Rheumatoid arthritis (RA) is a disease in which the joints in the body become inflamed.
Fast facts
- RA is the most common type of arthritis triggered by the immune system.
- Approximately 1% of the world’s population including India has RA
- If you have symptoms such as pain and swelling in the joints and stiffness in the mornings, we recommend you see a Rheumatologist as soon as possible as these symptoms could be caused by RA
- Treatment has improved dramatically and must be started as early as possible to achieve the best outcome
Rheumatoid arthritis symptoms
RA varies from one person to another but in most people it starts quite slowly. A few joints – often the fingers, wrists or the balls of the feet – become uncomfortable and may swell, often intermittently. About 1 in 5 has an explosive onset of disease.
The stiffness seen in active RA is typically worst in the morning and may last one to two hours or throughout the entire day.
Although arthritis means inflammation of the joints, it's not just the joints that are affected. Other symptoms that can occur in RA include: loss of energy, appetite & weight; low-grade fevers; dry eyes and mouth from an associated condition known as Sjogren's syndrome; firm lumps, called rheumatoid nodules, which grow beneath the skin in areas such as the elbow and hands.
Who gets rheumatoid arthritis?
It affects approx. 1% of the world’s population including India. It can affect adults at any age, but most commonly starts between the ages of 40 and 50. About three times as many women as men are affected.
Genetic factors alone do not cause RA. Also there is little evidence that lifestyle factors like diet, weather, etc. affect the risk of developing the disease.
What causes rheumatoid arthritis?
Inflammation is a normal body defense mechanism. It is there to help fight off viruses and bacteria that cause illness.
While 'normal' inflammation dies down once the 'bug' that triggered it has been destroyed, in RA the inflammation becomes a long-term (chronic) process. We don't yet know exactly what sets off the inflammation in RA.
How does rheumatoid arthritis progress?
It isn't possible to predict exactly how RA will progress for each patient. The inflammation in rheumatoid arthritis damages the cartilage and sometimes the bone itself. It may also damage any ligaments within the joints.
Inflammation can sometimes affect the blood vessels, the lungs and, rarely, the membrane around the heart. People with RA are also more at risk of heart attack and strokes.
How is rheumatoid arthritis diagnosed?
There is no single test that can give a definite diagnosis of early rheumatoid arthritis. Rheumatologists are doctors who specialize in the care of patients with RA. They arrive at this diagnosis based on your symptoms, a physical examination, and the results of a variety of blood tests and x-rays.
Blood tests
Blood tests may show you are anemic. ESR & CRP are two commonly used tests to measure inflammation.
Rheumatoid factor (RF) is positive in 70-80% of RA patients. But the presence of RF can't confirm the diagnosis because some people who don't have RA also test positive for this protein. And only about half of all people with RA have a positive RF when the disease starts. Anti- CCP antibodies are more specific for RA, although not very sensitive. When used with the RF, this test’s results are very useful in confirming a RA diagnosis.
X-rays and other imaging techniques
X-rays will show any damage caused to the joints by the inflammation in rheumatoid arthritis. However X rays are entirely normal early in the disease.
Rheumatoid arthritis treatment
Although there is no cure for RA as yet, a variety of treatments is available that can slow down the disease and minimize the joint damage that it causes. Numerous studies have shown that earlier the treatment is started, the more effective it's likely to be.
Rheumatoid arthritis drugs
Many people are worried about the possible side-effects of drugs. We have to accept that all drugs have side-effects, but for most people with rheumatoid arthritis, the benefits of drug treatment far outweigh any possible side-effects. These include:
Analgesics, Non-steroidal anti-inflammatory drugs (NSAIDs) & Cortcosteroids
They are not sufficient by themselves as a treatment for rheumatoid arthritis, but they are useful for short term use to give symptomatic relief till DMARDs start working.
Disease-modifying anti-rheumatic drugs (DMARDs)
These drugs don't treat the symptoms directly and it takes longer, often weeks or months, before the benefits start to be felt. The drugs alter the way the disease progresses and slow down the damaging effects of inflammation on the joints. This group of drugs includes methotrexate, leflunomide, sulfasalazine, hydroxychloroquine & cyclosporine.
The newest DMARDs for rheumatoid arthritis are known as biological therapies, and include Infliximab, etanercept and adalimumab (anti- tumour necrosis factor (TNF agents), Anakinra (anti-interleukin-1 (IL-1), Rituximab (anti- CD 20) & many others.
What You Can Do: The Importance of Self-Care
The real key to living well with the disease is to understand the disease.
Exercise
Rest will make inflamed joints feel more comfortable, but without movement your joints will stiffen and your muscles will become weaker. You'll need to find for yourself the right balance between rest & exercise. In general it’s best to avoid exercises involving hard impacts, such as step exercises. Aquaerobics (aerobics in a swimming pool) is suitable for most people.
Diet and nutrition
There is a lot of publicity for diets that claim to cure rheumatoid arthritis. Unfortunately none do.
Complementary therapies
Many people try herbal or complementary therapies. Unfortunately, the promises made by many of these remedies aren’t always realistic.
Be careful of what you buy, as unfortunately some ‘traditional’ medications sold in this country have been found to contain large quantities of steroids and other drugs.
Supports, aids and gadgets
A huge variety of gadgets that reduce unnecessary strain on the joints, are available to help with daily tasks whether at work, around the home or in the garden.
Sleep
Tiredness (fatigue) is an important aspect of this disease, which makes it important to maintain a healthy sleep- wake cycle.
Pregnancy
Use of contraceptive pill is safe in RA and there is no reason why you should not have a baby if you have RA. Discuss your plans with your Rheumatologist well in advance as you may need to change your medications some time before you start trying for a baby.
Most mothers with rheumatoid arthritis feel better during pregnancy – though symptoms are likely to return once the baby is born.
Work and rheumatoid arthritis
With modern treatments it’s usually possible to keep on working, unless it involves a lot of manual effort. You can ask for help if your workplace needs to be adapted because of your condition. If necessary you can undergo retraining for alternative work.