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What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease characterised by inflammation in the joints and other areas of the body. An autoimmune disease occurs when the immune system attacks the body’s own tissues, particularly the joints. Unlike the wear-and-tear damage of osteoarthritis, which affects joint cartilage, RA affects the lining of your joints (synovium), causing a painful swelling that can eventually result in bone erosion and joint deformity.

Rheumatoid arthritis can also affect youths aged 16 or younger. This is known as juvenile rheumatoid arthritis or JRA. Juvenile rheumatoid arthritis is not permanent like those seen in adults, and it usually resolves as the child grows.

rheumatoid arthritis singapore
Rheumatoid arthritis affects the lining of your joints, causing a painful swelling.

What causes rheumatoid arthritis? 

Our immune system is responsible for protecting the body against dangerous foreign substances like bacteria and viruses. However, with autoimmune diseases, the immune system attacks and kills the body’s own cells. This can happen in various parts of the body, but with rheumatoid arthritis, it occurs in the synovium.

When the synovium is attacked, it becomes inflamed, tender, and swollen, making movement difficult and stiff. The affected joint will also appear red and swollen. Rheumatoid arthritis is also a systemic disease, which means that although it primarily affects the joints, it can also affect other body areas, such as the heart, kidneys, lungs, skin, eyes, and digestive and nervous systems.

Sometimes, an overreaction to a viral infection can trigger the immune system to malfunction, resulting in autoimmune diseases. However, the main cause of all autoimmune disorders, including rheumatoid arthritis, remains unknown.

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis symptoms vary in severity and may be intermittent. Flare-ups of the disease can be followed by periods of relative remission, where the swelling and pain fade or disappear completely. Typical symptoms include:

  • Joint symptoms: pain, swelling, stiffness, and loss of function in multiple joints are common. These symptoms typically affect both sides of the body.
  • Stiffness after inactivity: joint stiffness after periods of prolonged inactivity or in the morning, which can last several hours, is a hallmark symptom of rheumatoid arthritis.
  • Systemic symptoms: rheumatoid arthritis is a systemic disease that can result in symptoms such as fatigue, fever, and weight loss.
  • Rheumatoid nodules: rheumatoid nodules are characterised by firm bumps of tissue under the skin on the arms​.
  • Limited range of motion: the affected joints will have a limited range of motion due to pain, tenderness, and stiffness.
rheumatoid arthritis symptoms
Joint pain, swelling, stiffness, and loss of function are common in rheumatoid arthritis.

Is rheumatoid arthritis painful?

Yes, rheumatoid arthritis can be quite painful. The pain is often a direct result of the inflammation in the joints, which becomes particularly acute during flare-ups or periods of increased disease activity. This pain can significantly affect the quality of life, making everyday activities challenging.

Who is at risk of developing rheumatoid arthritis in Singapore?

Rheumatoid arthritis can affect anyone, but several factors increase the risk of developing the disease:

  • Gender: women are three times more likely to develop rheumatoid arthritis than men.
  • Age: while rheumatoid arthritis can occur at any age, it typically develops between the ages of 30 and 50.
  • Family history: some individuals have a genetic predisposition to developing rheumatoid arthritis. In fact, a family history of any autoimmune disease increases your risk of rheumatoid arthritis.
  • Smoking: the tobacco in cigarettes triggers your body to release cytokines, a type of immune cell related to inflammation in rheumatoid arthritis. Therefore, smoking increases the risk of developing the disease.
  • Obesity: research has shown that a majority of people with rheumatoid arthritis are obese. Additionally, obesity has also been linked to an increased risk of developing rheumatoid arthritis before the age of 55.
rheumatoid arthritis Singapore
Rheumatoid arthritis is more commonly diagnosed in women than men.

How is rheumatoid arthritis diagnosed?

Diagnosing rheumatoid arthritis can be challenging as its symptoms can mimic those of other conditions. However, a combination of the following is typically used to diagnose rheumatoid arthritis:

  • Medical history and physical examination: your specialist will inquire about your symptoms, triggers or flare-ups, and family history of the disease. The affected joints will be examined for swelling, warmth, and redness.
  • Blood tests: blood tests are conducted to check for markers like rheumatoid factor, anti-cyclic citrullinated peptide antibodies, erythrocyte sedimentation rate, and C-reactive protein, which can help indicate inflammation and the presence of autoimmune disease.
  • Imaging tests: imaging tests such as X-rays, ultrasounds, and magnetic resonance imaging (MRI) can help identify the degree of joint damage and inflammation.

What are the treatment options for rheumatoid arthritis in Singapore?

While there is no cure for rheumatoid arthritis, treatments can reduce inflammation in the joints, relieve pain, prevent or slow joint damage, and improve the person’s sense of well-being and ability to function. Treatment for rheumatoid arthritis usually includes:

  • Medications:
  • Physical therapy: physical therapy can help improve mobility, relieve pain, and maintain fitness.
  • Surgery: procedures such as synovectomy, tendon repair, joint fusion, or total joint replacement may be necessary to restore function or relieve pain when other treatments have not been effective.

Frequently asked questions

The initial signs of rheumatoid arthritis often involve a general feeling of pain and stiffness in the joints, particularly affecting the smaller joints in your hands and feet. As the condition progresses, symptoms can spread to the wrists, knees, ankles, elbows, hips, and shoulders. You may also notice your joints beginning to swell or turn red, experiencing these symptoms in a symmetrical pattern (affecting both sides of your body equally). Morning stiffness lasting for a half hour or more is also a common early sign.

Rheumatoid arthritis is an autoimmune disease, meaning it occurs when your immune system mistakenly attacks healthy tissue in your joints and potentially other parts of your body. The exact trigger for this immune response is not fully understood, but it’s believed to involve a combination of genetic and environmental factors. Genetics can make you more susceptible to environmental triggers, such as infections, which may initiate the disease.

Managing rheumatoid arthritis typically involves a combination of medication, lifestyle adjustments, and sometimes surgery to manage symptoms and slow disease progression. Medications like disease-modifying antirheumatic drugs (DMARDs) and anti-inflammatory drugs can help control symptoms and prevent further joint damage. Regular exercise, a healthy diet, and quitting smoking can also support overall health and reduce symptoms of rheumatoid arthritis. 

As of now, there is no cure for rheumatoid arthritis. However, treatment strategies have significantly improved over the years, allowing many individuals to manage their symptoms effectively and maintain a good quality of life. Early diagnosis and treatment are key to minimising joint damage and improving outcomes.