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Rheumatoid arthritis

Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints.[1] It typically results in warm, swollen, and painful joints.[1] Pain and stiffness often worsen following rest.[1] Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body.[1] The disease may also affect other parts of the body, including skin, eyes, lungs, heart, nerves, and blood.[1] This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart.[1] Fever and low energy may also be present.[1] Often, symptoms come on gradually over weeks to months.[2]

For juvenile rheumatoid arthritis, see juvenile idiopathic arthritis.

While the cause of rheumatoid arthritis is not clear, it is believed to involve a combination of genetic and environmental factors.[1] The underlying mechanism involves the body's immune system attacking the joints.[1] This results in inflammation and thickening of the joint capsule.[1] It also affects the underlying bone and cartilage.[1] The diagnosis is made mostly on the basis of a person's signs and symptoms.[2] X-rays and laboratory testing may support a diagnosis or exclude other diseases with similar symptoms.[1] Other diseases that may present similarly include systemic lupus erythematosus, psoriatic arthritis, and fibromyalgia among others.[2]


The goals of treatment are to reduce pain, decrease inflammation, and improve a person's overall functioning.[5] This may be helped by balancing rest and exercise, the use of splints and braces, or the use of assistive devices.[1][6][7] Pain medications, steroids, and NSAIDs are frequently used to help with symptoms.[1] Disease-modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine and methotrexate, may be used to try to slow the progression of disease.[1] Biological DMARDs may be used when the disease does not respond to other treatments.[8] However, they may have a greater rate of adverse effects.[9] Surgery to repair, replace, or fuse joints may help in certain situations.[1]


RA affects about 24.5 million people as of 2015.[10] This is 0.5–1% of adults in the developed world with between 5 and 50 per 100,000 people newly developing the condition each year.[3] Onset is most frequent during middle age and women are affected 2.5 times as frequently as men.[1] It resulted in 38,000 deaths in 2013, up from 28,000 deaths in 1990.[11] The first recognized description of RA was made in 1800 by Dr. Augustin Jacob Landré-Beauvais (1772–1840) of Paris.[12] The term rheumatoid arthritis is based on the Greek for watery and inflamed joints.[13]

acute phase reactants: 1 point for elevated erythrocyte sedimentation rate, , or elevated CRP value (c-reactive protein)

ESR

duration of : 1 point for symptoms lasting six weeks or longer

arthritis

Persistent synovitis

Early erosive disease

Extra-articular findings (including subcutaneous rheumatoid nodules)

Positive serum RF findings

Positive serum anti-CCP autoantibodies

Positive serum 14-3-3η () levels above 0.5 ng/ml [185][186]

YWHAH

Carriership of HLA-DR4 "Shared Epitope" alleles

Family history of RA

Poor functional status

Socioeconomic factors

[47]

Elevated acute phase response (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP])

Increased clinical severity.

Distance from primary care and specialist care in rural communities

[47]

Research[edit]

Meta-analysis found an association between periodontal disease and RA, but the mechanism of this association remains unclear.[200] Two bacterial species associated with periodontitis are implicated as mediators of protein citrullination in the gums of people with RA.[3]


Vitamin D deficiency is more common in people with rheumatoid arthritis than in the general population.[201][202] However, whether vitamin D deficiency is a cause or a consequence of the disease remains unclear.[203] One meta-analysis found that vitamin D levels are low in people with rheumatoid arthritis and that vitamin D status correlates inversely with prevalence of rheumatoid arthritis, suggesting that vitamin D deficiency is associated with susceptibility to rheumatoid arthritis.[204]


The fibroblast-like synoviocytes have a prominent role in the pathogenic processes of the rheumatic joints, and therapies that target these cells are emerging as promising therapeutic tools, raising hope for future applications in rheumatoid arthritis.[17]


Possible links with intestinal barrier dysfunction are investigated.[205]

Osteoarthritis

Psoriatic arthritis

at Curlie

Rheumatoid arthritis

. MedlinePlus. U.S. National Library of Medicine.

"Rheumatoid Arthritis"