Rheumatoid arthritis

Symptoms of Rheumatoid Arthritis

 

Symptoms of rheumatoid arthritis tend to fluctuate. There are times when the symptoms are severe, known as ‘flares’. The symptoms might go into ‘remission’ when they become mild. 

Signs and symptoms include:

1. Fatigue: Fatigue or the feeling of tiredness and exhaustion is the first sign of RA which affects a person’s everyday routine and productivity.

2. Fever: Fatigue is followed by a rise in temperature which further leads to a feeling of sickness and exhaustion.

3. Loss of weight: Occurrence of fever and fatigue results in the loss of appetite and this can lead to weight loss and weakness. 

4. Pain and stiffness: Pain and stiffness are first felt in the smaller joints like joints of the fingers or the toes. The intensity of these symptoms increases over time. The pain often lasts for several days and is followed by a gradual stiffness in the body. This stiffness intensifies after periods of inactivity for eg.after getting up from sleep in the morning.

5. Swelling: Swollen hands and feet are the most common signs of rheumatoid arthritis. The inflammation in the joints causes the lining of the joints to thicken, leading to excess production of fluids in the joints. This excess fluid production puts pressure on the area surrounding the joints, leading to irritation of the nerve endings and pain and swelling of the joints. 

Causes Of Rheumatoid Arthritis

 

The immune system safeguards the body from infections and diseases by producing antibodies. However, sometimes antibodies tend to attack the thin layer that covers the joints. This thin layer becomes inflamed and affects the surrounding bones, cartilage, tendons, and ligaments, resulting in rheumatoid arthritis.

Genes play a role in causing rheumatoid arthritis. They make us vulnerable to infections caused by certain viruses and bacteria. This sometimes triggers the development of autoimmune diseases like rheumatoid arthritis. 

Risk Factors For Rheumatoid Arthritis

The exact cause of rheumatoid arthritis is yet unknown; however, the researchers have pointed out a few factors that could increase its risk:

1. Genetic factors: Genes play an important role in the development of autoimmune diseases, like rheumatoid arthritis. Therefore, if a close family member has this disease,  then an individual has an increased risk of developing it.

2. Age: Although rheumatoid arthritis can develop at any age, it has an increased chance of developing during middle age. Its onset is mostly noticed among senior citizens or those in their 60s.

3. Sex: Women are more prone to developing RA than men because the hormonal changes during prenancy and menopause might increase one’s susceptibility to this disease.

4. Obesity/Excessive weight: Obese individuals are at a higher risk of developing rheumatoid arthritis. The excess fat tissue releases cytokines (proteins that cause inflammation) into the body. This aggravates the pain and increases the progression of the disease.

5. High birth weight: Research has shown that high birth weight (>4 kg) is associated with an increased risk of RA.

6. Smoking: It is the most substantial known environmental risk factor for RA. The risk of RA increases with the amount and duration of cigarette use.

7. Diet: Many dietary factors, such as red meat intake and vitamin D deficiency, have been found to increase the risk of RA. Excessive coffee consumption and salt intake can also be a risk factor for ACPA-positive RA (the most aggressive form of RA with a worse prognosis). 

8. Infections: Microbes, like Mycoplasma, Enteric bacteria, and Epstein-Barr virus, are the commonly implicated infective agents that cause infections and predispose to RA. In India, an epidemic of chikungunya virus infection also contributed to the increase in the prevalence of RA in the susceptible population.

9. Periodontitis: It is a chronic inflammatory disease of the gums in which gums pull away from the teeth and form pockets that become infected. Various studies have shown that the occurrence and severity of periodontitis were found to be higher in people suffering from RA, suggesting a positive correlation between these two chronic inflammatory diseases.

Diagnosis Of Rheumatoid Arthritis 

 

The signs and symptoms of rheumatoid arthritis are very similar to some other joint disorders, which make the diagnosis of this disease difficult in the early stages. But, if you experience any of the symptoms, consult a doctor at the earliest. It is essential to get a check-up done within six months of noticing the symptoms. This helps in slowing down the damage to the joints and in better management of the disease. 

The doctor will conduct a physical examination during which they will check the joints for redness, swelling, and warmth. They may also check the muscle strength and reflexes. 

There are specific blood tests and imaging tests/X-rays that help in the diagnosis of RA. The doctor will prescribe the tests depending upon the symptoms and the results of the physical examination. 

