ARTHRITIS AND YOGA THERAPY
What’s Rheumatoid Arthritis?
The term “arthritis” feels familiar because: Who hasn’t seen the stock image of elderly-person-gripping-knee? But in fact, the word is often used incorrectly. First, “arthritis” is a catchall term; there isn’t just one variety. Rheumatoid arthritis (RA) is the second most-common type, affecting approximately 1.3 million people in the United States, 70% of whom are women, according to the Arthritis Foundation. Second, RA doesn’t affect only the retirement set, nor does it hit just knees and hands. RA is an autoimmune disorder that causes systemic inflammation, which primarily infiltrates the joints but also has effects beyond them. While it can occur at any time, RA typically develops between ages 40 and 60. That being said, RA can also affect children via a condition called juvenile idiopathic arthritis.
To really understand RA, it helps to have an image in your mind of how joints work. So, picture this: Joints contain several structures that allow you to move easily.
When healthy, the ends of the bones in a joint are protected from rubbing together by an elastic slippery material called cartilage (yep, the same stuff your ear is made of).
The entire joint is surrounded by a capsule, known as the synovial sac.
A thin layer of tissue called the synovial membrane lines the sac.
The membrane secretes lubricating synovial fluid, which reduces friction, protecting the cartilage and joints during movement.
But here’s what happens when RA strikes: The immune system essentially misfires and sets its sights on the synovial membrane, attacking as if it’s a foreign invader.
In the early stages, the synovial membrane becomes inflamed and thickened, causing pain and limiting joint movement. Some people report feeling a warm or even burning sensation around the affected joints as well as a stiffness that makes movement slow. Over time, untreated inflammation can damage cartilage and bones. The space between bones can become smaller, causing joints to become unstable, misaligned, more painful, and sometimes even immobile.
Eventually, inflammatory tissue begins to build up, sometimes causing nodules to form around the area, most commonly along the back of the forearms, elbows, joints, and pressure points such as sacrum, occiput, and heel. These nodules will fluctuate with disease activity. However, if you imagine someone with arthritis in their hands, the very firm nodules at the furthest finger joints are actually those seen in Osteoarthritis and not rheumatoid arthritis. And while RA is known for causing joint pain and inflammation, it can spark other symptoms throughout your body, including dry eyes, chest pain, and osteoporosis.
Worth noting: Before you feel any joint pain, it’s common to experience general, nonspecific RA symptoms; unfortunately, they’re the kind that seem to go with everything–fever, fatigue, loss of appetite—so linking them with RA doesn’t often happen. And that tightness you feel in your joints may only be an issue in the morning (making it seem like not such a big deal). With rest, any synovial fluid you have is soaked up by the cartilage, much like a sponge absorbs water. As you move, the cartilage is “squeezed,” and the fluid bathes the joint. First thing in the a.m., there’s just not going to be a lot of extra fluid to keep things loose. But the more you move, the more fluid is released.
What Causes Rheumatoid Arthritis?
Scientists believe that the overactive immune response that precipitates RA is triggered by a complex interaction between genetic and environmental factors. Ital on the complex part, because not even the top minds in medicine have figured out the exact cause of rheumatoid arthritis. Conditions as diverse as periodontal disease (or gum disease) and Epstein-Barr virus, which causes mononucleosis, have been linked to RA. As scientists continue to chip away at the mystery, a few specific correlations have been identified or are currently being investigated:
Certain genes increase the risk for developing rheumatoid arthritis. For example, the genetic marker HLA-DR4 has been found in 60% to 70% percent of people of European ancestry with RA. But, what’s a “genetic marker”? It’s any variation in your DNA that may indicate an increased risk of developing a specific condition. However, simply having the gene does not mean that you have RA or that you will develop it. Because there are so many other factors that impact the development of rheumatoid arthritis and because the gene alone cannot confirm diagnosis or predict it in the future, docs do not perform genetic testing when diagnosing RA.
Being a Woman
Since women get the disease three times more often than men, some experts believe hormonal factors may play a role in causing rheumatoid arthritis. It has been shown that estrogen can rev up the B cells (those are the white blood cells that attack the synovial membrane) and thus exacerbate autoimmune diseases like RA.
