Rheumatoid Arthritis : a chronic inflammatory disease characterized by the pain, swelling, and stiffness of several joints

What is Rheumatoid arthritis?

Rheumatoid arthritis (RA) is a form of chronic inflammatory arthritis that causes persistent pain, swelling, stiffness and also loss of function in your joints. It can affect any joint but is common in the wrist and fingers, however involvement of joints of spinal column except uppermost cervical joint is rare.

More women than men get rheumatoid arthritis. It often starts between ages 25 and 55 years.Rheumatoid arthritis is different from osteoarthritis (OA), the common arthritis that often comes with older age. RA is a inflammatory condition but OA is degenerative condition, most often occurring due to excessive wear and tear. RA can affect body parts besides joints, such as your eyes, mouth, heart, nerves and lungs.

 Causes of Rheumatoid arthritis-

The cause of RA is unknown. It is considered an autoimmune disease. The body’s immune system normally fights off foreign substances, like viruses, bacterias. But in an autoimmune disease, the immune system confuses healthy tissue for foreign substances and starts forming protein particles to attack the body itself. RA can occur at any age.

Women are affected more often than men.RA usually affects joints on both sides of the body equally. Wrists, fingers, knees, feet, and ankles are the most commonly affected. The course and the severity of the illness can vary considerably. Infection, genes, and hormones may trigger the onset of the disease.

 symptoms of Rheumatoid arthritis-

The disease usually begins gradually with: Fatigue Loss of appetite Morning stiffness (lasting more than 1 hour)Widespread muscle aches Weakness. Eventually, joint pain and swelling appears. When the joints are not in use for a while, especially in the morning after overnight sleep, they can become warm, more tender and stiff. When the lining of the joints called synovium becomes inflamed, it gives off more fluid and the joint becomes swollen.

Joint pain is often felt on both sides of the body, and may affect the fingers, wrists, elbows, shoulders, hips, knees, ankles, toes, and neck.Additional symptoms includes: Anaemia due to failure of the bone marrow to produce enough new red blood cells, it occurs due to persistent chronic inflammation. Eye burning, itching due to lesser secretion of tears and then called dry eyes. Due to similar reason mouth also become dry. In that case this is called Sjogren’s syndrome, and it is secondary to RA.Hand and feet deformities.

Limited range of motionLow-grade fever may be there due to inflammation.Lung nodules and inflammation of lining of the lung (pleurisy)Nodules under the skin (usually a sign of more severe disease), called Rheumatoid nodules.

Numbness or tingling due to the involvement of nerves Paleness due to less haemoglobin. Skin redness or ulcers due to inflammation of vessels carrying the blood (It will require urgent care by Rheumatologist. Swollen parotid glands, this is also feature of Sjogren’s syndrome. As per latest research, Joint destruction starts after initial 12 weeks of persistent inflammation of the joints.

Diagnosis-

Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases. There is no one blood test or physical finding to confirm the diagnosis.

During the physical exam, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength.

Blood tests-

People with rheumatoid arthritis often have an elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

Imaging tests-

Your doctor may recommend X-rays to help track the progression of rheumatoid arthritis in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease in your body.

Treatment-

There is no cure for rheumatoid arthritis. But recent discoveries indicate that remission of symptoms is more likely when treatment begins early with strong medications known as disease-modifying antirheumatic drugs (DMARDs).

Medications-

The types of medications recommends  doctor will depend on the severity of 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 ringing in your ears, stomach irritation, heart problems, and liver and kidney damage.

Steroids. Cortico steroid 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 cortico steroid 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, Rasuvo), 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), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), 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.

Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.

 

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