Rheumatoid Arthritis is a common Rheumatological condition in the community. It affects 1% of the population in India. In Rheumatoid Arthritis multiple joints are painful, swollen and are tender to touch. The other important symptom in the disease is early morning stiffness in the joints. The early morning stiffness in the joints usually lasts for more than one hour. Rheumatoid Arthritis usually affects the same joint on both sides of the body, for e.g., arthritis affecting the left and right wrist. Rheumatoid Arthritis starts in the small joints of the hands and feet, later affect the big joints like knees and hips. In the normal joint end of the each bone is covered with healthy cartilage, which will be eroded in Rheumatoid Arthritis. A membrane, called synovium surrounds the joint, which will be inflamed and thickened in Rheumatoid Arthritis. Inflamed synovium secrets more synovial fluid in to the joints, causing swelling and pain in the joint. In a healthy joint cartilage provides smooth slippery surface, which helps free joint movement and the synovial fluid, acts as lubricant. Sometimes patient notice nodular swellings over the elbows these are called Rheumatoid Nodules, which are very characteristic of Rheumatoid Arthritis. Rheumatoid Arthritis rarely affects other parts of the body e.g., lungs, blood vessels and eyes etc.
Nobody knows exactly what causes Rheumatoid Arthritis; this is mainly due to imbalance in the immune system (not due to Immune Suppression). This immune imbalance sets off inflammation in several joints causing pain and swelling of the affected joints. Patients also feel generally ill and tired. Most of the patients develop flare-ups (periods of increased pain and swelling in the joints). The disease can start at any age from children to elderly; the most common age groups prone to Rheumatoid Arthritis are between 3rdand 5thdecades. Rheumatoid Arthritis does not run in families, occasionally it may affect more than one in same family. Typically it starts as painful, swollen, stiff hands and feet, especially in the morning. Less commonly it presents as Monoarthritis or relapsing and remitting arthritis. At the beginning of the illness the fingers look like sausages, in the late stages the fingers and toes will be deformed. The other symptoms include tiredness, weight loss, depression and irritability. The routine tests in Rheumatoid Arthritis include complete blood picture, erythrocyte sedimentation rate (ESR), Serum Creatinine, SGPT, Rheumatoid Factor (RF) and radiographs of the affected joints. The progression of the disease varies mild throughout the courses of the illness. Most people develop flare-ups now and then. Anemia (low Hemoglobin) is very common association, related to disease activity. There is no single diagnostic clinical or laboratory test to confirm the diagnosis of Rheumatoid Arthritis. It is a rather clinical diagnosis, made by physician depending of the signs and symptoms and also based on the laboratory reports. Erythrocyte Sedimentation Rate (ESR) is a marker of Inflammation, will be high in Rheumatoid Arthritis. C-Reactive Protein (CRP) is another marker of inflammation like erythrocyte sedimentation rate (ESR). Rheumatoid Factor (RF) is positive in the blood in 70% of the patients. In remaining 30% of the Rheumatoid Arthritis rheumatoid factor will be negative at the time of diagnosis. Presence of rheumatoid factor does not make the diagnosis certain. About 5% of healthy individuals will have positive rheumatoid factor without having the disease, plan radiographs of the affected joints will show erosions.
Treatment
Modern medicines are very effective in treating this arthritis. They help in reducing the pain, joint swelling and also suppress the arthritis. When the disease is quite active patient needs to take rest, but as the disease symptoms are getting better with medication, the patient needs to exercise the joints regularly. Regular exercise will definitely help the arthritis patients.
Basically there are two types of medicines available for treating this arthritis
 | Anti-Inflammatory painkillers | | Disease Modifying Anti Rheumatic Drugs (DMARDs) |
Anti-Inflammatory drugs like Brufen, Diclofenac Sodium, and Celecoxib etc., help in reducing the joint pain and swelling. They do not have any role in suppressing the arthritis. Where as Disease Modifying Anti Rheumatic Drugs (DMARDs) will not only suppress the arthritis, but also helps in preventing further progression and relapses. Commonly used anti rheumatic drugs are Methotrexate, Hydroxychloroquine, Sulfasalazine and Leflunomide. Drugs like Gold and Pencillamine are rarely used. Steroids are usually used at the beginning of the therapy only for few months. Though they are very effective in relieving the arthritis symptoms, they are not used for long term maintenance therapy due to side effects, for e.g., weight gain and Osteoporosis. Steroid injections are helpful when only few joints are affected.
New Treatment for Rheumatoid Arthritis
Two new injectable drugs are available in the market for treating Rheumatoid Arthritis. They belong to Anti-TNF (Tumour necrosis factor) drugs these are
| Remicade (INFLIXIMAB) | | Enbrel (ETANERCEPT) |
These drugs are very effective in controlling Rheumatoid Arthritis, but are quite expensive.
Frequently Asked Questions (FAQ)
| Is there any diet restrictions for Rheumatoid Arthritis?
There is no diet restriction for this kind of arthritis. Very rarely dairy products may aggravate arthritis symptoms. Vitamins C rich foods (ex. Amla and Lemon) and sea fish will help the arthritis patients. | | Is there any relation with climate?
Many people think that weather in winter may aggravate the arthritis. This is a mis-conception. Cold weather may cause more stiffness in the joints, but it will not aggravate or precipitate the arthritis. | | Does it run in families?
Rheumatoid Arthritis is not a familiar disease; rarely it may affect more than one in the family. |
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