1. Blood tests

• Rheumatoid factor (RF): The rheumatoid factor is an autoantibody that attacks joints in people with rheumatoid arthritis. This rheumatoid factor (RF) test measures the level of RF in the blood.
• C-reactive protein (CRP): This test checks for any kind of inflammation throughout the body. It helps detect rheumatoid arthritis and psoriatic arthritis. 
• Antinuclear antibody: This test helps in identifying abnormal antibodies for detecting rheumatoid arthritis. 
• Erythrocyte sedimentation rate (ESR): This test helps determine how fast the red blood cells cling together and settle at the bottom of a test tube. It helps indicate any inflammation in the body. 
• Anti cyclic citrullinated peptide (Anti-CCP): This test helps to detect autoantibodies (associated with joint damage) which are usually present in most patients with rheumatoid arthritis.
• Human leukocyte antigen tissue typing (HLA): This test helps detect the presence of specific genetic markers that indicate the possibility of developing rheumatoid arthritis.

2. Imaging techniques:

Apart from blood tests, scanning of joints is also conducted to detect rheumatoid arthritis. These scans detect the inflammation of the joints and the damage caused due to this inflammation. They also help in identifying the type of arthritis and how much the disease has progressed. 

• X-rays: They help to detect any damage to the joints or bones due to rheumatoid arthritis. 
• MRI: An MRI of the joints and the musculoskeletal system can help get a clear picture of the extent of inflammation and damage to the joints.

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Prevention Of Rheumatoid Arthritis

Various genetic and environmental factors are responsible for rheumatoid arthritis. While the genetic factors can’t be changed, modifications in one’s lifestyle and incorporation of healthy habits will go a long way in reducing the risk and the damaging side effects of this disease. 

Here are a few ways to stay safe and to prevent the worsening of this condition:

1. Quit smoking: Smoking increases the risk of developing rheumatoid arthritis in people who are genetically prone to developing this condition as this activity triggers a faulty immune system functioning. It causes the symptoms to advance at a faster pace. 

Quitting smoking is one of the best ways to prevent damage to your overall health. If you cannot quit smoking by yourself, you could use the help of family or friends to hold you accountable for quitting the habit. 

Here are some practical tips that can help quit smoking! 
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2. Lose weight: People with excess weight experience faster disease progression, pain, and disability. Obesity also increases the susceptibility to other diseases in people with rheumatoid arthritis. 

Low-intensity exercises (thirty minutes of physical activity), such as walking, swimming, and yoga, help reduce weight,pressure on the joints, and the chance of developing joint diseases. These activities also increase energy levels and improve flexibility, making one leaner and fitter and healthy in body and mind. 

Finding it challenging to lose weight? Here are some weight loss tips that can work for you!
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3. Change the diet: Changing the diet also goes a long way in preventing a disease or reducing the chances of damage to the body.

Foods  to consume: Foods rich in antioxidants help fight free radicals that damage the body. Increase the consumption of fiber and vitamin-rich foods and foods that help fight inflammation, like:

• Fruits
• Green vegetables
• Nuts and seeds
• Whole grains
• Low-fat dairy
• Lean proteins
• Small amounts of saturated fats
• Foods rich in omega-3 fatty acids 
• Spices, such as turmeric, are known to fight inflammation. Include them in the recipes to reap their benefits. 

Foods to avoid

• Red meat and protein 
• Caffeine 
• Sweetened beverages 
• Excessive salt 
• Processed, packaged, and junk food 

4. Vitamins and supplements: Supplements containing Vitamin D, Vitamin C, and antioxidants have been shown to reduce the risk for RA.

5. Dental health: There is a potential link between gum infections, like periodontitis, and RA. Getting regular checkups from the dentist, maintaining good oral hygiene, and not neglecting bleeding gums can help prevent the progression of minor gum diseases into periodontitis.

6. Seek timely help: If any signs or symptoms of rheumatoid arthritis, such as pain, tenderness, or swelling in the small joints of your hands and feet, are noticeable, then consult a doctor immediately. Seeking timely help will prevent damage to the joints and help in better management of the condition. A rheumatologist can guide towards the proper treatment and prescribe tests and scans to study the progress of the disease.

Specialist To Visit 

Early detection of rheumatoid arthritis helps in getting better treatment and in preventing damage to the joints. Specialists who will make the perfect diagnosis and prescribe the right treatment are:

• Rheumatologist

• General physician

• Orthopaedist

• Orthopedic surgeon

A rheumatologist specializes in arthritis, hence, is the ideal doctor to consult.

If not a rheumatologist, one may also consult a general physician who has treated patients with rheumatoid arthritis and who can also work closely with a rheumatologist. It is essential to consult a rheumatologist periodically as they will prescribe blood tests,joint scans, MRIs, or X-rays to inspect the joints and a suitable treatment based on the study.

