Rheumatoid Arthritis. Disease RA Final.indd :23

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1 Rheumatoid Arthritis Disease RA Final.indd :23

2 Understanding what to expect can help you prepare for your transition into treatment. Rheumatoid Arthritis What You Need To Know About Rheumatoid Arthritis This medical guide is designed for educational purposes to help patients understand Rheumatoid Arthritis. Please consult with your doctor for specific questions and details about your symptoms. Disease RA Final.indd :23

3 What You Need To Know About Rheumatoid Arthritis Contents How do healthy joints work? What is Rheumatoid Arthritis? What causes Rheumatoid Arthritis? What are the symptoms of Rheumatoid Arthritis? How is Rheumatoid Arthritis diagnosed? How is Rheumatoid Arthritis treated? How can I manage Rheumatoid Arthritis in daily life? How is Arthritis different from Osteoporosis? Frequently asked questions Disease RA Final.indd :23

4 How do healthy joints work?1 Disease RA Final.indd :23

5 02 How do healthy joints work?1 03 Joints are where two bones intersect and allow you to move parts of your body in certain ways. The joints are covered with cartilage, a smooth connective tissue that cushions the joints and helps the joints move smoothly without friction. The capsule encloses the joints and provides support. The inner lining of the capsule, called the synovium, secretes the synovial fluid that lubricates and nourishes the joints. Muscle Bursa Bone Synovial membrane Tendon Cartilage Synovial fluid Joint capsule Normal Joint Disease RA Final.indd :23

6 What is Rheumatoid Arthritis? 1,2 Disease RA Final.indd :23

7 What You Need To Know About Rheumatoid Arthritis What is Rheumatoid Arthritis? 1,2 Rheumatoid Arthritis is a chronic inflammatory disease that causes pain, swelling and stiffness in the joints. Approximately 1% of the population worldwide suffer from Rheumatoid Arthritis. What happens in a joint affected by Rheumatoid Arthritis? The synovium of the joints, especially that of the small joints in the hands and feet, becomes the main site of inflammation once Rheumatoid Arthritis develops. Inflammation in the synovium causes it to produce extra synovial fluid, which leads to swelling. The swelling causes the capsule to stretch and causes pain. Increased blood flow makes the joints feel warm. Rheumatoid Arthritis progress Normal Rheumatoid Arthritis Bone erosion Main site Synovium becomes swollen and inflamed Rheumatoid Arthritis Disease RA Final.indd :23

8 What causes Rheumatoid Arthritis? 3,4,5 Rheumatoid Arthritis Disease RA Final.indd :23

9 04 What causes Rheumatoid Arthritis? 3,4,5 05 Rheumatoid Arthritis is a disease of unknown causes. It has been determined that symptoms of Rheumatoid Arthritis develop due to a faulty immune system that attacks healthy cells, but it is uncertain why the immune system behaves this way. Research suggests that genes, hormones, and environmental factors play a role. Genes People with certain genetic markers such as HLA may be more susceptible to Rheumatoid Arthritis. Rheumatoid Arthritis Environment Smoking Dietary habits Stress Infection Hormones It is likely that hormones play a role in the development of Rheumatoid Arthritis, as there is a higher incidence in women, especially women going through menopause. Disease RA Final.indd :23

10 What are the symptoms of 1, 3, 6 Rheumatoid Arthritis? Disease RA Final.indd :23

11 What You Need To Know About Rheumatoid Arthritis What are the symptoms of 1, 3, 6 Rheumatoid Arthritis? Symptoms of Rheumatoid Arthritis depend on each person, and conditions may oscillate between remission and relapse. Hands, wrists, elbows, shoulders, knees, and ankles are most commonly affected sites. Rheumatoid Arthritis and Joint Inflammation Discomfort and swelling of joints Morning stiffness Chronic joint pain Tender, warm, and swollen joints Rheumatoid Arthritis Symptoms that Affect the Entire Body Fatigue and tiredness Anaemia Fever Loss of appetite and weight loss Inflammation in other body parts such as the eyes, lungs, and blood vessels Dry mouth and gum infection Rheumatoid nodules on the skin Common sites for rheumatoid nodules Disease RA Final.indd :23

