Written by Sophie Keshishian, Edited by Jacob Flores, Edited by Courtney Coleman
Leading an active life is a common goal for most healthy humans – a goal which can be hindered by inflammation and chronic pain in the joints. This is projected to be the painful reality for an estimated 78.4 million U.S. adults by 2040 (CDC, 2023). Rheumatoid arthritis (RA) is an autoimmune inflammatory disease in which a faulty immune system attacks the joints in the hands, wrists, knees, and ankles. It is characterized by inflamed joint linings causing lasting damage to the joint tissue (CDC, 2023). This damage causes chronic and lasting pain, severely hindering the lifestyle of those who deal with its symptoms. While there are ways to manage and reduce the severity of the disease, RA cannot easily be predicted or prevented, which is why people must remain aware of its mechanisms, symptoms, and course of treatment in order to be best prepared.
Causes
A healthy, functional immune system’s role is to attack foreign invaders in the body, like bacteria or viral infections, such as when you are infected with a common cold. In people who suffer from autoimmune diseases, the immune system mistakenly considers a body’s own cells as foreign and releases inflammatory factors to attack these cells. In RA, the immune system attacks the synovium, the connective tissue which lines the joints, making it thicker and inflamed, causing the joint to become tender and painful (Arthritis Foundation, 2021).
Research has narrowed down the causes of RA to genetic, environmental, and physical/emotional factors. People born with certain genes, specifically HLA (human leukocyte antigen) class II genotypes – which help the immune system distinguish foreign invaders from the body’s own cells – are more susceptible to developing RA due to potential excessive inflammatory responses. Along with the presence of these gene types, development of RA is also exacerbated by external factors (i.e., smoking and obesity) and inherent personal factors (age). RA may begin at any age, but its onset is most prevalent in adults over 60. When stratifying by sex, RA is 2-3 times more common in women than men, and women who have never given birth are at greater risk of developing RA. Interestingly, women who have breastfed their children have shown to have a decreased risk of RA. These lifestyle outcomes and external factors are all important to keep in mind in order to prevent RA and seek diagnosis if necessary (CDC, 2023).
Diagnosis
In order to reach the best possible outcome, it is important that RA gets diagnosed early on, within 6 months of the onset of symptoms. Since disease progression is gradual and creates perpetual damage to the joints, starting a treatment plan early can help mitigate the severity of progression. RA can be diagnosed through a review of symptoms, a basic physical exam, and X-rays and lab tests conducted by rheumatologists, which are RA specialists. Rheumatologists are able to differentiate the symptoms of RA from those of other inflammatory joint diseases, such as psoriatic arthritis or lupus, to name a few. Once the patient receives the necessary tests and appropriate diagnosis, an associated treatment plan can be implemented to address the inflammation (CDC, 2023).
Treatment
The typical course of treatment for RA involves medication and lifestyle changes. The most common prescribed drugs are called disease-modifying antirheumatic drugs (DMARDs), which slow disease and prevent joint deformity. Other anti-inflammatory drug classes such as NSAIDs (non-steroidal anti-inflammatory drugs) and steroids are also commonly prescribed to alleviate painful inflammation (Mayo Clinic, 2023). Ironically, in the case of autoimmune diseases, one of the most cutting-edge treatments for RA involves using one’s own cells to treat those which are damaged. Mesenchymal stem cells, a type of multipotent stem cell found in bone marrow, have anti-inflammatory properties which can be used to reduce pain and increase mobility for RA patients. Mesenchymal stem cells have immunosuppressive properties, meaning they can partially suppress an overactive immune response via inhibition of T-cell proliferation to alloantigens and mitogens, as well as cytotoxic T-cells. Studies have shown that patients treated with MSC therapy exhibited improvements in diet, sleep, and physical strength (DVC Stem, 2023). Traditional therapy, such as non-steroidal anti-inflammatory drugs (NSAIDs) and slow-acting antirheumatic drugs (SAARDs) – though effective – can result in reduced immunity and lack the regenerative repair effects of stem cell therapy (DVC Stem, 2023).
Conclusion
Rheumatoid arthritis has vast impacts on the livelihoods of those struggling with it. By increasing awareness about the symptoms of RA, and by funding research and development for treatment beyond existing drugs, we can tackle its progression from its onset, resulting in the ability for RA patients to lead stronger, more active, and healthier lives.
References
Arthritis-Related Statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm. May 5, 2021. Accessed October 20, 2023.
Rheumatoid arthritis (RA). Centers for Disease Control and Prevention. July 27, 2020. Accessed October 13, 2023. https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html#:~:text=What%20is%20rheumatoid%20arthritis%20.
Rheumatoid arthritis: Causes, Symptoms, treatment: Arthritis foundation. Rheumatoid Arthritis: Symptoms, Diagnosis, and Treatment | Arthritis Foundation. October 15, 2021. Accessed October 13, 2023. https://www.arthritis.org/diseases/rheumatoid-arthritis.
Rheumatoid arthritis: Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653. Accessed October 20, 2023.
Rheumatoid Arthritis and Stem Cell Therapy. DVC Stem. https://www.dvcstem.com/post/rheumatoid-arthritis#:~:text=Stem%20cell%20therapy%20for%20Rheumatoid%20Arthritis&text=When%20used%20in%20regards%20to,properties%20of%20mesenchymal%20stem%20cells. October 10, 2023. Accessed November 1, 2023.
This post is not a substitute for professional advice. If you believe that you may be experiencing a medical emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on March 14, 2024.
Sophie Keshishian is a second year majoring in molecular cell biology and business at UC Berkeley.
Jacob is a 2nd-year MPH student with an emphasis in Epidemiology & Biostatistics at UC Berkeley.
Courtney Coleman is a master's degree candidate in biology at Harvard and Co-President of Students vs Pandemics.