If the symptoms intensify, consultation from an orthopedist or an orthopedic surgeon can also be considered. Orthopedic surgeons specialize in joint replacement surgery. So, if the damage to the joints is severe and is hampering your daily life, they will recommend surgery, or any other treatment, as per requirement. 

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Treatment Of Rheumatoid Arthritis

Rheumatoid arthritis has no cure. However, an early diagnosis can help in selecting a treatment to keep the symptoms under control. Some medications, such as disease-modifying antirheumatic drugs (DMARDs), work in slowing down the progression of the disease and saving the joints from damage.

There are three methods of treating rheumatoid arthritis related pain and symptoms:

A. Medications

These are given depending upon the intensity of the symptoms and the progression of the disease. 

1. NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for reducing pain and inflammation. NSAIDs, like ibuprofen, are available as an over the counter drug, but for stronger NSAIDs, a doctor’s prescription is needed. 

2. DMARDs: Disease-modifying antirheumatic drugs (DMARDs) slow down the progression of this disease. This action helps save the joints and tissues from damage and disability.

• Methotrexate: It is an immunosuppressant. It slows the activity of the body’s immune system and reduces pain, swelling, and stiffness.
• Leflunomide: It blocks the chemical messengers that cause inflammation and swelling. 
• Hydroxychloroquine: It eases the progression of the disease and reduces pain, swelling, and redness. 
• Sulfasalazine: It suppresses the overactivity of the immune system and blocks the chemical messengers that cause inflammation. 

3. Steroids: Corticosteroids reduce inflammation and damage to the joints and provide relief from pain. These drugs have specific side effects, such as weight gain, diabetes, and thinning of the bones. Therefore, they are prescribed for a short duration and the dose is decreased gradually. Prednisone is one such corticosteroid that is prescribed to patients with rheumatoid arthritis.

4. Biological DMRADs: These are some of the latest DMARDs that are prescribed for swelling and redness. These are also known as biologic response modifiers. They block the chemical messengers that cause inflammation and give relief from swelling and redness. This category includes drugs like:

• Rituximab: This drug works by targeting the unwanted activity of immune cells (B cells) in rheumatoid arthritis.
• Abatacept: It blocks the action of certain chemical messengers that are responsible for inflammation, swelling, and redness associated with certain joint diseases.
• Tocilizumab: This is an anti interleukin-6 (IL-6) medication. IL-6 plays a key role in driving the inflammation that is responsible for joint destruction in rheumatoid arthritis.
• Anakinra: Interleukin-1(IL-1) is another important chemical messenger responsible for the development of RA. This drug works by blocking interleukin-1.

5. Anti-TNF drugs: Tumor necrosis factor (TNF) is a cytokine involved in systemic inflammation which plays a major role in the pathogenesis of RA. Some anti-TNF drugs which can be used in this condition are: 

• Infliximab
• Etanercept
• Adalimumab

6. Targeted synthetic DMARDs: If the conventional DMARDs and the biological agents do not work, then targeted synthetic DMARDs are prescribed. Take these as per the doctor’s prescription to notice their effect. Doctors can also advise regular blood tests to monitor the liver, kidneys, and blood count. Examples of these drugs include:

• Bariticinib
• Tofacitinib
• Upacitinib

B. Therapy

Physical or occupational therapy helps improve flexibility and eases joint pain. A therapist may teach ways to simplify tasks and to reduce mental and physical strain and stress. They may also guide in selecting gadgets that don’t strain the painful joints.

C. Surgery

It is advised when medications and therapy fail to slow the damage. It improves the functioning of joints and restores one’s ability to lead a productive life. A rheumatologist will advise some of the following procedures:

• • Tendon repair: This consists of repairing the tendons around the joints.

  • Synovectomy: It’s a surgery to remove the inflamed lining of the joints.

  • Joint fusion (arthrodesis): Fusing of two or more bones in a joint to get relief from pain.

  • Total joint replacement surgery: It consists of removing the damaged parts of the joint and replacing them with a metallic or plastic prosthesis.

Home-care For Rheumatoid Arthritis

Although painkillers help ease the pain and the inflammation, there is no cure for this condition. Therefore, making lifestyle changes, dietary changes, and managing stress are crucial in reducing the discomfort and slowing down the progress of the disease. 

