What is Rheumatoid Arthritis (RA)?

Rheumatoid arthritis is a disease characterised by chronic inflammation of small and medium-sized joints. This disease can also affect several organs including the lungs, the blood vessels and the blood-forming system. 

One of the symptoms of RA is morning stiffness that can last for an hour or even much longer. Other symptoms are pain and swelling.


In the joint itself, cells of inflammation invade the joint membranes or synovium, this joint membrane proliferates and changes into an invasive tissue (called pannus) and this invasive tissue causes damage to cartilage and causes erosion of bone. 
The chronic inflammation in the body, also has a detrimental chronic impact on the internal organs and blood vessels causing damage to blood vessels (atherosclerosis), and even increases the risk of developing lymph gland cancer (lymphoma). Atherosclerosis or blood vessel damage, may lead to heart disease including angina and heart attacks, as well as ischaemic stroke of the brain. 
The burden of untreated rheumatoid arthritis is not limited to joint damage and joint distraction with resulting deformities and loss of function, but it also reduces life expectancy with up to 7 years. 


Can Rheumatoid arthritis be treated?
For more than 15 years rheumatologists have changed the paradigm of the treatment of rheumatoid arthritis. The treatment to target treatment strategy has been established to be the preferred strategy of treatment for patients with rheumatoid arthritis. Although the benefit of the strategy has been well established, is has not reached all patients in all countries.
 
The concept of treatment to target involves the following:
- The firm or certain diagnosis established by the use of internationally accepted diagnostic or classification criteria.
- A planned protocol of how to utilise both traditional small molecules, so-called disease-modifying medicines, as well as a strategy for the use of our new large molecules or biologically manufactured medicines.
- Regular assessment of response to treatment, to establish efficacy of treatment, but also to monitor for the potential side-effects of medicines.
- The target of treatment is remission or near remission, using disease activity scales to establish whether or not the patient has reached this goal. The tools we use mostly in South Africa is the simplified disease activity index, but in Europe the DAS28 scores are also popular.
 
The alternative to treatment to target the so-called traditional treatment, with the general impression of the response to treatment is the guide of adjusting medication.
 
Research has shown the benefit of the strategy of treatment to target, with higher remission rates, reduction of damaged joints and improved functional outcomes.

What causes Rheumatoid Arthritis?

The cause of RA is not known, but both genetic and infective causes are being investigated. Due to an inappropriate reaction of the immune system the lining of joints get inflamed. This inflammation causes joint damage due to destruction of cartilage and bone (bony erosions). The inflammation can also have effect on internal organs causing disease in these organs relating directly to the disease.

Who gets Rheumatoid Arthritis?

Rheumatoid arthritis is 3 times more common in woman and often presents in the child bearing age. It can of cause also present (begin) in the more mature woman. Rheumatoid arthritis can also affect children, but thankfully arthritis is relatively uncommon in children. Rheumatoid Arthritis affects about 1% of the population, and is at about as common as diabetes.

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