Early arthritis and rheumatoid arthritis

Rheumatoid arthritis is a chronic and progressive inflammatory disease that affects many people in Belgium, most often at a young age. At Hôpital Erasme, this condition is treated by a specialized team within the Rheumatology department.

Rheumatoid arthritis is the most common systemic autoimmune disease and affects approximately 0.5% of the population. If the disease is not correctly diagnosed and treated within the first months after the onset of symptoms, it can lead to irreversible joint damage. Early treatment of the disease can positively influence its course and thereby prevent disability.

The HERA early arthritis clinic rapidly receives patients in whom inflammatory arthritis is suspected and uses advanced techniques to establish a diagnosis as quickly as possible.

Tailored tools

The traditional approach based on systematic history-taking and clinical examination is complemented by joint ultrasound, which can visualize intra-articular inflammation and detect joint erosions even before they become visible on X-rays.

A blood test, performed by your general practitioner before the consultation or prescribed during the first visit, provides additional information to support the diagnosis. In addition, X-rays of the affected joints are performed in all patients.

If necessary, a more in-depth examination using MRI is proposed to further clarify the cause of the pain. All of this information makes it possible to establish a diagnosis of polyarthritis within one week and to start the necessary treatment to relieve pain, control inflammation, and improve joint function.

The clinic’s physicians then ensure effective treatment and close follow-up of the disease, and provide you with all necessary information regarding your condition. In parallel, the early arthritis clinic offers access to a specialized rheumatology nurse, a team of physiotherapists and occupational therapists specialized in rheumatoid arthritis, as well as rapid access to studies of new medications if needed.

How to request a consultation

Your general practitioner can use this form to refer you to the clinic; you will then be seen within 15 days.

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic inflammatory disease that causes pain, stiffness, and swelling (inflammation) of the joints. Joints that remain inflamed can become damaged and deformed, which may lead to disability. The synovial membrane can thicken, and the surrounding ligaments, cartilage, and bone may also be affected.

Rheumatoid arthritis typically affects joints in a symmetrical pattern: if, for example, one hand is affected, the other is likely to be affected as well.

Causes of rheumatoid arthritis

The exact cause of rheumatoid arthritis is unknown. It is an autoimmune disease, meaning that the patient’s immune system attacks its own healthy cells and tissues. This causes inflammation in the joints and surrounding tissues. Often, this inflammation is also systemic and may affect other organs such as the lungs and the heart.

Heredity is a risk factor for developing rheumatoid arthritis, and smoking is also recognized as a factor that promotes its onset.

The disease most commonly affects adults between 30 and 50 years of age, and more often women, but it can occur at any age and in both sexes.

Symptoms of rheumatoid arthritis

RA most commonly affects the hands, wrists, ankles, feet, knees, shoulders, and elbows. The onset of the disease may be gradual and slow or sudden and rapid. Each patient may experience different symptoms, including:

• Pain
• Joint stiffness, especially in the morning
• Joint swelling
• Reduced joint mobility
• Difficulty with daily activities (opening a jar, buttoning a shirt, etc.)
• Difficulty grasping or pinching objects
• Fatigue and lack of energy
• Occasional fever

This list is not exhaustive, and these symptoms can also occur in other conditions. A medical consultation with a rheumatologist is necessary to establish a diagnosis.

Diagnosis of rheumatoid arthritis

The initial diagnosis of RA is often challenging: symptoms are usually mild, and abnormalities in blood tests or X-rays may not yet be visible. The rheumatologist will perform a full medical history and a detailed clinical examination. Several diagnostic tests may be carried out:

• Bone X-rays
• Joint aspiration and synovial fluid analysis to detect infection, signs of inflammation, or crystals
• Blood tests for inflammatory markers such as CRP, and diagnostic markers such as rheumatoid factor and anti-citrullinated protein antibodies (anti-CCP)

• Joint ultrasound and MRI: specialized imaging studies to detect joint inflammation and damage to bone and cartilage.

   

Duration of the disease

Most people with polyarthritis face a chronic disease, often with alternating periods of severe pain (inflammatory flare-ups) and periods of symptom improvement. In rare cases, symptoms disappear completely, known as spontaneous remission. Fortunately, thanks to currently available treatments, most patients are able to return to a normal life, something that would be impossible without medical treatment.

Treatments for rheumatoid arthritis

Treatment is usually medication-based, but physiotherapy and a balanced approach between rest and physical activity can also help. At present, there is no cure for polyarthritis, but treatment helps control symptoms and prevent inflammatory flare-ups and disease-related damage.

Treatment varies from person to person depending on disease severity, comorbidities, other medications, and patient preferences. The goal is to allow patients to maintain their lifestyle, reduce joint pain, and prevent permanent joint damage and disability.

The mainstay of treatment consists of so-called DMARDs (disease-modifying antirheumatic drugs), which aim to control inflammation and prevent joint damage. These include classic drugs such as methotrexate, leflunomide, and sulfasalazine, as well as biological agents (anti-TNFα, anti-IL6, CTLA4 agonists, and rituximab) and small synthetic molecules (JAK inhibitors), which are second-line treatments.

These medications are often combined with systemic anti-inflammatory drugs (NSAIDs and corticosteroids) and local treatments (intra-articular corticosteroid injections). These are needed as a “bridge” between the start of DMARD therapy and the time it takes for them to become effective, which can sometimes take several months.

At Hôpital Erasme, the rheumatoid arthritis team provides comprehensive care in a single location, ranging from medical imaging to physiotherapy, including treatment follow-up and pain management.