Rheumatoid Arthritis

Rheumatoid arthritis (RA) is chronic inflammatory diseases that can affect any part of the body. According to the epidemiological data 0.75- 1% of Indian Population have this disease. It is an autoimmune disorder in which the immune system that protects the body from infection attacks healthy tissues. The synovial tissue is the primary target of the RA. Rheumatoid Arthritis typically affects small joints like in hands and feet and occasionally large joints like knee, hip and shoulder.

• The synovial membrane of a joint is the site of initial inflammatory process in RA
• As the disease progresses, it damages the cartilage and further causes a permanent damage to the join.

Impact of RA on Quality of Life

Rheumatoid arthritis adversely affects work and social life. Many people with RA have restricted mobility and difficulties with activities of daily living. Inability to work is the primary symptom observed early in the course of the disease, especially in individuals with a manual occupation. Approximately one-third of people stop working because of the disease within 2 years of onset, and the proportion of people stop working increase with time.

Causes and Risk factor

The cause of rheumatoid arthritis is unknown. It is a very active area of worldwide research. It is believed that the tendency to develop rheumatoid arthritis may be genetically inherited (hereditary). It is also suspected that certain infections or factors in the environment might trigger the activation of the immune system in susceptible individuals. This misdirected immune system then attacks the body's own tissues, which leads to inflammation in the joints.

Environmental factors also seem to play some role in causing rheumatoid arthritis. For example, scientists have reported smoking tobacco, exposure to silica mineral, and chronic periodontal disease all increase the risk of developing rheumatoid arthritis.

Sign and Symptoms

RA symptoms come and go, depending on the degree of tissue inflammation. When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission). Remissions can occur spontaneously or with treatment and can last weeks, months, or years. During remissions, symptoms of the disease disappear, and people generally feel well. When the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare. The course of rheumatoid arthritis varies among affected individuals, and periods of flares and remissions are typical.

RA symptoms can include fatigue, loss of energy, lack of appetite, low-grade fever, muscle and joint aches, and stiffness. Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity. This is referred to as morning stiffness and post-sedentary stiffness. Arthritis is common during disease flares.

Diagnosis

The first step in the diagnosis of rheumatoid arthritis is a meeting between the doctor and the patient. The doctor reviews the history of symptoms, examines the joints for inflammation, tenderness, swelling, and deformity, the skin for rheumatoid nodules (firm bumps under the skin, most commonly over the elbows or fingers), and other parts of the body for inflammation. Certain blood and X-ray tests are often obtained. The diagnosis will be based on the pattern of symptoms, the distribution of the inflamed joints, and the blood and X-ray findings. Several visits may be necessary before the doctor can be certain of the diagnosis.

Different Treatment Options

Various options are available for the treatment of RA. These options are used in different times during the course of the disease and chosen based on the severity of the disease.

Following is an overview of medication used:

• Analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDS): Used for pain relief
• Corticosteroids: Used to relieve inflammation and to reduce swelling, redness, Itching and allergic reaction.
• Disease-modifying Antirheumatic Drugs (DMARDs): Used to relieve painful, swollen joint and slow joint damage.
• Biologic Response Modifiers: Selectively block parts of immune system that play role in inflammation.

Prevention

urrently, there is no specific prevention of rheumatoid arthritis. Because cigarette smoking, exposure to silica mineral, and chronic periodontal disease all increase the risk for rheumatoid arthritis, these conditions should be avoided.

Prognosis (outlook) for patients with rheumatoid arthritis

With early, aggressive treatment, the outlook for those affected by rheumatoid arthritis can be very good. The overall attitude regarding ability to control the disease has changed tremendously since the turn of the century. Doctors now strive to eradicate any signs of active disease while preventing flare-ups. The disease can be controlled and a cooperative effort by the doctor and patient can lead to optimal health.

Importance of Self –Care in RA

The key to living well with the disease lies with the patients. People who take part in their own care report less pain and make fewer doctor visits. They also enjoy a better quality of life. Patients education, arthritis self-management programs and support groups help people to become better informed so that they can participate in their own care.

Routine Monitoring and Ongoing Care

Routine medical care is important to monitor the course of the disease, determine the effectiveness and side effects of medications and modify therapy as needed. Monitoring includes regular visit to the doctor. Regular blood tests, urine analysis, other laboratory tests and x-rays are also a part of it.

FAQs on RA

Does the term arthritis refer to stiffness in the joints?

The definition of arthritis is inflammation of the joints. This inflammation causes symptoms such as stiffness of the joints. It also causes pain, swelling, redness, and warmth.

Why is rheumatoid arthritis (RA) is different from some other forms of arthritis?

Rheumatoid arthritis (RA) differs from some other forms of arthritis because it is symmetrical, affecting both sides of the body. Other types of arthritis may affect only one side of the body.

Rheumatoid arthritis is more severe in whom: Men or Women?

Rheumatoid arthritis tends to affect three times as many women as men, and symptoms may be more severe in women as well. RA tends to affect women at earlier ages, and men seem to have more cases of remission of the disease.

Rheumatoid arthritis is most likely caused by what factor?

There are thought to be several causes or risk factors associated with rheumatoid arthritis, Genetics is one of the components. Hormones are believed to be another as women are diagnosed with RA more often, and it is suspected estrogen may play a role. The environment may be a factor: occupational exposure to certain dusts such as silica, wood, or asbestos can also lead to a higher risk for developing the illness, as can cigarette smoking. It is thought there may be a viral or bacterial infectious cause of RA but that is still being studied.

Do people with rheumatoid arthritis experience the most stiffness at night?

People with rheumatoid arthritis tend to experience muscle and joint stiffness most in the morning or after extended periods of inactivity.

Is Surgery is the only way to treat RA?

Treatment for rheumatoid arthritis usually involves a combination of medication, exercise, rest, and protecting the joints. Surgery may be needed in some cases.

The sudden appearance or worsening of RA symptoms is referred to as what?

A flare is the sudden appearance, increase, or worsening of rheumatoid arthritis symptoms such as pain, inflammation, redness, warmth, or tenderness. Flares can last for days or week.

With rheumatoid arthritis, deformity of the joints is caused by chronic inflammation. Is it true?

It’s true. The chronic inflammation caused by rheumatoid arthritis can lead to debilitating loss of cartilage, bone weakness, and joint deformity in some patients. Damage to the joints is progressive and can occur over time.

What increases the risk of the disease?

Rheumatoid arthritis affects women 2 to 3 times as often as men. Being between the ages of 40 and 60. Rheumatoid arthritis can begin at any age, but it most often begins in adulthood. Smoking cigarettes is another important risk factor.

What treatment beside medicine should be used for rheumatoid arthritis?

• Physical activity to improve joint function.
• Occupational therapy. This helps you learn how to maintain movement in the joints while carrying out the activities of daily living.
• Assistive devices such as household aids or mobility aids.
• Behavioural modification techniques to reduce pain and stress. These include biofeedback and relaxation therapy, such as breathing exercises and muscle relaxation.
• Counselling. It can help you cope with long-term pain and disability.

Source :
Prof (Dr) Sukumar Mukherjee, MD, FRCP (Lond), FRCP (Edin), FICP, FIAMS, FSMF,
Ex Prof. & HOD, Medical College Kolkata.

Pampita Chakraborty, MSc.Microbiology
Ph.D Research Fellow, IPGME & R and SSKM HOSPITAL, Kolkata-700 020
Email: pampita.chakraborty@gmail.com