Bay Biosciences provides high quality, clinical grade, cryogenically preserved sera (serum), matched K3-EDTA plasma, and PBMC samples from rheumatoid arthritis (RA) patients.
The sera (serum), PBMC and K3-EDTA plasma specimens are processed from rheumatoid arthritis patient’s peripheral whole-blood using customized collection and processing protocols.
Rheumatoid Arthritis (RA) Overview
Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and can affect other parts of the body. Various treatment options can help manage the disease.
The joint damage that rheumatoid arthritis causes usually happens on both sides of the body. RA usually affects the hands and feet first, but it can occur in any joint. It usually involves the same joints on both sides of the body.
Rheumatoid arthritis is an autoimmune disease which means that the patient’s immune system mistakes the body’s healthy tissue for foreign invaders. It is also as systemic disease that can affect the whole body. Inflammation occurs in the target tissue or organ as a result of the immune system response. This can include the joints, lungs, eyes, and heart
Types of Rheumatoid Arthritis (RA)
Generally rheumatoid arthritis is divided into the following two distinct types:
-
Seropositive
-
Seronegative
Patients living with seropositive RA will have high levels of antibodies in their blood called anti-cyclic citrullinated peptides (anti-CCP). High levels of these antibodies can occur for up to 10 years before symptoms begin.
According to the Arthritis Foundation, about 60–80% of people diagnosed with RA will fall into the category of seropositivity. In addition, they may have another antibody in their blood called the rheumatoid factor (RF). However, this does not necessarily mean a person has RA, as the RF can also indicate other conditions.
In contrast, people with seronegative RA will not have these antibodies in their blood, making diagnosing more difficult.
There is a third type of RA called juvenile rheumatoid arthritis. Today, doctors call it juvenile idiopathic arthritis (JIA), which usually develops before age 16.
Signs and Symptoms of Rheumatoid Arthritis (RA)
RA is a chronic disease marked by symptoms of inflammation and pain in the joints. These symptoms and signs increase during periods known as flares or exacerbations. Other times are known as periods of remission, this is when symptoms can disappear completely.
Rheumatoid arthritis symptoms commonly affect joints in the hands, wrists, and knees, but can also affect tissues and organs throughout the body including the lungs, heart, and eyes.
Symptoms can include the following:
- A general feeling of being unwell
- Fatigue
- Joint deformity
- Loss of joint function and deformities
- Pain or aching in more than one joint
- Stiffness in more than one joint
- Symmetrical joint involvement
- Tenderness and swelling in more than one joint
- The same joint symptoms on both sides of the body
- Low-grade fever
- Loss of appetite
- Unsteadiness when walking
- Weakness
- Weight Loss
Symptoms can vary from mild to severe. It’s important not to ignore your symptoms, even if they come and go.
According to the Centers for Disease Control and Prevention (CDC), people most often experience the onset of rheumatoid arthritis in their 60s. Symptoms may start slowly and often worsen gradually with time.
Patients with rheumatoid arthritis usually experience periods when their symptoms get worse, known as flares. RA symptoms may flare up due to stress, overactivity, or stopping medications.
Sometimes, a person with RA can go into remission if their symptoms go away or are mild. Most people continue to experience flares and remissions throughout their lives.
RA usually affects the same joints on both sides of the body. Pain and stiffness tend to worsen after sleep or periods of inactivity.
Severe RA can lead to other complications throughout the body and cause joint damage that may lead to disability. Treatment can help manage the severity of symptoms and may reduce the likelihood of experiencing complications.
Rheumatoid Arthritis (RA) Flare Ups
When a person with rheumatoid arthritis has a flare-up, their symptoms worsen for a time. Medication and home remedies can help manage symptoms during a flare.
Typical symptoms of rheumatoid arthritis (RA) include the following:
- Joint pain and swelling
- Stiffness
- Fatigue
Symptoms can vary in intensity, worsening during a flare and improving or disappearing during times of remission.
A flare can last from a few hours to several weeks or longer. How it affects an individual will also vary.
For some people, medications can help prevent flares and stop symptoms from becoming severe. Medical treatment and home remedies can also help manage symptoms during a flare.
Remission Rheumatoid Arthritis (RA)
Although there is no cure for RA, a person can go into remission. Treatment with disease-modifying antirheumatic drugs (DMARDs) can reduce symptoms and help a person achieve remission.
