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Rheumatoid Arthritis by Dr. Humeira Badsha

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  • RA can be the most severe arthritis if left untreated
  • It is triggered by the body’s immune system attacking one’s own body
  • Many new treatments mean patients can lead a normal life if treated promptly.

RA is a chronic disease. This means that it lasts a long time. A small percentage of patients go into remission, which means that the disease corrects itself and requires little or no treatment. Another group of patients have a ‘remitting’ course, which means that the disease can be very quiet, interrupted by shorts flare-ups. Most patients experience it as a long term diseases which requires daily medication to keep the diseases quiet, prevent pain and inflammation, and prevent joint damage. When I first give patients the diagnosis of rheumatoid arthritis, they inevitably burst into tears. I reassure them that they will not be crippled and will not be in life long pain. Rheumatoid arthritis is similar to many life long diseases such as hypertension and diabetes. If left untreated, high blood pressure can give you constant headaches. We may take pain killers for the headache caused by high blood pressure. However, the pressure remains high and damage such as heart attacks and stokes can occur. Similarly, rheumatoid arthritis cannot be treated with merely pain killers or cortisone but requires treatment of the disease itself to prevent joint damage.

The typical features of rheumatoid arthritis are:

  1. Pain in more than one joint, usually affecting the fingers, wrists, elbows, toes, knees, shoulders, and ankles.
  2. Swelling of joints. Usually the joints feel like small balloons filled with water. When the doctor presses on the joint it feels like a sponge filled with water.
  3. Stiffness worse first thing in the morning, or after sitting for a long time. This stiffness usually lasts an hour or more
  4. Both sides of the body are equally affected.
  5. Nodules, or lumps under the skin may develop in different areas
  6. The blood test for rheumatoid arthritis (rheumatoid factor) is positive in 75% of patients. Others who do not show it in the blood may have ‘seronegative arthritis’. A new test called anti-CCP antibody is present in 60-70% of patients with arthritis.
  7. X-rays may be helpful only in later stages, showing érosions’or joint damage.

Patients usually have to have at least four of the above 7 features to be diagnosed with RA.

  • Other features of rheumatoid arthritis could be:
  • Extreme tiredness or loss of energy
  • Weakness of body
  • Dry eyes and dry mouth
  • Low fevers
  • Rarely, breathing difficulties

What causes Rheumatoid Arthritis?

RA is an auto-immune disease which is caused by the immune system, the body’s defense mechanism, attacking one’s own body. It is not clear what triggers this civil war within one’s body. It could be an unknown virus, an injury, or extreme stress.

Auto-immune disease

The immune system is the body’s defense mechanism. When you have immunity to a disease it means that you are resistant to it. When the body is attacked by the ‘enemy’, outside invaders such as bacteria or viruses, many cells in our body act like policemen and destroy these germs. In most people the policemen become quiet after their job is done. In people with auto-immune diseases the policemen remain active and excited and start attacking and destroying the city (body) they have to defend. Examples of autoimmune diseases can be juvenile diabetes, thyroid problems and rheumatoid arthritis.

According to scientific evidence now available, rheumatoid arthritis is NOT CAUSED by:

  • cold, dampness or changes in weather
  • lack or excesses of vitamins or any other dietary elements such as fats, sugars, acids or metals
  • faulty absorption or elimination of substances from the bowel
  • infection in the internal organs of the body

What is happening inside the joints:

The war which is taking place in the joints causes the release of many chemicals, called cytokines. These chemicals cause inflammation in the joints which leads to pain and swelling. When the swelling and inflammation is left in the joint for a long time, it starts chewing into the cartilage and bone, causing joint damage.

Because the inflammation leaves ‘jelly like’swelling in the joints which accumulate overnight or when the joint is immobile, there is a lot of stiffness which improves after the joint is moved.

This constant process of fighting multiple wars daily leaves a patient feeling tired and exhausted. Occasionally the body attacks the glands, causing dry eyes or mouth; the lungs causing difficulty breathing; the nerves causing numbness, weakness or tingling.

Who gets RA?

Rheumatoid arthritis can affect anyone from young babies to older people. It is generally a disease of young and middle-aged people. Women are more prone to the disease than men. It usually affects 1 % of the population.

In the UAE it is estimated that there are 40,000 people with rheumatoid arthritis, many not adequately treated or diagnosed.

