1. Overview of Rheumatoid Arthritis
Rheumatoid arthritis is a chronic autoimmune disorder. It directly affects the synovial membrane of the joints, causing inflammation and pain, which may lead to bone erosion and joint deformities. This causes difficulties in daily activities such as writing, opening bottles, dressing, or carrying objects.
Additionally, many patients experience difficulty walking or bending due to inflammation in the ankle, knee, or foot joints. According to statistics, the prevalence of RA in Asian countries ranges from 0.17% to 0.3%. In northern Vietnam, it is approximately 0.28%. The disease most commonly affects people aged 20 to 40.
Women are 2 to 3 times more likely to develop RA than men. Early detection and timely treatment are crucial because the disease is complex and can cause serious consequences.
Although RA cannot be completely cured, early and aggressive treatment can slow or halt disease progression, reducing the risk of disability and improving quality of life.
Moreover, the introduction of new medications has significantly improved treatment options, providing better outcomes for patients.
2. Risk Factors for Rheumatoid Arthritis
- Gender: Women have a higher risk than men.
- Age: RA typically begins in middle age but can occur at any age.
- Family history: Having relatives with RA increases one’s risk.
- Smoking: Smoking raises the risk of developing RA.
- Environmental exposures: Exposure to substances such as asbestos or silica can increase risk. Rescue workers exposed to dust from collapses may also have a higher risk of autoimmune diseases like RA.
- Obesity: Overweight or obese individuals, especially women under 55, have an increased risk
3. Causes of Rheumatoid Arthritis
RA occurs when the immune system attacks the synovium (joint lining), causing inflammation and thickening. This leads to cartilage and bone destruction, as well as weakening of the tendons and ligaments, resulting in joint deformity and loss of function.
The exact cause of this immune dysfunction remains unclear. Genetic factors play a significant role, making individuals more sensitive to environmental triggers like infections.
4. Symptoms of Rheumatoid Arthritis
The two main symptoms are joint pain and stiffness, often worst in the morning or after prolonged inactivity. Movement usually improves stiffness, which tends to appear suddenly and then resolve quickly.
Other symptoms include eye irritation or burning, fatigue, loss of appetite, skin nodules, tingling or numbness, shortness of breath, high fever, weakness, joint swelling, redness, warmth, tenderness, and deformity.
5. Stages of Rheumatoid Arthritis
RA progresses through four stages:
- Stage I: Early symptoms include joint swelling and pain due to synovial inflammation. Immune cells infiltrate the joint, increasing fluid cell count.
- Stage II: Inflammation spreads, bone growth affects joint space and cartilage, leading to cartilage loss and joint narrowing. Deformities are usually absent at this stage.
- Stage III: Severe stage with cartilage loss exposing underlying bone. Patients feel pain, swelling, stiffness, muscle wasting, and develop nodules and deformities.
- Stage IV: Final stage where joint function is lost due to fibrosis and bone ankylosis.
6. Diagnostic Methods for Rheumatoid Arthritis
Early diagnosis is difficult due to overlapping symptoms with other diseases. Diagnosis cannot rely solely on blood tests or routine clinical exams. Clinical signs such as joint swelling and deformity typically appear only in later stages.
In Vietnam and many other countries, the 1987 American College of Rheumatology (ACR) criteria remain the primary diagnostic tool for polyarticular rheumatoid arthritis with a disease duration of 6 weeks or more.
- In the morning, joint stiffness lasts for more than 1 hour.
- Inflammation in at least three joint areas: swelling of the soft tissues or effusion in at least 3 of the following 14 joint groups (including both sides): proximal interphalangeal joints, metacarpophalangeal joints, wrists, elbows, knees, ankles, and metatarsophalangeal joints.
- Inflammation of hand joints: swelling in at least one group of wrist, proximal interphalangeal, or metacarpophalangeal joints.
- Symmetrical arthritis.
- Subcutaneous nodules.
- Positive serum rheumatoid factor.
- Typical radiographic findings: erosions, cystic lesions, marginal bone defects, joint space narrowing, and juxta-articular osteopenia seen on X-ray of the hands, wrists, or affected joints.
