Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that primarily affects joints.
RA is a chronic autoimmune disorder the causes of which are still not completely understood. It is a systemic (whole body) disorder principally affecting synovial tissues. There is no evidence that physical and emotional effects or stress could be a trigger for the disease. The many negative findings suggest that either the trigger varies, or that it might in fact be a chance event inherent with the immune response.
Half of the risk for RA is believed to be genetic；Smoking is the most significant non-genetic risk
Epidemiological studies have confirmed a potential association between RA and two herpesvirus infections: Epstein-Barr virus (EBV) and Human Herpes Virus 6 (HHV-6).
Vitamin D deficiency is more common in people with rheumatoid arthritis than in the general population.
It may result in deformed and painful joints, which can lead to loss of function. The disease may also have signs and symptoms in organs other than joints.
The process involves an inflammatory and fibrosis of the capsule around the joints. It also affects the underlying bone and cartilage. RA can produce diffuse inflammation in the lungs, the membrane around the heart, the membranes of the lung, and whites of the eye. It can also produce nodular lesions, most common within the skin.
X-rays of the hands and feet are generally performed in people with a many joints affected. In RA,
Other medical imaging techniques such as magnetic resonance imaging (MRI) and ultrasound are also used in RA.
When RA is clinically suspected, testing for the presence of rheumatoid factor (RF, a non-specific antibody) and (ACPAs) may be required
There is no cure for RA, but treatments can improve symptoms and slow the progress of the disease. Disease-modifying treatment has the best results when it is started early and aggressively.
Regular exercise is recommended as both safe and useful to maintain muscles strength and overall physical function.
Disease modifying agents
Disease-modifying antirheumatic drugs (DMARD) are the primary treatment for RA. They are a diverse collection of drugs, grouped by use and convention. They have been found to improve symptoms, decrease joint damage, and improve overall functional abilities.
The most commonly used agent is methotrexate with other frequently used agents including sulfasalazine and leflunomide.
Biological agents should generally only be used if methotrexate and other conventional agents are not effective after a trial of three months.
NSAIDs reduce both pain and stiffness in those with RA. Generally they appear to have no effect on people's long term disease course and thus are no longer first line agents.
COX-2 inhibitors, such as celecoxib, and NSAIDs are equally effective.
Glucocorticoids can be used in the short term for flare-ups, while waiting for slow-onset drugs to take effect.
In early phases of the disease, an arthroscopic or open synovectomy may be performed. It consists of the removal of the inflamed synovia and prevents a quick destruction of the affected joints
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