Introduction
Normally, the body's immune system is supposed to protect a person from disease-causing organisms. However, the body's defense mechanism can engage in the destruction or rejection of the body's own cells in a process known as autoimmunity. Rheumatoid arthritis (RA) is an example of an autoimmune disease. Instead of attacking the foreign materials, the defense system instead goes for the joints and attacks them. As a result, it leads to the inflammation of the synovium tissue leading to thickening, swelling, and pain in the joint areas. Statistics have shown that RA affects about 1.5 million Americans. The disease is more prevalent in women than in men. RA mainly sets in at the advanced stages of an individual's life, particularly between the ages of 30 and 60. Although the disease has a genetic implication, most people with RA do not have any family history. The discussion will highlight the etiology of RA, including the signs and symptoms, occurrence, and the possibility of transmission.
Etiology
RA is an example of an autoimmune disorder. Alam, Jantam, and Bukhari (2017) define an autoimmune disease as a clinical syndrome that results from the activation of the immune cells, T cell, and B cell, without the presence of an infection. Many autoimmune diseases are common, but the only problem is that few have a known etiology. The released white blood cells in the body instead of fighting infection target the tissues of the body, especially the ones located in the joint area. Several aspects characterize the disease, including hyperplastic synovium and the production of several chemicals, including chemokine, cytokines, and autoantibodies (Alam et al., 2017). The primary antibodies released in a person suffering from the disease include anticitrullinated protein antibody (ACPA) and the rheumatoid factor (RF). Systematic disorders associated with RA include pulmonary, cardiovascular, skeletal, and psychological problems. Several white blood cells are actively involved in the process of autoimmunity. They include macrophages, dendritic cells, plasma cells, and lymphocytes, among others. All these, together with other immune complexes, accumulate at the synovium. The white blood cells thereby reduce a host of chemicals and adhesion molecules that end up destroying the articular structures of the synovium. RA targets the joints of hands, elbows, wrists, ankles, and feet, among others. The jaw, shoulders, and hips can also be affected.
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Signs and Symptoms
Important to note is that RA affects individuals in different ways. Also, the symptoms progress slowly and could take years. The symptoms can also vary in severity. The hallmark characteristic of RA includes the pain and swelling in the joint area. The symptoms sometimes go away, thereby giving an individual a false sense of healing. However, it is essential to note that this stage is known as remission. The small joints located in the wrist and the hands experience inflammation first. However, as time moves, the joints become painful and swollen as a result of the disease. The general symptoms of RA include painful joints, swollen joints, joint stiffness, fatigue, and loss of appetite (Just et al., 2018). The individual will experience a general feeling of weakness. The skin will develop lamps, especially on the hands and elbows. Over a period of time, the person will have a diminished range of motion. The eyes and mouth will show some signs of dryness. As the disease continues to progress, the damage in the joint area also increases. Damage is also witnessed in the ligaments, muscles, and tendons. As such, movement becomes particularly difficult as these parts are unable to function properly.
Other than the effects witnessed in the joints, RA also causes complications that have far-reaching consequences on the human body. The same mechanism of injury on the joints could also result in a plethora of problems affecting the eyes, lungs, heart, skin, blood vessels, and other organs of the body (Just et al., 2018). In some instances, the medications taken during illness could also have adverse side-effects on the overall health of a person. On the skin, a person can develop lumps known as the rheumatoid nodules. The nodules can appear in various areas, including the forearms, elbows, heels, and fingers. RA also causes complications on the eye. Among the many complications facing this area, the most common is the inflammation of the episclera. RA also predisposes an individual to a condition referred to as the Sjogren’s syndrome. The condition comes about when the autoimmunity targets the cells producing tears. In the heart, RA can cause several conditions, including pericarditis and myocarditis, which involve the inflammation of the pericardium and the heart muscles, respectively. RA can also increase the risk of cardiovascular disease and stroke (Just et al., 2018).
Occurrence
Research indicates that RA is an old disorder that might have affected many people during the ancient days. However, increased occurrence dates back to the 19 th century. In its early days, RA was commonly confused for other conditions such as gout. Research has shown that the prevalence of RA is at about 40 per 100,000 annually. However, worldwide, the prevalence is at 3 incidences in 100,000 people (Guo et al., 2018). Therefore, the disease causes approximately 1% of the global population. As previously indicated, women are more poised to acquire the disease compared to their male counterparts. The chances of developing RA are three times that of the males. In many cases, the disease develops later as a person enters adulthood. Estimates, however, show that individuals between the age of 30 and 60 have the highest risk of developing the disease (Guo et al., 2018). However, in unusual circumstances, children can also develop the disease. The lifetime risk of developing the disease in women and men is at 3.6% and 1.7% respectively (De Soyza et al., 2016). The occurrence and development of the disease can take many different courses. In the minority, approximately 10%, the condition can vanish within the first six months (De Soyza et al., 2016). However, in the majority, the symptoms vary from time to time and tend to worsen as the disease progress. Important to note is the fact that the disease affects individuals of all the races in the US, including the whites, blacks, and the Hispanics among others.