According to a 2017 review, a patient who has maintained remission for 6 months or more has achieved sustained remission.
Criteria of Rheumatoid Arthritis (RA) Remission
The American College of Rheumatology and the European League Against Rheumatism have developed criteria for defining RA remission. These guidelines allow researchers to compare the effectiveness of different treatments in achieving rheumatoid arthritis (RA) remission.
The criteria for RA remission include the following:
- A patient assessment showing that on a 0–10 scale, the arthritis activity is 1 or less
- One or fewer swollen joints
- Blood test results that show little or no inflammation in the levels of C-reactive protein, which is a key marker of inflammation
- One or fewer tender joints
A doctor may also use a second definition to decide whether a person has entered RA remission. This definition uses the Simplified Disease Activity Index (SDAI), which measures disease activity.
To get an SDAI score, the doctor will combine a sum score of the four measures above with an assessment.
Prevalence of Rheumatoid Arthritis (RA)
As of 2014, the global prevalence rate of rheumatoid arthritis was about 0.24%, though estimates vary. This means that 240 people out of 100,000 will develop it around the world.
RA tends to be more common in women than men. The risk of non-juvenile RA is highest in older adults between 65–80 years of age.
In addition, a 2021 study showed that Non-Hispanic African Americans and people in low-income households have a significantly higher risk of developing rheumatoid arthritis (RA).
The researchers explain that due to healthcare inequities, these groups may have less access to quality healthcare and may have a higher exposure to risk factors, such as stress.
Causes of Rheumatoid Arthritis (RA)
RA is an autoimmune disease and is the result of the body’s immune system attacking healthy body tissues. However, the specific causes or triggers of rheumatoid arthritis (RA) are unknown.
In RA, the immune system attacks the synovium, the membrane lining of joints. When this happens, the synovial cells proliferate, which leads to synovial thickening. Pain and inflammation result.
Eventually, if left untreated, the inflammation can invade and destroy cartilage, which is the connective tissue that cushions the ends of the bones.
The tendons and ligaments that hold the joint together can also weaken and stretch. The joint can eventually lose its shape and configuration, and the damage can be severe.
Genetics and Rheumatoid Arthritis (RA)
Scientists have identified several parts of the human DNA code that could relate to RA. One example involves the human leukocyte antigen (HLA) genes. Doctors have pinpointed the HLA-DRB1 gene as having an association with RA.
Patients who have this genetic marker are more likely to develop rheumatoid arthritis (RA) than those who do not.
Other genes that may have an association with rheumatoid arthritis (RA) include the following:
- PTPN22
- STAT4
- TRAF1 and C5
Risk Factors of Rheumatoid Arthritis (RA)
The CDC notes that individuals with a higher risk of developing rheumatoid arthritis (RA) may include the following:
- Age: The onset of RA is highest among adults in their 50s. Risk continues to increase with age for people assigned male at birth. RA often occurs in people assigned female at birth during their child-bearing years.
- Diet: High consumption of sodium, sugar (especially fructose), red meat, and iron is associated with an increased risk of developing RA.
Diagnosis of Rheumatoid Arthritis (RA)
Diagnosing rheumatoid arthritis (RA) can take time and may require multiple lab tests to confirm clinical examination findings. A healthcare provider will use several tools to diagnose RA.
Your doctor will ask about your symptoms and medical history. They’ll also perform a physical exam of your joints. This will include the following:
- Check for skin nodules
- Examine joint function and range of motion
- Evaluate the affected joints, to check for warmth and tenderness
- Look for swelling and redness
- Check the reflexes and muscle strength
The CDC recommends getting a diagnosis within 6 months of the onset of symptoms so that treatment can begin as soon as possible.
A doctor will look at the patient’s clinical signs of inflammation and will ask how long the patient has experienced them and how severe their symptoms are. If they suspect RA, they’ll most likely refer you to a specialist known as a rheumatologist.
Since no single test can confirm a diagnosis of rheumatoid arthritis (RA), your healthcare provider or rheumatologist may use several different types of tests.
Your healthcare provider may also test your blood for certain substances like antibodies, or check the level of certain substances like acute phase reactants that are elevated during inflammatory conditions. These can be a sign of RA and help support the diagnosis.
