Rheumatoid Arthritis: No Cause, No Cure

Sahasra Karamsetty, 4/1/24

Arthritis: A chronic disease characterized by inflammation and stiffness of the joints, leading to pain and reduced mobility. There are many different types of arthritis, but the most common ones include osteoarthritis and rheumatoid arthritis.

Rheumatoid arthritis: An autoimmune disorder where the body's immune system mistakenly attacks the joints, leading to inflammation, swelling, and pain. It can affect not only the joints but also organs such as the heart and lungs. RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness). 

There is no pathognomonic laboratory test for rheumatoid arthritis, which makes the diagnosis of this disease challenging in the early stages. A comprehensive clinical approach is required to make the diagnosis and prevent debilitating joint damage. The treatment of patients with rheumatoid arthritis requires both pharmacological and non-pharmacological therapy. 

The worldwide prevalence of RA in the Global Burden of Disease 2010 Study is about 0.24%.

Causes

Many autoimmune diseases, including RA, have a genetic basis, which means people with certain genetic markers have a slightly higher chance of developing the disease. There is no single rheumatoid arthritis gene; rather, researchers have identified the location of more than 150 locations that are associated with RA that, coupled with environmental factors, increase the risk of developing the disease.

It is hence thought to result from the interaction between patients' genotypes and environmental factors.

Cigarette smoking is the strongest environmental risk factor associated with rheumatoid arthritis. Studies have shown in anti-citrullinated protein antibody (anti-CCP) positive individuals, there is an interaction between the shared epitope (SE) and smoking that increases the risk of RA.

Other environmental triggers may play a role as a trigger for RA, which is more closely associated with seropositive RA. These include silica, asbestos, textile dust, and P gingivalis. This suggests that external exposure to various antigens in parts of the host distant from the joints then triggers an autoimmune inflammatory response in the joints.

RA is hereditary, meaning there is an inherited component. Research shows that the disease rate is 0.5% in the general population and 0.8% among those with a family history of RA.

The risk of developing RA is hence linked to a combination of genetics, family history, and environmental triggers. It’s been called the “Bermuda triangle” of genetic and environmental factors and immunity triggers that are underlying an RA diagnosis. While one of these factors or a couple of them could cause Arthritis ,there is no definite cause of this disease .

Symptoms

The most common arthritis symptoms and signs include:

• Joint pain.

• Stiffness or reduced range of motion (how far you can move a joint).

• Swelling (inflammation).

• Skin discoloration.

• Tenderness or sensitivity to touch around a joint.

• A feeling of heat or warmth near your joints.

Where you experience symptoms depends on which type of arthritis you have, and which of your joints it affects.

Some types of arthritis cause symptoms in waves that come and go called flares or flare-ups. Others make your joints feel painful or stiff all the time, or after being physically active.

RA especially is characterized by:

•  Tender, warm, swollen joints

•  Joint stiffness that is usually worse in the mornings and after activity

•   Fatigue, fever and loss of appetite

Treatment

The most common arthritis treatments include:

• Over-the-counter (OTC) anti-inflammatory medicine like NSAIDs or acetaminophen.

• Corticosteroids (prescription anti-inflammatory medicine, including cortisone shots).

• Disease-modifying antirheumatic drugs (DMARDs) if you have rheumatoid or psoriatic arthritis.

• Physical therapy or occupational therapy can help you improve your strength, range of motion and confidence while you’re moving.

• Surgery (usually only if nonsurgical treatments don’t relieve your symptoms).

Surgery might be required if one has severe arthritis and other treatments don’t work. The two most common types of arthritis surgery are joint fusion and joint replacement.

Joint fusion is exactly what it sounds like: surgically joining bones together. It’s most common for bones in your spine (spinal fusion) or your ankle (ankle fusion).

If the joints are damaged or there is bone loss, one might need an arthroplasty (joint replacement). The surgeon will remove your damaged natural joint and replace it with a prosthesis (artificial joint). You might need a partial or total joint replacement.

It is important to note that though there is treatment available, the drugs given only reduce the inflammation, pain, or discomfort, but the entire disease cannot be eradicated. The drugs prescribed to manage rheumatoid arthritis often come with a spectrum of potential side effects, the extent of which can vary widely from person to person. 

Why is there no cure?

One of the major impediments to the development of definitive treatment for RA is the inability to detect it. Arthritis affects individuals differently, and what works for one person may not work for another. Factors such as genetics, lifestyle, overall health, and the specific type and severity of arthritis can influence treatment response, making it difficult to develop a one-size-fits-all cure.

The precise interplay between genetic, environmental, and immunological factors complicates efforts to develop targeted treatments.

In autoimmune forms of arthritis like rheumatoid arthritis, the immune system attacks the body's own tissues, leading to inflammation and joint damage. The immune system is highly complex, and understanding its dysregulation in autoimmune arthritis and finding ways to specifically target it without causing harmful side effects is a significant challenge.

While treatments can help manage symptoms and slow down the progression of the disease, reversing the degenerative process and restoring damaged cartilage or lost bones remains elusive.

Arthritis is often a chronic condition, meaning it persists over the long term. Managing a chronic condition like arthritis typically involves ongoing treatment and lifestyle modifications rather than a one-time cure.

While a universal cure for arthritis may not exist at present, ongoing research into the underlying mechanisms of arthritis, advances in medical technology, and the development of innovative treatment approaches offer hope for improved management and quality of life for individuals living with arthritis.

Sources

https://www.pfizer.com/news/articles/is_rheumatoid_arthritis_genetic_or_hereditary_and_what_role_does_environment_play

https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

https://my.clevelandclinic.org/health/diseases/12061-arthritis

https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis

https://www.cdc.gov/arthritis/basics/index.html

https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648