A diagnosis of rheumatoid arthritis is confirmed when at least 4 of the criteria are present. To be considered arthritic symptoms (criteria 1–4), these must persist for at least 6 weeks and be confirmed by a specialist.
6.1 Diagnosis of rheumatoid arthritis based on blood tests
The presence of systemic inflammation may be indicated by elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) levels in people with rheumatoid arthritis. Other common blood tests check for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
6.2 Diagnosis of rheumatoid arthritis based on imaging tests
To monitor disease progression over time, doctors may recommend X-rays. Additionally, MRI and ultrasound tests can help assess disease severity.
7. Prevention of rheumatoid arthritis
Currently, there is no way to completely prevent rheumatoid arthritis. If there is a family history, individuals should undergo regular health checkups for early detection and timely treatment.
8. Treatment of rheumatoid arthritis
Rheumatoid arthritis cannot yet be completely cured. However, various effective treatments help relieve symptoms and improve quality of life.
Research has shown that early treatment with disease-modifying antirheumatic drugs (DMARDs) increases the likelihood of symptom remission.
8.1 Medication
Depending on the severity and duration of symptoms, doctors may prescribe:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation, such as ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve). Side effects may include gastric irritation, cardiovascular issues, kidney damage, prolonged bleeding, or increased hemorrhagic risk.
- Corticosteroids (e.g., prednisone) to reduce inflammation, pain, and slow joint damage. Side effects include osteoporosis, weight gain, and diabetes. These are usually prescribed for acute symptom control, then tapered gradually.
- Disease-modifying antirheumatic drugs (DMARDs) to slow disease progression and prevent permanent joint or tissue damage. Common DMARDs include methotrexate (Trexall, Otrexup), leflunomide (Arava), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine). Side effects may include hepatotoxicity, bone marrow suppression, and severe lung infections.
- Biologic agents (biologic response modifiers), a newer DMARD class, include anti-TNF, anti-IL-6, B-cell inhibitors, and T-cell inhibitors. Effectiveness depends on the individual case and is especially beneficial for patients unresponsive to conventional therapies.
8.2 Surgery
If medications fail to stop or slow joint damage, surgery may be considered to repair damaged joints, restore function, relieve pain, and improve mobility.
Surgical options include:
- Arthroscopy: Removal of inflamed synovial tissue in joints such as knees, elbows, wrists, fingers, and hips.
- Tendon repair: Repairing tendons loosened or ruptured due to inflammation and joint damage.
- Joint fusion: A procedure to stabilize or realign joints and relieve pain when joint replacement is not possible.
- Total joint replacement: Damaged parts are replaced with prosthetic components made of metal and plastic.
8.3 Supportive measures
- Exercise and guided movement therapy to prevent contractures, joint adhesions, and muscle atrophy: during acute inflammation, joints should rest in functional positions, avoiding pressure. Once inflammation subsides, gradual and frequent exercises combining active and passive movements should be performed according to physiological joint function.
- Physical therapy, rehabilitation, and mineral bath treatments.
- Use of assistive devices.
9. Prevention of complications
- Gastric and duodenal ulcers: Since over 80% of patients are asymptomatic, early detection and treatment are crucial. Protective gastric medications or acid-suppressing agents should be used concurrently.
- Osteoporosis prevention: Supplement calcium and vitamin D; if high risk, bisphosphonates may be prescribed.
- Anemia management: Supplement folic acid, iron, and vitamin B12 if deficiencies are present.
Vinmec Orthopedic Trauma & Sports Medicine Center specializes in the management of trauma and musculoskeletal disorders involving bones, joints, and ligaments.
- Partial or total bone and joint replacement;
- Hip, knee, and elbow arthroplasty;
- Reverse shoulder arthroplasty and small joint replacements (first and only in Vietnam);
- Arthroscopic reconstruction and repair of ligament and meniscus injuries;
- Bone and soft tissue tumor management;
- Specialized sports medicine rehabilitation;
- Motion analysis for diagnosis, monitoring, and performance optimization in athletes and patients.
The center applies modern technologies such as 3D imaging and 3D printing for bone and joint prosthetics, individualized assistive devices, new biomaterials, and robotic-assisted precision surgery.
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