Rheumatoid arthritis: most effective dietary supplements

Rheumatoid arthritis is a chronic inflammatory disease that primarily affects the joints but can also involve other organs. It is an autoimmune disease, which means the immune system, which is supposed to protect the body, mistakenly attacks healthy tissues. This condition causes persistent inflammation that leads to pain, swelling, and, over time, destruction of the joints. Without management, it can lead to joint deformities and significant disability, with repercussions on patients' quality of life.

Pathophysiology

Rheumatoid arthritis results from a complex dysregulation of the immune system. This process begins when certain immune cells, called antigen-presenting cells, activate specific lymphocytes (T lymphocytes). These cells orchestrate a cascade of inflammatory reactions by releasing substances called cytokines, which amplify inflammation. These cytokines include interleukin-1, interleukin-6, and tumor necrosis factor alpha, chemical messengers responsible for the attack on joint tissues. Chronic inflammation primarily targets the synovial membrane, a thin layer of tissue that lines the joints. This inflammation causes two main phenomena: • An excessive proliferation of synovial membrane cells, which forms an abnormal tissue called pannus, capable of eroding cartilage and bone. • An accumulation of synovial fluid, responsible for swelling and pain. • Over time, this persistent inflammation destroys joint structures, preventing their natural repair. This process is not limited to the joints and can extend to other tissues, such as tendons or adjacent cartilage.

Etiological factors

Rheumatoid arthritis is a multifactorial disease. • Genetic factorsThe presence of certain genes, notably those related to the HLA (human leukocyte antigen) system, is strongly associated with the disease. These genes influence the immune response and increase the risk of developing rheumatoid arthritis. • Environmental factorsSmoking is one of the main environmental risk factors, promoting the onset of the disease in genetically predisposed individuals. Certain infections may also play a triggering role. • Hormonal factorsThe disease affects about four times as many women as men, which suggests the involvement of sex hormones, particularly during periods such as menopause. • Immunological factorsA dysregulation of the immune system, characterized by an excessive production of antibodies directed against the body's own tissues, is central to the development of the disease.

Symptoms

The symptoms of rheumatoid arthritis generally occur as inflammatory flares, interspersed with periods of partial remission. • Joint pain: Pain, often symmetrical, affects the small joints of the hands, wrists, and feet. It is more intense in the morning and is accompanied by prolonged stiffness. • Joint swelling: The joints become swollen, warm, and tender. Over time, these swellings can cause irreversible deformities. • Fatigue and fever: These general symptoms often accompany inflammatory flares. • Extra-articular manifestations: Rheumatoid arthritis can affect other organs, causing subcutaneous nodules, dry eyes and mouth (Sjögren's syndrome), lung or heart involvement, and vasculitis. Without treatment, progressive joint destruction can lead to severe disability, making daily tasks such as dressing or cooking difficult.

Complications

Complications of rheumatoid arthritis include: • Joint destruction: Erosion of bone and cartilage leads to deformities and loss of mobility. • Cardiovascular risks: Chronic inflammation increases the risk of stroke and coronary artery disease. • Infections: Immunosuppressive treatments increase susceptibility to bacterial and viral infections. • Pulmonary complications: Diffuse interstitial lung disease is common.

Diagnosis

The diagnosis is based on a combination of clinical, biological, and radiological criteria. • Clinical criteria: Joint swelling, morning stiffness lasting more than one hour, persistent pain. • Biological criteria: Presence of inflammatory markers (elevated C-reactive protein, erythrocyte sedimentation rate) and autoantibodies (rheumatoid factor and anti-citrullinated peptide antibodies). • Imaging: X-rays can reveal bone erosions and joint demineralization. Early diagnosis is crucial to prevent irreversible damage and to optimize management.

Treatment

Management of RA is based on several therapeutic approaches: • Disease-modifying treatments: Synthetic DMARDs (Disease-Modifying Anti-Rheumatic Drugs) (such as methotrexate) and biologics (such as TNF inhibitors) are the main treatments. They aim to control inflammation and prevent joint damage. • Symptomatic treatments: Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to manage acute symptoms. • Non-pharmacological approaches: Physical therapy, occupational therapy, therapeutic education, and sometimes surgery. • Monitoring comorbidities: In particular, managing cardiovascular risks, preventing infections, and monitoring for osteoporosis are essential to improve overall prognosis.