Rheumatoid Arthritis: You Need To Know
What is Rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic autoimmune and inflammatory disease that causes pain, swelling, and stiffness in the joints. RA affects the hands and feet joints on both sides of the body, distinguishing it from other forms of arthritis. It leads to bone erosion and joint deformity. The disease may also affect many other body systems, such as skin, lungs, eyes, nerves, heart, and blood vessels.
What are the causes of Rheumatoid Arthritis?
In rheumatoid arthritis, the body’s natural defense system confuses healthy cells of joint lining with abnormal body cells and attacks them. It is usually the inflammation associated with RA that damages joints and other areas associated.
The exact cause of this disease is not known, although genetics appears to play a role. People with certain genes are more likely to have rheumatoid arthritis after a particular viral or bacterial infection. Other risk factors include being a woman, middle or old age, family history, smoking, and obesity.
What are the signs and symptoms of Rheumatoid Arthritis?
The immune cells attack the joint lining leading to inflammation and periods of flare or exacerbations. It is during these periods that most of the clinical signs and symptoms appear. The symptoms in RA are as follows
- Joint Pain
- Redness, tenderness, and swelling in joints of both sides of the body
- Joint stiffness usually in the morning, after some activity or sitting still for sometime
- Loss of function, mobility, or joint deformities
- Low-grade fever
- Loss of appetite
- Lack of energy
RA affects the smaller joints of the hand and feet first and then progresses to the hips, knees, ankles, elbows, and wrists. More than one-third of the people with RA may experience symptoms of areas other than joints. These areas can be skin, heart, lungs, eyes, kidneys, nerves, and blood vessels. RA complications include osteoporosis, infections, dry mouth and eyes, and heart or lung problems.
How to make a diagnosis of Rheumatoid Arthritis?
Rheumatoid arthritis is diagnosed based on signs and symptoms, medical history, physical examination, and diagnostic tests.
Physical examination includes checking warmth, redness, tenderness, swelling, movement, deformity, reflexes, and strength of joints.
Many tests are performed to confirm the diagnosis of rheumatoid arthritis. These tests are
- Erythrocyte sedimentation rate or ESR tests. ESR is elevated during rheumatoid arthritis
- C-reactive protein level test. The liver produces C-reactive proteins during inflammation
- Rheumatoid factor test. Performed to check for the elevated levels of proteins called rheumatoid factor.
- Anti-cyclic citrullinated peptide test. Usually, patients with RA have this antibody in their blood.
Imaging tests like X-rays, MRI, and ultrasound are also performed to judge disease severity.
What is the prognosis of Rheumatoid Arthritis?
The disease has no cure, and the treatment focuses on managing the symptoms. Early diagnosis — within six months — is crucial for treatment to reduce joint damage and improve quality of life. Prognosis is much worse among patients with a positive rheumatoid factor or Anti-cyclic citrullinated peptide test. The disease is not fatal. Although, in some patients, the life expectancy may shorten by up to 10 years due to RA complications.
What are the treatments of Rheumatoid Arthritis?
Fortunately, clinical studies report disease remission in patients who adhere to the treatment. Depending on disease severity, the following drugs may be recommended,
- NSAIDs (Non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen, or aspirin are available over the counter and reduce pain and inflammation in the joints temporarily.
- Corticosteroids like prednisone reduce joint pain and inflammation quickly and slow joint damage. Their side effects make their use very limited.
- DMARDs (disease-modifying anti-rheumatic drugs) like methotrexate slow the progression of rheumatoid arthritis and save joints from damage. If conventional DMARDs are not effective, targeted synthetic DMARDs may be used in place.
- Biologic DMARDs are a newer generation of disease-modifying anti-rheumatic drugs that reduce inflammation without suppressing the immune system. They are used in patients who do not respond to conventional DMARDs. These are costly, but best treatment of Rheumatoid Arthritis particularly when other medicines are not that effective.
What are the physical therapies for Rheumatoid Arthritis?
A therapist can teach a person exercises to keep their joints flexible. They can suggest new and effective ways of doing daily tasks that are easier on joints. They may advise the use of assistive devices such as a cane to avoid stressing the joints.
What are the surgical treatments of Rheumatoid arthritis?
If medications and therapies don’t work, surgeries may become necessary to repair damaged joints. Surgery may involve the following procedures
- Synovectomy to remove inflamed joint lining
- Tendon repair of loose or ruptured tendons
- Joint fusion to stabilize or realign a joint when joint
- Total Joint replacement as the last resort
What are interventional pain procedures in Rheumatoid arthritis?
Ultrasonography-guided intraarticular steroid injection is one of the very important treatments for Rheumatoid arthritis.