What is rheumatoid arthritis? Rheumatoid arthritis is a chronic inflammation of multiple joints in the body with predilection for smaller joints in the hands. Rheumatoid arthritis causes signs and symptoms of inflammation in joints that include pain, swelling, redness, warmth and loss of function i.e. stiffness and limitation in the motion and function of multiple joints. Although joints are the main structure affected by this condition, it can cause inflammation in other body parts too for example, the eyes, lungs, heart, blood vessels and kidneys.

Symptoms of rheumatoid arthritis are typically worst in the morning with gradual easing of symptoms throughout the day. This chronic worsening of symptoms in the morning, especially of stiffness in the joints, are important diagnostic clues in differentiating other forms of arthritis for example osteoarthritis and gouty arthritis.

Other symptoms of rheumatoid arthritis are non-specific, which may include loss of appetite, chronic fatigue, weight loss, hair loss, low grade fevers and so on.

What are the causes of rheumatoid arthritis and who is at risk? Rheumatoid arthritis is categorized as autoimmune disease, in which the body produces an immunogenic response to some constituent of its own tissue, in this case, the joints. In other words the immune system loses its ability to recognize some tissue or system within the body as "self" and targets and attacks it as if it were foreign.

People who are at risks of having the disease include:

1. Those who have a family history of rheumatoid arthritis
2. Those who have other forms autoimmune disease i.e. autoimmune thyroiditis, vitiligo, type 1 diabetes, etc
3. Sex: typically affects women more than men in the ratio of 3:1
4. Age: the age of onset is usually between third and fourth decades of life

How is rheumatoid arthritis diagnosed? Clinical suspicion is the first step towards confirmation of the diagnosis. Once rheumatoid arthritis is suspected, a series of laboratory and radiological tests are performed and these include full blood examination, erythrocyte sedimentation rate, rheumatoid factors, autoimmune markers and x-rays. If these tests turn out positive, rheumatoid arthritis is very likely.

How is rheumatoid arthritis treated? Treatment of rheumatoid arthritis can be categorized as non-medical and medical treatments.

1. Non-medical treatments: these include physiotherapy with hot wax, joint exercises and assistive devices. More often than not, conservative treatment alone is inadequate, therefore, addition of chemotherapeutic agents is warranted.

2. Medical treatment: since rheumatoid arthritis is a chronic autoimmune disease that mounts an inflammatory response towards self, the use of chemotherapeutic agents, which alter and dampen the immune response, is nonetheless, effective. These chemotherapeutic agents include steroids, methotrexate, sulfasalazine and plaquenil. Pain, that often is the dominant symptom in rheumatoid arthritis, can be managed by taking anti-inflammatory medications such as non-steroidals.

Does rheumatoid arthritis only affect joints? No. As a matter of fact, rheumatoid arthritis is a systemic autoimmune, inflammatory disease that has a predilection for joints. It can affect skin, brain, heart, lungs and other bodily systems.

What is your advice for people who suffer rheumatoid arthritis? It is paramount that people who suffer rheumatoid arthritis should remain active. Seeking advice with a physical and occupational therapist may help to decide what level and types of activities are appropriate. It is important to discuss your progress with your physician and health care providers, who can provide you with appropriate information and resources you need during your treatment.