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Questions & Answers About Rheumatoid Arthritis

Who Is Affected?
What Are The Causes?
What Are The Joints Affected?
How Will It Affect Me?
How It Is Diagnosed?
How Is It Different From Osteoarthrits?
Laboratory Differentiation in rheumatoid arthritis:
How Is It Treated?
What Are Different Stages of Rheumatoid Arthritis?  
Is There Any Staged Therapy In Rheumatoid Arthritis?
What Is The Suggested Treatment Protocol For RA?  
Routine Monitoring & Ongoing care
Rheumatoid arthritis (RA) is an immuno-inflammatory disease that affects joints & extra-articular tissue.

Who Is Affected?

The reported prevalence in adults varies from 0.5 to 3.8%. The sex ratio is 4:1 in favor of females. The prevalence increases with age & sex differences diminish in the older age group. The onset is most frequent during the fourth & fifth decades of life, with 80% of all patients developing the disease between the age of 35-50

What Are The Causes?

It is one of several "Autoimmune" diseases with exact etiology not known. Various factors may be involved:

Genetic (Inherited Factors): It has been found that certain genes that play a role in the immune system are associated with a tendency to develop rheumatoid arthritis.

Environmental Factors: Many scientists think that something must occur to trigger onset of disease in those people who are genetically susceptible. The triggering factor may be a virus or bacteria.

Hormonal: Deficiencies or changes in certain harmones may trigger onset of disease. Over a period of years, the consensus which has developed is that this disease is multi factorial & caused due to interaction of many factors.

What Are The Joints Affected?

Common: Hands, Wrist, Knee, ankle & Elbows

Less Common: Hip Joints

Uncommon: Cervical Spine (Neck)

How Will It Affect Me?

It generally occurs in a symmetrical pattern i.e. if one knee or hand is involved, the other one is also. In addition to joint complaints, people with disease may have fatigue, occasional fever and a general sense of not feeling well (malaise)

The severity of symptoms may vary from one person to another. Some people have periods of worsening symptoms called flares, and periods in which they feel better called remissions. Some people have self- limiting disease which goes away without causing nay noticeable damage while in others disease may progress to serious joint damage & disability.

How It Is Diagnosed?

The diagnostic tools used include medical history, physical examination, laboratory tests & x-rays

Medical History: Presence of hand involvement, early morning stiffness or soreness lasting for more than 30 minutes, relief with activity, exacerbations with periods of rest & bilaterally symmetrical involvement of joints are suggestive of rheumatoid arthritis.

Physical Examination: This includes the doctor's examination of the joints, skin, reflexes & muscle strength to assess severity of disease.

Laboratory Test: One common test done is for rheumatoid factor. Not all people with rheumatoid arthritis test positive for rheumatoid factor especially in the early stages of the disease. And some others who do test positive never develop the disease. Other common test include haemoglobin (for anaemia), a white blood cell count & ESR (to determine severity of inflammation & later response to therapy)

X-Rays: X-Rays are used to find joint destruction. Not so useful in early stages, but these are useful later to monitor the progression of the disease.

How Is It Different From Osteoarthrits?

Clinical differentiation between RA and OA: Table 

Laboratory Differentiation in rheumatoid arthritis:
Table

How Is It Treated?

Principle:

  • Control of joint inflammation

  • Arrest &/ or retard the disease process

  • Maintain joint function & prevent deformities

Goal:

  • The goal of treatment is to control inflammation sufficiently to prevent or retard joint damage with ultimate goal being to induce complete remission.

Treatment Methods:

1.      Medication

·        By simple analgesics

·        By corticosteroids

·        By disease modifying anti rheumatic drugs (DMARDs)

      2.Orthopaedic Treatment

            I.      Rest

 

           II.      Application of Splint:

a.       For relief of pain & inflammation

b.      Prevention of deformity

c.       Correction of deformity

d.      Postoperative

 

           III.  Hydrocortisone Injection: When one or two large joints are involved not responding to systemic medication, intra-articular steroid injection can give dramatic relief.

 

          IV.   Surgery: Surgical options are:

a.       Synovieoctomy(removal of synovial membrane)

b.      Corrective surgeries including soft tissue surgeries & bony surgeries for correction of deformities

c.       Joint Replacement: Which is done in advanced stages mainly for hips, knee & MCP joints.

What Are Different Stages of Rheumatoid Arthritis?

Stage 1) Potentially reversible soft tissue (synovial) involvement

Stage 2) Controllable but irreversible soft tissue destruction & early cartilage erosions, the articular contact at joint is still maintained

Stage 3) Irreversible soft tissue & bony changes with subluxation or dislocation of joint

Is There Any Staged Therapy In Rheumatoid Arthritis?

There are difficulties methods advocated for different stages of rheumatoid arthritis as follows

Table

What Is The Suggested Treatment Protocol For RA?

Treatment cycle algorithm

Routine Monitoring & Ongoing care

Regular medical care is important to monitor the course of the disease, determine its efficacy and any negative (side effects) effects of medications, and change therapies as needed. Monitoring typically include regular visits to the doctor. It may also include blood, urine & other laboratory tests & x-rays.