Rheumatoid Arthritis – Overview, Risks, Symptoms, Diagnosis and Treatment.

X – Ray of Rheumatoid Arthritis Hand

Rheumatoid Arthritis (RA) is a chronic autoimmune disease that’s progressive in nature, causes disabling pain and inflammation in and around the joints and, at times, damage to the skin, lungs, eyes, heart and blood vessels. It’s the most common form of autoimmune arthritis and is estimated to affect up to one percent of the global population.

Understanding Rheumatoid Arthritis

Rheumatoid arthritis is a systematic disorder caused when the body’s own immune system – the body’s defense against foreign bodies like viruses and bacteria – starts to malfunction, mistaking the body tissue for unwanted, foreign material. This causes the immune system to attack the joints, causing inflammation that leads to thickening of the synovium – the soft membrane that lines the insides of the joints.

The synovium’s primary goal is to supply the fluid that lubricates the joints and keeps them working smoothly. If the inflammation is left untreated, it can cause damage to the cartilage – the rubber like elastic tissue that covers and safeguards the ends of bones in the joint region. Over time, the loss of cartilage decreases the joint spacing in between the bones leading to painful joints and irreversible joint deformation.

The most commonly affected areas are the joints of hands and wrists, elbows, feet, ankles and knees. In addition to the joints, rheumatoid arthritis can also affect the respiratory, cardiovascular and other bodily systems.

Rheumatoid Arthritis – The Risks

The most obvious risks of rheumatoid arthritis are the destruction of the cartilage and the bone inside the joints. Left unchecked, rheumatoid arthritis can cause weakening and stretching of the joints to the extent that they lose their original form and alignment.Individuals affected by rheumatoid arthritis are also susceptible to formation of rheumatoid nodules (small lumps of tissue) around the lungs, elbows and other parts of the body.

Sjogren’s syndrome – an autoimmune disease that causes dry eyes and mouth, disproportioned body mass and a range of infections round up the long list of health risks associated with rheumatoid arthritis.

Rheumatoid Arthritis symptoms

  • Tenderness and swelling of the joints

At the onset, rheumatoid arthritis usually causes tenderness and swelling in the smaller joints such as toes and fingers. As it progresses, the person affected begins to feel similar discomfort in the larger joints like the wrists, ankles, elbows, shoulders and hips. 

Stiffness in the joints

Joint stiffness is a common symptom of rheumatoid arthritis. The stiffness is more severe at the morning time and after a period of inactivity such as after waking up from sleep.

  • Other common symptoms

A lasting feeling of fatigue, loss of appetite are other indicators of rheumatoid arthritis. The discomforts associated by rheumatoid arthritis can come and go periodically, the joint swelling and pain can significantly fade away for a while before returning.

Who all are at risk?

The exact cause of rheumatoid arthritis is still unknown, but there are several factors that have been known to increase the chances of an individual contacting the disease. These are:

  • Gender

Women are more susceptible to rheumatoid arthritis than men, with one in four women in the world being affected by the disease. In comparison, one in five men around the world are affected. It’s been discovered that women suffering from rheumatoid arthritis experience fewer or no symptoms when they’re pregnant. Breastfeeding has also been found to significantly reduce the risks of rheumatoid arthritis, with women that have breastfed for 2 years reducing their risks of contacting the disease to half. 

  • Age

While rheumatoid arthritis can affect people of all ages, it’s most common at the middle age. 

  • Family history

Research has revealed that people who have a family history of rheumatoid arthritis are more at risk than those with no family history of the disease. 

  • Obesity

Overweight people, particularly women up to the age of 55 have been known to be at a greater risk of rheumatoid arthritis than any other demographic.

  • Smoking

Smokers have been found to have a high risk of developing rheumatoid arthritis. The severity of pain and other symptoms is also higher in people who smoke regularly. 

Rheumatoid arthritis diagnosis

Rheumatoid arthritis can be hard to diagnose early on as the same symptoms are shared by several other diseases. Usually, swelling in 3-4 or more different joints, pain and stiffness that lasts over 6 weeks, morning stiffness that lasts over half an hour, symmetrical symptoms on both sides of the body are factors that point towards rheumatoid arthritis. 

In addition to carrying out a physical checkup of the joints, the doctor will also inquire about the patient’s past and family history of autoimmune and other diseases. The doctor is will recommend blood tests. 

Imaging scans like X-ray, MRI and Ultrasound are also a common way of diagnosing rheumatoid arthritis. These scans can present a clear picture of cartilage and bone erosion and joint damage and help the doctor reach a diagnosis.

Rheumatoid Arthritis treatment

Treatment of rheumatoid arthritis varies with the severity of the patient’s symptoms. Based on the age of the disease and damage caused to the body, the doctor can recommend these courses of medication:

NSAIDs (Nonsteroidal anti-inflammatory drugs)

Over the counter NSAIDs can be effective in managing the pain and discomfort caused in the early stages of rheumatoid arthritis. In more serious cases, the doctor can give you stronger, prescription only NSAIDs.

Steroids

Inflammation reducing steroidal drugs such as prednisone and other corticosteroids can help slow down joint damage and relieve acute pain. 

