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 elbows
- the neck
- the jaw
- the hips
- the knees
- the ankles
- the feet
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 defence 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:
- frequent pain
- difficulty in mobility
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:
- lose your appetite
- lose weight
- have low energy
- present fever of low temperature (febrile)
- become anemic (have a lower number of red blood cells than normal);
- develop rheumatoid nodules (lumps of tissue that form under the skin)
Rheumatoid arthritis can affect different parts of a joint, such as:
- the membrane
- the joint capsule
- the muscle
- the bag
- the tendon
- Synovial fluid
- the cartilage
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:
- the linings that surround the heart (pericarditis) and the lungs (pleuritis).
- lung tissue
- tear glands and salivary glands (syndrome of sica / dryness or Sjögren’s syndrome)
- blood vessels (vasculitis)
How is it diagnosed?
Clinical history and physical examination
To diagnose RA, your rheumatologist in Delhi will take your medical history and perform a physical exam. The doctor will look for certain characteristics of RA, including:
- swelling, heat and limited mobility of the joints
- nodules or lumps under the skin
- the pattern of the affected joints
Your arthritis doctor in Delhi 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 arthritis specialist in Delhi 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 anaemia 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:
- bone loss in the margins of the joint called erosions
- loss of articular cartilage
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 rheumatoid arthritis treatment in Delhi is crucial and there are currently treatments with very effective medications.
Current methods of treatment focus on:
- ease the pain
- reduce inflammation
- stop or delay joint damage
- improve patient functions and well-being
The program of rheumatoid arthritis treatment in Delhi will be adapted according to your needs taking into account the severity of 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 in Delhi (a doctor specializing in arthritis and other diseases of the bones, muscles and joints) should participate as a leader of the health team.
The best rheumatologist in Delhi 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:
- occupational therapists
- orthopedic surgeons
- social workers
WHAT MEDICATIONS ARE USED?
The medications used to treat RA can be divided into two groups:
- those who can relieve the symptoms;
- those who can modify the disease.
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 rheumatoid arthritis treatment in Delhi 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.
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:
- reduce fatigue
- strengthen muscles and bones
- increase flexibility and energy
- improve the feeling of general well-being
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 a range of motion and isometric exercises for muscle strength. The exercises of the 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 the 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:
- health in general
- weight control
- muscle strength
- the energy level
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 surgery in Delhi can help you preserve your independence.
Orthopaedic surgeon in Delhi is 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 the replacement of a joint.
CAN DIET HELP TO CONTROL RA?
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 arthritis they have to justify that move.
HOW CAN YOU CONTROL BETTER THE RA?
Coping with RA 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 combinations 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:
- an adequate treatment
- good health practices
- enough rest
- enough exercise
- control of emotional stress
- help from arthritis doctors
Who is at risk?
In India, approximately two per cent of the population have RA. 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.