QUICK FACTS :
- Rheumatoid arthritis is an autoimmune disease triggered by a faulty immune system.
- Rheumatoid arthritis is the most common type of autoimmune arthritis.
- Treatments have enhanced broadly and help many of those affected.
- Rheumatologists can precisely diagnose Rheumatoid Arthritis and recommend treatments.
ABOUT RA: Rheumatoid arthritis is a condition that may cause pain, swelling and stiffness in joints. It is known as an autoimmune condition. This means that the immune (body’s natural self-defence system) system gets confused and starts to attack the body’s healthy tissues. In RA, the major way it does this is with inflammation in the joints.
Rheumatoid arthritis is a chronic condition that damages the joints of the body. Chronic conditions are long lasting (greater than 3 months), and they can not be managed easily or quickly. Over twice as many women as men get this condition. Although it may appear at any phase of life, Rheumatoid arthritis usually starts in patients when they are aged between 30 & 60 years. Rheumatoid arthritis causes ongoing joint damage to numerous patients. To reduce the damage and other complications, Rheumatoid arthritis (RA) must be diagnosed and treated as early as possible, and optimally must be managed throughout life
How Does It Affect the Joints?
If you have RA, your immune system causes inflammation inside a joint or a number of joints. Inflammation is an foremost part of how your immune (defense) system acts. It helps enable the body to forward additional fluid and blood to a part of the body under attack from an infection. For instance, in case you have a cut that gets infected, the skin around the cut can become swollen and a different colour.
However, in Rheumatoid arthritis, this inflammation in the joint is unnecessary and responsible for causing the complications. When the inflammation goes down, the capsule around the synovium remains stretched and can’t hold the joint in its proper position. This may cause the joint to become unstable and move into unusual positions.
SYMPTOMS: Early signs of Rheumatoid Arthritis include:
- Swelling, aching, stiffness, or pain of one or more joints
- Morning stiffness which lasts for at least 30 minutes and often for several hours
- Difficulty grasping the objects as strongly as you used to
- Rheumatoid arthritis commonly affects the small joints of the feet, fingers, and wrists, but it may also affect other joints, including the knees, ankles, elbows, shoulders, and hips.
- Rheumatoid arthritis is not osteoarthritis (OA), a much more common condition which generally occurs with older age. It is possible, though, to have both osteoarthritis and rheumatoid arthritis together.
What Does It Do to the Rest of the Body?
RA mainly affects the Joints of Neck/Spine, Shoulder, Elbow, Hip, Knee, Ankle, Foot, Toes, Wrist, Hand, Fingers. Although, other organs that may be affected if RA is not treated early:
- Eyes: dryness and damage to delicate structures
- Lungs: a bit greater risk of getting severe infections and other complications
- Heart disease: may occur about 10 years sooner than in individuals without rheumatoid arthritis
- Stomach: increased risk of bleeding with some medicines
- Cancer: double the risk of some types of cancer, such as lymphoma. Increased vigilance is advisable.
- Early diagnosis and appropriate treatment may prevent these complications.
CAUSES: The following can play a part in why someone has rheumatoid arthritis:
- Age: RA affects adults of any age, although most individuals are diagnosed b/w the ages of 40 & 60. Approx three-quarters of individuals with RA are of working age when they are first diagnosed.
- Sex: RA is 2 to 3 times more common among women than men.
- Genetics: RA develops due to a combination of genetic and environmental factors. In case you’ve a genetic predisposition to RA, it means you have a greater likelihood of occuring the condition on behalf of your genetic makeup. It is not clear what the genetic link is, but it is thought that having a relative with RA increases your chance of occuring the condition.
- Smoking: RA occurs through a combination of genetic and environmental factors. Cigarette smoking is classed as an environmental factor and significantly increases the risk of occuring the condition.
- Diet: There is some evidence that if you eat a lot of red meat and don’t consume much vitamin C, you may have a greater risk of occuring RA.
- Weight: In case you are overweight, you have a significantly greater chance of occuring RA than if you are a healthy weight.
How Rheumatoid Arthritis Is Diagnosed: A diagnosis of RA is based on your symptoms, a physical examination and the results of x-rays, scans and blood tests.
It can be tough to diagnose because there isn’t a test that can prove you definitely have it. There are also quite a few conditions that have the identical symptoms.
Your health specialist will ask about your symptoms and perform a physical examination. They will do an assessment for swollen joints and will look how well your joints move. RA can affect different and several parts of your body at once, so it’s crucial to tell your health specialist about all the symptoms you’ve had, even in case they don’t seem to be related. In case they think you have RA, you will be referred to a rheumatologist, and may arrange blood tests to help confirm a diagnosis.
Blood Tests: There’s no single blood test that can prove you have RA. Although, there are certain tests that can find possible signs of the condition. Some of the main tests are outlined below.
- Erythrocyte sedimentation rate (ESR): A sample of your RBCs are put into a test tube of liquid. The cells are timed to observe how long they take to get to the bottom of the tube. In case the cells sink quickly than usual, you may have levels of inflammation that are greater than normal. RA is just one possible cause.
- C-reactive protein (CRP): This test can indicate if there is inflammation in the body. It does this by checking how much C-reactive protein there is in the blood. In case there is more C-reactive protein than usual, you may have inflammation in your body.