Here are a few changes that will provide relief and help live a comfortable life:

1. Home remedies

Rheumatoid arthritis (RA) involves inflammation; therefore, adding anti-inflammatory herbs and spices will have health benefits. However, these should be taken after consulting a healthcare provider. These herbs include:

• Turmeric (haldi): This golden spice has anti-inflammatory properties and analgesic (pain relieving) effects. 
• Ginger (adrak): It has anti-inflammatory properties and may improve RA symptoms by affecting the expression of certain genes.
• Green tea: It is rich in antioxidants. It can help reduce inflammation and can protect joints.op
• Cinnamon (chakla): This ancient spice is filled with antioxidants that can prove beneficial for tender and swollen joints.
• Garlic (lehsun): This spice can liven up any meal and has anti-inflammatory properties that reduce cytokines (known to cause inflammation) and relieve pain due to RA.
• Black Pepper (kalimirch):  This simple and household spice has antioxidant, antimicrobial, anti-inflammatory, and gastro-protective effects. 
• Willow bark: This spice has significant anti-inflammatory properties and reduces various markers of inflammation.
• Indian frankincense: It is derived from the bark of the Boswellia tree, which has strong anti-inflammatory as well as analgesic properties.
• Ashwagandha: It is also called Indian ginseng and is known to ease pain and joint swelling in people with rheumatoid arthritis. However, the supplement can cause an additive effect if taken with diabetes or thyroid medications. Hence, do not consume it without consulting a physician. Moreover, pregnant women should talk to their doctors before taking ashwagandha.

2. Physical activity

This is the most important and effective way of reducing pain and discomfort associated with rheumatoid arthritis. 

Tailor an exercise program according to the schedule and health benefits that are needed with the help of a doctor or physiotherapist. Half an hour of physical activity every day is enough to increase stamina and flexibility. This will also improve one’s sleep pattern and will ease depression and anxiety related to rheumatoid arthritis. 

3. Dietary changes

Make informed choices about diet with the help of a nutritionist to not just reduce weight but to also improve the overall health. The necessary nutrients supplied through a tailored diet will improve one’s energy levels as their weight decreases. Having a well-balanced diet rich in antioxidants can lessen the pressure on the joints and give comfort from pain. Make sure to consult a doctor or dietician before starting any supplements. The food or supplements rich in the following can be beneficial:

• • Omega-3 fatty acids

  • Zinc

  • Iron

  • Folate

  • B vitamins

  • Calcium

  • Vitamin D 

  • Fluoride

4. Sleep

It is of utmost importance in one’s fight against any disease. Eight hours of sound sleep every night helps maintain a positive mindset and also eases pain. Consult a doctor if you have difficulty sleeping. Also try taking short naps in the afternoon to energize you for the remaining part of the day.

5. Massage

Massages increase the fresh oxygenated blood supply to the muscles and organs and aid in removal of waste products from the body, which alleviate rheumatic disorders. It also improves flexibility and reduces soreness of the joints.

Castor oil or essential oils, like black currant seed, evening primrose, lemongrass, and borage seed, can be used for massages. However, they should be used only after testing on your skin to ensure there is no irritation.

6. Heat and cold

Ice packs help bring down the swelling and the inflammation. One can use them during the flares but only for 15 minutes. Alternately, use a hot water bag or a warm towel to relax the muscles and to increase blood flow to the treatment area. Hot tub baths also provide relaxation to stiff, painful muscles.

Complications Of Rheumatoid Arthritis

Rheumatoid arthritis affects the lining of the joints and causes gradual bone erosion and deformity. Besides these side effects, rheumatoid arthritis increases the risk of developing other ailments, such as:

1. Osteoporosis: Rheumatoid arthritis and the medications used to treat it increase the risk of developing osteoporosis. In this condition, our bones become weaker and are prone to fractures. Lack of exercise due to pain and swelling and insufficient calcium intake are other factors that lead to loss of bone density, which further leads to osteoporosis.

Osteoporosis is a disease condition in which bones get thin and weak due to low bone mass (bone density). This makes bones fragile and increases the risk of fractures from the slightest trauma. 
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2. Carpal tunnel syndrome: When the nerve that serves the hand and the fingers get compressed due to inflammation, it is referred to as a condition known as carpal tunnel syndrome. As rheumatoid arthritis typically affects the hands, it will also affect the wrist, putting it at a greater risk of developing carpal tunnel syndrome. 

3. Lung diseases: Rheumatoid arthritis increases the chances of inflammation and scarring of the lung tissues. This could lead to shortness of breath, dry cough, fatigue, loss of appetite, and weakness. Due to the inflammation, obstruction in the walls of the airway in the lungs can also cause shortness of breath and chronic dry cough. 

