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Rheumatoid arthritis is an inflammatory disorder primarily affecting the joints but can also other body parts/systems such as the skin, eyes, lungs, heart and blood vessels.

Rheumatoid Arthritis is an autoimmune condition.
Autoimmune condition means when the body’s defense system (immune), designed to protect the body, undergoes some changes, and starts attacking the body’s tissues.

The prevalence of Rheumatoid arthritis in India is 0.34% which is considered to be high.

What are the symptoms of Rheumatoid Arthritis?

These are:

  • Tender, warm, swollen joints.
  • Joint stiffness usually worse in mornings and after certain periods of inactivity
  • Fatigue,

Other symptoms may be –

  • Fever
  • Loss of appetite

Early RA affects the smaller joints first, like the hands and toes of the feet.

Progression of disease may result in symptoms seen in the wrists, knees, ankles, elbows, hips, and shoulders. A huge number of people (About 40%), experience signs and symptoms not restricted to the joints and include the skin, eyes, lungs, heart, kidneys, salivary glands, etc.

Rheumatoid arthritis Flare-ups:

The signs and symptoms in RA may vary in severity and may also come and go. Sometimes these also include periods of increased disease activity – RA flares, as opposed to periods when the swelling and pain fade or disappear. Joints in RA may deform and shift over a period.

What are the causes and risk factors of Rheumatoid Arthritis?

Rheumatoid Arthritis occurs because of the immune system attacking their body. The exact cause of this is unknown but a genetic component may be present.

The following risk factors may increase chances of getting RA:

  • Sex: Women are more likely than men to develop RA.
  • In case a family member has the disease (family history).
  • Cigarette smoking increases the risk of developing rheumatoid arthritis and also the severity of disease.
  • Overweight people

How is Rheumatoid Arthritis diagnosed?

The doctor checks for any tenderness, swelling or warmth around affected bone. The doctor also checks for the location and symmetry of painful joints, especially the hand joints.

Rheumatoid Arthritis is difficult to diagnose since early signs and symptoms are similar to other disease.

  • Blood tests: Doctor usually checks for ESR (elevated erythrocyte sedimentation rate) or C-RP levels (C-reactive protein) since elevated levels of those indicate presence of inflammatory condition.
    • Other tests are rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies
  • Imaging tests:
    • X-rays – to keep track of RA progression
    • Magnetic resonance imaging (MRI): To assess disease severity using radio waves and a strong magnetic field.
    • Ultrasound

What are the treatment options for Rheumatoid Arthritis?

Treatments include medications, exercise, and, in some cases, surgery to correct joint damage. Rest is also suggested in case of flare-ups.

Medications focus on –

  • easing joint pain, swelling, and inflammation.
  • preventing disease
  • slowing down the disease.

The doctor will prescribe medications called disease-modifying antirheumatic drugs (DMARDs) which work by interfering with or suppressing the immune system’s attack on the joints. Consult the doctor for understanding the course of action of these drugs.

Although there isn’t a cure of RA, early, aggressive treatment may prevent disability and increase chances of remission.

Surgery

Certain surgeries may be suggested:

  • Surgery to remove the inflamed lining of the joint (Synovectomy)
  • Tendon repair
  • Surgically fusing joint to stabilize or realign a joint and for pain relief in absence of joint replacement as an option.
  • Total joint replacement

References

  1. Malaviya AN, Kapoor SK, Singh RR, Kumar A, Pande I. Prevalence of rheumatoid arthritis in the adult Indian population. Rheumatol Int. 1993;13(4):131-4
  2. Rheumatoid arthritis. WebMD. March 2024. https://www.webmd.com/rheumatoid-arthritis/default.htm
  3. Rheumatoid arthritis. Mayo Clinic. March 2024. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

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