Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a long term auto-immune disorder affecting the synovial joints of the body. It can also affect other organs of the body causing cardiovascular disease, lung disease and osteoporosis.  Rheumatoid arthritis involves inflammation of the synovial membrane leading to swollen, tender and warm joints.  Stiffness ensues with associated pain.  The symptoms are often worse in the early morning and ease with activity.  This is discreet from the symptoms of osteoarthritis which often worsen with activity. As the pathology progresses, the synovial inflammation leads to destruction of the joint surface, erosion of cartilage and damage to surrounding soft tissues such as tendons.  This leads to rapidly progressing joint deformity and skin changes.  Rheumatoid arthritis most commonly affects the small joints of the hands but can also affect the spine and larger joints such as hips and knees.  

The cause is an auto-immune disease but certain factors can increase your risk of developing rheumatoid arthritis such as a family history of auto-immune conditions, smoking and being exposed to high levels of silica in the workplace. 

Diagnosis involves clinical examination, imaging including x-rays and MRI scans and blood tests to look for rheumatoid factor and other antibodies characteristically found in rheumatoid arthritis.  

Management initially involves a non-operative approach including lifestyle modification with regular exercise and weight loss followed by medication in the form of disease modifying agents (DMARDS) such as methotrexate, hydroxychloroquine and TNF-alpha inhibitors. In the vast majority of cases, these medications dramatically improve symptoms and keep the pathology under control for many years. 

Eventually if symptoms dictate, surgery can be indicated.  Particularly for joints affected in the fingers and hands, a synovectomy may be needed to reduce pain, swelling and prevent tendon damage.  In larger joints such as the hips and knees, joint replacement surgery may be indicated. 

If you would like to discuss the management of rheumatoid arthritis with one of specialists.  Please contact the office on 01483 938750 or email info@oneorthopaedics.co.uk