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Rheumatoid Arthritis (RA)

What is Rheumatoid Arthritis?

inflamed synovial membrane
Rheumatoid arthritis is characterised by inflammation of the synovium (which is also known as the synovial membrane)

Rheumatoid arthritis (RA) is a chronic autoimmune disorder in Singapore that primarily targets the joints but can also affect various body parts. In this condition, the immune system, which typically defends against harmful invaders such as viruses and bacteria, mistakenly attacks healthy joint tissues, particularly the synovium (the lining membranes surrounding the joints). This leads to persistent joint inflammation and, eventually, joint damage.

Rheumatoid arthritis often exhibits symmetrical joint involvement, affecting joints on both sides of the body in a similar fashion. It is characterised by a relapsing and remitting pattern, with periods of increased disease activity (flares) followed by periods of reduced activity (remissions). This fluctuating nature of the condition can lead to varying levels of joint pain and inflammation over time. Therefore, it is important to seek prompt and effective treatment to prevent joint deformities and irreversible joint damage.

What are the common causes Rheumatoid Arthritis in Singapore?

The exact cause of rheumatoid arthritis is not fully understood; however, it is believed to be attributed to a combination of genetic, environmental, and hormonal factors. Some of these factors include:

  • Genetics: individuals with a family history of the condition are at a higher risk of developing the disease. Specific genetic markers, including certain human leukocyte antigen (HLA) genes, are associated with an increased susceptibility to rheumatoid arthritis.
  • Environmental factors: Infections, particularly viral or bacterial infections, smoking and exposure to certain pollutants, may increase the risk of rheumatoid arthritis or trigger its onset in those with a genetic predisposition.
  • Immune system dysfunction: abnormal immune system responses play a central role in the development of rheumatoid arthritis. It is believed that an initial trigger, possibly an infection or environmental factor, may lead to the immune system attacking the synovium.
  • Hormonal factors: hormonal changes, particularly in women, may influence the development and progression of rheumatoid arthritis. Women are more likely to develop rheumatoid arthritis than men, and hormonal changes, such as during pregnancy or menopause, can affect the condition.

What are the symptoms of Rheumatoid Arthritis?

Rheumatoid arthritis can present with a range of symptoms that primarily affect the joints but can also involve other body systems. Common symptoms of rheumatoid arthritis include:

  • Joint pain: joint pain, which is usually worse in the morning and after periods of inactivity.
  • Joint swelling: inflamed synovial membrane in the affected joints, which leads to swelling and a feeling of warmth in the joints.
  • Stiffness: joint stiffness, especially in the morning or after sitting for extended periods, can last several hours.
  • Decreased range of motion: rheumatoid arthritis can limit the range of motion in affected joints, making it difficult to move.
  • Fatigue: many people with rheumatoid arthritis experience fatigue, which can be severe and disabling.
  • Systemic symptoms: rheumatoid arthritis can have systemic effects on the body, leading to low-grade fever, weight loss, and overall malaise.
  • Joint deformities: untreated rheumatoid arthritis can lead to joint deformities, such as swan neck or boutonniere deformities (finger joints deformities) and ulnar deviation (sideways deviation of the fingers from the knuckles).
  • Rheumatoid nodules: some individuals with rheumatoid arthritis develop small lumps, called rheumatoid nodules, under the skin, usually near joints.
  • Eye issues: rheumatoid arthritis can occasionally affect the eyes, causing dryness, redness, or pain.
  • Lung and heart complications: in severe cases, rheumatoid arthritis can affect the lungs and heart, leading to pleuritis (inflammation of the lining around the lungs) or pericarditis (inflammation of the lining around the heart).
Joint pain
Joint pain, swelling, and stiffness of joints are common symptoms associated with rheumatoid arthritis.

If you suspect you have rheumatoid arthritis or are experiencing any of the symptoms mentioned above, make an appointment with Asia Arthritis Rheumatology Clinic today.

Is Rheumatoid Arthritis painful?

Yes, rheumatoid arthritis is painful. Pain is one of the most common and prominent symptoms and is typically described as aching and throbbing, which worsens in the morning or after periods of inactivity.

Who is at risk of developing Rheumatoid Arthritis?

Rheumatoid arthritis can affect people of all ages, but certain factors increase the risk of developing the condition. These risk factors include:

  • Gender: women are two to three times more likely to develop rheumatoid arthritis than men.
  • Age: it most commonly begins between the ages of 25-45. However, it can also affect children and older adults.
  • Genetics: a family history of rheumatoid arthritis increases the risk of developing the condition. Specific genetic markers, such as human leukocyte antigen (HLA) genes, are associated with a higher susceptibility to rheumatoid arthritis.
  • Environmental factors: certain environmental factors such as smoking, exposure to pollutants, and infections have been associated with an increased risk.
  • Hormonal factors: hormonal changes, particularly in women, may influence the development and progression of rheumatoid arthritis.

How is RA diagnosed in Singapore?

