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. 

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. 

www.jointpaindoctor.in