Overview#
Rheumatoid Arthritis (RA) is a chronic autoimmune disease in which the immune system attacks the lining of the joints (synovium), causing inflammation, pain, swelling, and progressive joint destruction. It typically affects small joints of the hands and feet symmetrically. RA affects approximately 0.7-1 % of the Indian population, with women being 2-3 times more likely to develop it than men. Early diagnosis and treatment within the first 3-6 months ("window of opportunity") can prevent irreversible joint damage.
Causes & Risk Factors#
- Autoimmune mechanism – the immune system produces antibodies (RF, anti-CCP) that attack joint tissue.
- Genetic susceptibility – HLA-DR4 gene is strongly associated with RA.
- Smoking – the strongest modifiable risk factor; doubles RA risk and worsens disease severity.
- Hormonal factors – higher prevalence in women suggests oestrogen may play a role; onset often occurs around menopause.
- Infections – certain bacterial and viral infections may trigger RA in genetically susceptible individuals.
Signs & Symptoms#
- Symmetrical joint pain and swelling (both hands, both wrists, both knees)
- Morning stiffness lasting more than 30-60 minutes
- Swelling of small joints – metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of fingers
- Fatigue and general malaise
- Low-grade fever
- Gradual loss of joint range of motion
- Nodules under the skin near affected joints (rheumatoid nodules)
- Joint deformities in advanced disease (swan-neck, boutonnière, ulnar deviation)
Diagnosis#
Early diagnosis is critical. The following tests are used:
- Rheumatoid Factor (RF) – positive in 70-80 % of RA patients, but not specific. Book RA Factor
- Anti-CCP Antibodies – more specific than RF; positive in 60-70 % of RA patients, often before symptoms appear.
- ESR and CRP – elevated inflammatory markers indicate active disease. Book CRP
- Complete Blood Count – may show anemia of chronic disease. Book CBC
- X-ray of hands and feet – shows joint erosions and space narrowing in established disease.
- Ultrasound or MRI – can detect early synovitis before X-ray changes appear.
Treatment Options#
Disease-Modifying Anti-Rheumatic Drugs (DMARDs):
- Methotrexate – the anchor drug for RA; started early and continued long-term. Taken once weekly with folic acid supplementation.
- Hydroxychloroquine and sulfasalazine – often used in combination with methotrexate.
- Leflunomide – an alternative for methotrexate-intolerant patients.
Biologic DMARDs: TNF inhibitors (adalimumab, etanercept), IL-6 inhibitors (tocilizumab), and JAK inhibitors (tofacitinib) for patients not responding to conventional DMARDs. Indian biosimilars have made biologics more accessible.
Supportive care:
- Physiotherapy and joint exercises to maintain mobility.
- Short courses of low-dose prednisolone for flare management.
- Occupational therapy for hand function and assistive devices.
Prevention#
- There is no proven way to prevent RA, but early detection significantly improves outcomes.
- Quit smoking – it is the single most important modifiable risk factor.
- Maintain oral hygiene – periodontal disease is linked to RA onset.
- If you have a first-degree relative with RA and develop joint symptoms, seek rheumatology evaluation promptly.
- Regular exercise and a balanced anti-inflammatory diet (rich in omega-3, turmeric, and vegetables) may help reduce inflammation.
When to See a Doctor#
See a rheumatologist if you experience joint pain and swelling lasting more than 6 weeks, morning stiffness exceeding 30 minutes, or symmetric involvement of small joints. Do not self-treat with painkillers alone – DMARDs must be started early to prevent permanent joint damage. Seek urgent care for sudden severe joint inflammation, fever, or eye redness (possible complication).