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Rheumatoid Arthritis

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Described as a chronic auto immune disease, rheumatoid arthritis causes inflammation of the joints and tissues of the body. It may cause pain, swelling, stiffness and loss of function in your joints.


Rheumatoid arthritis can produce diffuse inflammation in the lungs, pericardium, pleura, sclera, and nodular lesions and in subcutaneous tissues under the skin. The symptoms of rheumatoid arthritis are recurring. In certain cases, it may lead to long-term joint damage, resulting in chronic pain, loss of function and disability. Rheumatoid arthritis affects approximately 1% of the adult population. It is found that more women than men are affected with rheumatoid arthritis.


Causes of rheumatoid arthritis

Though the exact cause of rheumatoid arthritis is not clear, research indicates that rheumatoid arthritis might be the result of bacterial, viral or fungal infection that triggers auto immune response. Other possible factors that might contribute to the occurrence of rheumatoid arthritis include heredity and hormones. Environmental factors like smoking tobacco are also found to increase the risk of developing rheumatoid arthritis.


It is also said that rheumatoid is the result of autoimmunity. To understand autoimmunity, we need know the working of our immune system. The human immune system contains cells and proteins that fight infections. Auto immune disease is the result of failure in the immune system wherein it fails to recognize part of our body that is affected by virus and bacteria.


Though rheumatoid arthritis affects other tissues, the principal target is synovial membrane (synovium) that secrets synovial fluid to the joints. The fluid, also termed as joint fluid, lubricates and nourishes the joint. When the membrane is affected or destroyed, it becomes inflamed and can thicken and erode. As a result, the synovial fluid is also destroyed and is not secreted in the joints. In certain cases, the structures surrounding the joints also get affected thus leading to joint deformities.


Symptoms of rheumatoid arthritis


Rheumatoid arthritis is generally characterized by pain in one or many joints of the body. For instance, one can feel the pain as well as swelling both wrists. Hand joints like knuckle joints, and wrists, elbows, knees, ankles, feet and larger joints like shoulders, hips, and jaw are often affected by rheumatoid arthritis. People who suffer from the condition for many years might feel stiffness in the vertebrae of the neck.


Rheumatoid arthritis often occurs in a symmetrical pattern affecting different joints on both sides of the body. The general joint symptoms of rheumatoid arthritis include


  • Stiffness resulting in the inability to move the joints. Some may feel the stiffness in the joints soon after they wake up that does not subside for more than 30 minutes.

  • Inflammation causing redness, tenderness and warmth in the affected area/joint

  • Swelling or puffiness around the affected joint

  • Nodules or hard bumps might appear on or near the joint, especially near the elbows.

  • Pain because of inflammation or swelling of the joint. Pain might also occur from working the joint too hard.

Other than joint symptoms, the normal symptoms associated with rheumatoid arthritis include the following


  • malaise
  • fever
  • fatigue
  • loss of appetite
  • weight loss
  • muscle aches and
  • weakness or loss of energy

Rheumatoid arthritis may also trigger the following condition in certain people.


  • Inflammation / dryness of the glands of the eyes and mouth resulting in Sjogren's syndrome

  • Pleuritis, inflammation of the lung lining resulting in chest pain with deep breathing, shortness of breath or coughing.

  • Nodule inflammation of the lungs

  • Pericardium, inflammation of the tissue surrounding the heart called pericarditis. This can cause chest pain that changes in intensity when lying down or leaning forward.

  • Anemia, decreased number of red blood cells

  • Felty's syndrome that appears because of decrease in the white blood cells.

  • Tiny black areas around the nail beds or leg ulcers resulting in vasculitis, a very rare condition that impairs blood supply to tissues and leads to tissue death (necrosis).

Diagnosis

There is no single proven method to diagnose rheumatoid arthritis. The physician performs a variety of tests to confirm that you have rheumatoid arthritis and plans for a treatment accordingly. This might include all or any one of the following


Medical History : The doctor checks whether you have history of joint aches, or joint stiffness. This might be done through a Health Assessment Questionnaire (HAQ) and the Arthritis Impact Measurement Scales (AIMS).


Physical Exam : The physician might perform physical examination like checking the joints for swelling or tenderness, motion of the joints, and mal alignment of the joints. He/She might also check for symptoms in other organs like skin, lungs, and eyes.


Lab Tests : Lab test is prescribed in cases where the diagnosis becomes difficult through physical examination. These tests might include complete blood count test, Erythrocyte Sedimentation Rate (ESD or sed rate), C-Reactive Protein, Rheumatoid Factor, and Antinuclear antibodies (ANA).


Imaging Studies : Imaging studies including X-rays, Magnetic Resonance Imaging (MRI), Joint Ultrasound, and Bone Densitometry (DEXA) might also be prescribed to diagnose the presence of rheumatoid arthritis.


Treatment of rheumatoid arthritis

There is no cure for rheumatoid arthritis. However, the symptoms or the pain could be alleviated through several methods including medications and exercises. It is ideal to meet a doctor soon as you develop any of the above said symptoms.


Diet is found to be an effective treatment for rheumatoid arthritis. Your physician might advise you to partake of foods consisting of omega-3 fatty acids. Being overweight marks the entry point for any condition; rheumatoid arthritis being exception. Your doctor might prescribe you to lose weight, so that the pains and stiffness in the joints could be decreased. The other treatment includes exercise and rest. Regular cardiovascular exercise like swimming bicycling, stretching can alleviate your joint pains.


Occupational therapy and physical therapy are also found to be somewhat effective in treating rheumatoid arthritis. Occupational therapies include exercises to the commonly affected areas like wrists, fingers, and joints. This might include education of body biomechanics, use of splints like hand splints and wrist splints. Your physician might sketch out a structured program upon the diagnosis of your symptoms.


The best way to alleviate pains or swelling in the joints would be to use ice, heat, massage, ultrasound, warm wax and electric stimulation around the affected areas. However, consult your physician before performing the same.


Oral medications like non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, and etodolac are commonly prescribed for treating rheumatoid arthritis. These medications are at times combined with sucralfate and misoprostol or proton pump inhibitors like omeprazole or pantoprazole, since NSAIDs might cause some stomach problems. Steroids either in oral form or injection are also recommended for the treatment of rheumatoid arthritis.


DMARDS or disease-modifying anti-rheumatic drugs including hydroxycholoquine, sulfasalzine, methotrexate, D-penicillamine, gold salts, azathioprine, and cyclophosphamide are used as the second-line medications in treating rheumatoid arthritis. These are generally taken for months or years. Other medications prescribed for treating the condition include Methotrexate, D-penicillamine, and Anti-TNF alpha factor medications. Cortisone injections are also prescribed in treating symptomatic joints.


Surgery is the last option for rheumatoid arthritis and it is very rarely performed. The surgical options include either a total hip replacement, or total knee replacement, if the hip or knee is affected.


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