Understanding Rheumatoid Arthritis

Arthritis is a condition which is characterized by inflammation of the joints. Rheumatoid arthritis is one among the several types of arthritis. Approximately 1 in 100 people are diagnosed with rheumatoid arthritis at some point in their life. It commonly affects females in the fourth or fifth decade of their life.

There seems to be several misconceptions regarding the diagnosis and treatment of rheumatoid arthritis. Below are some of the common questions that patients ask in a busy rheumatology clinic.

What causes rheumatoid arthritis?
Rheumatoid arthritis is thought to be an autoimmune disorder in which the immune system of the body is attacking its own tissues resulting in joint inflammation. It is not entirely clear as to why the immune system behaves in such an erratic manner.

What are the symptoms of rheumatoid arthritis?
Commonly patients have joint pain and stiffness. Stiffness is most marked in the early morning hours affecting one’s ability to do daily routine activities. Swelling of the joints is another important symptom of rheumatoid arthritis which differentiates it from other causes of joint pain.

Which joints are affected by rheumatoid arthritis?
It commonly affects the small joints of the fingers, wrist, feet and ankle. However practically any joint in the body can be affected by rheumatoid arthritis. It usually affects the joints in a symmetrical fashion, for example if the right wrist joint is affected, then the same joint is affected on the left side also.

How is Rheumatoid arthritis diagnosed?
No single test gives an accurate diagnosis. Doctors reach a diagnosis based on the symptoms, physical examination and few investigations which include blood tests and X-ray’s.

My Rheumatoid factor is positive. Does it mean I have Rheumatoid arthritis?
Rheumatoid factor is a protein in the blood which is seen in about 2 out of 3 people with rheumatoid arthritis. However, it can also be positive in about 5-10% of healthy individuals. Rheumatoid factor can also be positive in other disease conditions which cause joint pain. So, a mere positivity of rheumatoid factor doesn’t mean that one has rheumatoid arthritis.

Does rheumatoid arthritis cause any symptoms except joint pain?
Rheumatoid arthritis should not be viewed as a disease that affects purely the joints. It can involve various internal organs including the eyes, lungs, heart and the kidneys. A rare patient with rheumatoid arthritis can also have inflammation in the blood vessels called vasculitis, which if not treated promptly can even be fatal.

Is there a cure?
There is no cure for rheumatoid arthritis yet. However, modern treatment can control the symptoms and help the patient in leading a normal life. But it is important to start treatment at the earliest to reduce joint damage.

What is the treatment for rheumatoid arthritis?
A century back doctors could offer very little in terms of treatment options. But today there are medications called disease-modifying antirheumatic drugs (DMARDs). These drugs not only reduce the symptoms but modifies the disease process in such a way that the joint damage is prevented. They act by reducing the harmful chemicals which contribute to joint inflammation. Good news to the common man is that these medications are cheap and go light on the monthly budget.

Are there any side effects for these DMARDs medications?
No medication is absolutely safe. This rule applies to DMARDs also. What is important to remember is that they are many times safer that the painkiller medications that patients commonly use. While on DMARDs some blood tests have to be done periodically and regular follow up with your doctor is a must.

Are there any new treatment options available?
The most recently added drugs to the armamentarium of treatment are called Biologics. They are primarily used in patients who do not have a good control of arthritis in spite of using DMARDs. These Biologics are to be given as injections and are relatively expensive.

Rheumatoid arthritis was once a nightmare for both the patient and the treating doctor, not anymore. One can confidently say that we have come a long way in diagnosing and treating rheumatoid arthritis. The road ahead looks much brighter with growing awareness among patients and newer treatment options.

Dr. M. Bhuvanesh MD, DM
Consultant Rheumatologist
KIMSHEALTH
Thiriuvananthapuram
Mail: drbhuvanesh.m@kimsglobal.com