What is Rheumatoid Arthritis?
Rheumatoid arthritis is an autoimmune disease which causes your body’s immune system to mistakenly attack its own joints and other body tissues. Approximately 1 in 100 people are affected, with women developing the disease two to three times more often than men. Rheumatoid arthritis antibodies lead to joint damage, stiffness, and pain. They are also responsible for widespread body inflammation which has been shown to weaken bones and increase your risk for fractures.
How is Rheumatoid Arthritis Diagnosed?
Unlike some of the conditions we’ve discussed which cause few recognizable symptoms, rheumatoid arthritis tends to be quite obvious. The most noticeable symptoms are those which involve your joints, including joint pain, warmth, swelling, and morning stiffness lasting longer than 30 minutes. Any joint can be impacted, with your knuckles (MCP joints), fingers (PIP joints), wrists, and feet (MTP joints) most commonly involved. Over time, rheumatoid arthritis can lead to joint destruction and deformity if not properly treated.
To definitively diagnose the condition, we look for the following features:
- 3 or more joints involved
- Symptoms that last for at least 6 weeks
- Lab tests that are positive for rheumatoid arthritis antibodies
There is not a single blood test that confirms the diagnosis, but the following lab tests are used to detect inflammation and antibodies which may be present in those with rheumatoid arthritis.
- C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR). These lab tests measure inflammation in the body. Both can be elevated for a variety of reasons, including inflammation from autoimmune disease, infections, and other causes. A positive result is just one piece of the puzzle in diagnosing rheumatoid arthritis.
- Rheumatoid Factor (RF). This lab measures an antibody found in 80% of those with rheumatoid arthritis. A positive test points us in the direction of diagnosing rheumatoid arthritis, but doesn’t necessarily confirm it since the antibody can be present in those with other conditions as well.
- Anti-Cyclic Citrullinated Peptide (Anti-CCP). This lab measures an antibody found in 60-80% of those with rheumatoid arthritis. A positive result is very specific to the disease… which means that if this lab comes back positive you likely have rheumatoid arthritis. However, it is not a sensitive test and it may miss the condition in up to 40% of people with the disease.
How Does Rheumatoid Arthritis Impact Your Bones?
Rheumatoid arthritis leads to inflammation throughout your entire body caused by your immune system releasing inflammatory proteins (interleukins, TNF-alpha). When these proteins reach your bones, they increase the activity of your bone breakdown osteoclast cells. Other factors that can weaken your bones include less weight bearing exercise due to joint pain, and use of oral steroids to reduce pain and swelling associated with flares of the disease. Studies have shown that those with rheumatoid arthritis have a 40% increased risk of hip fractures, and 30% increased risk of other osteoporosis-related fractures.
How Can Those With Rheumatoid Arthritis Improve Their Bone Health?
There are a variety of medications available to slow the progression of rheumatoid arthritis and to help with painful flares of the disease. However, even with exceptional medical management, your fracture risk will likely remain higher than normal and aggressive treatment of osteopenia and osteoporosis is recommended.