Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system mistakenly attacks healthy cells, including the joints.
The normal function of immune system is to protect from foreign invaders, such as bacteria and viruses. In people with RA, erratic immune system fails to differentiate between foreign invaders and normal body components thus causes inflammation that results in swelling and pain in and around the joints.
If inflammation continues for a long time, it can damage cartilage (the protective tissue that covers the ends of joints) and bones. This damage usually can’t be reversed once it happens. Apart from joint, RA can also affect eyes, nerve and lungs
What causes rheumatoid arthritis?
Exact cause is not known, it occurs due to complex interplay between ones genetic component, environmental factor (smoking, ? viral infection), which leads to formation of antibodies which attacks joints.
Symptoms
- RA can occur in both young and old age , females are more commonly affected than males
- Pain and swelling in joints of hands, elbow, shoulder and knee for more than 6 weeks duration , in most of cases symptoms appear in all joints at same time but in few case symptoms migrates form one joint to other joint.
- Some patient experience fatigue, fever , weight loss and loss of appetite
- In long standing cases skin rashes , dryness of mouth and eyes ,shortness of breath may occur
Diagnosis
- If your primary care physician suspects that you have rheumatoid arthritis , he refers to rheumatologist who treat the disease . There is no single test to diagnose RA , diagnosis based on clinical symptoms ,physical examination and blood tests .
- Blood test – Basic blood test complete hemogram , ESR , Rheumatoid factor , Anticcp ,Liver function test, kidney functions
- Imaging such as X ray , High resolution ultrasounds and MRI may required on case to case bases
Treatment
- Goal of treatment
- To control joint inflammation (pain , swelling )
- To preserve joint function and prevent joint damage
- To prevent effect of arthritis on body
- Patient will be started on , pain killer which reduces symptoms, steroids may be added for short duration depending upon symptom severity. Drugs – immunomodulators such as methotrexate , leflunomide , sulphasalazine , tofacitinib are started considering age , severity of disease , duration of disease and other factors
- Follow up – Once medications are started patient should be under regular follow up at interval of 2-3 months along with blood tests
- Follow up visit are needed to asses disease activity and side effects of drugs
Self management Tips
- Regular exercises to maintain ideal body weight and stretching exercises of upper and lower limbs to preserve mobility of joints
- Avoid exercises during disease flare
- Diet – There is no particular diet for rheumatoid arthritis but normal healthy diet – rich in green leafy vegetables, fruits and fibre, low in refined carbohydrates and fat, red meat
- There is scientific evidence to support nutritional supplements such as protein and herbal supplements to boost immunity, we strictly discourage intake of such products
- Avoid smoking and alcohol, smoking known to increase risk of development of rheumatoid arthritis in genetically predisposed individuals
- Immersion of hands or foot in lukewarm salt water is improves early morning stiffness
Precaution during winter
- To Keep hydrated with sufficient amount of water
- To Keep one self warm because cold weather known to increase joint symptoms
Pregnancy
- Pregnancy should be planned only after controlling disease , other symptoms may increase either during pregnancy or after delivery of baby.
- Certain medications should be stopped before conceiving, inform your rheumatologist before planning for pregnancy.