Rheumatoid arthritis is an inflammatory disease of immunogenic origin in which the immune system attacks the synovial membrane of the joints. It is more common in women and is usually diagnosed in patients around the age of 20 or 30, although it may occasionally appear after age 60.Although the origin of rheumatoid arthritis is unknown, recent research points to the existence of genetic susceptibility in the individual in conjunction with certain environmental factors such as tobacco, asbestos (impure derivative of asbestos) and certain microorganisms of the oral and intestinal flora , which have not yet been fully characterized.
Main Symptoms of Rheumatoid Arthritis and How to Diagnose It
The main symptoms of rheumatoid arthritis are pain and swelling of the joints, basically in the hands, elbows, lower extremities and ankles, although, basically, any joint of the body that is covered by synovial membrane. Such inflammation, in addition to producing pain, disability and a significant limitation in daily activities, may eventually produce irreversible erosions that can lead to chronic joint deformities. In addition, other organs may be affected, such as skin (in the form of cutaneous nodules), lungs (pulmonary fibrosis, nodules in the lung parenchyma or pleural effusion) and tendons (inflammatory tendinitis).The diagnosis of rheumatoid arthritis is basically clinical, depending on the patient's symptoms and the presentation of the arthritis, supported by an adequate physical examination, an ultrasound analysis to verify the presence of joint inflammation and an analysis of blood, in which autoantibodies are sought.
Treatment of rheumatoid arthritis
Initially, and waiting to confirm the diagnosis of rheumatoid arthritis, treatment is based on conventional anti-inflammatory and oral corticosteroids. These treatments can not be kept for long, so if arthritis is confirmed, they must be replaced by so-called Disease Modifying Drugs (FAME) , a series of antirheumatic drugs that serve to prevent inflammation. That is, they not only make the pain and inflammation disappear, they also slow the progression of the disease: they avoid the appearance of bone erosions and joint deformities, equating the quality of life with that of healthy people. These drugs are easy to take, with few side effects, although they require medical supervision by a rheumatology specialist and regular analytical checks
New treatments for rheumatoid arthritis: biological therapies
A slight percentage of patients treated with conventional DMARDs do not achieve pain and inflammation. In these cases they are often used the so-called biological therapies , introduced in the 90's and that supposed a true revolution by its high effectiveness in the control of the symptoms and in the halting of the progress of the disease. They consist of monoclonal antibodies specifically designed to block key molecules from the inflammatory process. There are different types of biological therapies: the best known are anti-TNF alpha drugs. However, in the last decade other biological agents have been developed directed against different targets of inflammation. It is the rheumatologist who will decide which of the multiple drugs is the most convenient, depending on the type of arthritis and the patient's history.
Prognosis of rheumatoid arthritis patients
There are different factors of poor prognosis in patients with rheumatoid arthritis: being a woman, a young onset age, a positive and very high rheumatoid factor, presence of joint erosions and polyarticular involvement, among others. Without any treatment, the prognosis is ominous, with poor quality of life, joint deformities, severe work incapacity and decreased life expectancy. At present, however, treatment with conventional antirheumatic drugs (FAME) or biological therapies allows the maintenance of quality and life expectancy similar to that of those without arthritis, by slowing down symptoms and progression. That is why it is very important to start these treatments as soon as possible, once the disease is confirmed, and ensure good adherence to treatment by the patient.