What Is Rheumatoid Arthritis (RA)?
- It is an inflammatory, autoimmune disease.
- Usually strikes between the ages of 25-50 years
- It can occur in children.
- Women have it three times more than men.
- It has a hereditary tendency but may skip generations.
- The onset varies but it may develop within weeks or months.
- Usually affects joints symmetrically on both sides of the body.
- The disease may cause major fatigue.
- Causes Pain, Redness, Warmth, Swelling and Loss of function of affected joints.
This process may migrate from one joint
- Affects many joints, usually small joints of the hand & feet, elbow, shoulder, ankles & knees.
- The disease can affect the entire system, with feeling of sickness, weight loss and fever.
It causes prolonged stiffness, mainly in
the morning and after rest.
How Is It Diagnosed?
- The diagnosis is essentially clinical.
- Rheumatoid factor and APCA tests is no indicator of the presence of the disease and is mainly used for its prognostic value.
X-rays, laboratory tests, etc. are done to monitor the progress of the disease and effects
What Are The Foods Restrictions?
There is no clear evidence for any food restrictions. Food like rice, wheat, lentils, fruits, curd, buttermilk, red meat, have been linked but with
- Weight loss is advised.
- Acidity, Flatulence & upset stomach are not related to the disease.
What Are The Effects Of Weather?
- There are no long-term effects of weather. Many people feel worse in cold and humid weather, and comfortable in dry and crisp conditions.
- Winters or cold cause pain & stiffness of affected joints.
What Happens In Rheumatoid Arthritis?
For reasons not fully understood the bodies immune system attacks the tissue surrounding
- Due to this attack the joint lining or ‘synovium' becomes inflamed and produces large quantities of synovial fluid.
- This leads to swollen, sore and stiff joints.
- If left untreated, this process damages the joint cartilage and erodes the bones, leading to joint destruction and deformity.
Does It Run In Families?
- Since we have good cure for the disease, do not be afraid that you may pass it on to your children.
- Genetic predisposition has been seen but the disease often skips every other generation.
Should Pregnancy Be Avoided?
- Those women taking DMARDs, and are planning pregnancy, must consult their Doctor.
- In 75% of mothers, RA improves during Pregnancy.
What Is The Different Causes Of Arthritis?
-The Greek word ‘Arthro' means joint while ‘itis' means swollen. Arthritis may be found in common viral fever, malaria or Typhoid etc. Other common causes are Rheumatoid Arthritis, Gout, Ankylosing Spondylitis, Systemic Lupus Erythematosis (SLE), Psoriasis, etc. Children may get Juvenile Rheumatoid Arthritis (JRA) and Juvenile Idiopathic Arthritis (JIA). The commonest type of arthritis is Osteoarthritis.
What Is The Treatment Fo Rheumatoid Arthritis?
-The treatment comprises of mainly the following aspects:
Early diagnosis -only an early and accurate diagnosis will prevent joint damage
Aggressive approach -early and aggressive treatment is aimed at for good salvage
Joint protection -joints have to be protected against damage when they are inflamed
Pain relief -physiotherapy and pain-killers and anti- inflammatory drugs
Disease modification -DMARDs-Disease Modifying Anti-Rheumatoid Drugs are essential for treatment
Regular follow-up -to monitor and modify the results and adverse effects of the treatment
Damage repair -repair of damaged joints by various methods
Counter Disability -help overcome the disabilities caused by the joint damage
Family Counselling -family should be educated about the needs of the patient
Patient support -Physically & Psychosocially help the patient to cope with the disease
Role of Exercise in Rheumatoid Arthritis
Exercise is very important in RA
The advantages are
- Proper exercise relieves pain
- Increase blood supply to the joints
- Increases bone mineralization and strength
- Improve joint function, and decreases stiffness
Rules of Exercise
- Rest is advocate when the joints are hot & inflamed
- Exercise should be carried out under proper advice & guidance
Medication in Rheumatoid Arthritis
1. Pain killers & Anti-inflammatory Drugs
- They have potentially serious side effects like Gastrointestinal Ulcers and Kidney Damage.
- They should not be used indiscriminately & ‘Over the Counter' use should be avoided.
- They are prescribed for pain relief and to decrease the inflammation.
- They improve the quality of life.
- They are strong Anti-inflammatory agents, and they also decrease pain.
- They have major Gastro-intestinal side effects and also cause bone degeneration.
- They are known as the double-edged sword of Rheumatology and should be used only under Medical Guidance.
- They give excellent symptomatic relief but do not stop the disease process.
- They have a rebound phenomenon when stopped & should be slowly tapered off.
- If used locally in the form of injections the side effects are minimized.
3. Conventional DMARDs: Disease Modifying Anti-rheumatoid Drugs
- They should not be stopped without proper medical advice as the sub-clinical levels exist for years and they have potential adverse effects.
They are essential in the treatment of
- They are potentially toxic which can be prevented and treated by proper follow-up and management.
- They cannot be removed by Dialysis - specific washout procedure is followed.
- They take time to start their effect.
- They should not be taken by pregnant ladies, or breast-feeding mothers.
4. Biologic DMARDs: Biologic Disease Modifying Anti-Rheumatoid Drugs
They are the new class of drugs that have a better result and may be used at the onset in case the disease is highly active with poor prognostic features, or if disease control is not acheaved by conventionsl DMARDs.
- They act on specific sites on the inflammatory cascade like TNF- Alfa , T cells, B cells, IL6, Etc.
- They increase chances of infection because of immunity suppression, but if used after proper screening the chances are very low and controlable.
5. Food supplements
- Calcium, Vitamins, Joint regenerators, Anti-oxidants, and other substances are given to facilitate treatment and prevent damages.
6. Why should i take treatment and is it expensive? -Treatment is a must since Rheumatoid arthritis is a Progressive Degenerative Disease that causes:
Deformity- in the form of disfigured
Death- if not treated it shortens life spans for about 10-15 years
Discomfort- in the form of pain
Disability- in the incapacitation to do work