Only if we understand the causes of rheumatoid arthritis can we hope to find the right treatment for this debilitating condition.
Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation not just in one part of the body, but in the whole system. It might start off with minor symptoms, but gradually becomes more painful and debilitating.
How common is it?
This condition affects mainly the joints and the surrounding tissues of hands, wrists, elbows, shoulders, knees and ankles, most commonly on both sides at the same time.
It seems that most problems are caused by a malfuntioning immune system. Yes, we all know what can happen if we have a weak immune system, but an overactive immune system can be as harmful as a weak one.
Problems begin when the body's immune system attacks its own synovial membrane (a layer of connective tissue that lines the joints and produces synovial fluid to lubricate it) and the process of inflammation is started.
But what is even more interesting, recent studies have demonstrated that even before the joints are affected, RA-related autoimmunity may originate at a mucosal site, as you see in Figure 1.
RA-specific antibodies are found in the mucosa lining the oral cavity, the lungs and the gut well before the joints are affected, indicating that environmental factors play a huge role in the onset of this condition.
This immune response may first start in the mucosa but over time it becomes systemic, with RA-related antibodies first detected in the blood and later in the joints.
Could it start in the mouth...?
It does seem that the causes of rheumatoid arthritis may be traced back to the mouth, or more specifically, to the gums and periodontal regions.
RA-related antibodies have been found in people suffering from periodontitis, who hadn't developed yet other symptoms of the disease, but further studies are necessary to determine the exact relationship between these factors.
Another possible location of the origins of RA seems to be the mucosa lining the lungs.
It seems pretty certain that exposure to cigarette smoke increases the risk of developing RA and lung inflammation appears to be connected to the development of the condition.
Also, it may be that different mucosal sites are responsible for generation of autoimmunity in different individuals that develop RA, such as the nasopharyngeal, genitourinary (GU) and cervicovaginal (CV) mucosa, as they have similar biologic features, and could also be the origins of rheumatoid arhtitis.
... or possibly in the gut?
There's no doubt that the intestinal flora plays an important part in the development of autoimmunity, but whether there is a strong link between this and the onset of RA remains to be confirmed.
There seems to be strong evidence that suggests that the causes of rheumatoid arthritis could be traced back to the imbalance of gut bacteria, but additional study of subjects prior to the onset of joint inflammation will be needed to understand the relationship between the gastrointestinal microbiome and the development RA.
There is no doubt that a healthy gut bacteria is essential to protect the body from invading infectious agents. These bacteria synthesize and change a variety of compounds that affect physiology and immunity, and can make the difference between health and disease.
To recap what we've seen so far, the exact causes of rheumatoid arthritis are unknown. However, RA is believed to be caused by a combination of the following factors:
Regardless of the origins of the disease, gradually joint inflammation results, damaging cartilage and tissues in and around the joints. Often the bone surfaces are destroyed as well because inflammation in the joints triggers the production of enzymes that slowly digest adjacent tissue.
The body replaces this damages tissue with scar tissue, forcing normal spaces within the joints to become narrow and the bones to fuse together.
Some symptoms of rheumatoid arthritis are :
In about a quarter of cases, painless hard round rheumatoid nodules appear under the skin, usually on pressure points such as the elbow or Achilles tendon.
Joints affected by rheumatoid arthritis tend to make a sound like crinkling cellophane, whereas osteoartritic joints make a popping, clicking and banging noise.
Juvenile arthritis is a form of rheumatoid arthritis that strikes children under the age of sixteen. It affects 71,000 young American, again, most of them female.
Understanding the causes of rheumatoid arthritis has helped us to see that far from being untreatable, ther's a lot we can do to bring about some relief from the painful symptoms and even, possibly, a remission of the condition.
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When and Where Does Inflammation Begin in Rheumatoid Arthritis? - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033623/ by M. Kristen Demoruelle, MD, Kevin D. Deane, MD, PhD, and V. Michael Holers, MD
Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. https://www.frontiersin.org/articles/10.3389/fnut.2019.00141/full - A Review by Jihad Alwarith1, Hana Kahleova, Emilie Rembert, Willy Yonas, Sara Dort, Manuel Calcagno, Nora Burgess, Lee Crosby and Neal D. Barnard
Rheumatoid arthritis: Disease or syndrome? - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074722/ by Jessica A Stanich, John D Carter, Judith Whittum-Hudson, and Alan P Hudson
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