Blood Tests for Rheumatoid Arthritis (RA)
There are several types of blood tests that help your healthcare provider or rheumatologist determine whether you have RA. These tests include the following:
- Anti-CCP
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR or sed rate)
- Rheumatoid factor
Imaging Scans and X-rays
An X-ray or MRI of a joint can help a doctor identify what type of arthritis is present and monitor the progress of a person’s RA over time.
Diagnostic Criteria
Guidelines recommend the following criteria for diagnosing rheumatoid arthritis (RA):
- Number and location of affected joints
- Blood tests indicate the presence of RA
- Symptom duration
- Inflammation indicators, or acute phase reactants
Diseases with Similar Symptoms as RA
A doctor will need to distinguish rheumatoid arthritis (RA) from other conditions with similar symptoms, such as:
- Psoriatic arthritis (PsA)
- Septic arthritis
- Sjögren’s Syndrome
- Lyme disease
Treatment of Rheumatoid Arthritis (RA)
There’s no cure for RA, but there are effective treatments that can help you manage it and prevent damage.
Treatment of rheumatoid arthritis will aim to:
- Minimize any loss of function caused by pain, joint damage, or deformity
- Prevent flares and reduce their severity if they occur
- Reduce inflammation in the joints
- Relieve pain
- Slow down or prevent damage to joints and organs
Options include medications, physical therapy, occupational therapy, counseling, and surgery.
Medications for Rheumatoid Arthritis (RA)
There are many types of medications available for rheumatoid arthritis. Some of these medications help to reduce the pain and inflammation of RA. Others help to reduce flares and limit the damage that rheumatoid arthritis does to the joints.
Following drugs can help relieve symptoms and slow the disease’s progression.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are available over the counter (OTC). Examples include Advil, A;eve and Motrin. Long-term use and high doses can lead to the following side effects:
- Bruising
- High Blood Pressure (Hypertension)
- Gastric ulcers
- Kidney and liver issues
Corticosteroids
These type of medications educe pain and inflammation and may help slow joint damage, but they cannot cure RA. If NSAIDs do not work, a doctor may inject a steroid into the joint. Relief is usually rapid, but the effect is variable. It can last a few weeks or months, depending on the severity of the symptoms.
Corticosteroids help with acute symptoms or short-term flare-ups. However, a doctor will limit these injections to no more than three times per year because of their impact on the soft tissue structures around the joints.
More frequent injections can potentially damage these structures or cause them to tear off from where they attach to bone.
Disease-Modifying Anti-rheumatic Drugs (DMARDs)
The American College of Rheumatology (ACR) recommends treatment with disease‐modifying antirheumatic drugs (DMARDs), either alone or with other treatments, in people with moderate to severe RA. Methotrexate (Rheumatrex or Trexall) is an example of a DMARD.
DMARDs affect how the immune system works. They can slow the progression of RA and prevent permanent damage to joints and other tissues by interfering with an overactive immune system. A patient usually takes DMARDs for life.
These types of medications are most effective if a person uses them in the early stages of RA, but it can take several weeks to a couple of months to fully experience their benefits. Some people may have to try different types of DMARDs before finding the most suitable one.
Side effects can include the following:
- Abnormal blood counts
- Hair loss
- Immune related disorders
- liver damage
- Loose stools
- Mouth ulcers
- Nausea
- An increased risk of infections
Biologic Treatments
Biologic treatments, such as tumor necrosis factor-alpha (TNF-alpha) inhibitors, also change how the immune system works. When the human body faces an infection or other threat, it produces TNF-alpha, an inflammatory substance. TNF-alpha inhibitors suppress this substance and help prevent inflammation.
TNF-alpha inhibitors can reduce pain, morning stiffness, and swollen or tender joints. Patients usually notice an improvement 2 weeks after starting treatment.
Examples include the following:
- Adalimumab (Humira)
- Certolizumab pegol (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi)
- Infiximab (Remicade)
Possible side effects include the following:
- Congestive heart failure
- Demyelinating diseases, which are conditions that damage the myelin sheath that normally protects nerve fibers
- Higher risk of infection
- Lupus
- Lymphoma
- Skin reactions
JAK Inhibitors
Janus kinase (JAK) inhibitors are a newer subtype of DMARD medications. These include tofacitinib (Xeljanz), baricitinib (Olumiant), and upadacitinib (Rinvog).