Rheumatoid Arthritis survey

  • The average age of patients with RA in the UAE is 44 years
  • A majority of patients were female (60%)
  • Average delay in diagnosis was 1 year
  • Average delay in starting correct medications was 2 years
  • A majority of patients (58%) were not on correct treatment

Is There Any Effective Treatment for Rheumatoid Arthritis?

YES. Treatment involves a combination of medication, rest, exercise and methods of protecting the joints.

Medication

Highly effective drug treatments exist for rheumatoid arthritis. Early treatment is critical. Current treatment methods focus on relieving pain, reducing inflammation, stopping or slowing joint damage, and improving patient function and well being. Medications can be divided into two groups

  • Symptomatic medications, such as non-steroidal anti-inflammatory drugs (NSAIDS) and analgesics. These help reduce joint pain, stiffness and swelling. These drugs may be used in combination.
  • Disease modifying agents, such as methotrexate, sulfasalazine, hydroxychloroquine, cyclosporine, D-Penicillamine, gold therapy and azathioprine. Newer agents include leflunamide and biologic agents like anti tumour necrosis factor inhibitors (anti TNF) and IL-1 receptor antagonists. Not all the newer agents are available in Singapore at the present time. These agents may alter the disease course and therefore improve long term outcome.

Your doctor may also decide to start you on corticosteroids, which are drugs related to the natural hormone cortisone. These medications can be given either orally (by mouth) or by an injection into the joint.

Exercise
Appropriate and regular exercises are essential to strengthen muscles weakened by disease. Rheumatoid arthritis often makes joints stiff and restrict their motion if they aren’t used regularly. Exercises are designed to meet the needs of each patient and should be monitored by professionals specialising in physical medicine (physiotherapists). Generally, if joints are very inflamed or swollen it is advisable to rest the joint rather than exercise.

Heat and Cold Treatment
Heat and cold treatment are effective means of relaxing muscles and relieving pain in arthritic joints. A hot bath, hot pads, paraffin wax and cold compresses are some methods frequently used. If joints are swollen wrapping them with an ice cold towel is useful. If muscles are stiff then warm compresses can help.

Adequate Rest
Rest decreases the swelling and pain around inflamed joints and reduces fatigue. The number of hours that a patient should rest every day and the way they should rest should be reviewed with your doctor. In some cases, splints may be prescribed by the occupational therapists to rest joints, hold them in correct positions and prevent muscles around joints from becoming too tight.

No special diet causes or cures rheumatoid arthritis. Nevertheless, a well-balanced and nutritious diet is beneficial. If you are overweight, a diet to reduce weight will reduce stress on affected joints.

Is There a Cure for Rheumatoid Arthritis?

NO. But with appropriate treatment the disease can be kept under control.

What is the Outlook for Patients?

Rheumatoid arthritis can be mild, moderate or severe. For most people who begin to follow a proper treatment program early in their illness, the amount of permanent joint damage is small. In fact, most of the disabilities due to rheumatoid arthritis are preventable. A small minority of patients develop severely deformed joints. This is because of unusually severe disease or neglect. In the early stages of the disease with appropriate treatment, the majority of patients improve. Most patients with rheumatoid arthritis can look to the future with confidence.

If You Have Rheumatoid Arthritis

  • SEEK a doctor’s advice early and follow the advice faithfully. An early diagnosis is the way to successful treatment.
  • AVOID unnecessary strains on affected joints. Follow a program of exercise prescribed by your team of doctor, physiotherapist and occupational therapist.
  • GET adequate rests and sleep.
  • BEWARE of any individual or organisation that promotes special “cures”. Do not rely on unproven remedies in the hope that the disease will go away.
  • DO NOT doctor hop.
  • DO NOT be afraid of arthritis. Handled by a physician, the arthritis can be controlled.
  • TAKE medications as advised by your doctor. Never change dosage or medications without your doctor’s knowledge.
  • LEARN as much as you can about your disease.
  • JOIN the Emirates Arthritis Foundation, an organisation formed to disseminate information on arthritis, research on and fight against arthritis.

This is one of a set of articles by Dr. Humeira Badsha, Specialist Rheumatologist, for patient awareness.

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This web site is run by an Arthritis Specialist based in Dubai, United Arab Emirates. On this site you will find news about the latest in arthritis, information about research results in the field, tips and information and diet and exercise, and much more.

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