Rheumatoid Arthritis: Treatment & Precautions

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic disease characterised by inflammation of various joints in the body, causing pain, swelling, stiffness and loss of function in extreme cases.  It is distinguished from other forms of arthritis in that it occurs symmetrically in joints on both sides of the body (both knees, both hands, or both wrists).

Further, it is a systemic disorder that can affect other body organs like skin, lungs, heart, eyes, blood or nerves. Osteoarthritis, on the other hand, is limited to the joints.

Rheumatoid arthritis is classified as an autoimmune disorder, wherein your body's immune system attacks the joints and other tissues.

 What are the causes of the disorder?

Rheumatoid arthritis develops when your body's own immune system triggers an inflammation in the membrane lining the joints (synovium), causing swelling, pain and stiffness in the joint. A more severe condition occurs when bone, cartilage and other tissues get inflamed.

The exact cause that triggers the disorder is unknown, but it is thought to be a result of genetic, hormonal and environmental factors. It is postulated that environmental agents like viruses or bacteria may alter the immune system, leading to its attack on the joints. Lifestyle habits like smoking are also considered to increase your risk towards developing RA.

What you need to know about symptoms or signs?

Symptoms of rheumatoid arthritis include:

• Joint pain and swelling
• Stiffness, especially in the morning or upon long periods of sitting
• Fatigue 

Which specialist should you consult if you have any of the signs and symptoms?

Visit your general practitioner if you are experiencing persistent pain and swelling in your joints. Based on your symptoms, your doctor will refer you to a rheumatologist who specialises in treatment of inflammatory conditions like arthritis.

What are the screening tests and investigations done to confirm or rule out the disorder?

It can be tricky to diagnose rheumatoid arthritis because the symptoms are quite similar to other ailments. However, common procedures to identify and determine the severity of RA are as follows:

• Blood tests - Identification of rheumatoid factor antibodies, high levels of erythrocyte sedimentation rate (determines how advanced the condition is) and C-reactive protein (CRP), and antibodies to cyclic citrullinated peptides (CCP) are common blood tests to indicate inflammation of joints.
• Imaging tests - X-rays are useful in tracking the progression of damage to joints over time. Other imaging tests that your doctor may recommend include ultrasound and Magnetic Resonance Imaging  (MRI). Dual energy x-ray absorptiometry or bone densitometry can detect loss of bone density as a result of osteoporosis.
• Test for anaemia - Anaemia is a common manifestation of rheumatoid arthritis.

What treatment modalities are available for management of the disorder?

Though there is no cure for rheumatoid arthritis, you can find relief from pain, reduce inflammation and slow down or even prevent joint damage through medication, physical therapy and surgery. Studies show that starting treatment early can help prevent disability.

• Medication - Commonly prescribed medicines for RA are nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), biologic response modifiers (also known as biologic DMARDs), corticosteroids and immunosuppressants.
• Therapy - Your doctor may refer you to a physiotherapist to learn exercises that will keep your joints flexible.
• Surgery - Surgery is considered if medications and therapy fail to provide you relief from joint pain and do not slow down joint damage. The different types of surgeries available for repairing joints are:
• Total joint replacement (damaged portion of your joint is removed and replaced with a plastic or metal prosthetic)
• Tendon repair (Loosened or ruptured tendons resulting from joint inflammation are repaired)
• Joint fusion (Fusion of joints stabilises and realigns joints; provides relief from pain)

What precautions or steps are necessary to stay healthy and happy during the treatment?

Along with medications for rheumatoid arthritis, you can help limit the extent of your symptoms through few self-care methods such as:

• Exercise - Helps to strengthen muscles around the affected joint
• Heat or cold treatment - Provides relief from pain and relaxes tense muscles
• Relaxation techniques - Stress management techniques help coping with the pain.

What are the dietary and physical activity requirements during the course of the treatment?

Relieve muscle weakness and fatigue associated with rheumatoid arthritis by taking adequate rest during the day. Support of family, friends and support groups can provide comfort. In terms of diet, studies show that omega-3 fatty acids in fish oil contain anti-inflammatory properties that can provide relief from RA symptoms. 

Is there any risk to other family members of having the disorder?

It is suggested that inheriting certain genes can make family members more prone towards developing RA. Other risk factors to rheumatoid arthritis include:

• Age - Rheumatoid arthritis usually develops between the ages of 30 - 50 years.
• Gender - Women are more susceptible to RA than men.
• Smoking - Heavy smoking habit greatly increases your risk for RA.

How can you prevent the disorder from happening or recurring?

Following a rigorous treatment plan can prevent the disease from progressing towards disability.

Also Read What are the early warning signs of psoriatic arthritis

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