The etiology of rheumatoid arthritis is not fully understood. Evidence points to a complex interplay between environmental and genetic factors. In monozygotic twins, there is a more than 30 percent concordance rate for rheumatoid arthritis development, and 80 percent of whites with rheumatoid arthritis express the HLA-DR1 or -DR4 subtypes. These and other regions of the Major Histocompatibility Complex may confer susceptibility to more severe disease by causing a specific arthrogenic peptide to be presented to CD4+ T cells.
Gender — 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.
Heredity — Rheumatoid arthritis is not an inherited disease. Genes do not cause rheumatoid arthritis, they merely affect the risk of its development.
Specific genes — People with specific variants of human leukocyte antigen (HLA) genes are more likely to develop rheumatoid arthritis than people other gene variants.
Initiating factors — many individuals who carry HLA genes never develop the condition. Indeed, when one identical twin has rheumatoid arthritis, the chance that the other will develop disease is only about 1 in 3. This suggests that additional factors must be necessary for a person to develop RA.
Infection — 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 — 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.
Stress — Patients often report episodes of stress or trauma preceding the onset of their rheumatoid arthritis. Stressful "life events" (divorce, accidents, grief, etc.) are more common in people with RA in the six months before their diagnosis compared with the general population
Symptoms of RA
The arthritis of joints known as synovitis is inflammation of the synovial membrane that lines joints and tendon sheaths. Joints become swollen, tender and warm, and stiffness limits their movement. With time RA nearly always affects multiple joints (it is a polyarthritis), most commonly small joints of the hands, feet and cervical spine, but larger joints like the shoulder and knee can also be involved. Synovitis can lead to tethering of tissue with loss of movement and erosion of the joint surface causing deformity and loss of function.
Rheumatoid arthritis typically manifests with signs of inflammation, with the affected joints being swollen, warm, painful and stiff, particularly early in the morning on waking or following prolonged inactivity. Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for more than an hour. Gentle movements may relieve symptoms in early stages of the disease. These signs help distinguish rheumatoid from non-inflammatory problems of the joints, often referred to as osteoarthritis or "wear-and-tear" arthritis. In arthritis of non-inflammatory causes, signs of inflammation and early morning stiffness are less prominent with stiffness typically less than 1 hour, and movements induce pain caused by mechanical arthritis. In RA, the joints are often affected in a fairly symmetrical fashion, although this is not specific, and the initial presentation may be asymmetrical. As the pathology progresses the inflammatory activity leads to tendon tethering and erosion and destruction of the joint surface, which impairs range of movement and leads to deformity. The fingers may suffer from almost any deformity depending on which joints are most involved. Medical students are taught to learn names for specific deformities, such as ulnar deviation, boutonniere deformity, swan neck deformity and "Z-thumb," but these are of no more significance to diagnosis or disability than other variants, since they occur in osteoarthritis as well. "Z-thumb" or "Z-deformity" consists of hyperextension of the interphalangeal joint, fixed flexion and subluxation of the metacarpophalangeal joint and gives a "Z" appearance to the thumb.
Other symptoms —
Although joint problems are the most commonly known issues in rheumatoid arthritis, the condition can be associated with a variety of other problems.
Rheumatoid nodules — Rheumatoid nodules are painless lumps that appear beneath the skin. These nodules may move easily when touched or they may be fixed to deeper tissues. They most often occur on the underside of the forearm and on the elbow, but they can also occur on other pressure points, including the back of the head, the base of the spine, the Achilles tendon, and the tendons of the hand.
Inflammatory conditions — Rheumatoid arthritis may produce a variety of other symptoms, depending on which tissues are inflamed.
Inflammation of the tissue lining the chest cavity and surrounding the heart may cause chest pain and difficulty breathing.
Inflammation of the lung that is not due to infection may cause shortness of breath and a dry cough.
Abnormal nerve function may cause numbness, tingling, or weakness.
Inflammation of the white part of the eye may cause pain or vision problems.
Enlargement of the spleen may cause a fall in the number of white blood cells, which may lead to infections.
Sjögren's syndrome causes dry eyes and dry mouth, which can lead to a gritty feeling or a sensation of irritating material in the eyes. Mouth dryness may make it difficult to chew or swallow without drinking something at the same time. Women may develop vaginal dryness due to Sjögren's syndrome, leading to pain with sexual intercourse.
Vasculitis (inflammation of the blood vessels) may cause a wide variety of symptoms, depending upon where the inflamed blood vessels are located.
Laboratory tests help to confirm the presence of rheumatoid arthritis, differentiate it from other conditions, and predict the likely course of the condition and its response to treatment.
Rheumatoid factor (RF) — An antibody called rheumatoid factor is present in the blood of 70 to 80 percent of people with rheumatoid arthritis. However, rheumatoid factor is also found in people with other types of rheumatic disease and in a small number of healthy individuals.
Anti-citrullinated peptide/protein antibody test — Blood tests for antibodies to citrullinated peptides/proteins (ACPA) are more specific than rheumatoid factor for diagnosing rheumatoid arthritis. Anti-ACPA antibody tests may be positive very early in the course of disease. The test is positive in most patients with rheumatoid arthritis.