While traditional DMARDs stop the immune system from producing immune cells that cause rheumatoid arthritis (RA) to develop, JAK inhibitors target specific signaling molecules. This helps prevent the cellular process that causes RA to progress.
For the 20–30% of patients living with rheumatoid arthritis who do not respond to traditional DMARDs or biologics, JAK inhibitors have proven to be an effective option.
Occupational or Physical Therapy
An occupational therapist can help a person learn new and effective ways of carrying out daily tasks. This can minimize stress on painful joints. For example, a person with painful fingers might learn to use a specially devised gripping and grabbing tool.
A physical therapist can advise people about using assistive devices, such as a cane, and help individuals develop a suitable exercise plan.
Surgery
In some cases, a doctor may recommend surgery to:
- Repair damaged joints
- Correct deformities
- Reduce pain
The following procedures are possible:
- Arthroscopic surgery, a procedure to remove inflamed joint tissue
- Carpal tunnel release to relieve nerve compression in the hand and wrist
- Surgery to release tendons responsible for unusual bending in the fingers
- Arthroplasty, a total joint replacement surgery
Home Remedies
Several strategies can help a patient manage their rheumatoid arthritis (RA). Examples include the following:
- Applying heat or cold packs
- Low impact exercises, such as swimming, boost overall health and mobility and strengthen the muscles around a joint
- Managing weight, which can prevent additional stress on joints
- Meditation, guided imagery, deep breathing, or muscle relaxation to relieve stress
- Rest, especially during an rheumatoid arthritis (RA) flare
A healthcare professional can help a RA patient make a plan incorporating dietary advice, exercise suggestions, and other tips.
Diet
Varied and balanced diet can help control the inflammation that causes rheumatoid arthritis (RA) symptoms. It can also help a patient manage their weight, reducing joint stress.
A Mediterranean diet s a good option for many people with RA. This diet focuses on inflammation-fighting foods, such as:
- Fatty fish, such as salmon or tuna, which are high in omega-3 fatty acids
- Legumes, including peas and beans, which are a healthy source of protein
- Nuts, which are also a great source of monounsaturated fats and other nutrients
- Olive oil, which has heart-healthy monounsaturated fats
- Plenty of fresh fruits and vegetables, which are rich in antioxidants
- Whole grains, which have fiber and antioxidants to help boost heart health
Patients with rheumatoid arthritis (RA) should additionally eat foods rich in calcium and vitamin D to support strong bones, as some RA medications can increase the risk of osteoporosis. Good sources include low fat dairy and dark, leafy green vegetables.
Because anemia can occur during RA flare-ups, causing fatigue, it is a good idea for people to incorporate iron-rich foods into their diet, including:
- Eggs
- Fortified breakfast cereals
- Lean meats
- Leafy greens
- Legumes
Complications of Rheumatoid Arthritis (RA)
Patients with rheumatoid arthritis (RA) have a higher risk of some other conditions, including:
The joint damage that occurs with rheumatoid arthritis (RA) can make it difficult to perform daily activities. RA can also be unpredictable. Often, a person does not know when a flare will happen.
This uncertainty can lead to:
- Anxiety
- Employment difficulties
- Stress
There is also a higher risk of developing various other conditions, including:
- Carpal tunnel syndrome, which can cause aching, numbness, and tingling in the fingers, thumb, and part of the hand
- Inflammation, which can affect the lungs, heart, blood vessels, eyes, and other parts of the body
- Cervical myelopathy, a serious condition that can dislocate the joints at the top of the spine, causing pressure on the spinal cord
- Cardiovascular disease, which is a general term for conditions affecting the heart or blood vessels, including a heart failure or stroke.
Damage can occur in tendons near the joints. A patient’s susceptibility to infections also may increase, and they have an increased risk of developing colds, flu, pneumonia, COVID-19, and other diseases, especially if they are taking immunosuppressant medications to manage their rheumatoid arthritis (RA).
Complementary Therapies for Rheumatoid Arthritis (RA)
Some patients with rheumatoid arthritis (RA) use the following complementary therapies:
- Acupuncture: A 2018 systemic review shows this may help a person relieve symptoms in combination with medication, but more research is necessary.
- Chiropractic manipulation: This therapy appears to provide significant pain relief to one person living with RA, but this is not sufficient to back up the effectiveness of this treatment.
- Massage: Massage may help relieve the symptoms of rheumatoid arthritis (RA) and other conditions.
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