initial symptoms, causes, treatment and mortality

The affected joints become painful, swollen and deformed over time.

It can also involve other organs and systems such as the lungs, serous membranes, eyes, skin and vessels.

It differs from osteoarthritis in that it initially affects the synovial membrane and not the cartilage; it strikes less frequently and at an earlier age than osteoarthritis; women are more affected (ratio 3:1). It affects 1 to 2% of the population and the number of cases increases with age, with 5% of women over 55 being affected.

The onset is observed mainly in late adolescence or between the 4th and 5th decade of life; a second peak is observed between 60 and 70 years.

An early variant of RA is childhood rheumatoid arthritis.

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic, systemic inflammatory disease that affects both small and large joints, which become painful, swollen and deformed over time, but can also involve other organs and systems such as the lungs, serosa, eyes, skin and vessels.

There are two particular and rare variants of rheumatoid arthritis

  • Felty’s disease, characterized by an enlarged spleen, reduction of neutrophil granulocytes in blood counts and fever;
  • Kaplan’s syndrome: pulmonary pneumoconiosis.

It most often affects women, especially between the ages of 40 and 50.

The prevalence is estimated at around 1% of the general adult population and familial cases may occur, but it is most often a sporadic illness.

What causes rheumatoid arthritis?

Rheumatoid arthritis does not have a single well-determined cause: it is thought that an environmental factor can trick the immune system (molecular mimicry) or modify certain antigens that should be perceived as its own by the immune system (self), which disrupts immunological tolerance to certain human proteins, such as joint collagen, leading to dysregulation of T cells and B cells and the consequent production of inflammatory cytokines, such as TNF alpha and IL17.

In a high percentage of subjects with rheumatoid arthritis, particularly those with HLA DR4 or DR1, antibodies to rheumatoid factor and cyrullin protein (anti-CCP) are present, the latter being highly specific for the disease.

What are the symptoms and signs of rheumatoid arthritis?

The joints are usually affected in a symmetrical and complementary manner; usually the small joints of the hands and feet are affected, but any diarthrodial joint (that is, one with a synovial membrane) can be affected.

Most commonly, the inflammation is polyarticular, meaning it affects more than four joints and, if left untreated or unresponsive to treatment, can lead to bone erosion and deformity .

One of the clinical features of the disease is predominant joint stiffness in the morning, which can last for several hours.

Spinal involvement is not typical of rheumatoid arthritis although in advanced disease there may be involvement of the cervical spine with engagement of the epistrophic tooth and possible spinal cord involvement .

With regard to systemic involvement, the disease can cause pulmonary fibrosis, serites, vasculitis, nodulosis of the skin and internal organs, episcleritis and scleritis, and amyloidosis.


Investigations for disease diagnosis and for detection and staging of organ involvement include, in addition to blood tests for rheumatoid factor and anti-CCP antibodies, measurement of indices of inflammation such as erythrocyte sedimentation (ESR) and C-reactive protein (PRC).

In addition:

  • joint effusion, synovial hypertrophy, bursitis/tenosynovitis, bone erosions:
  • joint ultrasound;
  • joint x-ray;
  • Joint MRI;

for the study of bone mineral density:

  • calculated bone mineralometry (MOC).

In case of extra-articular involvement

  • spirometry, DLCO, high resolution chest scanner for studying the lungs;
  • echocardiogram for the study of the heart.

Ranking criteria

The classification criteria have recently been revised by an international group of experts and require a score greater than or equal to 6 to make the diagnosis considering

  • joint participation:
  • major joint involvement (0 points),
  • involvement of 2 to 10 large joints (1 pt)
  • involvement of 1 to 3 small joints (2 pts)
  • involvement of 4 to 10 small joints (3 pts),
  • damage to more than 10 joints (5 pts),
  • rheumatoid factor and anti-CCP:
  • rheumatoid factor and anti-CCP negativity (0 pt),
  • low rheumatoid factor or anti-CCP positivity (2 pts),
  • high rheumatoid factor or anti-CCP positivity (3 pt,
  • inflammatory signs:
  • normal inflammatory indices (0 pt),
  • altered inflammatory indices (1 pt),
  • duration of symptoms:
  • duration of symptoms less than six weeks (0 pt),
  • duration of symptoms greater than six weeks (1 pt).

Staging, course and treatment

The disease state can be identified by analyzing the type of lesions on the patient; the course is varied; various pharmacological treatments are possible.

Prognosis and mortality

Joint impairment leads to a limitation in mobility which can lead to disability and subsequent premature death.

The evolution of the disease is very variable from one case to another.

Some patients have mild symptoms in the short term, but in most the disease progresses throughout life.

About 20% to 30% of cases will develop subcutaneous nodules (called rheumatoid nodules).

Negative prognostic factors include:

  • Persistent synovitis.
  • Early erosive disease.
  • Extra-articular findings (including subcutaneous rheumatoid nodules).
  • Positive serological results for rheumatoid arthritis.
  • Serological positivity to anti-CCP antibodies.
  • Family history of rheumatoid arthritis.
  • Poor working condition.
  • Low socio-economic status.
  • Elevated acute phase response (erythrocyte sedimentation rate, C-reactive protein).
  • Rapid increase in clinical severity.
  • Poor response to medications and physiotherapy.
  • Sedentary lifestyle.
  • Drug use, alcoholism, smoking.
  • A poor diet.
  • Advanced age.
  • Presence of other pathologies (heart disease, diabetes, coagulopathies, obesity, etc.).

A 2006 study claims that rheumatoid arthritis shortens people’s lifespan by about 3 to 12 years.

A 2005 study by the Mayo Clinic noted that people with the condition have a doubled risk of developing heart disease regardless of other risk factors such as diabetes, alcohol abuse, high cholesterol, high blood pressure and a high body mass index.

The mechanism by which rheumatoid arthritis causes this increased risk remains unknown; the presence of chronic inflammation has been proposed as at least partly responsible.

Positive responses to treatment can certainly indicate a better prognosis

Read also :

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Rheumatoid arthritis: staging, course and treatment

Juvenile idiopathic arthritis: study of oral therapy with tofacitinib by Gaslini of Genoa

Rheumatic Diseases: Arthritis And Osteoarthritis, What Differences?

Rheumatoid arthritis: symptoms, diagnosis and treatment

A low-fat vegan diet may relieve rheumatoid arthritis

Bone callosity and pseudoarthrosis, when the fracture does not heal: causes, diagnosis and treatment

Septic arthritis: what is it, what are its causes and what are the treatments


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About Antoine L. Cassell

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