Management of RA
Diet: One of the simplest treatments, and yet a treatment that has been found to be effective for many people, is consuming an anti-inflammatory diet. Primarily, this consists of consuming omega-3 fatty acid containing foods, including small cold water fish, fruits, and vegetables. See the section on diet and nutrition for more details.
Weight loss: As with other forms of arthritis, if you are overweight then losing weight can make a large impact on decreasing pain and stiffness in your joints by taking some of the pressure off of them
Exercise and rest: Rest is an important part of treating rheumatoid arthritis. One of the symptoms of rheumatoid arthritis can be fatigue as well as a sense of generalized malaise. It is important to get adequate rest so that your body does not get run down, This is true for everyone, but particularly true for people with rheumatoid arthritis. People with rheumatoid arthritis should not exercise to the point of exhaustion. Rather, they should take frequent breaks and rest before they get too tired.
Homeopathy for Rheumatoid Arthritis
You cannot take homeopathic remedy without your homeopath’s advice. I have listed a number of medicines below which may or may not suit for you. A single medicine is selected after a complete case taking which is obtained on analyzing your mental physical and emotional planes. Your diseased side desires and aversions to particular food, your thirst is important for a good prescription.
Arnica: Useful for chronic arthritis with a feeling of bruising and soreness. The painful parts feel worse from being moved or touched.
Aurum metallicum: This remedy is often prescribed for wandering pains in the muscles and joints that are better from motion and warmth, and worse at night. The person may experience deep pain in the limbs when trying to sleep. Also may feel discomfort that may wake the person up. People who need this remedy are often serious and focused on work or career, with a tendency to feel depressed.
Bryonia: Helpful for stiffness and inflammation with tearing or throbbing pain, made worse by motion. The condition may have developed gradually, and is worse in cold dry weather. Discomfort is aggravated by being touched or bumped, or from any movement. Relief can be had from pressure and from rest. The person may want to stay completely still and not be interfered with. Business minded People.
Calcarea carbonica: Helpful for deeply aching arthritis involving node formation around the joints. Inflammation and soreness are worse from cold and dampness, and problems may be focused on the knees and hands. Common symptoms are: weakness in the muscles, easy fatigue from exertion, and a feeling of chilliness or sluggishness. The person who benefits from Calcarea is often solid and responsible, but tends to become extremely anxious and overwhelmed when ill or overworked. Timid fatty people with slowness in all their actions.
Causticum: Useful when deformities develop in the joints, in a person with a tendency toward tendon problems, muscle weakness, and contractures. The hands and fingers may be most affected, although other joints can also be involved. Stiffness and pain are worse from being cold, and relief may come with warmth. The person often feels best in rainy weather and worse when the days are clear and dry. Causticum people cannot bear injustice.
Calcarea fluorica: Helpful when arthritic pains improve with heat and motion. Joints become enlarged and hard, and nodes or deformities develop. Arthritis after chronic injury to joints also responds to Calcarea fluorica.
Dulcamara: Indicated if arthritis flares up during cold damp weather. The person gets chilled and wet. They are often stout, with a tendency toward back pain, chronic stiffness in the muscles, and allergies.
Kali bichromicum: This is useful when arthritic pains alternate with asthma or stomach symptoms. Pains may suddenly come and go, or shift around. Discomfort and inflammation are aggravated by heat, and worse when the weather is warm. Anxious about health and restless in sleep.
Kali carbonicum: Arthritis with great stiffness and stitching pains, worse in the early morning hours and worse from cold and dampness, may respond to Kali carbonicum. The joints may be becoming thickened or deformed. People who can benefit from this remedy often have a rigid moral code, and tend to feel anxiety in the stomach.
Kalmia latiflora: Useful for intense arthritic pain that flares up suddenly. The problems start in higher joints and extend to lower ones. Pain and inflammation may begin in the elbows, spreading downward to the wrists and hands. Discomfort is worse from motion and often worse at night.
Ledum palustre: Arthritis that starts in lower joints and extends to higher ones are candidate for this remedy. Pain and inflammation often begin in the toes and spread upward to the ankles and knees. The joints may also make cracking sounds. Ledum is strongly indicated when swelling is significant and relieved by cold applications.
Pulsatilla: Applicable when rheumatoid arthritis pain is changeable in quality, or when the flare-ups move from place to place. The symptoms (and the person) feel worse from warmth, and better from fresh air and cold applications. Can benefit people who are emotional and affectionate, sometimes having teary moods. Affectionate and obstinate with intolerance to fatty food. It is a right sided remedy with thirstlesness.
Rhododendron: Strongly indicated if swelling and soreness flare up before a storm, continuing until the weather clears. Cold and dampness aggravate the symptoms. Discomfort is often worse toward early morning, or after staying still too long.
Rhus toxicodendron: Useful for rheumatoid arthritis, with pain and stiffness that is worse in the morning and worse on first motion, but better from continued movement. Hot baths or showers, and warm applications improve the stiffness and relieve the pain. The condition is worse in cold, wet weather. The person may feel extremely restless, unable to find a comfortable position, and need to keep moving constantly. Continued motion also helps to relieve anxiety.
Ruta graveolens: Arthritis with a feeling of great stiffness and lameness, worse from cold and damp and worse from exertion, may be helped by ruta graveolens. Tendons and capsules of the joints can be deeply affected or damaged. The arthritis may have developed after overuse, from repeated wear and tear.