Symptoms: From Joint Pain to Systemic Effects
Rheumatoid arthritis arises from chronic inflammation of the synovium, the tissue lining the joints, which can damage cartilage, erode bone, and ultimately lead to joint destruction. In severe cases, it may cause significant functional impairment. The condition affects women three to five times more frequently than men and can manifest across all age groups.
Early symptoms, known as prodromal signs, include fatigue, loss of appetite, generalized weakness, and vague muscle or joint pain, often persisting for weeks. As the disease progresses, synovitis develops, causing joint swelling and fluid accumulation. Affected areas—commonly the fingers, wrists, shoulders, elbows, ankles, and knees—typically exhibit symmetrical pain and swelling. A hallmark feature is morning stiffness, or "gelling," where joints feel rigid upon waking, often lasting over an hour before gradually improving.
Diagnosis: A Multi-Faceted Approach
Diagnosing RA involves a scoring system based on four criteria: joint involvement, blood tests, acute-phase reactant levels, and symptom duration. A total score of 6 or higher confirms the diagnosis.
- Joint Involvement: Points are assigned based on the number and type of affected joints. Involvement of one large joint (e.g., shoulder, elbow, ankle, or knee) scores 0 points, while 2–10 large joints score 1 point. Small joints (e.g., fingers or wrists) are scored as follows: 1–3 joints (2 points), 4–10 joints (3 points), or over 10 joints, including at least one small joint (5 points).
- Blood Tests: Tests for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies determine seropositivity. Negative results score 0 points, weakly positive (below three times the upper limit of normal) scores 2 points, and strongly positive (three times or more above the limit) scores 3 points.
- Acute-Phase Reactants: Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels add 1 point.
- Symptom Duration: Symptoms persisting for six weeks or longer add 1 point.
Treatment and Management: Aiming for Remission
RA treatment primarily focuses on pharmacotherapy to control inflammation, alleviate symptoms, and slow joint damage. While a complete cure remains elusive, recent treatment strategies aim for complete remission.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and pain but may cause gastrointestinal side effects, often requiring co-prescription of protective agents. Corticosteroids provide rapid anti-inflammatory relief in acute phases but are recommended at low doses for short periods (within six months) to minimize side effects. Neither NSAIDs nor corticosteroids halt disease progression.
Dr. Lee emphasizes the role of disease-modifying antirheumatic drugs (DMARDs): “DMARDs suppress immune or inflammatory cells to alleviate symptoms and slow disease progression. Early initiation improves outcomes, though effects may take 1–3 months to manifest, with individual variability. Combining multiple DMARDs can enhance efficacy.” Newer biologic agents and targeted synthetic therapies, which address specific inflammatory pathways or overactive immune cells, are increasingly used worldwide, particularly for patients unresponsive to conventional DMARDs. These therapies allow tailored treatment based on disease severity and progression.
Surgical intervention may be considered for severe joint destruction or deformity impacting daily life. However, as joint damage can affect adjacent structures, thorough consultation with a specialist is crucial.
Non-Pharmacological Management: Balancing Rest and Activity
As a chronic condition, RA requires a holistic approach. Dr. Lee notes, “Non-pharmacological treatments like nutrition, physical therapy, exercise, and rest are vital. During acute flares, rest is prioritized to reduce inflammation, but excessive immobility can worsen stiffness. Gentle range-of-motion exercises can help maintain joint mobility without strain.”
Once inflammation subsides, exercise is encouraged to preserve joint function. Patients should aim to fully flex and extend affected joints 3–4 times daily. Low-impact activities like walking, swimming, aqua aerobics, cycling, and stretching are recommended after symptoms improve. High-impact exercises or squatting should be avoided to prevent joint stress.
Dr. Lee concludes, “Though RA is a chronic, intractable disease, combining pharmacological and non-pharmacological treatments can prevent joint deformity, reduce pain, and improve quality of life. Understanding prescribed medications and adhering to treatment is critical. While no specific diet is required, weight management can reduce joint strain.”
Lim Hye Jung, HEALTH IN NEWS TEAM
press@hinews.co.kr
