Arthritis means inflammation of the joint. Rheumatoid arthritis, often shortened to RA, is a long-term (chronic) inflammatory disease that causes significant pain, swelling, stiffness and damage to joints. Over time with continuing inflammation, the disease gets worse, leading to joint deformity and disability and sometimes, joint replacement.

RA affects the whole body, often starting in the small joints of the hands and feet, but over time it affects the larger joints like knees and shoulders. Some people with more severe disease can develop inflammation in their organs like eyes, skin and heart.

People with RA often feel very tired and lack energy. Daily activities like turning door knobs, opening jars, and walking are very painful and difficult because of joint stiffness. The continual pain and inability to do simple activities can also lead to depression.

RA is an automimmune disease. Normally our immune system fights foreign invaders like bacteria and viruses, which may cause infections. Once an infection is stopped, the inflammation goes away. In RA, a person’s immune system over-reacts and attacks healthy joint tissue. The inflammation continues even without the foreign invader, causing ongoing destruction and potentially leading to deformity of the joint.

White blood cells are the cells in the body that fight infection. The white blood cells involved in RA are B and T cells. These and other immune cells produce chemical messengers, called cytokines, which recruit more immune cells into the joint. Common cytokines found in high levels in people with RA are Tumour Necrosis Factor alfa (TNF-alfa), interleukin-1 (IL-1) and interleukin-6 (IL-6).

B cells also produce antibodies. An antibody is a molecule that seeks, targets the invader and with the aid of cells in the immune system, destroys the invader. In RA, the body produces antibodies like Rheumatoid Factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) that attack healthy joint tissue. This “soup” of infection fighting cells and messenger molecules causes ongoing inflammation, seen as redness, pain and swelling in the joint. Over time, destruction of the bone and cartilage and changes in the tendons and muscles around the joint, leads to a deformed joint that can’t function normally

Unfortunately, what triggers the body to attack its own healthy joints is unknown. Genes, hormones and environmental factors are known to be involved.

• RA affects between 40,000 to 80,000 (1-2%) New Zealanders
• It is the second most common arthritis in New Zealand, after osteoarthritis (joint damage caused by wear and tear)
• RA is three times more common in women than men
• RA can occur at any age, usually affecting people aged between 25 and 60 years of age.
• People who smoke have higher rates of RA

RA may affect people in many different ways. Not everybody will experience the same pattern of disease. Usually RA starts slowly with tenderness and stiffness in the joints of the hands and feet. Some people with more severe RA can experience a sudden onset of symptoms that affects many joints. Other people experience a disease that comes and goes; the arthritis flares-up and is painful for a period and then dies down again.

Symptoms that are commonly looked for in RA are:

• Ongoing joint pain and swelling
• A symmetrical disease; pain and swelling that affects both sides of the body at the same time
• Joint pain usually in the hands and feet and more than one joint is affected
• Morning stiffness that lasts longer than 30 minutes.

Often, other symptoms can affect the whole body:

• Fatigue or tiredness
• A low grade or intermittent fever
• Difficulty performing daily activities which affects the quality of life
• Depression or sadness.

You should talk to your doctor if you have ongoing pain and stiffness in your joints. The earlier that treatment begins, the earlier you can control your RA and limit joint damage, deformity and other diseases that occur as a consequence of RA.

Your doctor will:

• Ask about recent and current joint pain and swelling
• Physically examine your body and the joints, for tenderness, swelling and movement and take your temperature
• Complete blood tests that look at the white blood cell levels, inflammatory markers and antibody levels
• Ask for imaging tests to be able to see a picture of the joint damage

Your doctor may also refer you to a rheumatologist, a doctor with expertise in diseases that affect the joints.

You can locate a rheumatologist here www.rheumatology.org.nz/

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