of most severe limitation even in the early stages of rheumatoid arthritis [3]. Work disability is also a common problem amongst people with rheumatoid arthritis, with only 80% of sufferers likely to continue working at 2 years after disease onset, and 68% at 5 years [4]. People with this condition are more likely to suffer from anxiety, depression and low self-esteem [5]. Rheumatoid arthritis is also associated with increased mortality due to related complications and comorbidities including infections and cardiovascular disease [6].

At present there is no cure for rheumatoid arthritis. The Australian Models of Care for the management of the disease focus on early diagnosis, early management, and coordination of multidisciplinary care needs [7,8]. Treatment for rheumatoid arthritis has improved dramatically over the past 20 years, with new medicines now very helpful for people, particularly in the early stages of the disease. Evidence suggests initiation of aggressive treatment with disease-modifying anti-rheumatic drugs (DMARDs) within 12 weeks of symptom onset is associated with less joint destruction and a higher chance of achieving DMARD-free remission as compared with a longer delay in assessment [9].

References

  1. RACGP (The Royal Australian College of General Practitioners) 2009. Clinical guideline for the diagnosis and management of early rheumatoid arthritis. Melbourne: RACGP.
  2. Tobón GJ, Youinou P & Saraux A 2010. The environment, geo-epidemiology, and autoimmune disease: Rheumatoid arthritis. Journal of Autoimmunity 35 (1):10–14.
  3. Koevoets R, Dirven L, Klarenbeek NB et al. 2013. Insights in the relationship of joint space narrowing versus erosive joint damage and physical functioning of patients with RA. Annals of the Rheumatic Diseases 72:870–874.
  4. Sokka T, Kautiainen H, Pincus T et al. 2010. Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA Study. Arthritis Research & Therapy 12:R42.
  5. Covic T, Cummin SR et al. 2012. Depression and anxiety in patients with rheumatoid arthritis: Prevalence rates based on a comparison of the Depression, Anxiety and Stress Scale (DASS) and the Hospital, Anxiety and Depression Scale (HADS). BMC Psychiatry 12:6. doi:10.1186/1471-244X-12-6.
  6. Lassere MN, Rappo J, Portek IJ et al. 2013. How many life years are lost in patients with rheumatoid arthritis? Secular cause-specific and all-cause mortality in rheumatoid arthritis, and their predictors in a long-term Australian cohort study. Internal Medicine Journal 43 (1): 66–72.
  7. Speerin R, Slater H, Li L et al. 2014 (in press). Moving from evidence to practice: Models of care for the prevention and management of musculoskeletal conditions, Best Practice & Research Clinical Rheumatology.
  8. Arthritis Australia 2014. Time to move: rheumatoid arthritis, a national strategy to reduce a costly burden. Sydney: Arthritis Australia.
  9. Van der Linden MPM, le Cessie S, Raza K et al. 2010. Long-term impact of delay in assessment of patients with early arthritis. Arthritis and Rheumatism 62 (12): 3537–3546.