RHEUMATOID ARTHRITIS (RA)
It is a chronic inflammatory condition affecting mainly the joints (both small & large). It also damages wide variety of body systems including skin, eyes, lung, heart and blood vessels.
It is one of the most common autoimmune disease, which occur when immune system mistakenly attacks our own body’s tissue.
RA most commonly begins between the ages of 30 and 50, though it can start at any age. Female are more affected than male.
Multiple joint pain, migratory type, mostly bilateral, associated with morning stiffness >30 min. Pain is more in the morning and decreases with activity. Initially small joints of hands are affected followed by large joints. On examination: presence of tender, warm and swollen joints with reduced mobility.
Others constitutional symptoms like fatigue, malaise and low fever may be seen.
RA is an autoimmune disease. Our immune system normally attacks the foreign cells like bacteria and viruses, but in autoimmune disease our immune system mistakenly attacks our own body cell creating inflammation causing pain and swelling. If the inflammation is chronic then it will damages the joints. RA also runs in families.
Diagnosis is based on clinical history, blood test and x-ray to see whether it’s early or chronic.
Blood test includes: inflammatory marker (CRP, ESR), Rheumatoid factor (positive in 80%), Anti-CCP antibodies which signifies high specificity and high sensitivity and also predicts the prognosis of joint destruction. ANA(antinuclear antibodies) test is also done to rule out if any internal organ is affected.
Main aim of treatment is to decrease pain and swelling and improve the functional status of patients. Treatment constitutes NSAIDs or Steroids and DMARDs (methotrexate, hydroxychloroquine, sulfasalazine and leflunomide). Azathioprine is also used in selected cases. For more serious cases, not responding to initial therapy, biologics is the only option (rituximab, adalimumab).
Patients are advised to come for regular follow up to monitor the disease as sometimes it may flare or go in remission, as well as look for side effects of drugs which can be prevented.
Patients with RA can lead a normal and active life if diagnosed early with early start of treatment. They are encouraged to do low impact aerobic exercise such as jogging, walking to increase the muscle strength and stretching exercise to keep the joint flexible. They should consult with physiotherapist to find out their suitable exercises.
Exposure to cold and smoking aggravates the disease so patients are advised to avoid it.