Rheumatoid Arthritis Treatment in Delhi, India

Rheumatoid arthritis (RA) is an autoimmune condition that involves the immune system attacking the joints and causing inflammation in the lining (the synovium) of the joints.

Associated Anatomy of Rheumatoid Arthritis

Joints on both sides of the body; can involve any of them:

• Hands
• Knees
• Wrists
• Fingers
• Ankles
• Feet
• Toes

Eventually, RA may affect other parts of the body, such as the eyes, heart, lungs, skin, and blood vessels.

Alternative Names of Rheumatoid Arthritis

Rheumatoid arthritis is known as RA or referred to as rheumatism.

Types of Rheumatoid Arthritis

Some additional types of RA include:

• Seropositive RA: When blood tests are positive for RF or rheumatoid factor, suggesting immune reaction to the tissues.
• Seronegative RA: If blood tests are negative for antibodies or RF you are seronegative, and need further examination to rule out RA.
• Juvenile RA: Type affecting children under 16 years of age.

Rheumatoid Arthritis Causes

The exact causes of RA have yet to be known. Researchers believe that a combination of genetic, hormonal, or environmental factors seems to trigger the immune system to attack the joints. As per some experts, viruses or bacteria modulate our immune system, making it attack our joints. Some others point out habits like smoking.

Rheumatoid Arthritis Symptoms

Some common symptoms that may be observed in RA include:

• Pain and swelling in joints
• Redness on joints
• Joints feel warm to touch
• Bumps or nodules under the skin (rheumatoid nodules)
• Stiffness, particularly in the mornings or after sitting for a long time.
• Fatigue and weakness
• Fever

Stages of Rheumatoid Arthritis

There are four stages of Rheumatoid arthritis:

• Stage 1: Early RA is characterized by some inflammation in the tissue around the joint(s), with some pain and stiffness. However, there are no evident changes in the bones on the X-ray.
• Stage 2: The inflammation starts to damage the cartilage in the joints, resulting in a decreased range of motion.
• Stage 3: Severe inflammation that damages the bones. It is likely to have more pain, stiffness, and further decreased range of motion and some physical changes.
• Stage 4: Although inflammation may not be evident, the joints keep deteriorating in this stage. You may experience severe pain, swelling, stiffness, and loss of mobility.

Rheumatoid Arthritis Diagnosis

The differential diagnosis of RA comprises:

• Fibromyalgia
• Lyme Disease
• Psoriatic Arthritis
• Myelodysplastic Syndrome (MDS)
• Osteoarthritis
• Reactive arthritis
• Paraneoplastic Syndromes
• Relapsing Polychondritis
• Polymyalgia Rheumatica
• Sarcoidosis
• Systemic Lupus Erythematosus (SLE)
• Sjogren Syndrome

Typical Tests for Diagnosing RA

There is no certain test to diagnose RA. It includes a combination of things like:

• Check up for location and symmetry of painful joints, specifically the hand joints, and the presence of nodules under the skin.
• Blood tests: To assess the number of red blood cells (usually low in RA), C-reactive protein (CRP) levels, Cyclic citrulline antibody test (anti-CCP), and Erythrocyte sedimentation rate (ESR).
• Rheumatoid factor (RF): Positive in 80% of people
• Antinuclear antibody test (ANA): This test detects the presence of autoimmune disease.
• X-ray
• Ultrasounds
• MRI scans

Rheumatoid Arthritis Treatment

Treatment options for Rheumatoid Arthritis comprise:

• Anti-inflammatory drugs like ibuprofen, aspirin, or naproxen
• Topical pain relievers
• Corticosteroids
• Pain relievers like acetaminophen (Tylenol)
• Some medications like disease-modifying antirheumatic drugs (DMARDs)
• Biologic response modifiers for severe cases of RA, where other medications don't help
• Adequate rest and exercise for joints.
• Surgery, if RA is very severe
• Lifestyle changes, occupational therapy
• Nutritious diet

Risk Factors of Rheumatoid Arthritis

RA is most likely to happen:

• If a person has a family history.
• Women are more likely to develop RA than men.
• Middle-aged are more likely to get RA.
• Smoking increases the risk of getting RA and can aggravate the condition.
• Obesity

Possible Complications of Rheumatoid Arthritis

RA may lead to several complications by affecting other organs and tissues like:

• Eyes: Dryness, pain, inflammation, and unclear vision
• Mouth: Dryness, infection, and gum inflammation.
• Skin: Rheumatoid nodules or lumps under the skin covering bony areas.
• Lungs: Inflammation and scarring may cause shortness of breath and lung disease.
• Blood vessels: Inflammation causing damage to the nerves, skin, and other organs.
• Blood: Reduced RBC count causing anemia
• Heart: Inflammation can affect the heart muscle and the associated areas.
• Painful joints: Reduced mobility of joints causes weight gain, making you likely to develop high cholesterol, diabetes, heart disease, and high blood pressure.

Rheumatoid Arthritis Prevention

Although it is difficult to prevent RA altogether, certain lifestyle changes can delay its onset and minimize its impact on the quality of life. Some preventive measures are:

• Quitting smoking
• Limiting alcohol intake
• Minimizing bone loss by ensuring a nutritious diet rich in calcium and vitamin D.
• Taking supplements for bone health if required.
• Improving oral health
• Maintaining healthy weight
• Staying active
• Taking early action if RA symptoms are observed.

Epidemiology of Rheumatoid Arthritis

• More than 0.5 to 1% of adults (5 to 50 adults in 1 lakh people) are affected by RA every year.
• RA is 2.5 to 3 times more common in females than males; however, men show more severe symptoms than women.
• This condition primarily affects the middle-aged population, between 30 to 60 years of age.
• Some cases of RA are noted after people turn 60, known as later-onset rheumatoid arthritis (LORA).
• Although less common, even children or young adults (between 16 and 40 years) are likely to get this condition, which is called young-onset rheumatoid arthritis (YORA).
• RA is relatively rare in under-aged men.

Expected Prognosis of Rheumatoid Arthritis

Many effective medications and treatment approaches help reduce your pain and inflammation and slow down the progress of the disease. Early diagnosis and aggressive treatment play a vital role in the prognosis of RA.

Pathophysiology of Rheumatoid Arthritis

RA is a chronic inflammatory condition in which specific cells of the immune system mistakenly target the healthy body tissues, especially the cartilages, which act as a shock absorber in the joints. Unlike wear and tear damage of arthritis, RA affects the joints and tissues that line them (called synovium), causing severe inflammation, pain, and swelling in the joints eventually causing bone erosion and joint deformity.

Natural Progression of Rheumatoid Arthritis

The damage to cartilage resulting from uncontrolled inflammation in RA can cause a formation of a cushy layer of tissues to cover the end of the bones, resulting in deformation of the joints (misshapenness). It causes chronic or long-lasting pain and may further lead to a lack of balance (unsteadiness). Eventually, the bone erodes and can lead to fusion of the joint (an effort taken by the body to prevent constant irritation).

Inflammation associated with RA can affect other body parts like skin, eyes, lungs, heart, and mouth, causing physical disability.

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