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Rheumatoid Arthritis

What is Rheumatoid arthritis?

Rheumatoid arthritis (RA) is a chronic autoimmune and inflammatory disease that causes pain, swelling, and stiffness in the joints. RA affects the hands and feet joints on both sides of the body, distinguishing it from other forms of arthritis. It leads to bone erosion and joint deformity. The disease may also affect many other body systems, such as skin, lungs, eyes, nerves, heart, and blood vessels.


Causes of Rheumatoid Arthritis:

In rheumatoid arthritis, the body’s natural defense system confuses healthy cells of joint lining with abnormal body cells and attacks them. It is usually the inflammation associated with RA that damages joints and other areas associated.
The exact cause of this disease is not known, although genetics appears to play a role. People with certain genes are more likely to have rheumatoid arthritis after a particular viral or bacterial infection. Other risk factors include being a woman, middle or old age, family history, smoking, and obesity.


What are the signs and symptoms of Rheumatoid Arthritis?

The immune cells attack the joint lining leading to inflammation and periods of flare or exacerbations. It is during these periods that most of the clinical signs and symptoms appear. The symptoms in RA are as follows

  • Typically young women (♀:♂— 3:1).
  • Joint Pain
  • Redness, tenderness, and swelling in joints of both sides of the body
  • Joint stiffness usually in the morning, after some activity or sitting still for sometime
  • Symmetrical polyarthritis involving the small joints of the hands and feet.
  • Loss of function, mobility, or joint deformities
  • Low-grade fever
  • Loss of appetite
  • Lack of energy
  • May present as relapsing or persistent monoarthritis.
  • Signs most common in hands, feet, knees— but remember synovial joints of the spine (and atlantoaxial joint/ ligaments) and larynx (arytenoid joints).


RA affects the smaller joints of the hand and feet first and then progresses to the hips, knees, ankles, elbows, and wrists. More than one-third of the people with RA may experience symptoms of areas other than joints. These areas can be skin, heart, lungs, eyes, kidneys, nerves, and blood vessels. RA complications include osteoporosis, infections, dry mouth and eyes, and heart or lung problems.

  • Extra- articular manifestations: vasculitis, subcutaneous nodules,
  • lymphadenopathy, peripheral neuropathy, anaemia (normochromic
  • normocytic, iron deficiency, drug- induced aplasia, haemolytic), ocular
  • involvement (e.g. scleritis), pleurisy, pericarditis, pulmonary fibrosis.



How to make a diagnosis of Rheumatoid Arthritis?

  • Rheumatoid arthritis is diagnosed based on signs and symptoms, medical history, physical examination, and diagnostic tests.
  • Physical examination includes checking warmth, redness, tenderness, swelling, movement, deformity, reflexes, and strength of joints.
  • Many tests are performed to confirm the diagnosis of rheumatoid arthritis. These tests are
  • Erythrocyte sedimentation rate or ESR tests.
  • C-reactive Qualitative protein level test.
  • Rheumatoid factor test. Performed to check for the elevated levels of proteins called rheumatoid factor.
  • Anti-cyclic citrullinated peptide test. Usually, patients with RA have this antibody in their blood.

Imaging tests like X-rays, MRI, and ultrasound are also performed to judge disease severity.


Prognosis of Rheumatoid Arthritis-

The disease has no cure, and the treatment focuses on managing the symptoms. Early diagnosis — within six months — is crucial for treatment to reduce joint damage and improve quality of life. Prognosis is much worse among patients with a positive rheumatoid factor or Anti-cyclic citrullinated peptide test. The disease is not fatal. Although, in some patients, the life expectancy may shorten by up to 10 years due to RA complications.


Treatments option for Rheumatoid Arthritis-

Fortunately, clinical studies report disease remission in patients who adhere to the treatment. Depending on disease severity, the following drugs may be recommended,

  • NSAIDs (Non-steroidal anti-inflammatory drugs) such as ibuprofen, naproxen, or aspirin are available over the counter and reduce pain and inflammation in the joints temporarily.
  • Corticosteroids like prednisone reduce joint pain and inflammation quickly and slow joint damage. Their side effects make their use very limited.
  • DMARDs (disease-modifying anti-rheumatic drugs) like methotrexate slow the progression of rheumatoid arthritis and save joints from damage. If conventional DMARDs are not effective, targeted synthetic DMARDs may be used in place.
  • Biologic DMARDs are a newer generation of disease-modifying anti-rheumatic drugs that reduce inflammation without suppressing the immune system. Biological therapies are increasingly used, e.g. anti- cytokine therapies such as tumour necrosis factor (TNF)- α blockers (etanercept, adalimumab, and infliximab), B- cell depletion (rituximab), interleukin (IL)- 6 receptor blockade (tocilizumab) and, more recently, small molecules, e.g. Janus kinase ( JAK) inhibitors.


Physical therapies for Rheumatoid Arthritis?

A therapist can teach a person exercises to keep their joints flexible. They can suggest new and effective ways of doing daily tasks that are easier on joints. They may advise the use of assistive devices such as a cane to avoid stressing the joints.


What are the surgical treatments of Rheumatoid arthritis?

If medications and therapies don’t work, surgeries may become necessary to repair damaged joints. Surgery may involve the following procedures

  • Synovectomy to remove inflamed joint lining
  • Tendon repair of loose or ruptured tendons
  • Joint fusion to stabilize or realign a joint when joint
  • Total Joint replacement as the last resort


What are interventional pain procedures in Rheumatoid arthritis?

Ultrasonography-guided intraarticular steroid injection is one of the very important treatments for Rheumatoid arthritis.