The morbidity of RA is well-documented in the literature. The disease has a varied progression and affects the quality of life. Most fundamentally, it affects an individual towards the mid and late stages of life. Patients with RA have high morbidity compared to the general population. The increased mortality among this population of people stems from cardiovascular death, which remains one of the most significant complications. The inflammation associated with the autoimmune responses plays a fundamental role in cardiovascular death. Therefore, it is important to note that individuals with complications have the highest death rates from the disease. People with a history of autoimmune disorders are likely to develop RA in the latter stages of their lives. Examples of other autoimmune diseases include lupus erythematosus, Hashimoto syndrome, and Sjogren’s syndrome, among others. Although not conclusive, a body of research has shown that high immunity could be a major contributor to the occurrence of the disease. Overreacting white blood cells in an individual could contribute to high autoimmunity, therefore, leading to the onset of the disease (De Soyza et al., 2016). Lastly, with age remaining a critical factor, the disease is more prevalent among older adults aged 60 years and above.
Transmission
First, it is crucial to appreciate that RA has genetic implications. The chances of acquiring the disease are high if one of the family members had the condition. Several genome-wide studies have been conducted to ascertain the veracity of these claims. The genes located in the major histocompatibility complex (MHC) have provided the clearest indication that the disease could have significant be transmitted as a result of the familial ties (Chen et al., 2016). However, research involving monozygotic twins have shown a weaker association between the genetic and RA. As such, the most plausible conclusion is that both genetic and environmental factors have a critical role in enhancing the advancement of the disease. The only problem is that the research is conclusive, and more is yet to be done to establish a relationship. Secondly, more focus has been placed on the relationship between gut microbes and the body's immune homeostasis. Previous research has established that gut microbiota plays an essential role in enhancing the immune homeostasis. It is, however, critical to note that RA comes due to the abnormalities witnessed in the immune system. Therefore, the inappropriate immune responses witnessed in RA patients could be as a result of the dysbiosis happening in the gut microbes (Chen et al., 2016).
Any changes in the gut microbiome could set the center-stage for problems in the body’s immune system at the mucosal region. As such, this could lead to extra-intestinal diseases such as diabetes, RA, and obesity. The recent few years have witnessed an increased insight into the relationship between gut microbiota and the onset of RA. Evidence has since shown that there is a slight correlation in the two aspects. The evidence has further received support from the fact that many patients have received successful RA treatment with antibiotics. Environmental exposures have also been implicated in the transmission of the disease among individuals. However, this area is poorly understood. Exposure to materials such as silica and asbestos can increase the likelihood that an individual will acquire the disease. Emergency workers that responded to the World Trade Center collapse showed a greater risk of autoimmune diseases with RA being among them (Chen et al., 2016). Behavioral factors have also been implicated in the transmission of RA. For instance, researchers believe that smoking is one of the behavioral practices that could increase an individual's risk of acquiring the disease. However, it combines with other factors, including genetics and environmental exposures.
The presence of lifestyle diseases such as obesity has also been documented as a factor affecting the transmission of the disease. No evidence has shown that the disease could be transmitted directly from one person to the other, including the complications that arise. However, studies have shown that there is a direct correlation between physical inactivity and the onset of the disease. As such, this explains why RA is common among elderly people whose level of physical inactivity has significantly reduced. Exercise is closely related to immune system modulation and flexibility in the joint area.
References
Alam, J., Jantan, I., & Bukhari, S. N. A. (2017). Rheumatoid arthritis: Recent advances on its etiology, role of cytokines and pharmacotherapy. Biomedicine & Pharmacotherapy, 92, 615-633.
Chen, J., Wright, K., Davis, J. M., Jeraldo, P., Marietta, E. V., Murray, J. ... & Taneja, V. (2016). An expansion of rare lineage intestinal microbes characterizes rheumatoid arthritis. Genome medicine, 8(1), 43.
De Soyza, A., McDonnell, M. J., Davidson, J., Goeminne, P. C., Hill, A. T., Polverino, E. ... & Chalmers, J. D. (2016). Rheumatoid arthritis is a common and essential comorbidity in bronchiectasis: Data from the EMBARC European bronchiectasis registry.
Guo, Q., Wang, Y., Xu, D., Nossent, J., Pavlos, N. J., & Xu, J. (2018). Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Research, 6(1), 15.
Just, S. A., Rostgaard, K., Titlestad, K., Edgren, G., Erikstrup, C., Ullum, H. ... & Hjalgrim, H. (2018). Transmission of rheumatoid arthritis through blood transfusion: a retrospective cohort study. Annals of the rheumatic diseases, annrheumdis-2017.
