Rheumatoid Arthritis: A joint problem

What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) also known as “Baath rog” in Nepali language is a type of rheumatic disease with predominant effect on the joints. RA is a destructive disease which can cause damage and deformities of the affected joints. The major brunt of the disease falls in females of 25 to 50 years of age. However, people of both gender and all age groups may be affected. People with severe disease are known to have impaired lifestyle due to deformities, loss of function and pain. They are also known to have a shorter lifespan if untreated.

RA shows Iceberg phenomenon

RA shows Iceberg phenomenon

What are the symptoms of Rheumatoid Arthritis?

Pain, swelling and morning stiffness of the joints of hands are the most common symptoms. People with this disease feel unwell, fatigued and feverish too. The severity of disease varies among individuals. It may also involve the joints of lower limbs. Patients with RA may also have symptoms of dry eye, red eye, skin ulcers, and difficulty in breathing in addition to joint symptoms.

Hand Deformity in RA

Hand Deformity in Rheumatoid Arthritis

What causes of Rheumatoid arthritis?

In this disease, the body’s defence system designed to fight with the external elements attacks the persons own joints and tissues. This is thus a type of auto-immune disease. Many factors like genes, environment and smoking have been postulated in the development of this disease but what exactly triggers this disease is still unknown despite a lot of research going on.

How is Rheumatoid Arthritis diagnosed?

It is generally possible to diagnose RA based on the symptoms and the findings on examining the joints of the person. However, there are many diseases that mimic the symptoms of RA and they should be differentiated. Sometimes a few blood tests and x-rays are helpful in making the diagnosis. The diagnosis is either made by a physician or a rheumatologist. A rheumatologist is a person who helps and treats people with problems in joints, bones and muscles.

What are the treatment modalities of Rheumatoid Arthritis?

The various treatment modalities are:

  • Lifestyle changes
  • Drug treatment
  • Physiotherapy and occupational therapy
  • Surgery

Lifestyle changes: People with RA are required to maintain a proper balance between exercise, diet correct posture.

Drug treatment: Drug treatment for RA is most effective when started early and before any damage to the joints have already set in. Effective therapy at this stage can control the disease effectively and prevent deformity and hence the disability in these people. Because, the disease is actually a fight with the body’s own defence system, treatment has to be taken long-term or even lifelong. Most important drugs used in the treatment of RA are called disease modifying anti-rheumatic drugs (DMARDS).

The drugs include methotrexate, sulfasalazine, hydroxychloroquine and leflunamide. Another group of drugs known as biological agents are now being available in India and Nepal too. These drugs are highly effective but are very costly. All medications should be properly supervised and regularly monitored to avoid the potential toxic effects of these medications. Pain killers and corticosteroids should be used judiciously and their chronic intake for long term should be avoided as they can be harmful when taken regularly for a long time.

Physiotherapy and occupational therapy: This requires involvement of physiotherapist and occupational therapist and has a role is prevention and treatment of stiff joints. They can also help to make a deformed joint as functional as possible with the use of exercise and splints.

Surgery: Surgery may be required in a few cases with destroyed joints. It can help in pain relief as well as improvement in function. However, which patient needs surgery is a decision made by rheumatologist.

What are the goals of treatment of Rheumatoid Arthritis?

The main goals are control of pain and prevention of deformities with minimal use of drugs like steroids and pain killers. Also, the increased heart disease risk in these people has to be addressed.

Dr. Binit Vaidya

Featured article from:

  • Dr. Binit Vaidya
  • MBBS (BPKIHS, Nepal), MD(AIIMS, India), FACR
  • Department of Medicine, NMCTH, Nepal

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