- Full blood count: A complete blood count measures the number of RBCs you have. These carry iron around the body, and a decreased RBCs means you have a low iron content. This may mean you have anaemia and is common in individuals with RA. Anaemia is common in individuals with rheumatoid arthritis, although having anaemia doesn’t confirm you have the condition.
Rheumatoid factor and anti-CCP antibodies: Around half of all individuals with RA have a +Ve rheumatoid factor in their blood when their condition starts. Although, about 1 in every 20 individuals without RA also tests +Ve for the rheumatoid factor.
There is another antibody test named anti-CCP that you can take. Individuals who test +Ve for anti-CCP are very likely to get RA. Although, not everyone that has the condition has this antibody. Individuals who test +Ve for rheumatoid factor and anti-CCP may be more likely to occur severe RA.
Scans: Scans may be performed in order to check for joint inflammation and damage. These can be used in order to diagnose RA and check how the condition is developing.
These may include:
- X-rays: these will show any changes in your joints
- ultrasound scans: a picture of your joints is created using high-frequency sound waves
- MRI scans: certain pictures of the joints are produced with the help of strong magnetic fields and radio waves.
TREATMENTS FOR RA: There are a variety of treatments available for RA. The earlier that intensive treatment is initiated, the more likely it is to work. There are 3 main ways to treat RA (Rheumatoid Arthritis):
- physical therapies
MEDICINES: Several effective medicines to treat the RA symptoms. Options include:
Nonbiologic: Disease Modifying Antirheumatic Drugs (DMARDs)
- Methotrexate (Rheumatrex and Folex)
- Leflunomide (Arava)
- Hydroxychloroquine (Plaquenil)
- Sulfasalazine (Azulfi dine)
Older DMARDs include:
- Gold, given as a pill: auranofin (Ridaura): or more often as an injection into a muscle (such as Myochrysine)
Antibiotics and immune suppressants:
- Minocycline (eg, Minocin, Dynacin and Vectrin)
- Azathioprine (Imuran)
- Cyclosporine (Sandimmune and Neoral)
- The immunosuppressants or antibiotics and gold are rarely used for rheumatoid arthritis these days because other drugs act better or have minimal side effects.
Biologic agents: (often prescribed with methotrexate)
- Abatacept (Orencia)
- Adalimumab (Humira)
- Certolizumab (Cimzia)
- Etanercept (Enbrel)
- Golimumab (Simponi)
- Infliximab (Remicade)
- Rituximab (Rituxan)
- Tocilizumab (Actemra)
- Tofacitinib (Xeljanz)
- Anakinra injection (Kineret Injection)
NOTE: Kineret is the only FDA-approved medicine called an interleukin-1 receptor antagonist (IL-1ra). Kineret (anakinra medication) is used to reduce the signs and symptoms, and resist the damage of moderate to severe active RA in individuals aged 18 years and older when one or more other medications for RA have not worked.
Kineret is supplied in single-use, prefilled, graduated glass syringes. Each graduated syringe contains a kineret 100 mg solution. Kineret is dispensed in a 7-day pack. Kineret is injected subcutaneously at persistent time every day. It is stored in a refrigerator b/w 36° and 46°F (2° and 8°C). Kineret should not be frozen or shaken. Kineret should be kept in its original carton and away from the light. The anakinra cost is quite less and depends on certain factors including non-branded, brand-name products.
PHYSICAL THERAPIES: Several effective physical therapies to manage the symptoms. Options include:
Physical activity: Keeping yourself physically active can help improve your RA symptoms, including pain. You may find it tough to be physically active in the first place, especially in case you’re having a flare-up. Although, in case you find the apt activities, help and support, you can be active in a way that suits you.
Not keeping yourself active can lead to stiff joints and weak muscles. It could also be responsible for causing you to gain weight.
In case you are fresher to exercise, or haven’t exercised in recent times, you may experience a bit sore the initial few times you try a new activity. As you get used to it, this will get better.
Although, if a type of exercise always causes a flare-up, it’s perhaps appropriate to find another one. High-impact exercises such as step exercises, or contact sports, such as football and rugby, are more likely to be responsible for causing complications. Walking, swimming, gentle cycling and aqua aerobics generally put less strain on the joints.
Tai chi (tie-chee) and Yoga are generally thought to be suitable for individuals with RA. Although, there are a few different styles, so it is good to check which is suitable for your condition prior to signing up to a class.
Physiotherapy: A physiotherapist can help suggest apt and suitable exercises and support you in order to live an active life. Individuals with RA should have access to specialist physiotherapy in order to help manage their condition and improve their fitness, strength and flexibility. You should also have follow-up reviews.
Hydrotherapy: You may also find that hydrotherapy helps in order to ease your symptoms. This involves performing the special exercises in a warm water pool, under the supervision of a trained physiotherapist. Hydrotherapy can also be known as ‘aquatic therapy’ or ‘aquatic physiotherapy’.
POINTS TO REMEMBER:
- Newer therapies are effective. RA medicines have widely improved outcomes for patients. For most individuals with RA, early treatment can control the joint pain, swelling and lessen joint damage.
- Seek a rheumatologist. A physician who is mainly an expert in rheumatoid arthritis can make the apt diagnosis and design a customized treatment plan that is effectively suited to you.
- Initiate treatment early. Studies suggest that those individuals who receive early treatment feel better sooner and more often and are more likely to lead an active life.