What is it?
Rheumatoid arthritis (RA) is a common form of arthritis that causes inflammation in the lining of the joints, causing heat, reduced range of motion, swelling and pain in the joint. RA tends to persist for many years, often affects different joints of the body and can cause damage to cartilage, bones, tendons and ligaments of the joints.
WHAT DOES AR DIFFERENCE FROM OTHER FORMS OF ARTHRITIS?
One way to distinguish RA from other types of arthritis is by the pattern of the affected joints. For example, RA affects the wrist and many of the joints of the hand but, in general, does not affect the joints that are closest to the nails. Conversely, osteoarthritis, a more common type of arthritis, most often affects joints closer to the nails than other areas of the hand.
Other joints that may be affected by RA include:
The spine is usually not directly affected by RA, with the exception of the neck. Another essential feature of RA is that the joints on both sides of the body tend to be affected. That is to say, if the knuckles of the right hand are inflamed, it is probable that some knuckles of the left hand are also knuckles.
The general pattern of the affected joints, together with certain results in laboratory tests or X-rays, make it possible for a doctor to distinguish RA from other conditions.
What is the cause?
The cause of RA is still unknown; however, the body's immune system plays an important role in the inflammation and damage that RA causes in the joints. The immune system is the body's defense against bacteria, viruses and other foreign cells. In RA, the immune system attacks the joints themselves and may affect other organs of the body. In RA, the cells of the immune system invade the tissues of the joints and cause inflammation. These cells in the tissue and fluid of the joint produce many substances, including enzymes, antibodies and cytokines, which attack the joint and can damage it.
The role of genes
Genes play an important role in the development of RA. The genes that are associated with RA are more frequent in the Anglo-Saxon population. However, not all of these people will develop AR. It is believed that these genes generate, in some people, a susceptibility or tendency to increase the risk of developing RA.
The reason why some people who possess these genes are at higher risk of developing RA and others are not yet known.
What are the symptoms?
The symptoms of RA vary from one person to another and in almost all people also vary from one day to the next, although there is always a certain degree of arthritis. In some people, the disease can be mild, with periods of activity (in which the inflammation of the joints worsens) known as periods of exacerbation. In others, the disease remains active continuously and worsens, or progresses with the passage of time.
Joints that can be affected by rheumatoid arthritis:
If you have RA, you may feel the following symptoms in some joints:
These physical signs of arthritis are due to inflammation of the lining, or synovium, of the joints. If this inflammation persists or does not respond well to treatment, it can cause destruction of adjacent cartilage, bone, tendons and ligaments, leading to deformities of the joints.
Rheumatoid arthritis can make you feel completely sick, particularly during periods of aggravation and you could:
Rheumatoid arthritis can affect different parts of a joint, such as:
Often rheumatoid nodules are formed over bony areas exposed to pressure. These are often found around the elbow, and also in other parts of the body, such as the fingers, on the spine or on the feet.
Occasionally, people with RA have inflammation of:
How is it diagnosed?
Clinical history and physical examination
To diagnose RA, your doctor will take your medical history and perform a physical exam. The doctor will look for certain characteristics of RA, including:
Your doctor may also ask if you have experienced fatigue or a general feeling of stiffness, especially when getting up in the morning, since these two symptoms are associated with RA.
Your doctor may also recommend that you have some blood tests . Certain tests detect the presence of an antibody called rheumatoid factor, which may be an AR signal. However, the rheumatoid factor is also found in many people who do not have RA. Other abnormalities that are discovered through laboratory tests include anemia and a high rate of average globular sedimentation (ESR) or C-reactive protein (CRP), which indicate the presence of inflammation.
Although these blood tests may be useful in establishing a diagnosis, there is no single test that can establish or exclude a diagnosis of RA.
Although radiographs are usually normal during the first stage of RA , joint damage that may occur as the disease progresses helps confirm the diagnosis. Among the results that usually suggest the presence of RA include:
Consult a rheumatologist whenever there are doubts about the diagnosis.
