Rheumatoid Arthritis

An autoimmune disease is a condition in which the body’s immune system attacks its own healthy tissue, resulting in harmful effects, such as pain, tissue breakdown, and sometimes permanent damage. Rheumatoid arthritis is a systemic autoimmune disease in which the joints are preferentially attacked. Most autoimmune diseases are chronic, and each disease generally targets one or a few select tissue types.

Inflammation, the body’s normal healing response to an injury or infection, should subside after an infection resolves or after healing takes place. Chronic inflammation occurs when immune cells and proteins are persistently elevated, and it can affect the whole body or may target a specific location (or locations). The effects of chronic inflammation include swelling, tissue damage, fever, and fatigue.

A C-reactive protein (CRP) blood test measures CRP, a protein that is produced by the liver and released into the blood. This protein aids the body’s immune system function, and it is released in response to inflammation.1 A normal CRP level should be lower than 10 milligrams per liter (mg/L). An elevated level is a sign of inflammation. A chronically elevated CRP level suggests chronic inflammatory disease and may point to a risk of heart disease.

Rheumatoid factor is an autoantibody. A rheumatoid factor blood test measures the amount of it in the blood, which should normally be lower than 15 IU/mL. Elevated rheumatoid factor is associated with autoimmune disease, especially RA.1 But you could have elevated levels without autoimmune disease, and you may have a normal concentration even with autoimmune disease.

The ESR is a measurement of erythrocyte (red blood cells) sedimentation (settling to the bottom). Many conditions slow down this process, raising ESR. Infections, chronic inflammation, cancer, and heart or kidney disease are among the causes of high ESR. Your ESR would be interpreted based on standards calibrated in the lab where your test is being done. A few conditions, including sickle cell anemia and polycythemia, can be associated with low ESR.

Papules are small, solid bumps on the skin. They can be red or pink. Rheumatoid papules are skin lesions that can appear with rheumatoid arthritis. They look like a patchy rash, and they can appear anywhere on the skin. Rheumatoid arthritis papules differ from rheumatoid nodules, which are large, thick, firm lumps near the joints.

Plaques are thick, scaly skin lesions. They can itch or they might not produce any discomfort. Psoriasis, an autoimmune skin disease, is characterized by plaques. Psoriatic arthritis is a type of psoriasis characterized by inflammation that affects the skin and the joints. It differs from rheumatoid arthritis in that the joint inflammation is part of the autoimmune process of psoriasis.

A synovectomy is a type of operation in which the synovium (thin, fluid-filled lining inside the joints) is surgically removed due to severe inflammation. This surgery may be done to relieve symptoms of RA or other types of joint inflammation when medication is ineffective. The inflamed synovium can be resected with a surgical blade or removed with radiation. Recovery takes three to four months, and the synovium can grow back, potentially causing symptoms again.