Diagnosing rheumatoid arthritis involves the following:

  • Medical history taking: a detailed medical history will be taken; this includes information about your symptoms, the duration of symptoms, and any family history of autoimmune diseases or rheumatoid arthritis.
  • Physical examination: a thorough physical exam will assess joint tenderness, swelling, warmth, and range of motion; this is to identify signs of inflammation or deformities.
  • Blood tests: can help to support the diagnosis of RA and provide information about disease activity.
    • Rheumatoid factor (RF): an antibody often elevated in individuals with rheumatoid arthritis. It is non-specific and may be elevated in other autoimmune conditions.
    • Anti-cyclic citrullinated peptide (anti-CCP) antibodies: an antibody which is often used in conjunction with rheumatoid factor to enhance diagnostic accuracy.
    •  C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR): measure markers of inflammation in the body and help assess the degree of inflammation in rheumatoid arthritis.
  • Imaging studies: X-rays, ultrasound, or magnetic resonance imaging (MRI) scans may be used to identify joint damage, inflammation, and synovial thickening and to provide more detailed images of the joints and surrounding tissues.
  • Synovial fluid analysis: a sample of synovial fluid from the affected joint may be aspirated and analysed to check for signs of inflammation or to rule out other forms of arthritis.
x-ray rheumatoid arthritis
Imaging techniques such as x-rays can be used to diagnose rheumatoid arthritis.

If you suspect you have rheumatoid arthritis or are experiencing symptoms such as joint pain, swelling, and stiffness, consult a rheumatologist for a proper evaluation and diagnosis.

What are the treatment options for Rheumatoid Arthritis in Singapore?

The treatment of rheumatoid arthritis aims to relieve symptoms, reduce inflammation, slow or prevent joint damage, and improve the overall quality of life for individuals with the condition. Treatment plans are often tailored to each patient's specific needs and may involve a combination of the following approaches:

  • Medications:
    • DMARDs: Disease-modifying antirheumatic drugs(DMARDs) are the cornerstone of RA treatment. They work to reduce joint inflammation, slow disease progression, and help prevent joint damage. These include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide.
    • A newer class of DMARDs: these drugs target specific immune responses in the immunity cascade. Examples include tumour necrosis factor (TNF) inhibitors, interleukin-6 (IL-6) inhibitors, and Janus Kinase (JAK) inhibitors, which can be used to provide rapid, effective control of the condition.
    • Corticosteroids: corticosteroids such as prednisolone and nonsteroidal anti-inflammatory drugs (NSAIDs) are also frequently used to manage symptoms and reduce inflammation. However, corticosteroids are typically used for short-term relief due to their potential side effects when used long-term.
  • Physical and occupational therapy: physical therapy exercises and techniques can improve joint mobility and strength and help individuals adapt to their daily lives without putting excessive strain on the affected joints.
  • Lifestyle modifications: regular, low-impact exercise can help improve joint function and overall well-being. A balanced, anti-inflammatory diet rich in fruits, vegetables, whole grains, and lean proteins may help manage rheumatoid arthritis symptoms.
  • Surgery: surgery may be considered in severe cases of rheumatoid arthritis where joint damage is significant and other treatments have been ineffective. Joint replacement surgery, such as knee or hip replacement, can help improve mobility and reduce pain.
Yoga
Low-impact exercises such as gentle yoga can work for pain management in rheumatoid arthritis.

Make an appointment with Asia Arthritis Rheumatology Centre where we prioritise our patient’s health by ensuring accurate diagnosis and personalised treatment.

Frequently Asked Questions

What are the early symptoms of rheumatoid arthritis?

Early symptoms of rheumatoid arthritis include joint pain, swelling, and morning stiffness, especially in the hands and feet. Fatigue, low-grade fever, and joint tenderness may also be present.

Is there a cure for rheumatoid arthritis?

Currently, there is no cure for rheumatoid arthritis, but the condition can be managed effectively with medications, lifestyle modifications, and therapies to reduce symptoms, slow disease progression, and improve quality of life.

Can rheumatoid arthritis affect other body parts besides the joints?

Yes, rheumatoid arthritis is a systemic disease affecting various organs and systems, including the heart, lungs, skin, and eyes.

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Dr Annie Law

Senior Consultant Rheumatologist
MB BCh BAO, MRCP (UK), MMed,
FAMS (Rheumatology)

Dr Annie Law is an experienced Senior Consultant Rheumatologist and Medical Director at Asia Arthritis & Rheumatology Centre.

She leads subspecialty SLE clinics, showcasing her dedication to lupus care. Dr Annie Law has been duly recognised for patient-oriented care, earning multiple awards. Her extensive education includes FAMS (Rheumatology) and MRCP (General Medicine). Actively involved in lupus research, she established a lupus database and contributed to paramount protein therapy discoveries. Dr Law is a committed medical educator, holding faculty positions and receiving accolades for her teaching. Her impactful contributions extend to the professional organisation for rheumatology in Singapore exemplifying deep commitment to advancing rheumatology knowledge.

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