12 How is Rheumatoid Arthritis diagnosed?1, 3 Disease RA Final.indd :23

13 06 How is Rheumatoid Arthritis diagnosed?1, 3 07 Confirming Rheumatoid Arthritis is difficult and may require a combination of tests for a proper diagnosis. Medical History Your rheumatologist will ask you questions about personal and family medical history and check for possible risk factors. Physical Exam Your rheumatologist will examine joints that are commonly affected and check for symptoms such as tenderness, swelling, and pain. Blood Test Your blood sample will be tested for ESR (erythrocyte sedimentation rate), rheumatoid factors, anti CCP (cyclic citrullinated peptide) antibodies, and CRP (C-reactive proteins) that may be indicative of Rheumatoid Arthritis. Radiology Test X-rays, ultrasound scans, and MRI scans will allow your doctor to visually assess the inflammation and damage occurring in your joints. Disease RA Final.indd :23

14 How is Rheumatoid Arthritis Treated? Disease RA Final.indd :23

15 What You Need To Know About Rheumatoid Arthritis How is Rheumatoid Arthritis Treated? Biologics 7 Target parts of the immune system that triggers inflammation and causes joint/ tissue damage. Anti-TNF agents: infliximab, etanercept, adalimumab, certolizumab, golimumab. Non Anti-TNF agents: abatacept, rituximab, tocilizumab, anakinra. Taken by subcutaneous injection or through an intravenous line. Biosimilars biologic medical products highly similar to previously authorized biological medicines. Disease-modifying anti-rheumatic drugs (DMARDs) 7,8 First-line treatment option for Rheumatoid Arthritis. If DMARDs alone do not work, switching to or adding another DMARDs is recommended. Ease symptoms and prevent permanent joint damage. Include methotrexate, sulfasalazine, and hydroxychloroquine. Corticosteroids 3 Have fast-acting and strong anti-inflammatory effects. Include prednisone, prednisolone, and methylprednisolone. Non-steroidal anti-inflammatory drugs (NSAIDs) 4,7 Mostly available as over-the-counter tablets. Include aspirin, ibuprofen, ketoprofen, naproxen sodium, and celecoxib. Surgery 10 Not all patients with Rheumatoid Arthritis require surgery. Whether surgery is necessary or not will be determined by your doctor after considering your symptoms, overall health, risk, and benefits. Surgery may involve joint replacement or reconstruction. Disease RA Final.indd :23

16 How can I manage Rheumatoid Arthritis in daily life? 1 Disease RA Final.indd :23

17 08 How can I manage Rheumatoid Arthritis in daily life? 1 09 Pace yourself Rheumatoid Arthritis is a condition that alternates between remission and relapse. You will have good days and bad days. It is important not to overwork on days you feel better, as it may cause flare-ups. Take things slow and steady with a positive attitude. Get a good night s sleep You may experience a decrease in your quality of sleep due to pain and symptoms. Yet, it is important to get restful sleep for you to keep your condition under control. The following tips may help. Make sure your bed is supportive and comfortable. Follow a regular bedtime schedule that helps you relax. Take a warm bath before going to bed. Stretching and light exercise may help you sleep. Exercise regularly Lack of exercise may stiffen your joints and weaken your muscles. Make sure to keep a good balance between rest and exercise. Try low- or no-impact aerobic exercises such as cycling, walking, swimming, and yoga following a proper warm up. Disease RA Final.indd :23

