Rheumatoid arthritis

The symptoms of rheumatoid arthritis vary from patient to patient, but several clinical manifestations are common and characteristic. The first signs often appear insidiously, with symmetrical joint pain, mainly in the small joints of the hands, wrists, and feet. This pain is often accompanied by morning stiffness lasting more than an hour, which indicates the inflammatory nature of the condition.
As the disease progresses, other joints may be affected, including the elbows, shoulders, hips, and knees. Chronic inflammation can lead to joint deformities, functional loss, and tendon disorders such as ruptures.

In addition to joint symptoms, systemic signs are common: intense fatigue, loss of appetite, weight loss, moderate fever, and even diffuse muscle pain. Extra-articular involvement (lungs, heart, eyes, skin, nervous system) may occur in more advanced forms.

The exact cause of rheumatoid arthritis remains unknown. However, it is believed to result from a complex combination of genetic, environmental, and immunological factors.
The pathological mechanism is based on an autoimmune response in which the immune system attacks synovial tissue as if it were foreign. This process triggers persistent inflammation which, if left untreated, damages cartilage, bone, and periarticular structures.
Genetically, certain variations in the major histocompatibility complex (HLA-DRB1) genes significantly increase the risk, particularly in patients with specific autoantibodies such as rheumatoid factors or anti-CCP antibodies. Epigenetic factors such as DNA modifications and certain microRNAs may also play a role.

Among the suspected environmental triggers, smoking is one of the most well-documented. It is thought to promote the development of anti-citrullinated protein antibodies, especially in genetically predisposed patients. Other hypotheses suggest exposure to silica, certain chronic infections, or an imbalance in the gut microbiota.

Certain personal or environmental characteristics increase the likelihood of developing rheumatoid arthritis, without being the direct cause.

• The disease mainly affects women, who account for around 75% of cases, suggesting a probable hormonal influence. It most often begins between the ages of 30 and 50, although it can appear at any age.
• Heredity plays a partial role: the presence of certain HLA genes, particularly those carrying the shared epitope, increases susceptibility to the disease and the development of specific autoantibodies such as ACPA.
• Among environmental factors, smoking is the most well-established. It promotes the onset of the most aggressive forms in genetically predisposed patients.

Other factors such as obesity, poor oral hygiene (particularly in relation to periodontitis), or occupational exposure to silica are also associated with an increased risk.

The diagnosis of rheumatoid arthritis is based on a set of clinical, biological, and imaging criteria. No single test can confirm the disease on its own.

A classification based on four categories has been established: number of joints affected, serology, intensity of the inflammatory reaction, and duration of symptoms.

• The most characteristic functional sign is prolonged morning stiffness lasting more than one hour. Clinical examination looks for inflammatory synovitis, particularly in the joints, typically bilateral and symmetrical.
• Laboratory tests include screening for rheumatoid factor (RF) and anti-CCP antibodies (ACPA). These autoantibodies are often present in severe forms and are strongly associated with the development of bone erosion. Elevated CRP or sedimentation rate is also common, indicating an active inflammatory process.
• Standard imaging (X-rays) may reveal periarticular demineralization or erosion, but these signs often appear late. More sensitive techniques such as ultrasound or MRI can detect early joint damage, sometimes even before clinical symptoms appear.

The therapeutic strategy is based on a multidisciplinary, individualized approach that aims to control inflammation, prevent joint deformities, and maintain quality of life.
Disease-modifying antirheumatic drugs (DMARDs) are the mainstay of treatment. Methotrexate is generally used as first-line therapy. In case of failure or intolerance, other synthetic or biological DMARDs may be prescribed, as well as biological agents. Early treatment, ideally within a window of opportunity of a few months after the onset of symptoms, yields the best results in terms of clinical remission and limiting joint destruction.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are used symptomatically, as adjunctive therapy, and to relieve flare-ups. However, their prolonged use should be avoided due to associated side effects.
Finally, non-pharmacological measures such as adapted physical activity, psychological support, smoking cessation, and an anti-inflammatory diet reinforce the overall effectiveness of treatment.

Rheumatoid arthritis is a chronic disease characterized by persistent inflammation. Without treatment, it causes progressive destruction of joint structures, leading to deformities, loss of mobility, and even long-term functional disability. Severe forms are often associated with the presence of autoantibodies such as ACPA and rheumatoid factor, which are signs of more active and destructive inflammation.
In the long term, extra-articular complications may arise. These mainly affect the lungs (interstitial fibrosis), the heart (pericarditis, heart failure), the eyes (scleritis, dry keratoconjunctivitis), the vascular system (vasculitis), and the blood (inflammatory anemia).
Rheumatoid arthritis also increases the risk of developing osteoporosis, due to inflammation but also to certain treatments such as corticosteroids. In addition, patients have an increased cardiovascular risk, sometimes equivalent to that seen in diabetes.
Finally, the use of immunosuppressive treatments exposes patients to a higher risk of infections. Rheumatoid nodules, peripheral neurological lesions, and psychological disorders (chronic fatigue, depression) are also possible.

Although there is no sure way to prevent rheumatoid arthritis, certain lifestyle habits can reduce the risk or slow its progression. To limit inflammation in the joints, it is recommended to stop smoking, maintain a balanced diet, and engage in regular physical activity. For those at risk, medical monitoring can help identify the early warning signs of the disease.

Any persistent joint pain accompanied by swelling, morning stiffness lasting longer than 30 to 60 minutes, or unexplained functional discomfort should prompt a visit to the doctor.

The early symptoms of rheumatoid arthritis are often subtle and can be confused with other conditions. It is therefore recommended not to wait for severe deterioration before seeking medical advice. Early diagnosis and treatment can prevent joint destruction and systemic complications.

It is also important to see your doctor in the event of an inflammatory flare-up, unusual pain, fever while on immunosuppressive treatment, or any adverse effects related to medication.

At Hôpital de La Tour, patients with rheumatoid arthritis receive specialized care coordinated by the institution's rheumatologists. Diagnosis is based on close collaboration between the rheumatology, medical imaging, and biology departments. Once the disease is confirmed, basic treatments are offered based on the patient's profile.