Viruses and Infections
While we know that RA occurs because the immune system attacks the body’s healthy tissue, the medical jury’s still out on the cause for that response. Some researchers believe that healthy cells may get mixed up in the action when the body senses danger from a virus or infection; when the immune system kicks into gear and attacks the germs (aka an immune response), the body’s own tissue may get assaulted, too. That's when autoimmune diseases like RA pop up, and healthy joints fall under siege.
Rheumatoid Arthritis in the Hands
RA typically starts in the hands or feet and later spreads to larger joints like knees and ankles, so it’s common to see the first signs of it here. You might notice stiffness, especially in the morning, and joint swelling, tenderness, and warmth.
Treatments for Rheumatoid Arthritis in Hands
There are several ways to treat RA in your hands, from medicine to inexpensive home treatments. Talk with your doctor about oral and topical anti-inflammatory medications that may help and surgical options. You may also want to change your diet or purchase some inexpensive items that could help, such as arthritis gloves.
Osteoarthritis vs Rheumatoid Arthritis in Hands
Osteoarthritis in hands is the most common form of the condition, caused when cartilage in the joints starts to break down and cause pain, stiffness, and inflammation. It primarily affects older people, while RA is most common in people ages 30 to 50. RA in the hands also causes pain, stiffness, and swelling but will come with other symptoms as well, since the disease affects your entire body.
Early Signs of Rheumatoid Arthritis in Hands
Along with the stiffness, swelling, and pain you might notice in the joints of your hands, other symptoms can be early signs that the discomfort you’re experiencing might be rheumatoid arthritis. Look for signs like a low-grade fever, ongoing fatigue, and decreased appetite or weight loss.
Difference Between Osteoarthritis and Rheumatoid Arthritis
Arthritis is the overarching term referring to inflammation of the joints. But not all arthritis is the same—there are significant differences between osteoarthritis and rheumatoid arthritis. OA is a degenerative disease that affects primarily older people while RA is most common around middle age. Joint pain with OA often occurs on only one side—your right knee or left hand, for instance—while joint pain with RA is typically symmetrical.
While both osteoarthritis and rheumatoid arthritis come with some similar symptoms, like joint stiffness and inflammation, there are other signs associated with RA. Because RA is an autoimmune disorder, it affects body symptoms beyond just your joints and often comes with low-grade fevers, decreased appetite, and fatigue.
Is Rheumatoid Arthritis Hereditary?
While there are several contributing factors for RA, it’s common to ask: Is rheumatoid arthritis genetic or hereditary? The simple answer is that yes, studies show that genetics do increase your risk of developing the disease. Having a close relative with RA, especially a parent or sibling, ups your chances too. If it does appear in your family, you might want to ask your doctor about rheumatoid arthritis genetic testing. But know that having it in the family doesn’t guarantee you’ll have RA; heritability accounts for only about 20 to 50 percent of your odds of getting the disease, while other environmental and behavioral factors also play a large role.
Diseases Similar to Rheumatoid Arthritis
Rheumatoid Arthritis is notoriously tricky to diagnose, especially because the symptoms overlap with several other diseases, including:
Osteoarthritis comes with similar joint pain, stiffness, and swelling, though it typically only affects older individuals.
Gout is another form of inflammatory arthritis—but unlike RA, it usually affects only one or two joints, and symptoms are shorter lived.
Lupus is another autoimmune disease that can leads to swelling and pain in joints, but it typically also comes with a distinctive rash.
Lyme disease and fibromyalgia can also result in pain in soft tissues and joints.
Parvovirus is another with joint soreness and swelling that can be mistaken for RA; a blood test can confirm if you have parvovirus.
Rheumatoid Arthritis Symptoms
Early symptoms of RA may include:
Fatigue and weakness
General feeling of poor health
Loss of appetite and weight loss
Tight joints, usually on both sides of the body, that may be warm to the touch
With long-term, untreated rheumatoid arthritis, these additional symptoms may occur:
Stiffness (especially after waking up)
Hard—but painless—skin lumps, known as rheumatoid nodules, on the hands, elbows, knees, or toes that can range in size from a pea to a mandarin orange
Bent and misshapen joints
Red, itchy eyes
Chest pain and breathing difficulty (in advanced cases where inflammation affects heart and lungs)