Currently, there is no cure for RA and maybe until a cause of RA is known, it will probably not be possible to eradicate the disease completely. However, immediate treatment is crucial and there are currently treatments with very effective medications.
Current methods of treatment focus on:
The treatment program will be adapted according to your needs taking into account the severity of the arthritis, if there were other clinical conditions and your own lifestyle. Your doctor and other members of your health care team will work together to find the best treatment program for you.
Your medical assistance team
The treatment of RA often requires teamwork, which benefits the patient, by uniting the experience of health professionals from different branches. A rheumatologist (a doctor specializing in arthritis and other diseases of the bones, muscles and joints) should participate as a leader of the health team.
The rheumatologist can coordinate your care with the family doctor, with a doctor specializing in internal medicine (an internist), or with other health professionals who often play important roles to help you control RA, including:
WHAT MEDICATIONS ARE USED?
The medications used to treat RA can be divided into two groups:
Your doctor may recommend the use of two or more medications simultaneously, each of which will have a specific purpose in the treatment of RA. Some of these medications affect the immune system or have side effects, so careful monitoring during treatment will be of great importance.
It is necessary to consider that, although all medicines (even those whose sale is not restricted) have side effects, it is necessary to treat RA soon, because if it is not treated it can cause serious problems, such as the destruction of the joints. Therefore, decisions related to treatment should be made also thinking about the benefits of treatment (pain relief, prevention of disability ) and risks. Even the cost of using certain types of drugs must be analyzed.
Call your doctor, nurse or pharmacist if you have any questions about your medications, or if you think they are causing side effects or if they are not acting appropriately. More information ahead.
EXERCISE, ACTIVITY AND REST: HOW MUCH SHOULD YOU DO?
Doctors and therapists know that exercise can improve your health and fitness without hurting your joints. Moderate and habitual physical activity helps:
You can work with your health care team to determine the best combination of exercise, activity and rest for your condition. The intensity and frequency of the exercises, activity and rest, will be based on how active your illness is. It is important that you learn to adapt your activities to achieve the best state of physical health. When a joint is hot, sore and swollen, rest will help decrease the swelling of the joint. Your doctor or physiotherapist can guide you about the amount and type of rest you need. You still have to deal with joint mobility by performing range of motion and isometric exercises for muscle strength. The exercises of amplitude of movement help to maintain the mobility of the articulations and usually they realize without weight.
Isometric exercises can help you maintain strong muscles without moving the joints. Your doctor or physiotherapist can teach you the proper way to perform these exercises. As these exercises do not involve movement of the joints, they can be done comfortably even when inflammation is present. In general, you can continue with water exercises during periods of aggravation, because water flotation helps protect the joints and facilitates movements.
When symptoms are under control, you should gradually resume a full program of exercises that includes aerobic exercises, since cardiovascular exercise is important for:
Low-impact fitness programs, such as walking or riding a stationary bicycle, are usually good choices. Talk to your doctor or physiotherapist about the right program for you.
WHEN IS IT POSSIBLE TO RECOVER JOINT SURGERY?
If you feel pain and disability due to severe joint damage, your doctor may suggest total joint replacement (also called total joint arthroplasty). Joint replacement can help you preserve your independence.
Orthopedic surgeons are those who perform these procedures that involve the replacement of damaged parts of the joints with metal and plastic components. Total hip and knee replacements are the arthroplasties that are performed more frequently and with better results. Most surgeries require postoperative rehabilitation to obtain the maximum benefit of the new joint. They can also assign you an exercise program before surgery to strengthen the muscles.
In general, doctors indicate a medication and therapy program before suggesting replacement of a joint.
CAN DIET HELP TO CONTROL AR?
In most people who have RA, it has not been proven if changes in diet can be the cause or can relieve the symptoms of RA.
However, it is very important to maintain a healthy diet that includes adequate amounts of protein and calcium. During periods of arthritis exacerbation, you may lose appetite and weight. During these periods, it is important to consume enough calories. When arthritis is less active or if you take corticosteroids, it is important to avoid excessive weight gain.
