4 min|Dr. Maya Kuczma
Autoimmune Disease 101: What is Rheumatoid Arthritis?Autoimmune Disease
Know the Numbers
- Over 4.6 million Canadians report having arthritis (1)
- Roughly 1 in 100 Canadians have Rheumatoid arthritis (2)
- Rheumatoid arthritis affects women 2-3 times more often than men (2)
A joint is a place in the body where two parts of the skeleton join together, or ‘articulate’. There are many structures within a joint that allow for smooth movement of the two bones, such as:
- cartilage, a tough but flexible connective tissue that covers the surface of a bone within a joint, reducing friction
- synovial membrane, a tissue that lines the joint capsule and secretes synovial fluid to lubricate the joint
- bursas, fluid-filled sacs that reduce friction in a joint
- ligaments, tough strips of connective tissue that connect bones
- tendons, connective tissue that links bones within a joint to muscle
There are over 300 joints in the body. When healthy, these joints articulate smoothly, leading to pain-free movement and mobility. If structures within a joint become inflamed, known as ‘arthritis’, joint articulation is altered, leading to pain and reduced range of motion.
Evaluating Joint Health
A patient’s history is the most important factor when evaluating joint health. A skilled practitioner will ask about your activities of daily living, such as getting up from a seated position, walking, lifting, and sleeping, to determine your level of discomfort and altered mobility, and how these factors have changed over time. The timing, intensity, and location of physical discomfort are all vital components of a diagnosis. Additionally, they will observe your movement patterns, and manually examine one or many joints, assessing for pain during articulation or application of pressure through the joint, as well as heat, swelling, or redness. They may also complete tests to assess muscles, ligaments, cartilage, and bursa, to identify which components of a joint are affected.
If your history or physical examination leads your Doctor to suspect arthritis, they may order further diagnostics, such as blood work and imaging. These diagnostics can be helpful in determining whether you are experiencing:
- osteoarthritis, a type of arthritis associated with aging, and ‘wear and tear’ of cartilage
- gout, a type of arthritis that occurs due to the deposition of uric acid within a joint
- scleroderma, rheumatoid arthritis, or systemic lupus erythematous, autoimmune conditions that can lead to joint inflammation
Since the root cause of each of these types of arthritis is unique, it is vital to diagnose the type of arthritis you are experiencing, in order to identify the correct course of treatment. Unfortunately, it can be difficult to diagnose the type of arthritis, particularly in the early days of symptom progression, when symptoms can mimic many different conditions. Particularly in the case Rheumatoid Arthritis, there is no single blood test that can definitively diagnose it; however, a complete evaluation of imaging, blood work, and history, can lead to a diagnosis.
Diagnosing Rheumatoid Arthritis
Rheumatoid arthritis typically affects the wrists, elbows, shoulders, knees, ankles, and/or the small joints of the hands and feet. Typically, more joints are affected over time. Early symptoms may include:
- pain or stiffness within multiple joints
- warmth or redness over joints
- weight loss, decreased appetite
- reduction in mobility, such as an inability to form a fist, climb the stairs, or open the lid of a jar
- appearance of lumps under the skin
- obvious deformity of the joints
The risk of developing Rheumatoid Arthritis (RA) and osteoarthritis (OA) increases with age. However, genetics and gender appear to play a role in the pathogenesis of RA; if you have a family history of RA, and are female, you are more likely to experience RA. Additionally, hormonal changes (such as those associated with pregnancy and breastfeeding), smoking, and certain infections have been linked to RA.
Magnetic Resonance Imaging (MRI) is the most sensitive imaging type for early diagnosis and subsequent evaluation of RA; this form of imaging can identify early joint changes associated with RA, such as inflammation of the synovium, inflammation of the tendon sheath, and joint erosions.(2) X-ray is more widely available, and is effective at identifying bony changes associated with RA, but is less likely to identify changes within the joint during early stages of disease progression.
Certain blood markers tend to be elevated in people with RA, such as C-reaction protein (CRP), and erythrocyte sedimentation rate (ESR); both are markers of inflammation within the body. Levels of auto-antibodies, such as Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP), may also be elevated, indicating an immune-mediated destruction of the joint.
A complete evaluation of your symptoms, risk factors, imaging results, and blood work can help inform a diagnosis of RA. Early diagnosis is preferable, as it allows for intervention to slow or stop the progression of joint destruction.(4)
Learn about the holistic approach to treating Rheumatoid Arthritis in next week's blog!