Rheumatoid arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is a condition that makes your immune system attack your own joints. It lasts for a long time and affects both sides of your body. It affects small joints of hand and foot but spares the spine or big joints. This sets it apart from other kinds of arthritis. You might feel pain and swelling in your: fingers, hands, wrists, elbow, ankle joints, feet, and toes.

When inflammation is out of control, it harms cartilage, which usually cushions your joints. This can change the shape of your joints over time. This can ultimately lead to the fusion of the joints. This is an effort of your body to protect itself from constant pain.

Why does Rheumatoid arthritis affect other parts of body apart from joints?

Some cells in our immune system (similar to our body’s defence against germs) help us for living. If they start working abnormally, they attack our own body tissues. These substances can attack our joints joints but also travel to other areas via blood. In rheumatoid arthritis can also harm other parts of our body besides our joints, such as skin, eyes, mouth mucosa, lungs, heart etc.

Who gets Rheumatoid Arthritis?

Rheumatoid arthritis is 2.5 times more common in females than males. RA often begins when people are 30 to 60 years old. But rheumatoid arthritis can affect anyone. It has different names depending on the age of the person. For people who are 16 to 40 years old, it’s young-onset rheumatoid arthritis (YORA). For people who are older than 60, it’s later-onset rheumatoid arthritis (LORA).

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis is different for everyone. Some people have joint problems that get worse slowly. Others have joint problems that get worse fast. Many people have times when they feel sick (flares) and times when they feel better (remission).

Some signs of rheumatoid arthritis are:

• Pain, swelling, stiffness and soreness in more than one joint.

• Stiffness, especially when you wake up or sit for a long time.

• Pain and stiffness in the same joints on both sides of your body.

• Feeling very tired.

• Feeling weak.

• Having a fever or febrile feeling.

What is the cause of rheumatoid arthritis?

Rheumatoid arthritis has no known cause. Scientists believe it’s the result of a mix of genes, hormones, and some factors in the environment.

Your immune system usually keeps your body healthy. But with rheumatoid arthritis, something makes your immune system turn on your joints. A germ, smoking or pressure in your life may set it off.

What are the risk factors for developing rheumatoid arthritis (RA)?

Risk factors for developing rheumatoid arthritis may include:

• Positive Family history

• gender: Women are three times more likely to develop rheumatoid arthritis.

• Smoking: Smoking increases a person’s risk of rheumatoid arthritis. It also makes the disease worse.

• Obesity: Chances of developing RA are higher in an obese patient.

How to make a diagnosis of rheumatoid arthritis?

There are some diagnostic criteria to level the joint pain as rheumatoid arthritis. Some people with RA don’t meet all the criteria, but still they are put under treatment as early RA. The diagnostic criteria for rheumatoid arthritis are:

• Swollen and painful arthritis in two or more big joints (shoulders, elbows, hips, knees, and ankles).

• Swollen and painful arthritis in smaller joints.

• Positive blood tests for rheumatoid factor (RF) or CCP antibodies.

• High levels of CRP or a high ESR in blood test.

• Symptoms have been going on for more than six weeks.

Management and Treatment

What is the goal of Rheumatoid arthritis treatment?

The main immediate aim of treating rheumatoid arthritis is to ease the pain and swelling in your joints. This should help keep or make your joints work better. Managing joint swelling lowers your pain and makes your life better.

The long-term aim of treatment is to prevent or halt joint harm.

How is treatment of rheumatoid arthritis done?

Joint damage generally occurs within the first two years of diagnosis, so it’s important to start early and aggressive treatment. Treating rheumatoid arthritis in this “window of opportunity” can help prevent long-term consequences.

Treatments for rheumatoid arthritis include lifestyle changes, therapies, medicine. Treating physician considers your age, health, medical history and how bad your symptoms are when deciding on a treatment.

Medicines for treating Rheumatoid Arthritis

There are multiple options. They are 1. Non-steroidal anti-inflammatory drugs (NSAIDs) 2. Corticosteroids 3. Disease-modifying antirheumatic drugs (DMARDs) (Example: Methotrexate, Hydroxychloroquine, Sulfasalazine, Leflunomide) 4. Janus kinase (JAK) inhibitors (Tofacitinib, Baracitinib) 5. Biologics (Etanercept, Infliximab, Adalimumab, Anakinra, Abatacept, Rituximab, Certolizumab, Golimumab, Tocilizumab).

Biologics usually act fast — in two to six weeks. They may be prescribed alone or with a DMARD like methotrexate.

You can always contact Dr Chinmoy Roy at Rajarhat pain clinic at Newtown, Kolkata for best treatment of Rheumatoid arthritis.