Rheumatoid Arthritis

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Rheumatoid Arthritis

A complete guide for patients...

Rheumatoid arthritis is a common chronic inflammatory disease that affects the joints. Rheumatoid arthritis causes severe pain and swelling in your joints as a result it becomes difficult to bend and use them. Rheumatoid arthritis can affect other organs too.

What causes Rheumatoid Arthritis?

Most Rheumatic diseases are autoimmune in nature. An autoimmune disease develops when cells of your own immune system, which normally defends your body against diseases by mistake attack the healthy tissues which are the joints in the case of Rheumatoid Arthritis, resulting in pain and swelling.

Who gets Rheumatoid Arthritis?

Rheumatoid Arthritis can affect all age groups including children. It affects people in 30’s & 40’s with higher frequency over 50 years of age. The disease is 3 times more common in females than males.

There is a genetic link although not a fully hereditary condition. The family members of patients affected with Rheumatoid Arthritis are likely to develop Rheumatoid Arthritis or autoimmune conditions. It is not contagious.

What are the symptoms of Rheumatoid Arthritis?

Symptoms include:

 

  • Swelling, redness, warmth in joints
  • Stiffness in the joints that is worse in the mornings & gets better with
  • Movement. In some cases stiffness can be towards the end of the day
  • Some people can experience tiredness, weight loss, feverish feeling.

 

Rheumatoid arthritis affects all joints but particularly tends to affect small joints of hands and feet. As the disease progresses it involves the wrists, knees, ankles, elbows, hips and shoulders.

Why is it important to treat Rheumatoid Arthritis early?

We are much better at treating Rheumatoid Arthritis over the last 2 decades due to availability of modern treatment and awareness. If the disease is left untreated it causes significant pain and disability in the person limiting day to day activities. Also, in the future the disease can cause significant irreversible damage to the underlying joints resulting in deformities.  With early diagnosis, treatment can be initiated with medicines which reduces pain and also prevents damage in joints.

How is the diagnosis made?

Rheumatoid Arthritis is a clinical diagnosis made by a rheumatologist based on medical history and findings on physical examination. Blood tests are ordered to look for inflammation & include ESR, CRP and antibodies associated with Rheumatoid arthritis. The antibodies for Rheumatoid Arthritis include Rheumatoid factor and anti ccp.

 

These tests can confirm the diagnosis when your Rheumatologist clinically suspects the diagnosis of Rheumatoid Arthritis, however 20-30% of patients can have all the antibodies tests negative but can still have Rheumatoid Arthritis and require similar treatment.

What is the treatment of Rheumatoid Arthritis?

The current aims of treatments universally are to reduce pain and discomfort in patients and prevent long term joint damage. The treatment aspects include:

 

Pain killers or anti inflammatory medicines - This can be prescribed initially by family physician to relieve some of the symptoms of joint pain and swelling while awaiting a confirmation of diagnosis by a Rheumatologist. They are not used in the long run.

 

Steroids - They are helpful in the initial stages to control the disease quickly but should be started under the guidance of a Rheumatologist. They are very helpful initially as a bridging treatment until specific drugs for RA have their effect. However the steroids on long term can cause variety of side effects hence should not be taken without a prescription from your doctor. They are generally not taken in the long run.

 

DMARDS - This is the group of modern treatments available which are immunosuppressive and they alter the course of the illness thus preventing damage while giving relief from symptoms. These include Methotrexate, sulfasalazine, Hydroxychloroquine, leflunomide.
Your doctor will decide suitability of using one drug or combination above treatments depending on your condition and other illness you may be suffering from.

 

Biologic drugs - If disease is very severe and the above DMARDS have not given adequate response then your doctor will suggest biologic drugs which are injectable immunosuppressive treatment and are very effective .These can control very severe disease effectively.

 

Newer treatments - There is continuing research and development in the treatment of RA and the latest biologics in oral forms are also available

How long to continue the treatment?

Rheumatoid Arthritis is a chronic long term illness which can have a remitting and relapsing course, It is essential to treat Rheumatoid Arthritis on long term to keep joints pain free and prevent damage.

Do the medicines have side effects?

Yes they do - like most medications; however benefits outweigh risks and your Rheumatologist will ensure the right drug is chosen for your Rheumatoid Arthritis and monitor carefully with blood tests like liver function test, kidney function tests and CBC

Recognizing flare and stable disease

The disease can have an up and down course and patient may experience flare of well controlled symptoms when faced with physical or mental stress, infection or surgeries.

Role of exercise

It’s important to strike a balance between rest and exercise. Rest will make inflamed joints feel more comfortable, but without movement your joints will stiffen and muscles will become weaker.

 

It is very important to include exercise as part of routine in daily life especially when suffering from joint problems as it can help the joints to remain flexible and functional.

Diet in Rheumatoid arthritis

There are lots of myths in society regarding consumption of sour or fermented foods causing Rheumatoid Arthritis . However there is no scientific evidence to support the theories. It is advisable to eat healthy diet including lots of fresh fruits and vegetables, oily fish and avoid junk food.

 

If you quit certain foods you may develop deficiency of the essential nutrients. Gout is the only arthritis requiring dietary modification.

Does weather affect Rheumatoid Arthritis?

It can vary from individuals but most commonly in cold and damp weather patients experience more stiffness of joints.

Can I live a normal life?

Yes, absolutely - with early treatment and guidance from an expert the disease should not limit your capacity to live and function normally.

Can women with Rheumatoid Arthritis get married and pregnant?

YES absolutely. All women with Rheumatoid Arthritis can conceive and have successful pregnancies. It is advisable to plan marriage and pregnancy when the disease is well controlled.

Role of alternative medicines?

There is not enough scientific evidence available regarding the above.

How can family members help patients with Rheumatoid Arthritis?

When faced with chronic diseases, patients require a lot of social and emotional support. The family members should help by understanding the various aspects of illness and give positive outlook. This also includes encouragement to work in their individual capacities.

How can a patient with Rheumatoid Arthritis contribute to the society?

Unfortunately many patients suffer due to lack of awareness regarding the disease and which specialist to consult. This leads to delay in seeking the right advice and causing damage and disabilities which could have been preventable. Knowing this patients of Rheumatoid Arthritis should be the torch bearers in the community to spread awareness regarding all aspects of Rheumatoid Arthritis and bring positive changes.