What is rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune, inflammatory and systemic disease.
It is autoimmune because the immune system, which normally protects us from infections, begins to react against components of the body itself.
It is inflammatory because it causes persistent inflammation in the joints.
It is systemic because it does not affect only the joints. It may also involve the eyes, heart, lungs, blood vessels and other organs.
The hand is the mirror of rheumatoid arthritis
I have always said that the hand is the mirror of rheumatoid arthritis.
The disease characteristically affects the metacarpophalangeal joints, proximal interphalangeal joints and wrists.
There may be diffuse swelling, narrowing of the space between the second and third metacarpophalangeal joints, thickened wrists and loss of the normal definition of the tendons.
It can also cause pain, warmth, prolonged morning stiffness, loss of strength and difficulty with daily activities.
Early and very early arthritis
In rheumatology, rheumatoid arthritis is considered early when it is approximately within the first two years of its course.
It is considered very early when it has been present for less than six months.
This distinction is more than terminology. The first months represent a true window of opportunity to change the course of the disease.
Citrullination and the window of opportunity
During the first months, a process called citrullination occurs. Citrullinated proteins form and an autoimmune response may become established, making the disease more aggressive and more difficult to reverse.
Before this process is fully established, there is a greater possibility of modifying the disease and preventing irreversible damage.
For that reason, it is not advisable to wait for deformities, erosions or clearly abnormal X-rays before taking action.
An experience that shaped my practice
During my residency, I participated in creating an early rheumatoid arthritis clinic at Hospital Calderón Guardia.
That experience taught me directly that the speed with which a person is evaluated and treated can change their future.
Arthritis treated during its first months is not the same disease as arthritis that has remained active for years.
How is rheumatoid arthritis diagnosed?
Diagnosis combines the medical history, joint examination, duration and distribution of symptoms, inflammatory markers, rheumatoid factor, anti-CCP antibodies and, when appropriate, imaging studies.
A positive test may support the suspicion, but it does not establish the diagnosis by itself. Likewise, a negative result does not automatically exclude the disease.
At very early stages, laboratory tests and X-rays may be normal. Clinical judgment and experience are therefore essential.
Timely care matters
In private practice, it is often possible to complete the necessary studies and adjust treatment promptly.
In social security systems, despite their enormous value, waiting times can make it difficult for a person to be assessed within that initial window.
This difference in timing is particularly important in a disease in which the first months may determine how much damage remains reversible and how much does not.
Treatment and follow-up
Pain relievers and anti-inflammatory medicines may ease symptoms, but they do not control the immune cause of rheumatoid arthritis by themselves.
Treatment uses disease-modifying medicines and, when necessary, biologic medicines or targeted therapies.
The choice depends on disease activity, the organs involved, other medical conditions, previous treatments and each person's response.
The goal is remission or low disease activity, preservation of function and prevention of irreversible damage. Achieving this requires follow-up and timely adjustments.