CAN A DIFFERENT CLIMATE HELP?
Rheumatoid arthritis occurs in all regions of the world, therefore climate can not prevent it or cure it. Many people with RA observe that sudden changes in weather or barometric pressure tend to aggravate the symptoms of their arthritis. For most individuals, moving to a different climate does not make a big difference in the arthritis they have to justify that move.
HOW CAN YOU CONTROL BETTER THE AR?
Coping with AR can be difficult. As RA can be unpredictable, it is often characterized by long-term or continuous pain, and it can affect so many joints that it could suffer emotional stress or depression. It is normal to experience these types of feelings, but these may interfere with the control of the disease.
It is important that you decide to live each day as fully as possible. Medications, rest and exercise are the best combination for the relief of symptoms, but it is also important to focus on the positive aspects of life.
It is essential that you and your family learn as much as you can about the disease, and talk to each other, your doctors and other health professionals involved in your care. Mental health professionals can advise you on how to cope and solve problems.
It is essential to prevent the disease from controlling your life. You can enjoy a productive and full life, despite the disease, if you follow certain guidelines such as:
NSAIDs and aspirin
The NSAID or nonsteroidal antiinflammatory drugs are used to help relieve pain and fight inflammation accompanying RA. Some NSAIDs include aspirin, ibuprofen and naproxen, among others. These medications alone do not usually constitute an adequate treatment for RA. Most patients with RA also need to take disease-modifying medications or biological agents. NSAIDs and aspirin can cause side effects, such as stomach pain and even bleeding. They are also associated with heart problems and liver and kidney damage in susceptible people. If you have these side effects, you may be prescribed other medicines. Talk to your doctor about these and other risks.
In rheumatoid arthritis, analgesics relieve pain, but have no effect on the inflammation caused by joint damage. These medications include:
Narcotic pain medications are not usually recommended as monotherapy for the prolonged treatment of RA, because they often have undesirable side effects and can create dependence if taken in excess, without improving the evolution of the disease.
The corticosteroids (cortisone, prednisone) can help relieve the symptoms of RA. These medications are related to cortisol, a natural hormone found in the body. Low-dose corticosteroids may be used together with aspirin, NSAIDs, disease-modifying antirheumatic drugs (DMARDs), or biological agents to control joint inflammation.
Many of the benefits and side effects of corticosteroids are directly related to the dose administered. The objective is to find the lowest possible effective dose, in order to avoid so many side effects and to seek the use of corticosteroids for the shortest possible time. In general, corticosteroids are usually administered in combination with disease-modifying antirheumatic drugs or with biological agents and should not be considered as a single form of pharmacological treatment against RA.
Some side effects of corticosteroids include:
The administration of corticosteroids for prolonged periods reduces or stops the body's ability to produce natural corticosteroids. When it is necessary to reduce the ingested dose of corticosteroids, the doctor is required to reduce it slowly (gradual variation), since it is dangerous to stop or decrease it drastically or without medical supervision. The body needs time to normalize its natural production of cortisol. Also, it may be necessary to supplement or increase the dose in periods of high stress, such as before and after surgery.
Corticosteroids can be injected directly into the affected joints. Such treatments can reduce inflammation in swollen or painful joints, or frequent periods of aggravation. Because its effect is local, direct injection into the joint temporarily controls inflammation and avoids most of the undesirable side effects that appear with the daily use of corticosteroid tablets.
The injections can produce a temporary systemic effect and could have harmful side effects on the joints if they are used more than a few times a year. Also, although not frequently, there is a possibility that the joint becomes infected.
Who is at risk?
In India, approximately two percent of the population have AR. This disease can be contracted by anyone, whether children or the elderly, and it varies from one person to another. The disease usually begins between 25-50 years of age, with women outnumbering men by a ratio of three to one. Similarly, the disease occurs in all ethnic groups and in all parts of the world.