Rheumatoid arthritis (RA) is an autoimmune condition in which your body immune system gets malfunctioned and mistakenly attacks your joints. The bad news, it can affect your entire body, making it more difficult to control if it has become advanced. One of common questions asked by RA sufferers, does it always get worse? How the disease will progress can vary from person to person. But there are a few common patterns in the way it progresses over the years.
Though this chronic inflammatory arthritis is common, one of common types of arthritis, it’s not fully understood yet. It still has no curative therapy. The treatment goal is to control and prevent the inflammation from worsening.
What causes the disease is not known. Though there are some possible explanations, the exact cause is still debatable. What experts do know, RA is associated with an abnormal response of the body immune system.
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As mentioned before, the body immune system of people with RA gets malfunctioned. Normally, your immune system is responsible to fight against harmful invaders such as viruses and bacteria. But when it goes awry, it can mistakenly attack the wrong targets such as its own healthy cells /tissues. And no one knows what causes this malfunction!
Meanwhile, experts believe that some factors may have a role to trigger the disease. These include genes, environmental, and hormonal factors.
A study has shown that the HLA-shared epitope, a specific genetic marker, may have a role. Researchers say that the way of immune response is controlled by the HLA genetic site. According to the study, people with this genetic marker could have a fivefold higher chance of developing the disease. Other possible genetic markers that may have a role include:
- C5 and TRAF1, which are quite relevant to some cases of chronic inflammation.
- STAT4, an important gene that affects the regulation and activation of the body immune system.
- PTPN22, which is sometimes to blame for both the development and progression of RA.
Interestingly, not all people with RA have these genetic markers. Also, not all people with these genes develop RA. This suggests that the disease can be attributed by several factors.
Other factors that may have a role include:
- Hormonal factors. Changes of certain hormones, hormonal imbalances in women for example, may sometimes affect the risk. In fact, most cases of rheumatoid arthritis (about 70 percent) occur in women.
- Environmental factor such as exposure to infectious agents (viruses or bacteria) – this is especially true in people with specific genes associated with inflammatory or autoimmune diseases. Other environmental factors include air pollution, exposure to silica, or tobacco smoke.
- Sometimes other factors such as obesity (a common risk factor of other types of arthritis), emotional trauma, or physical trauma may also play a role!
Early diagnosis and prompt treatment are very critical to the prognosis of the disease. Patients with early treatment are more likely to have a better life expectancy. Unfortunately, sometimes the disease is not easy to diagnose at its early stages. Many times its early symptoms can mimic those of other ailments.
RA is a systemic inflammatory arthritis – How bad is it?
Most people with RA have anti-CCP (anticyclic citrullinated peptide), an autoantibody that attacks the body and causes inflammatory symptoms throughout the body. For this category, the disease is called seropositive RA. Anti-CCPs usually develop before RA symptoms appear.
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In less common cases, some patients don’t have anti-CCPs. This category is called seronegative RA. Since the existence of anti-CCPs is one of variables to help diagnose the disease, this may make it more difficult to get an early diagnosis.
About more than 50 percent of all cases, the first symptoms such as pain and swelling will affect one or more of the small joints – especially small joints of the fingers, toes, wrists, and ankles. As the disease progresses, it can affect the larger joints such as knees, hips, elbows, and shoulders. And interestingly, the disease is more likely to affect both sides of the body (symmetrical).
Though the exact cause is unknown, it’s clear that the synovial lining (the thin layer of cells that surround the joints) is involved. The malfunctioned immune system triggers the body to release cytokines, which infiltrate this intimal layer – and as a result, inflammation occurs. This inflammation is the answer of why patients experience discomforts in the affected joints such as pain, swelling, redness, and heat early in the disease process.
If the disease is poorly controlled, it can turn into serious or even become life threatening. The intimal layer of the affected joint can get so inflamed. This will seriously damage your cartilage and other joint structures, making the affected joints more difficult to move. And flare-ups can strike with greater frequency as the disease progresses.
Also, over time the disease can affect non-joint structures, because the impact of long term RA inflammation is systemic. In fact, people with RA are at also high risk of other medical conditions that have nothing to do with the joint such as problems affecting the heart, lungs, skin, mouth, eyes, or another autoimmune disease.
So, does it always get worse?
Each case is unique when it comes to the progression of this systemic inflammatory arthritis. Over the long run, your RA progression may be not the same as someone else (your neighbor /friend, for example, who also has the disease).
How you’ll fell can be attributed by several factors, such as:
- At what age your RA was diagnosed. If you were diagnosed at a young age, more severe symptoms are more likely to occur.
- How advanced the disease when it was diagnosed for the first time! If the disease has become advanced, it’s more difficult to treat. Also, you can experience more severe symptoms and complications.
- How ‘active’ it is – more flare-ups you have, more difficult to cope with! Therefore, it’s very important to keep following the treatment plan to keep the disease off (go into remission) as long as possible.
- Whether you have seropositive or seronegative RA. In general, the existence of anti-CCPs is often associated with the greater disease severity.
- Or something else.
Though everyone is different, there are a few common patterns of how the disease will progress over the years. These include: