What is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic condition in which small joints of hands and feet swell symmetrically. It is the most common form of chronic inflammatory arthritis which often results in joint disability and deformity. It is diagnosed with help of some subtle clinical features such as:
- Early morning stiffness of joints lasting for more than an hour that relieves after exercise
- Swelling of small joints of both hands and feet
Joint is made up of bones and a capsule covering it (synovium). Capsule contains fluid known as synovial fluid. The ends of two bones are covered with a soft covering knows as cartilage. Normal synovium is thin which secrete fluid and other protective factors. In Rheumatoid arthritis, the synovium becomes greatly thickened, causing boggy swelling around joints and tendon. This process gives rise to swelling and painful joints which in turn limits the movement. Further, increased thickness of synovium leads to a thick layer called as Pannus, which damages the cartilage by blocking its nutrition. Thus cartilage becomes thin and the underlying bone gets exposed. These exposed bones rub against each other causing further irreversible damage.
How common is Rheumatoid Arthritis?
More than 1 million cases per year are diagnosed with it in India.
What are the symptoms of Rheumatoid Arthritis?
- Pain and stiffness of small joints of hands and feet (early morning)
- Disturbed sleep
- Joints deformities in later stages like deviation of fingers, clawing of toes and fingers, broadening of feet
- Knee swelling can also be seen in later stages
There are some non-articular (other than joints) symptoms also with Rheumatoid arthritis, such as:
- Rheumatoid nodules: Subcutaneous nodules are firm and intradermal and they generally occur over pressure points
- Dry eyes
- Dry mouth
- Leg ulcer
- Ankle swelling
- Lung diseases
- Fatty kidney / liver
Who’s at risk for Rheumatoid Arthritis?
- Females have more risk than males (3:1)
- Age: 30-50 years. Chances of disease decrease after 50
- Disease in elderly have worse outcome than young ones
- Genetic factor: It accounts for 60% disease susceptibility
- Chronic smokers
What are the causes of Rheumatoid Arthritis?
No specific cause has been found yet. However, association with HLA DR4 gene is considered to be one of the causes.
What are the complications of Rheumatoid Arthritis?
- Permanent bone deformity
- Septic Arthritis: Joint swelling associated with infection
How is Rheumatoid Arthritis diagnosed?
The condition is diagnosed in the following ways:
- Lab examination: Blood count may show less Haemoglobin
- Serology shows:Rheumatoid factor (RA Factor) positive and ACPA (anti-citrullinated peptide antibody) positive
- X-Ray shows destruction of bones near joint
- Doppler ultrasound of joints is required to check the synovitis and effectiveness of drugs
How is Rheumatoid Arthritis treated?
- NSAIDs: Non-steroidal anti-inflammatory drugs or commonly known as pain killers are very useful in stopping symptoms and slowing progression of disease
- But in elderly, these drugs can cause other side effects like gastric upsets, hence should be given with caution
- Steroids: Oral steroids are not of much use. But injecting steroids into the joint can help to reduce local swelling and can be one of the options.
- Disease-modifying antirheumatic drugs (DMARDs) like Methotrexate (an anti-cancer drug, used in low doses), Sulfasalazine, Hydroxychloroquine, etc.
- Biologic drugs like Infliximab, Adalimumab, etc.
Surgery has a useful role in long term approach, but is less frequently needed. Single joint arthritis can be treated effectively by removing thickened synovium. But risk benefit ratio should always be decided by surgeon.
How is a Rheumatoid Arthritis patient rehabilitated?
In order to rehabilitate a patient with Rheumatoid Arthritis, physiotherapists usually advice combination of rest for joints with active arthritis and exercise for other joints to maintain mobility and muscle power. Other effective methods are exercise in hydrotherapy pool and occupational therapy.
What are some don’ts for Rheumatoid Arthritis?
- Not visiting Specialist – Rheumatologist
- Avoiding exercise and not moving joints
- Not taking medicines regularly
- Skipping medicines when you feel better
What lifestyle changes are required to manage Rheumatoid Arthritis?
The below tips will help in managing Rheumatoid Arthritis:
- Get sufficient rest: It is important to get a good night’s rest for physical and mental well-being. When we sleep, the body repairs itself.
- Eat an anti-inflammatory diet: Eating an anti-inflammatory diet can lower inflammation in the body. Include healthy fats like olive oil and nuts in your diet along with fresh fruits and vegetables.
- Do moderate exercise: Low impact exercises strengthen muscles and joints, and increases your range of motion. It also boosts energy.
- Manage stress: Stress can increase arthritis symptoms. Take an activity like painting or gardening to manage stress.
How to take care of someone with Rheumatoid Arthritis?
- Understand about the disorder
- Take them for timely check-ups
- Take care of their diet
- Encourage them to exercise
- Remind them to take medicines
- Help them maintain a positive outlook to the condition
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