RHEUMATOID ARTHRITIS

What is rheumatoid arthritis?
Rheumatoid arthritis is a chronic autoimmune disease, which occurs when the immune system attacks the synovium, the lining of the membranes that surround the joints. When the synovium becomes inflamed, it thickens and produces an excess amount of joint fluid. This leads to symptoms of pain, swelling and prolonged early morning stiffness in the joints. If left untreated, the inflammation can cause damage to the bone and cartilage within the joint. In addition, without effective treatment, the tendons that hold the joints together can weaken, causing the joints to lose their shape. A number of other body systems, like the skin, eyes, heart, and blood vessels, can also be affected by rheumatoid arthritis, but this is rare with modern-day treatment regimes.

In many cases, the condition begins in small joints, such as those in the fingers and toes. As it progresses, symptoms may spread to other areas of the body, such as the wrists, knees, ankles, hips, shoulder, and elbows. Symptoms generally occur on both sides of the body.

Rheumatoid Arthritis is more common in women than in men. It is not always inherited from generation to generation as the genetic patterns are very variable.

What are the symptoms?
Some common symptoms of rheumatoid arthritis include joint pain, swelling, and stiffness. Patients may experience fatigue, fever, and unexplained weight loss. In some cases, the condition can also cause loss of function in certain areas of the body. Symptoms may come and go, increasing during periods called flares, and disappearing during periods of remission.

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How is it diagnosed?
A full history and examination will be done by your doctor.

Thereafter, blood tests for antibodies (rheumatoid factor and anti-CCP antibody), inflammation levels and other necessary tests will be done.

Blood tests for rheumatoid arthritis may be negative in up to 20% of patients who are still diagnosed with rheumatoid arthritis.

X rays and even ultrasound or MRI of affected joints may be necessary to diagnose this type of arthritis.

It is very important to differentiate rheumatoid arthritis from other types of arthritis.

How can it be treated?
While there is no cure for rheumatoid arthritis, early, effective treatment can return joints to normal and prevent long term damage. The mainstay of modern therapy is disease-modifying anti-rheumatic drugs (DMARDs) that effectively control disease within the joints and hence prevent long-term damage and disability. The most commonly used DMARDs used include Methotrexate, Salazopyrine, Chloroquine and Leflunomide.

Early intervention with disease-modifying drugs has been shown to significantly control disease activity more effectively than delaying treatment even for a short period of time, preventing consequences of long-term inflammation such as loss of function. Whilst is may be tempting for patients to try and postpone commencing disease modifying therapy, early adequate treatment provides a better long term quality of life.

Very often, corticosteroids are used in the beginning to control inflammation quickly while the DMARDs start to work. Anti-inflammatory drugs to ease pain and reduce inflammation may be prescribed.

Biologic therapies are very effective targeted immune therapies that target the root cause of the inflammatory process. They are mostly administered by self- injection subcutaneously or in hospital via an infusion.

Biologics are paid by most medical aids but usually on the higher plans. The clinical trial side of our practice offers biologic therapies on clinical trials.

Your doctor may also recommend low-impact exercises, which can be useful in improving range of motion and general joint mobility. In some cases, devices like braces may be used to hold your joints in a resting position in order to reduce inflammation.

An anti-inflammatory diet rich in omega-3 fatty acids and low in processed carbohydrates and saturated fats, may also be recommended to help manage inflammation.

The prognosis for adequately treated rheumatoid arthritis has significantly improved over the last few years due to more aggressive disease control and the introduction of biologic therapies. This affords patients the ability to continue with a good quality of life despite the diagnosis.

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