18 How is Arthritis different from Osteoporosis?11,12 Disease RA Final.indd :23

19 What You Need To Know About Rheumatoid Arthritis How is Arthritis different from Osteoporosis?11,12 Because osteoporosis and some types of arthritis cause similar symptoms and affect similar sites, people may not be able to tell the difference between these completely different conditions. Comparison of Osteoporosis, Osteoarthritis, and Rheumatoid Arthritis: Osteoporosis causes bone loss and weakening of joints. Osteoarthritis results in damage of the bones due to wear and tear of cartilage. Rheumatoid Arthritis leads to swelling and inflammation of joints triggered by an unknown cause. Risk Factors Age-related Family history Overuse of joints Smoking Excessive alcohol Anorexia nervosa Excessive weight Physical Effects* Joints affected Autoimmunity involved Bony spurs Enlarged or malformed joints Height loss * 1) In Rheumatoid Arthritis, the same joints are usually affected on both sides of the body. This symmetry doesn t typically occur in Osteoarthritis. 2) Joints commonly affected in Osteoarthritis are weight-bearing joints such as the knees and hips, while in Rheumatoid Arthritis symptoms in fingers, wrists, and ankles are most common. 3) Osteoarthritis does not involve systemic symptoms of fever, weakness, and fatigue that are common in Rheumatoid Arthritis. Disease RA Final.indd :23

20 Frequently Asked Questions Disease RA Final.indd :23

21 10 11 Frequently Asked Questions Isn t Rheumatoid Arthritis just an elderly disease? 13,14 A_ Rheumatoid Arthritis can affect people at all ages, male or female. While other forms of arthritis that are caused by joint erosion occur in older people, Rheumatoid Arthritis can occur as early as in your thirties. Therefore, it is important to watch for symptoms and signs of Rheumatoid Arthritis even at an early age. Does having Rheumatoid Arthritis increase the risk of heart disease? 15 A_ Patients with Rheumatoid Arthritis are at an increased risk of heart disease. In fact, heart problems are the leading cause of death for Rheumatoid Arthritis patients. As high cholesterol is one of the major risk factors for Rheumatoid Arthritis, it is especially important that you keep track of your cholesterol levels and maintain a healthy lifestyle. I have Rheumatoid Arthritis. What are the chances of my child inheriting it? 16,17 A_ Studies have shown that having a family history of Rheumatoid Arthritis increases the risk of developing the disease by up to 3 times. However, a parent having Rheumatoid Arthritis does not necessarily mean the child will be born with Rheumatoid Arthritis. You should consult your doctor or genetic counsellor to assess the possible risks. Disease RA Final.indd :23

22 REFERENCES 1. Arthritis Research UK. Rheumatoid arthritis. Available at Accessed May Allan Gibofsky. Overview of Epidemiology, Pathophysiology, and Diagnosis of Rheumatoid Arthritis. American Journal of Managed Care. 2012;18:S Arthritis Foundation. Rheumatoid Arthritis. Available at Accessed May NHS Choices. Rheumatoid arthritis. Available at Accessed May Web med. The Gender Gap: How RA Differs in Women. Available at webmd.com/rheumatoid-arthritis/ra-and-women Accessed May Mayo clinic. Rheumatoid arthritis. Available at Accessed May University of Maryland Medical Center. Rheumatoid arthritis. Available at umm.edu/health/medical/reports/ articles/rheumatoid-arthritis Accessed May NRAS. Combination therapy for rheumatoid arthritis. Available at Accessed May American College of Rheumatology. Biologic Treatments for Rheumatoid Arthritis. Available at Clinical/Patients/Medications/Biologic_Treatments_for_Rheumatoid_Arthritis/ Accessed May National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rheumatoid arthritis. Available at Accessed May Osteoporosis and Arthritis: Two Common but Different Conditions. Available at Accessed May Krug, Barbara. Rheumatoid Arthritis and Osteoarthritis: A Basic Comparison. Orthopaedic Nursing. 1997;16: Arthritis Foundation. 10 Things to Know about Rheumatoid Arthritis. Available at Accessed May John s hopkins. Arthritis center. Available at hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-symptoms/ Accessed May Arthritis Foundation. 10 Things to Know about Rheumatoid Arthritis. Available at Accessed May Frisell et al. Familial Risks and Heritability of Rheumatoid Arthritis. Arthritis & Rheumatism. 2013;65: Arthritis Research UK. What are the chances of my child having arthritis?. Available at org/arthritis-information/arthritis-and-daily-life/pregnancy-and-arthritis/what-are-the-chances-of-my-child-having-arthritis.aspx Accessed May HCREM-04 PB-0515 Disease RA Final.indd :23