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Rheumatoid Arthritis

Dr. Sudhanshu Mishra    29-01-2016 Consult

RA is the most common form of autoimmune arthritis, affecting more than 1.3 million Indians. Of these, about 75 percent are women. In fact, 1-3 percent of women may get rheumatoid arthritis in their lifetime. The disease most often begins between the fourth and sixth decades of life. However, RA can start at any age. RA is a chronic (long-term) disease that causes pain, stiffness, swelling and limited motion and function of many joints. While RA can affect any joint, the small joints in the hands and feet tend to be involved most often. Inflammation sometimes can affect organs as well, for instance, the eyes or lungs. The stiffness seen in active RA is most often worst in the morning. It may last one to two hours (or even the whole day). Stiffness for a long time in the morning is a clue that you may have RA, since few other arthritic diseases behave this way.

For instance, osteoarthritis most often does not cause prolonged morning stiffness. Other signs and symptoms that can occur in RA include:

  1. Loss of energy
  2. Low fevers
  3. Loss of appetite
  4. Dry eyes and mouth from a related health problem, (Sjogren's syndrome)
  5. Firm lumps, called rheumatoid nodules, which grow beneath the skin in places such as the elbow and hands

RA is an autoimmune disease. This means that certain cells of the immune system do not work properly and start attacking healthy tissues - the joints in RA. The cause of RA is not known. Yet, new research is giving us a better idea of what makes the immune system attack the body and create inflammation. In RA, the focus of the inflammation is in the synovium, the tissue that lines the joint. Immune cells release inflammation-causing chemicals. These chemicals can damage cartilage (the tissue that cushions between joints) and bone. Other things likely play a role in RA as well. For instance, genes that affect the immune system may make some people more prone to getting RA.

RA can be hard to detect because it may begin with subtle symptoms, such as achy joints or a little stiffness in the morning. Diagnosis of RA depends on the symptoms and results of a physical exam, such as warmth, swelling and pain in the joints. Some blood tests also can help confirm RA. Tell-tale signs include:

  1. Anaemia (a low red blood cell count)
  2. Rheumatoid factor (an antibody, or blood protein, found in about 80 percent of patients with RA in time, but in as few as 30 percent at the start of arthritis)
  3. Antibodies to cyclic citrullinated peptides (pieces of proteins), or anti-CCP for short (found in 6070 percent of patients with RA)
  4. Elevated erythrocyte sedimentation rate (a blood test that, in most patients with RA, confirms the amount of inflammation in the joints)

X-rays can help in detecting RA, but may not show anything abnormal in early arthritis. Even so, these first X-rays may be useful later to show if the disease is progressing. Often, MRI and ultrasound scanning are done to help judge the severity of RA.

There is no single test that confirms an RA diagnosis for most patients with this disease. (This is above all true for patients who have had symptoms fewer than six months.) Rather, the diagnosis is made by looking at the symptoms and results from the physical exam, lab tests and X-rays.

Treatment for rheumatoid arthritis aims to decrease swelling, relieve pain and maintain function. While there is no cure for this condition, medications are available that slow the progression of the disease. Treatment typically involves a team approach among the patient, physicians and therapists. A rheumatologist is often the physician that monitors and determines the best type of medicine for the patient

Rheumatoid arthritis can be a progressive disease. In certain cases, preventive surgery may be recommended. Preventative surgery may include removing lumps, removing inflamed tissue, or removing bone spurs that may rub on tendons or ligaments.

Research shows that people with RA, mainly those whose disease is not well controlled, have a higher risk for heart disease and stroke. Talk with your doctor about these risks and ways to lower them.

It is important to be physically active most of the time, but to sometimes scale back activities when the disease flares. In general, rest is helpful when a joint is inflamed, or when you feel tired. At these times, do gentle range-of-motion exercises, such as stretching. This will keep the joint flexible.

When you feel better, do low-impact aerobic exercises, such as walking, and exercises to boost muscle strength. This will improve your overall health and reduce pressure on your joints. A physical or occupational therapist can help you find which types of activities are best for you, and at what level or pace you should do them.

Finding that you have a chronic illness is a life-changing event. It can cause worry and sometimes feelings of isolation or depression. Thanks to greatly improved treatments, these feelings tend to decrease with time as energy improves, and pain and stiffness decrease. Discuss these normal feelings with your health care providers. They can provide helpful information and resources.

To Summarise, the best treatment of RA needs more than medicines alone. Patient education, such as how to cope with RA, also is important.

 

 
 
 
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