Reading Test 1 — Questions 1–20

Rheumatoid arthritis (RA) is a long-term autoimmune disease that mainly affects the joints. The immune system mistakenly attacks the lining of the joints, causing inflammation, swelling and pain. Over time, the disease can damage cartilage, bone and surrounding tissues. RA usually affects joints on both sides of the body equally, particularly the hands, wrists and feet.

The exact cause of RA is unknown, although a combination of genetic, hormonal and environmental factors is believed to contribute to the development of the disease. Smoking is considered one of the strongest environmental risk factors. Women are affected more frequently than men and the condition most commonly develops between the ages of 30 and 60 years.

Early symptoms often include joint stiffness, especially in the morning, fatigue, muscle aches and mild fever. As the disease progresses, joints may become swollen, tender and warm to touch. Some patients develop rheumatoid nodules beneath the skin. Severe untreated RA may lead to permanent joint deformity and reduced mobility.

RA can also affect organs outside the joints, including the lungs, heart and eyes. There is currently no cure, but early diagnosis and treatment can significantly reduce joint damage and improve quality of life.

Clinical assessment

Obtain a patient history including onset and duration of symptoms, family history of autoimmune disorders and the impact of symptoms on daily activities.

Ask if the patient is experiencing any of the following signs and symptoms:

• Painful swollen joints.
• Morning stiffness lasting longer than 30 minutes.
• Fatigue and weakness.
• Difficulty gripping or performing fine movements.
• Warmth and redness around joints.
• Reduced range of joint movement.
• Loss of appetite or weight loss.
• Dry eyes or chest discomfort.

Perform a physical examination including inspection of joints for swelling, tenderness and deformity.

Further investigations to confirm diagnosis

• Blood tests including rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
• Inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
• X-rays, ultrasound or magnetic resonance imaging (MRI) scans to assess joint damage and inflammation.

There is no single test for RA. Diagnosis is usually based on a combination of symptoms, physical examination findings and investigation results.

Managing Rheumatoid Arthritis

Treatment aims to reduce pain and inflammation, prevent joint damage and maintain mobility.

• Disease-modifying anti-rheumatic drugs (DMARDs) are commonly prescribed to slow disease progression. Methotrexate is frequently used as a first-line medication.
• Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to relieve pain and stiffness.
• Corticosteroids can also be prescribed during disease flare-ups to reduce inflammation quickly.

Physiotherapy may help patients maintain joint flexibility, muscle strength and mobility. Occupational therapy can provide support with joint protection techniques and assistive devices for daily tasks.

Some patients with severe joint damage may require surgical procedures such as joint replacement surgery.

A healthy lifestyle is recommended for people living with RA

• Stopping smoking.
• Maintaining a healthy bodyweight.
• Participating in low-impact exercise such as swimming or walking.
• Balancing activity with adequate rest periods.
• Using heat or cold therapy to relieve joint discomfort.

Monitoring a Person

Regular monitoring is essential to assess disease activity and detect complications or medication side effects. Patients taking DMARDs require routine blood tests to monitor liver function, kidney function and blood cell counts. Joint function and mobility should be assessed regularly to identify any worsening deformity or disability.

Patients should be encouraged to attend regular eye examinations because some medications and inflammatory complications may affect vision. Bone density monitoring may be recommended in patients taking long-term corticosteroid treatment due to the increased risk of osteoporosis.

Encourage appointments with their doctor if they:

• Develop sudden worsening joint pain or swelling.
• Experience chest pain or shortness of breath.
• Develop signs of infection.
• Notice severe medication side effects.
• Experience increasing difficulty performing daily activities.

Psychological wellbeing should also be assessed as chronic pain and disability may contribute to anxiety and depression.