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