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Everything You Need to Know about Rheumatoid Arthritis

The term arthritis is used to describe nearly 200 conditions that affect joints along with the connective tissues and other some other tissues around the joints. The word arthritis means joint inflammation.

 

The symptoms of arthritis develop over the time, however, in some cases, they may also appear suddenly. The condition is most commonly seen after the age of 64. Sometimes it may also develop in children, teens or younger adults. Arthritis is more common in women than men. Also, the people who are overweight are more prone to arthritis. According to the Centers for Disease Control and Prevention (CDC), 54.4 million adults in the United States have received a diagnosis of some form of arthritis. Of these, 23.7 million people have their activity curtailed in some way by their condition.
 

Types of arthritis

 

Arthritis is majorly divided into 7 basic categories that include:

  1. Inflammatory arthritis (commonly known as Rheumatoid arthritis)

  2. Degenerative or mechanical arthritis (commonly known as osteoarthritis)

  3. Soft tissue musculoskeletal pain

  4. Back pain

  5. Connective tissue disease

  6. Infectious arthritis

  7. Metabolic arthritis.

Rheumatoid arthritis is the most common form of arthritis discussed below in detail

 

Rheumatoid arthritis (RA)

 

This is an autoimmune disorder that occurs when the body’s immune system starts affecting its own body. Rheumatoid arthritis may also affect parts other than the joints such as skin, eyes, lungs, heart and blood vessels. The joints that are most commonly affected are hands, feet, wrists, elbows, knees, and ankles.


How rheumatoid arthritis damages the joints?

 

When the immune system starts attacking its own joints, it creates an inflammation in tissue that lines that inside of the joints. This leads to thickness, swelling, and pain around the joints.

If this inflammation is not stopped, it can damage the cartilage, the elastic tissue that covers the ends of bone in a joint and the bone itself.  With time, there is a loss of cartilage and spacing between the bones starts getting reduced. The joints become loose, unstable and painful and lose their mobility.

The joint damage cannot be reversed. Hence it is important to be diagnosed and controlled at an early stage.

 

Rheumatoid arthritis

 

Signs and symptoms

 

The symptoms and effects of RA may come and go. A period of high disease activity (increases in inflammation and other symptoms) is called a flare. A flare can last for days or months.

The initial signs of RA may include only pain and tenderness. There may not be any redness or swelling in the joints.

 

At later states, the following symptoms may get associated :

  • Joint pain, tenderness, swelling or stiffness for six weeks or longer

  • Morning stiffness for 30 minutes or longer

  • More than one joint is affected

  • Small joints (wrists, certain joints of the hands and feet) are affected

  • The same joints on both sides of the body are affected

  • Associated fatigue, loss of appetite and low-grade fever.

 

Other than joints, following body parts, may also be affected by RA:

 

  • Eyes. Dryness, pain, redness, sensitivity to light and impaired vision

  • Mouth. Dryness and gum irritation or infection

  • Skin. Rheumatoid nodules – small lumps under the skin over bony areas

  • Lungs. Inflammation and scarring that can lead to shortness of breath

  • Blood Vessels. Inflammation of blood vessels that can lead to damage in the nerves, skin and other organs

  • Blood. Anemia, a lower than normal number of red blood cells

 

rheumatoid arthritis in hands


 

Diagnosis

 

Diagnosis of Rheumatoid arthritis consists of blood tests and imaging tests. Blood tests such as elevated erythrocyte sedimentation rate or C-reactive protein may indicate the presence of inflammation in the body. Other than this blood tests detecting the presence of rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies can also be done.

The imaging tests include an X-ray, ultrasound or an MRI scan to look out for any joint damage such as erosions, loss of bone within the joint and narrowing of joint space. If the radiology tests do not show any damage, it may mean that the disease is at the initial stages and has not damaged the joints.

 

Treatment

 

Ideally, the treatment should aim to:

  • Stop inflammation

  • Relieve the symptoms

  • Prevent joint and organ damage

  • Improve physical function and overall well-being

  • Reduce long-term complications.

 

As per the best orthopedic surgeons in India, the following are the forms of treatment for RA.

 

Medications

NSAIDS - Non-Steroidal Anti-Inflammatory Drugs  - These are prescribed to help ease arthritis pain and inflammation. NSAIDs can be taken by mouth or applied on the skin of the swollen joint. They are available over-the-counter or can be prescribed by the doctor.

 

Corticosteroids - They are used to control the progressing inflammation, while the other medications take longer to start the effect. However, corticosteroids are not used for a longer time or in high doses due to their side effects that include thinning of bones, weight gain, and diabetes.

 

Disease-modifying anti-rheumatic drugs (DMARDs)- These drugs help in slowing down the progression of the disease and reduced the damage to the joints and other body parts that are affected.

 

Biologics- These are also known as biology response modifiers that target parts of the immune system which trigger inflammation and causes joint and tissue damage. Biologics increase the risk of infection in the patient.  


 

Surgery

Cases in which medications do not work well, surgery is the ultimate option.

Following types of surgeries can be done depending upon the cases,

  • Synovectomy - Surgery to remove the inflamed synovium (lining of the joint). Synovectomy can be performed on knees, elbows, wrists, fingers, and hips.

  • Tendon repair. Inflammation and joint damage may cause tendons around the joint to loosen or rupture. Hence, the surgery may be performed to repair the tendons around your joint.

  • Joint fusion. Surgical fusion of a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.

  • Total joint replacement. During joint replacement surgery, the damaged parts of the joint are removed and replaced with a prosthesis made of metal or plastic.

The best orthopedic hospitals in India are equipped with world-class infrastructure to perform the most complex orthopedic surgeries with a high success rate.

 

Physical therapy

This form of therapy is mostly done after treating the condition by medications or the surgery. Physical therapy done under a trained professional helps in keeping the joints flexible and active.

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