DMARDs (Disease-modifying antirheumatic drugs)

DMARDs like methotrexate, hydroxychloroquine and sulfasalazine can effectively slow down the disease’s progression and prevent permanent damage to joints and tissue.

Biologic Response Modifiers

Biologic response modifiers are the new class of DMARDs that include the likes of abatacept, anakinra, baricitinib, certolizumab, etanercept, golimumab, infliximab, rituximab, sarilumab and tofacitinib. Also known as biologic agents, these DMARDs directly target inflammation causing parts of the immune system and are usually paired with non biologic DMARDs like methotrexate. 

Physical Therapy

Physical therapy is beneficial in helping improve joint flexibility in rheumatoid arthritis patients. A trained therapist can help patients adapt to new ways of carrying out day to day tasks which have been made difficult by pain, swelling or loss of joint mobility. He/she may also recommend assistive devices and medical supplies like hand grips and buttonhooks to protect affected joint and body parts when carrying out simple tasks like working with tools and changing clothes. 

Surgery

The common surgical procedures for treating rheumatoid arthritis:

Synovectomy

The goal of this surgery is to remove the synovium – the inflamed membrane lining the insides of the joint. 

Joint fusion

This procedure involves surgically fusing an affected joint with the aim of realigning or stabilizing it. Joint fusion is usually carried out in cases where the doctor has ruled out joint replacement surgery.

Tendon Repair Surgery

At times, the joint damage and inflammation caused by rheumatoid arthritis can rupture or loosen the tendons around the joints. In such cases, the surgeon will operate on the affected areas and repair the tendons. 

Total joint replacement

In this procedure, the damaged parts of the joint are surgically removed and replaced by prosthesis composed of plastic and metal. 

Early diagnosis and the Right treatment can reduce the damage and help the patient lead an active, pain free life. 

Frozen Shoulder.

Frozen shoulder, also known as adhesive capsulitis is a disorder that cause stiffness thereby resulting in pain in the shoulder joint. This condition leads to the loss of normal range of motion of the shoulder, leaving the affected individual unable to perform even simple physical activities like reaching for objects placed on an overhead shelf. A frozen shoulder can get significantly worse if left untreated. In most cases, the problem deteriorates, and then goes away over the course of time, usually over a period of 1 to 2.5 years.

Symptoms

Dull, lingering pain in one of the shoulders or in the muscles of the outer shoulder and upper arm region accompanied by stiffness of the shoulder joint are common symptoms of frozen shoulder. The pain may worsen at night in some cases. Most patients will experience pain at the slightest movement of the shoulder.

Who all are at risk?

For reasons yet unclear, women are more likely to develop a frozen shoulder than men. People belonging to the age group of 40-60 years old and those recovering from a stroke, mastectomy and other medical conditions that restrict the movement of arms are most likely to be affected by a frozen shoulder. 

Individuals suffering from heart and thyroid related issues (hyperthyroidism/ hypothyroidism), tuberculosis, cardiovascular disorders, Parkinson’s disease and diabetes too have a high susceptibility to developing a frozen shoulder.

In addition, individuals recovering from tendinitis or injuries that cause them to wear a sling for several days are also at the risk of getting a frozen shoulder in absence of regular stretching. An estimated 10 percent of people suffering from rotator cuff disorders are affected by frozen shoulder.

Diagnosis

A physical examination is required for diagnosing a frozen shoulder. This involves active and passive movement tests. In the ‘active’ part, the doctor will have the affected individual move the shoulder on his/her own to get a measure of pain and stiffness. In the ‘passive’ leg of the examination, the doctor will move the affected individual’s shoulder to gauge the differences in discomfort and range of motion. 

In some instances, the doctor can administer anesthesia to numb the shoulder in order to carry out the physical examination. In addition, imaging tests such as X-ray, MRI or ultrasound may also be required if the doctor suspects a torn rotator cuff, arthritis or a similar condition to be the underlying cause of shoulder distress.

Treatment

In some cases, non-steroidal anti-inflammatory drugs are prescribed to alleviate the pain, especially if there’s noticeable swelling in the affected shoulder. If there is significant inflammation or pain, the doctor can prescribe different, more potent medications.

Physiotherapy has been found to be effective in improving mobility of the shoulder and is often recommended. In severe cases wherein oral medication fails to bring relief, the doctor can revert to administering a corticosteroid injection into the shoulder joint.

Some rare cases may call for a shoulder surgery. The surgery is an arthroscopic or keyhole procedure.

Bursitis

Tender, swollen joints that ache when you move – you could be suffering from Bursitis, a painful medical condition wherein bursae – the small, fluid filled sacs that work as cushion between the bones, muscle and tendons around the joints have become inflamed. 

The human body has 150 plus bursae. Their primary function is providing lubrication to reduce friction between the tissue during physical activity. Joints like hips, shoulders and elbows that engage in frequent physical activity are the most commonly affected by Bursitis. 

Bursitis too can affect other joints, like the knee and the base of the big toe. Bursitis of the knee is commonly called “Housemaid’s knee” or “Clergyman’s knee”.

