Wednesday, February 06, 2013

Rheumatoid Arthritis

Joints are complex moving parts of the body made up of bones and ligaments and moved by muscles. Inside the joint, the bones are lined by a smooth cartilage that allows friction free movement between the bones. The joint is covered by a capsule that has an inner lining (synovium) which secretes lubricating fluid. Arthritis means inflammation of a joint (from Greek: arthro - joint + itis - inflammation). In arthritis there is damage to cartilage. Arthritis causes the joint to become painful, swollen and stiff.  There are different types of arthritis. The commonest type is called osteoarthritis. Osteoarthritis (OA) is caused by wear and tear that occurs with age (mechanical disorder). It usually affects large weight bearing joints like the hip and knee. It is a slow process that worsens over many years and it affects the older individual. The second type of arthritis is inflammatory arthritis. In this type there is severe inflammation of the lining of the joint (synovium). There are many types of inflammatory arthritis. Rheumatoid arthritis is the most common type of inflammatory arthritis. In addition to osteoarthritis and rheumatoid arthritis, arthritis can also be caused by infection (septic arthritis) and trauma.
Rheumatoid arthritis (RA) is a type of inflammatory arthritis. It typically affects the younger individual and is more common in women. Why rheumatoid arthritis occurs, is still not clear. It is hereditary, which means that if a mother has it, her daughter is more likely to get it. It is also an auto-immune disorder. Normally the immune system of the body has mechanisms to detect foreign bodies (invading bacteria in infection) and attack them. In auto-immune disorders, these mechanisms are disturbed and the immune system starts attacking the body’s own structures (self). RA affects multiple joints. The commonest joints to be affected are the small joints of both hands and feet. In addition to the hands and feet, it can affect almost all other joints like ankle, knee, hip, wrist, elbow and shoulder. In the spine it affects the cervical spine (neck). In addition to pain, RA causes swelling of the joints and stiffness. The swelling is severe and obviously visible. The stiffness also is severe and typically occurs in the morning. It usually takes more than an hour for the stiffness to settle. RA factor is a blood test that is positive in RA. But RA is a clinical diagnosis and around 30% of RA patients will show RA factor negative. So a negative RA factor may not mean that a patient does not have RA and vice versa. RA is an aggressive disorder causing severe pain, deformity and disability. It is also a very destructive disease and disfigures the joints in a short time if untreated. Unfortunately many patients have become permanently handicapped by this disorder.
The good news is that RA can now be treated effectively. Modern medicine has made progress in the treatment of RA. There is no need for patients to suffer from this disease anymore. The usual pain killers reduce pain but are unable to control the disease and stop the destruction. Treatment of RA is with a special group of drugs called DMARD’s (Disease Modifying Anti-Rheumatoid Drugs). These drugs not only control pain but also stop the disease process. So patients have a reduction in swelling and stiffness. These medicines prevent the destruction and deformity of joints. Permanent handicap can be prevented. These are strong medicines and patients need to be monitored for side effects. In spite of this, I recommend patients to take these medications as the benefit outweighs the risk from side effects. These medications typically take 1-2 months to take effect. Also your doctor may change the combinations to find the medicines that best suit your body. Most patients tolerate these medications well for many years. We need to understand that there is no cure for RA. The disease can only be controlled like blood pressure or diabetes. So it is important for patients to continue these medications for a long period of time. Most failures in treatment are because patients stop taking the medication.
Patients who have severe pain in multiple joints accompanied my swelling and morning stiffness should visit a doctor to check if they are suffering from RA. Patients suffering from RA should take treatment with DMARD’s and continue treatment for many years if necessary. They should regularly visit their doctors to manage dosage and monitor side effects. For advanced stages of arthritis, especially of the hip and knee, joint replacement (hip replacement / knee replacement) is a boon.
To conclude, patients of RA don’t need to suffer anymore. With modern medicine, deformities and handicap can be prevented and patients can remain pain free.