Rheumatoid arthritis is a disease that causes pain, swelling, and stiffness in the joints. It is one of many different types of arthritis. Rheumatoid arthritis symptoms develop gradually. The condition can affect many tissues throughout the body, but the joints are usually most severely affected. The specific cause of rheumatoid arthritis is not well unknown, but the disease happens when the body’s infection-fighting system, called the immune system, "attacks” the joints.

Research has shown that rheumatoid arthritis most likely occurs when a susceptible person is exposed to factors that start the inflammatory process. Approximately one in every 100 individuals has rheumatoid arthritis. Gender, heredity, and genes largely determine a person’s risk of developing rheumatoid arthritis.

Gender appears to play a major role in a person’s susceptibility to rheumatoid arthritis. Women are about three times more likely than men to develop rheumatoid arthritis.

Rheumatoid arthritis is not an inherited disease. Genes do not cause rheumatoid arthritis; they merely affect the risk of its development.

People with specific variants of genes (called human leukocyte antigen (HLA) genes) are more likely to develop rheumatoid arthritis than people with other gene variants. Many individuals who carry these genes never develop the condition. Indeed, when one identical twin has rheumatoid arthritis, the chance that the other will develop disease is only about a third. This suggests that additional factors must be necessary for a person to develop Rheumatoid arthritis other than genes.

Researchers suspect that infection with bacteria or viruses may be one of the factors that initiate rheumatoid arthritis. However, at this time, there is no definite evidence linking infection to rheumatoid arthritis.

Cigarette smoking may increase the risk of developing rheumatoid arthritis. There is also some evidence that cigarette smoking increases the likelihood that rheumatoid arthritis will be severe when it occurs.

Patients often report episodes of stress or trauma preceding the onset of their rheumatoid arthritis. Stressful "life events” (e.g., divorce, accidents, grief, etc.) are more common in people with rheumatoid arthritis in the six months before their diagnosis compared with the general population.

In most people, rheumatoid arthritis begins insidiously, and weeks or months may pass before the characteristic symptoms are bothersome enough to cause a person to seek medical care. Early symptoms may include fatigue, muscle pain, a low-grade fever, weight loss, and numbness and tingling in the hands. In some cases, these symptoms occur before joint pain or stiffness is noticeable.

Occasionally, rheumatoid arthritis begins with symptoms related to inflammation of tissues other than the joints. For example, a person may experience chest pain or shortness of breath.

Rheumatoid arthritis usually affects the same joints on both sides of the body at the same time. In the early stages, rheumatoid arthritis typically affects small joints, especially the joints at the base of the fingers, the joints in the middle of the fingers, and the joints at the base of the toes. Though not common, it may also begin in a single, large joint, such as the knee or shoulder, or it may come and go and move from one joint to another. As the condition progresses, most people have inflammation of the joints in the arms or legs, and between 20 and 50 percent of people have inflammation of the large central joints (eg, hips) and spine.

There is no single test used to diagnose rheumatoid arthritis. Instead, the diagnosis is based upon many factors, including the characteristic signs and symptoms, the results of laboratory tests, and the results of x-rays. There are some laboratory tests that help to confirm the presence of rheumatoid arthritis, to differentiate it from other conditions, and to predict the likely course of the condition and its response to treatment.

Once diagnosed with rheumatoid arthritis, there are some treatments that help in controlling the inflammation of rheumatoid arthritis and in minimising joint damage. Treatment usually entails a combination of drug therapy and other non-drug therapies. In some cases, treatment may also involve surgery.

Rheumatoid arthritis can cause problems in other parts of the body, such as the heart, lungs, or eye and medics have no way of knowing which people will get which symptoms or how bad the symptoms will get hence once should start treatment as soon as diagnosed with the condition to prevent a lot of the damage the disease can do to one’s body, some of which can be irreversible damages

Dr. Ian ShyakaResident in Surgery, Rwanda Military Hospital