Symptoms

Bursitis is marked by easy to spot visual and physiological cues. These include – 

  • Stiffness and ache in the joint region.
  • Swelling and redness in the affected joint.
  • Experiencing increased pain when moving or putting pressure on the affected areas.

Causes

Bursitis is usually caused by repetitive movements that wear out or stress the bursae. Athletes and laborers whose daily routine involves lifting objects over their heads or kneeling for long durations are at a high risk of developing bursitis.

Something as seemingly innocuous as leaning on your elbows for long when studying or reading can also lead to bursitis. Ageing, rheumatoid arthritis, gout, infections and injuries suffered to the joint region are other common causes.

Diagnosis

Diagnosis of Bursitis involves an examination of the affected joint and inquiry into recent physical activities and injuries. In some cases, swelling and soreness in the joint can be accompanied by fever. In such an event, the doctor will draw a small quantity of fluid from the bursa close to the affected joint which will be tested.

You might have to undergo an X-ray if the doctor suspects a break or a fracture or MRI in case of torn tendons. If the doctor suspects rheumatoid arthritis, you might have to undergo some blood testing. 

Management

Minor discomfort and inflammation can be managed and cured by ice packs and rest. Raising the affected joint to reduce the blood flowing into it can also sometimes help to reduce swelling. 

If you experience a sharp pain in the joint, are unable to move, develop a rash and/or a fever, consult your doctor. Based on the underlying cause and diagnosis, the doctor may administer steroid injections at the site of the pain and/or prescribe a course of antibiotics. Some cases may require intravenous administration of antibiotics and surgical draining to reduce fluid buildup. 

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Tips for Preventing Sports-Related Injuries

Sports injuries generally occur for two different reasons: trauma and overuse.  While traumatic sports injuries are usually obvious, dramatic scenes, like when we see a player fall down clutching their knee, overuse injuries are actually more common.

Traumatic Sports Injury

Overuse injuries often occur when the body is pushed past its current physical limits or level of conditioning — but poor technique and training errors, such as running excessive distances or performing inadequate warm-ups, frequently contribute. To help keep you or your young athlete from experiencing a sports-related injury following are the prevention tips:

1. Set realistic goals.

Setting goals and work hard to achieve them but it is crucial that our goals are realistic, achievable and sustainable. Whether your goal is to swim more laps, lift a certain amount of weight or run a specific distance, set an obtainable goal and gradually work to improve.

2. Plan and prepare.

If you plan to begin exercising regularly or want to begin a new program, take the time to learn the proper techniques required for your sport. Working with a coach or a knowledgeable group is often safe and enjoyable ways to start a new activity.

3. Warm up and cool down.

It is important to warm up before physical activity because research has shown that a heated muscle is less likely to be strained. To accomplish this some light walking or jogging before you start your exercise and then again afterward to help your muscles cool down slowly. Another important way to prevent injury is to increase your flexibility. Stretching before and after a workout can do this, but it is best to do so once the body is already warm.

4. Take your time.

Don’t push yourself too hard too fast. Getting in shape or learning a new sport takes time. We need to allow for adequate time to gradually increase training levels so that our bodies have time to adjust to the stresses on our bones, joints and muscles. For instance, when running, increase mileage gradually and give yourself plenty of time to recover between workouts. 

5. Listen to your body.

Adjust your activities if your body is showing signs of too much stress. While a mild and short-lived muscle ache is generally considered ‘good pain,’ pain in your joints is not normal and is a sign that you should cut back. Always listen to your body.

Proximal Fibular Osteotomy – A breakthrough procedure for treating knee pain.

Proximal fibular osteotomy (PFO) is a simple, innovative surgical procedure that’s fast becoming the go-to pain relief solution for knee osteoarthritis patients. It’s less invasive than other prevalent surgical procedures recommended for the same medical conditions, highly effective in treating knee pain and improving the patients’ quality of life, easy to perform and has a relatively short post-surgery recovery period. 

Who’s it meant for?

If you’re affected by medial compartment osteoarthritis and suffering from debilitating knee pain that’s affecting your ability to walk and engage in even basic physical activity, you might want to consult your doctor about Proximal fibular osteotomy. Total knee arthroplasty has been one of the most recommended treatments for osteoarthritis in elderly patients. For younger patients ailed by Varus knee deformity, High tibial osteotomy (HTO) and Unicondylar knee replacement (also known as partial knee replacement) have remained the physicians’ go-to solutions for long. These procedures, in addition to being rather invasive, require lengthy recovery periods, and pose restrictions on weight bearing and even on physical activity. In Proximal fibular osteotomy, you have a novel alternative to these popular surgical procedures, with proven success rate, minus the complications that can arise with the prevalent treatments.

What to expect from a Proximal Fibular Osteotomy?

Proximal fibular osteotomy is a cost-effective procedure requiring a shorter recovery span than other conventional surgeries. Patients can expect reduced knee pain within days of undergoing the procedure, and total pain relief in the following months. They can also look forward to becoming more active and self-sufficient than they’ve been in years, to a happier, pain free future. 

Contact Dr. Manu Mengi for further information.