RHEUMATOID ARTHRITIS
Rheumatoid arthritis is a long-term, progressive, and disabling autoimmune disease. It causes inflammation, swelling, and pain in and around the joints and other body organs.
In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels.
In rheumatoid arthritis, the body's immune system attacks its own tissue, including joints.
SYMPTOMS:
Symptoms of RA include:
- pain, swelling, and stiffness in more than one joint
- symmetrical joint involvement
- joint deformity
- unsteadiness when walking
- a general feeling of being unwell
- fever
- loss of function and mobility
- weight loss
- weakness
- loss of appetite
- anemia
- Ocular symptoms: Dryness of the eyes, mouth. Other ocular manifestations include episcleritis, scleritis, scleromalacia & peripheral ulcerative keratitis.
CAUSES:
Rheumatoid arthritis occurs when your immune system attacks the synovium — the lining of the membranes that surround your joints.
The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint.
The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.
RISK FACTORS:
The CDC notes that people with a higher risk of developing RA may include those who:
- sex: Women are more likely than men to develop rheumatoid arthritis.
- Age: Rheumatoid arthritis can occur at any age, but it most commonly begins in middle age.
- Family history: If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking: Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures: Although poorly understood, some exposures such as asbestos or silica may increase the risk of developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity: People — especially women age 55 and younger — who are overweight or obese appear to be at a somewhat higher risk of developing rheumatoid arthritis.
COMPLICATIONS:
Rheumatoid arthritis increases your risk of developing:
- Osteoporosis: Rheumatoid arthritis itself, along with some medications used for treating rheumatoid arthritis, can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture.
- Rheumatoid nodules: These firm bumps of tissue most commonly form around pressure points, such as the elbows. However, these nodules can form anywhere in the body, including the lungs.
- Dry eyes and mouth: People who have rheumatoid arthritis are much more likely to experience Sjogren's syndrome, a disorder that decreases the amount of moisture in your eyes and mouth.
- Infections: The disease itself and many of the medications used to combat rheumatoid arthritis can impair the immune system, leading to increased infections.
- Abnormal body composition: The proportion of fat to lean mass is often higher in people who have rheumatoid arthritis, even in people who have a normal body mass index (BMI).
- Carpal tunnel syndrome: If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
- Heart problems: Rheumatoid arthritis can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
- Lung disease: People with rheumatoid arthritis have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.
- Lymphoma: Rheumatoid arthritis increases the risk of lymphoma, a group of blood cancers that develop in the lymph system.
DIAGNOSIS:
Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases.
A. PHYSICAL EXAMINATION:
- looking for swelling and redness
- examining joint function and range of motion
- touching the affected joints to check for warmth and tenderness
- testing your reflexes and muscle strength.
( IF ALL ARE POSITIVE REFER TO RHEUMATOLOGIST)
B. BLOOD TEST:
Erythrocyte sedimentation rate (ESR or sed rate):
This test assesses levels of inflammation in the body. It measures how fast red blood cells in a test tube separate from blood serum over a set period. If the red blood cells settle quickly as sediment, inflammation levels are high. This test is not specific for RA and is a useful test for other inflammatory conditions or infections.
C-reactive protein (CRP):
The liver produces CRP. A higher CRP level suggests that there is inflammation in the body. This test is not specific for RA and CRP can occur in other inflammatory conditions or infections.
Anemia:
Many people with RA also have anemia. Anemia happens when there are too few red blood cells in the blood. Red blood cells carry oxygen to the tissues and organs of the body.
Rheumatoid factor:
If an antibody known as the rheumatoid factor is present in the blood, it can indicate that RA is present. However, not everyone with RA tests positive for this factor.
Imaging scans and X-rays
An X-ray or MRI of a joint can help a doctor identify what type of arthritis is present and monitor the progress of RA over time.
Conditions with similar symptoms
The doctor will need to distinguish RA from other conditions with similar symptoms, such as:
- gout
- osteoarthritis
- lupus
- psoriatic arthritis
TREATMENT:
There is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (DMARDs).
Medications
The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis.
- NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include stomach irritation, heart problems, and kidney damage.
- Steroids: Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain, and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.
- Disease-modifying antirheumatic drugs (DMARDs): These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine).Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
- Biologic agents: Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), baricitinib (Olumiant), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), sarilumab (Kevzara), tocilizumab (Actemra) and tofacitinib (Xeljanz).These drugs can target parts of the immune system that trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections. In people with rheumatoid arthritis, higher doses of tofacitinib can increase the risk of blood clots in the lungs. Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.
THERAPY:
Physical & occupational therapy is helpful for rheumatoid arthritis.
***PATIENT SHOULD REST FOR SOME DAYS
*** ALWAYS LIVE IN A DRY AREA.
*** BATH IN WARM WATER
*** EXERCISE REGULARLY
*** MAINTAIN DIET PLAN.
.jpeg)
