Rheumatoid arthritis falls under the medical umbrella of autoimmune disease which is generally defined as; a disruption of the immune system resulting in attack of healthy cells.
According to the latest scientific research your susceptibility to developing arthritis depends mainly on your genetic blueprint. That blueprint is what your body uses as a map to build cellular structures and if there is a fault in the blueprint then the body builds faulty cells. These cells, although harmless, accidentally trick your own immune system into believing that your joints are under attack by a large bacterial invasion. The joints are attacked by the immune system to clear the invasion which results in the classic symptoms of rheumatoid arthritis:
- Inflammation and swelling of the synovial fluid that lubricates bone joints
- Cartilage and bone destruction
- Skeletal disorders such as osteoporosis
- Cardiovascular (heart) disorders
Inflammation of synovial fluid (Joint lubrication)
The synovial fluid is the lubricant for all the body’s joints and is contained within a compartment surrounding each joint. However, in arthritis there is an over production of a type of antibody called leukocytes. Once leukocytes reach large enough numbers they penetrate the synovial fluid. Once in they stimulate the over production of adhesive molecules (integrins, selectins and immunoglobulins). These adhesive molecules affect the delicate eco balance within the synovial fluid which leads to swelling and pain of the joint.
Cartilage and bone destruction
Cartilage is a delicate layer of cells that lies on top of each bone in a joint. Cartilage sliding against other cartilage has a very low friction, even less than that of an ice cube sliding on glass! In rheumatoid arthritis the destructive cascade caused by leukocytes within the synovial fluid also deprives the cartilage of a fundamental type of cell– chondrocytes.
Chondrocytes are like little repairmen; their main job is to fix cartilage where it has been worn away. If there are too few of them then the cartilage wears away faster than it can be repaired. As your joints are always moving they are always being worn away and having arthritis means this destruction will continue until the joint can no longer function.
Following the destruction of cartilage the bone structure itself is then exposed and attacked. Once again the malfunctioning eco system in the synovial fluid is responsible. This time it stimulates the over production of cytokines. Cytokines are immune system signallers; they tell the immune system what to attack and when to stop. In rheumatoid arthritis they mistakenly direct attacks at healthy bone. Eventually, the attacks penetrate through the bone and the bone marrow is then exposed to attack.
Once bone destruction takes hold the body tries to compensate by forcing bone to grow excessively fast which leads to reduced joint mobility and more pain. Think of the last time you saw an elderly person hunched over and shuffling down the street. It’s usually not from age but from decades of bone erosion and joint fusion; no matter how much effort they exert the joints simply cannot move far enough.
The army of cytokines destroying bone and bone marrow simultaneously cause insulin resistance body wide. Insulin resistance is part of the ‘metabolic syndrome’, currently very popular in the news. Metabolic syndrome is the leading identifier of potential heart attack. Therefore rheumatoid arthritis predisposes to an increased risk of heart attack (myocardial infarction) and subsequent death. Some estimates put heart attack risk in arthritis patients at as much as 50% more than a healthy person. Considering that heart failure kills 30% of people in the first world, rheumatoid arthritis ups this chance to a staggering 45%.
The pathology of rheumatoid arthritis is both fascinating and saddening. It is a slow, destructive process gradually wearing down joints and bones. Patients were usually once energetic, playful and full of life but now are reduced to shuffling and constant pain. This dramatic reduction in ability often leads to depression and even suicide.
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