Rheumatoid arthritis is an inflammatory arthritis in which the joints, usually in the hands and feet, develop inflammation, resulting in swelling, pain and, often, joint destruction.
The immune system damages the joints and connective tissues.
The joints (usually the small joints of the limbs) are painful and stiff for more than 60 minutes after getting up and after a period of inactivity.
Fever, weakness and damage to other organs may occur.
Diagnosis is made primarily on the basis of symptoms, but also on rheumatoid factor serologic tests and x-rays.
Treatment may include exercises, splinting, medications (nonsteroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and immunosuppressants), and sometimes surgery.
Worldwide, almost 1% of the population suffers from rheumatoid arthritis, regardless of ethnicity or country of origin, with an incidence 2 to 3 times higher in women than in men. Rheumatoid arthritis usually begins between the ages of 35 and 50, but it can occur at any age. A disease similar to rheumatoid arthritis can occur in children. The disease is then called juvenile idiopathic arthritis. Nevertheless, the prognosis for juvenile idiopathic arthritis is often somewhat different.
The exact cause of rheumatoid arthritis is unknown. It is considered an autoimmune disease. Components of the immune system attack the soft tissues that line joints (synovial structures) and can also reach connective tissue in other parts of the body, such as blood vessels and the lungs. Eventually, the cartilage, bone and ligaments of the joint can erode , causing joint deformity, instability and fibrosis. Joints deteriorate at varying rates. Many factors, including genetic predisposition, can influence the course of the disease. Unknown environmental factors (such as viral infections and smoking) are believed to have a role.
With new diagnostic tests such as the determination of anti-citrullinated protein antibodies and the appearance of new concepts such as the therapeutic window of opportunity, it seemed a few years ago that it was time to revise the classification criteria of Rheumatoid Arthritis (RA) of 1987. This revision was a multi-year international consensus process that concluded in 2010. The new ACR/EULAR 2010 criteria were originally designed as classification criteria for RA in order to homogenize the populations of patients included in clinical trials. However, they are also commonly used in practice as diagnostic criteria for RA to improve early diagnosis and treatment. Compared to the old criteria of 1987, the sensitivity is better but the specificity lower. The main drawback of the new criteria is therefore the probability of diagnosis and treatment by excess. Probability which is likely to be increased if one seeks to improve the sensitivity of the criteria by using, for example, imaging techniques to detect synovitis.
The ACR/EULAR criteria provide the possibility of early diagnosis of rheumatoid arthritis. A score of 6 or more is diagnostic of rheumatoid arthritis.