Rheumatoid Arthritis

What’s rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects joints, and that can damage other body systems such as the heart, skin, eyes, lungs, and blood vessels.

This is why about 40 percent of the people affected by rheumatoid arthritis experience signs and symptoms that don’t involve their joints.

It is called autoimmune because the immune system erroneously attacks joints and body tissues. In particular, it attacks the synovium, which is the lining of the membranes that surround your joints.

Rheumatologists are the more involved specialist.

Orthopedic surgeon plays their role when joint is completely destroyed and need to be replaced.

It usually happens in both sides of the body and causes inflammation in the joints, in particular of the hands, feet, wrists, elbows, knees, and ankles

What happens is that the lined inside the joints thicken, and this causes pain, swell, and can even lead to joint deformity and bone erosion.

This inflammation can also damage cartilage and other parts of the body, and this damage cannot be reversed. So it is essential not to ignore symptoms to have early diagnosis and start treatment as soon as possible.

Rheumatoid Arthritis Symptoms and signs

Symptoms of RA are usually worse in the mornings and may include:

• joint pain
• fatigue
• fever
• loss of joint function 
• deformities

It typically affects smaller joints such as fingers or toes and then spread to major joints such as ankles, knees, hips, wrists, and shoulders.

RA Causes

RA is most common in women: they are three times as many as the men. Even if the majority of people with RA have no family history, this can increase the probability of having it.

Even if the cause of RA is not really known to doctors, besides age and family history, other factors can be involved in the development of this disease such as:

• environmental factors (such as pollution, insecticides and occupational exposures to mineral oil, asbestos, and silica)
• genetic
• obesity
• smoking
• infectious agents such as bacteria or viruses
• physical and emotional traumas

Rheumatoid Arthritis Diagnosis

It is not easy to diagnose RA because, in its early stage, it may resemble other similar diseases such as other forms of inflammatory arthritis.

Unfortunately, there is no single blood test or physical sign that can confirm the diagnosis.

So the doctor will perform a physical exam to check joints looking for swelling, redness, or warmth. 

Then you will be asked about your medical personal and family history and recent signs and symptoms. 

As we said, there is no single test to confirm RA, so you may be asked to take different tests such as:

• Blood tests (to look for antibodies, C-reactive protein, erythrocyte sedimentation rate ESR, …)
• Imaging tests (X-rays, MRI and ultrasound)

Treatment

Even if there is no cure for RA, the therapy we know works best when we have an early diagnosis.

Treatments have the primary purpose of relieving symptoms and managing the disease. So they can help to:

• relieve symptoms
• stop inflammation
• improve physical functions
• reduce complications (such as prevent joint damage)

Medications can include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Disease-modifying antirheumatic drugs (DMARDs)
• Biologics
• JAK inhibitors

But there also other kinds of treatment and changes in lifestyle can help relieve symptoms and lead a better life: 

• Physical Therapy
• Dietary changes

An occupational therapist can teach you low-impact exercises to improve the flexibility of your joints and their range of motions and to strengthen muscles.

Yoga or Tai Chi may be useful as well to regain flexibility.

Cold and hot treatments may reduce stiffness, inflammation, and pain. For example, you can apply heat or ice on your joints.

Assistive devices such as splints and braces may help to reduce inflammation while holding your joints in a resting position

An anti-inflammatory diet may be useful, as well. For example a diet rich in

• Omega-3 fatty acid (salmon, tuna, herring, mackerel, chia seeds)
• Antioxidants and vitamins A, C, E, selenium (blueberries, goji, spinach, kidney beans, …)
• Fibers 
• Fresh vegetables, and fresh fruit
• Foods containing flavonoids (green tea, broccoli, grapes and once again berries)

Surgery for Rheumatoid arthritis

Surgery may be needed if medications fail or to reduce pain and repair damaged joints and deformities.

Surgery may help to improve your ability to use joint.

RA may require one of the following surgeries:

• Joint replacement. The orthopedic surgeon removes your damaged joints and places part or all of it with a prosthesis made of metal and plastic. Joint replacement is usually performed in the hip, knee, or shoulder. After surgery, several months of rehabilitation are mandatory.
• Synovectomy. This procedure removes the synovium (the inflamed lining of the joint) 
• Tendon repair and release. Inflammation around your joint may loosen and tear your tendons, and the orthopedic surgeon can repair or release them with surgery
• Joint fusion. Sometimes it is recommended to fuse a joint to realign it and reduce pain
• Carpal tunnel release (to reduce pressure on a nerve the orthopedic surgeon may cut a ligament in your wrists)

The experience of Prof. Portinaro

Although Prof Portinaro is mainly a Pediatric Orthopedic Surgeon, he has gained a great deal of experience over the years in performing surgeries such as joint repair, joint replacement, and fusion, in both arthritis and non-arthritis patients.