4. Heart problems: Inflammation due to rheumatoid arthritis causes plaque build-up in the arteries, leading to narrow blood vessels. This blocks the blood flow and affects the heart. Furthermore, the drugs used to treat RA symptoms and the lack of exercise due to pain and swelling increase blood pressure. People suffering from this disease tend to have high LDL (bad cholesterol) levels and low HDL levels (good cholesterol). All of these factors increase the risk of cardiovascular diseases in these patients.

5. Dry eyes: Rheumatoid arthritis also affects eye health. Dry eyes are the most common side effect of this chronic disease. Dry eyes increase the risk of damage to the cornea and cause inflammation in the sclera or the white part of the eyes. Therefore, eye pain or change in the vision needs to be addressed as soon as possible to prevent further damage to the eyes. 

6. Nodules on the skin: Rheumatoid arthritis can cause rheumatoid nodules under the skin. These typically appear on the fingers, forearms, elbows, and heel and are a sign of the progression of the disease. 

7. Depression or anxiety: Rheumatoid arthritis dramatically affects the patient’s emotional health. Feelings of sadness, anxiety, loss of interest, and lack of sleep can all lead to depression. Support groups and emotional bonding with family and friends can help patients deal with the condition better. 

Alternative Treatment For Rheumatoid Arthritis 

Apart from taking prescribed medications, one may also follow some alternative therapies to relieve pain and stiffness. Examples of these therapies  are:

1. Homeopathy: Studies suggest use of homeopathy for relief from pain and stiffness. It strengthens the immune system and controls the symptoms without the risk of side effects. However, it is essential to consult a doctor before beginning any alternative treatment. 

2. Acupuncture: It uses needles to heal chronic pain. It lowers the levels of chemicals that cause inflammation in the body. Since this method uses needles that need to be sterile and correctly used, ask a doctor to suggest the right acupuncture practitioner.

3. Chinese medicine: Thunder god vine is a herb that is used as a natural remedy to ease inflammation and tenderness of joints in people with rheumatoid arthritis. However, one needs to be sure about its quality. It also has certain side effects that could harm pregnant women. Therefore, caution is advised during its use.

4. Tai chi: It is a Chinese martial art that has several health benefits. Its slow and gentle movements improve strength, flexibility, and balance. This form of martial art has statistically shown significant benefits on lower extremity range of motion, in particular ankle range of motion, in people with RA.

5. Yoga: This low-intensity, ancient Indian workout is perfect for improving flexibility, easing pain, and bringing relief from mental stress. A few simple yoga asanas that help improve muscle strength and posture are mentioned below:

• • Virabhadrasana II (Warrior Pose 2)

  • Marjaryasana - Bitilasana (Cat pose - Cow pose)

  • Vrikshasana (Tree pose)

  • Setu bandha sarvangasana (Bridge pose)

  • Viparita-Karani (Legs-up-the-wall pose)

Read more about various alternative treatments to deal with long term pain.
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Living With Rheumatoid Arthritis 

Rheumatoid arthritis is an autoimmune disease. Although it doesn’t have any permanent cure, one can get the right treatment to keep the symptoms under control if detected early. Therefore, seeking early medical attention is crucial. 

The symptoms of this chronic disease aren’t constant. At times, they flare, while other times, they are in remission. Here are some essential things to remember when living with rheumatoid arthritis:

1. Health care

• Start an exercise program to increase your stamina and to improve flexibility.

• Maintain the right posture while sitting, standing, and walking.

• Do not lift heavy objects.

• Avoid kneeling or sitting down.

• Buy an ergonomic chair for work. 

• Make changes in the diet to help relieve inflammation and to improve overall health.

• Seek physical or occupational therapy.

• Do not miss medications or doctor’s appointments.

2. Lifstyle changes

• Plan the day ahead, but allow space for changes in the tasks.

• Simplify daily routine and everyday tasks.

• Cook simple meals.

• Shop online.

• Buy toothbrushes and combs/hair brushes with wide handles.

• Use a chair in the shower and install a handrail for support.

• Buy easy-to-wear clothes with large fasteners, such as buttons and zippers.

• Pick easy-to-wear footwear over ones with laces or buckles.

3. Self care

• Make self-care a priority.

• Avoid being homebound.

• Take care of both emotional and mental health. 

• Manage stress using stress management techniques, like meditation, mindfulness practices, or deep breathing.

• Indulge in a hobby.

• Spend time with the loved ones. 

• Join support groups.