What is Rheumatoid Arthritis?
Rheumatoid Arthritis (RA) is a chronic inflammatory autoimmune disease that predominantly affects the joints and causes pain, stiffness, swelling, limitation of movements and function. RA can affect any joint. The joints of the hands and feet are involved most often. At the onset it may affect single joint but over a period of time it progresses to other joints. It is usually symmetrical and involves multiple joints. Stiffness seen in active RA is most often worst in the morning or after a period of inactivity. It may last one to two hours (or even the whole day in some). Stiffness for a long time in the morning is a clue that you may have RA. Inflammation sometimes can affect other organs, for instance, the eyes or lungs. Other signs and symptoms that can occur in RA include: Loss of energy, Low grade fever, Loss of appetite, Dry eyes and mouth.
Who gets rheumatoid arthritis?
RA is the most common of autoimmune arthritis. Females outnumber males in the ratio of 3-4:1. About 1–3% of women may get rheumatoid arthritis in their lifetime. The disease often affects the females in the reproductive age group; however, it can start at any age.
How is rheumatoid arthritis diagnosed?
Diagnosis depends on the history, examination and supportive laboratory tests. Blood tests also can help confirm RA. Rheumatoid factor (RF) an antibody is found in about 80% of patients with RA. Antibodies to cyclic citrullinated peptides (anti-CCP) are found in 60–70% of patients with RA. Inflammatory markers like ESR and CRP may be raised and indirectly indicate the inflammation in the joints. X-rays can help in detecting damage to the bones, but may not show anything abnormal in early arthritis. Even so, these first X-rays may be useful later to show if the disease is progressing. Often, MRI and ultrasound scanning are done to help judge the severity of RA.
RA can be hard to detect because it may begin with subtle symptoms, such as achy joints or a little stiffness in the morning. Also, many diseases behave like RA early on. There is no single test that confirms an RA diagnosis for most patients with this disease. Rather, a doctor makes the diagnosis by looking at the symptoms, physical examination and results from the lab tests and X-rays.
How is rheumatoid arthritis treated?
Therapy for RA has improved greatly in the past 30 years from lonely steroids to newer biological agents. Current treatments give most patients good or excellent relief of symptoms and let them keep functioning at, or near, normal levels. Many patients can achieve “remission” means; have no signs of active disease. There is no cure for RA. The goal of treatment is to decrease the symptoms and prevent the damage and deformities to the joints. No single treatment works for all patients. Patients with RA should begin their treatment with Disease- Modifying Anti-Rheumatic Drugs (DMARDs) as early as possible. DMARDs have greatly improved the symptoms, function and quality of life for nearly all patients with RA. Common DMARDs include Methotrexate, Leflunomide, Hydroxychloroquine and Sulfasalazine. Patients with more serious disease or refractory to the DMARDs may need medications called “biologic agents.” These medications are Etanercept, Infliximab, Adalimumab, Certolizumab, Golimumab, Abatacept, Anakinra, Rituximab and Tocilizumab.
The best treatment of RA needs more than medicines alone. Patient education to cope with RA also is important. Proper care requires the expertise of a team of providers, including rheumatologists, primary care physicians and physical and occupational therapists. Patient will need regular checkups through the year with the Rheumatologist. These checkups let your doctor track the course of the disease and check for any side effects of the medications. Patients need to repeat blood tests and X-ray or ultrasound from time to time as required. Research shows that people with RA, mainly those whose disease is not well controlled, not only have the deformities but are also have a higher risk for heart disease and stroke.
What are long term complications of RA?
If not treated properly or controlled the disease activity earlier, RA may progress relentlessly and may lead to damage of the bones/joints and lead to deformities. This may lead to the loss of function of the particular joints. Patient may also develop dry eyes and dry mouth over a period of time. Lungs may get fibrosed in some and another few may develop subcutaneous nodules. Few may develop more severe disease called as rheumatoid vasculitis.
Living with rheumatoid arthritis
It is important to be physically active most of the time, but to sometimes scale back activities when the disease flares. In general, rest is helpful when a joint is inflamed, or when tired. At these times, do gentle range-of-motion exercises, such as stretching. This will keep the joint flexible. When better, do low-impact aerobic exercises, such as walking and exercises to boost muscle strength. This will improve overall health and reduce pressure on your joints. A physical or occupational therapist can help and suggest which types of activities are best and at what level or pace you should do them. Finding that you have a chronic illness at young age is a life-changing event. It can cause worry and sometimes feelings of isolation or depression. Thanks to greatly improved treatments, these feelings tend to decrease with time as improves pain and stiffness decrease.
Summary
People have long feared RA as one of the most disabling types of arthritis. The good news is that the outlook has greatly improved for many people with newly diagnosed RA. RA remains a serious disease and one that can vary widely in symptoms and outcomes. Even so, treatment advances have made it possible to stop or at least slow the progression of joint damage. Rheumatologists now have many new treatments that target the inflammation. They also understand better when and how to use treatments to get the best effects.
