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Rheumatoid arthritis

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Overview of rheumatoid arthritis

Rheumatoid arthritis is a long-term (chronic) disorder of the joints that affects multiple joints of the body causing pain, stiffness and swelling in the affected joints. This gradually progressing disorder leads to the reduction of the normal functioning of the joints and limited mobility. It affects about 0.5–1% of the adults worldwide and is seen more commonly in women.1 Rheumatoid arthritis usually affects adults between the ages 30 and 50 years. If left untreated, individuals may become unable to perform any work within about 3 years from the diagnosis.2      

Signs and Symptoms of rheumatoid arthritis

Rheumatoid arthritis is characterised by stiffness and swelling one or multiple joints simultaneously. The affected joints are painful and the individual can perform only restricted movements. Although the disorder can affect any joint in the body, the small joints of the hands and feet such as the wrists are more commonly affected.

The joints are generally swollen, painful to touch and warm. The stiffness is more common during the morning that lasts for about 45 min after the individual tries to move the hands or feet. These symptoms may either be noticed abruptly or may become evident over a period of time.

When noticed abruptly it may also be associated with low fever, general tiredness and body ache. Gradually as this disorder progresses, the tissues of the joint and the bones begin to wear out or resorb, which is associated with increased severity of the symptoms.2

Causes of rheumatoid arthritis

The exact cause of rheumatoid arthritis, which gradually destroys the bone and the surrounding tissues of the affected joint are not known. A complex interaction between the environmental factors and hereditary factors has been proposed as the possible pathway for this disorder. An infection or autoimmune reaction (wherein the body’s defence cells act against the body itself) generally triggers a series of changes within the tissues of the joints that result in the symptoms. Hence, rheumatoid arthritis is considered as an autoimmune disorder that is caused due to malfunctioning of certain cells of the body’s immune system.3

Risk Factors for rheumatoid arthritis

Some of the risk factors that have been associated with increased incidence of the disorder include

  • Family history of rheumatoid arthritis
  • Female gender
  • Middle or old age
  • Smoking and at times
  • Increased coffee consumption

Use of oral contraceptives, tea consumption and increased vitamin D intake are associated with a decreased risk of developing this disorder.2

Diagnosis of rheumatoid arthritis

The diagnosis of rheumatoid arthritis is based on:

  • The signs and symptoms noticed
  • Family and personal history of the individual
  • Certain laboratory investigations

The same joint of both the hands and legs (bilateral joint involvement) such as the wrists, elbows, knees or ankles are affected and are painful. Certain specialized blood tests to identify the specific factors such as rheumatoid factor and alterations in the blood cells that are associated with the disorder are generally advised. Radiographs of the affected joints are also helpful in identifying the bone loss caused due to this disorder.2

Treatment of rheumatoid arthritis

There is no cure for rheumatoid arthritis. However, the associated symptoms and the rate of progression of the disorder can be effectively treated. Numerous treatment modalities are being advised to alleviate the signs and symptoms associated with it. A commonly advised treatment is the combination of painkillers, certain medications that belong to the group of corticosteroids along with some specific medication known as disease-modifying antirheumatic drug (DMARD).

The type of combination,  dosage and mode of administration (tablet or injection)  are decided by the doctor based on the severity and stage of the arthritis. Generally the therapy lasts for a long duration, as rheumatoid arthritis is a lifelong illness. Newer medications are being researched, which may be more effective than the existing ones.2  

Alternative therapy for rheumatoid arthritis

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Various alternative therapies such as diet modifications, physiotherapy, spa therapies (relaxing bathing and massaging techniques), educating the affected individual about the condition and exercise have been found to have a beneficial effect. It is necessary to discuss with the doctor about these options before undergoing any of the alternative therapies. Other options such as herbal medications and acupuncture though found to be helpful have not been substantiated by many researchers.2,4

Surgery may be required in some instances wherein the symptoms are severe and the movement is highly restricted.2,4

Complications of rheumatoid arthritis

The complications that have been noticed in untreated cases of rheumatoid arthritis include:

  • Anaemia
  • Heart disorders
  • Disorders of the spinal cord
  • Formation of fistula near the joints
  • Defects of the joints that may lead to permanent deformity
  • Formation of small lumps of tissues known as rheumatoid nodules
  • Inflammation of the blood vessels 2

Prevention of rheumatoid arthritis

There are no methods to prevent the occurrence of rheumatoid arthritis. However, progression of the disorder and its complications can be effectively prevented with timely diagnosis and prompt treatment.

Living with rheumatoid arthritis

Though tiring at times rheumatoid arthritis when effectively treated does not cause any major disability. Following the therapeutic protocols along with the suitable modifications in the lifestyle help the individual lead a normal life.

Living with rheumatoid arthritis

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1.Emery P, Suarez-Almazor ME. Rheumatoid arthritis. Clin Evid Concise. 2003; 10: 274–276.

2.Rindfleisch AJ, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2005; 72(6): 1037–1047, 1049–1050.

3.Weissmann G. The pathogenesis of rheumatoid arthritis. bulletin of the nyu hospital for joint diseases. 2006; 64(1&2): 12–15.

4.Kavuncu V, Evcik D. Physiotherapy in rheumatoid arthritis. Med Gen Med. 2004; 6(2): 3.