Rheumatoid arthritis (RA) is an autoimmune disease that results in the immune system destroying cartilage, the tissue that provides the lining of bones that allows joints to move freely.
Whilst RA can happen to anyone, people with other autoimmune diseases, including type 1 diabetes , in the family have a higher chance of developing the condition.
Rheumatoid arthritis and diabetes
Research has shown that a number of specific genetic regions are associated with increased susceptibility for both type 1 diabetes (which includes diabetes LADA ) and rheumatoid arthritis.
These research findings explain why people with type 1 diabetes are statistically more likely to develop rheumatoid arthritis.
Variants of the following genes have been linked with higher susceptibility to both type 1 diabetes and rheumatoid arthritis:
- PTPN22
- TNFAIP3
- CTLA4
People with other forms of diabetes may also develop rheumatoid arthritis, albeit there is no increased risk.
Symptoms of rheumatoid arthritis
As with other forms of arthritis, the condition causes inflamed joints , which can be stiff and painful. Stiffness in the morning that lasts for more than 30 minutes may indicate that rheumatoid arthritis is present rather than other forms of arthritis.
The joints of the fingers and feet are often the first parts of the body to be affected. It is common for rheumatoid arthritis to affect joints of the body in a symmetric fashion. That is, if one wrist is affected, it is common for the other wrist to be affected too.
In addition to directly affecting the joints, rheumatoid arthritis may also cause other symptoms including:
- Anaemia
- Fatigue
- Fever (a temperature above 37.5C)
- Decreased appetite
- Weight loss
Diagnosis
If you have the symptoms of rheumatoid arthritis, see your doctor to get a diagnosis. There are many different forms of arthritis and this can sometimes complicated the process of diagnosing the correct form of arthritis
Autoimmune diseases frequently run in families so let your doctor know if you or others in your close family, such as siblings, parents or grandparents have or had rheumatoid arthritis or other autoimmune diseases such as type 1 diabetes and coeliac disease
The following blood tests can be taken to help diagnose rheumatoid arthritis:
- Erythrocyte sedimentation rate (ESR)
- Rheumatoid factor
- Anti-cyclic citrullinated peptide (anti-CPP )
- C-reactive protein (CRP)
- Full blood count
X-rays, ultrasound scans and magnetic resonance imaging (MRI) scans can be used to view the joints for specific signs of inflammation and damage to the cartilage.
Causes of rheumatoid arthritis
It is not known what the underlying cause is that leads the body’s immune system to attack and break down cartilage but a number of risk factors have been associated with a greater risk of developing rheumatoid arthritis, which include:
- Genetic variants – causing rheumatoid arthritis to sometimes run in families
- Women are more likely to develop RA
- Smokers also have an increased risk
Treatment
There are a number of different treatments for rheumatoid arthritis and it is common for people with RA to take a combination of treatments.
Medications commonly taken for rheumatoid arthritis include:
- Disease-modifying anti-rheumatic drugs (DMARDs)
- Biological therapies
- Non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofe, aspiri, diclofenac, naproxen
- Painkillers – such as paracetamol, codeine, tramadol
- Corticosteroids
The table below lists names of the medications in the DMARDs and biological therapies medication classes.
| Medication class | Medications |
|---|---|
| Disease-modifying anti-rheumatic drugs (DMARDs) | azathioprine gold injections hydroxychloroquine leflunomide methotrexate sulfasalazine |
| Biological therapies | adalimumab certolizumab pegol etanercept infliximab abatacept rituximab tocilizumab |
The different types of medication treat the condition in different ways, with DMARDs and biological therapies taken to limit the development of the condition, painkillers to reduce the pain of flare ups and NSAIDs and steroids to treat inflammation.
If you have diabetes, alternatives to NSAIDs should be used where possible as these medications can cause a small increase in risk of heart problems, stroke and kidney function.
Note also that corticosteroids may lead to increased blood glucose levels and present additional challenges in controlling diabetes.
Complications of rheumatoid arthritis
Untreated rheumatoid arthritis can lead to erosion of the joint causing joint deformities.
Less well controlled rheumatoid arthritis may also raise the risk of a number of other conditions including:
- Carpal tunnel syndrome
- Inflammation of the heart, lungs, eye and blood vessels (vasculitis)
- Cervical myelopathy
Adopting a healthy lifestyle of eating a balanced diet, exercising regularly, cutting down on alcohol and quitting smoking will help to reduce the risk of certain complications of the conditions.
Prevention
With the underlying cause of RA not yet well understood, there is little that can be done to prevent the condition developing. If you are a smoker, though, quitting smoking may help to reduce your risk of developing RA
