Rheumatoid Arthritis – Basics for Patient

Rheumatoid arthritis (RA) is one of more common arthritis seen in general population. At least 1 in 200 -300 people have RA. We don’t know why RA develops in some. It can be a combination of genetic and other external factors like smoking. There is no constant factor. When we say genetics, it doesn’t mean, someone in patients’s family need to have RA. Genes are complex and one can have many new genes at birth. One should not blame him/herself for getting RA, as there is nothing they could have done to prevent it.

Arthritis can be of more than 100 types. The two most common arthritis are Rheumatoid arthritis (RA) and Osteoarthritis (OA). RA  is different from OA. Unlike osteoarthritis, RA causes a lot of inflammation (pain, redness, swelling and lot of stiffness) in joints and sometimes other organs of the body. The treatment of RA is mainly drugs and medicines which suppress this process and inflammation.

RA is an autoimmune disease. Autoimmune diseases are diseases in which our immune system starts attacking our own body. Normally, our immune system protects from threats to the body. But, due to unclear reasons, a part of our immune system might get ‘auto’ or ‘self ‘ activated and starts damaging one’s own body. This ‘auto’ immune activation, for some reason, likes to hit joints. That is why most autoimmune diseases have arthritis. But they can involve other organs also.Why this occurs only in a few? Why this leads to different diseases in different people? We just don’t know. But, we now have treatment to suppress this overactive immunity and control such diseases.

Imagine one’s immune system being made of many family members who usually protect it. Sometimes, for unexplained reasons, a part or member of this family becomes over-active and goes against the family. It starts damaging its own family. In autoimmune diseases, a part of one’s own immunity becomes over-active automatically and starts damaging other organs including joints. RA is an autoimmune disease. The immunity is not low here, but a part of it is over-active.

• Pain and swelling in small joints of hands and feet, along with other joints like knees and hips, usually on both sides of the body.
• Sometimes rheumatoid arthritis can start as a painful attack in one joints, which subsides in few days. Later these attacks can slowly increase and become full-blown rheumatoid arthritis. This is known as palindromic RA.
• Having severe stiffness in early mornings lasting for more than an hour or so which decreases gradually with movement.
• Not feeling well, feeling feverish and fatigued all the time.
• Usually, a patient with RA will start having pain and swelling in few joints with stiffness, which will slowly involve many other with stiffness becoming very severe. This stiffness can make patient unable to get up from bed in mornings. A patient with severe RA will start feeling feverish, tired and ill all the time. Their appetite also goes down in severe cases.

Only a Rheumatologist doctor can surely say that you have RA. They will see multiple factors and blood reports. A postive RA factor can be seen in many normal people and once can have RA even with negative RA factor.

• My RA (rheumatoid) factor is positive. Do I have rheumatoid arthritis ?
• How do rheumatologists confirm diagnosis of Rheumatoid arthritis ?

Even though it might start in the fingers and toes, rheumatoid arthritis can affect any of the joints. If not controlled early, it damages the joints forever. Plus, rheumatoid arthritis can cause problems in other parts of the body, such as the heart, lungs, or eyes. RA patients also have increased risk of heart attacks.

• How bad is your disease?
• How many of your joints are involved?
• What do your blood tests and X-ray show?
• How your disease has progressed? What are your preferences? Are you planning pregnancy ?
• What side effects you feel with the medicines you try – do you have any other associated disease?
• It also sometimes might depend on what you can afford – this especially in a country like India where most insurance policies do not cover Rheumatoid arthritis.

• Medicines called “nonsteroidal anti-inflammatory drugs,” also known as NSAIDs  – which are known as ‘pain killers’ in common language (Eg -Etoricoxib, ibuprofen, naproxen, diclofenac etc.   Nucoxia, Flexon, Combiflam, Voveran, Naprosyn etc). They reduce pain, but they reduce inflammation (redness and swelling) also. They usually aren’t used continuously but used intermittently.
• Medicines called steroids – Everybody fears steroids because they feel that steroids cause side effects only. But, steroids used in very low doses and under supervision can really help a lot in patients with RA.
• Medicines called “disease-modifying antirheumatic drugs” also known as “DMARDs” – These are medications, which regulate the ‘auto’ active immune system in RA and control the disease so that disease doesn’t cause any damage. Eg : Methotrexate (Folitrax, Mexate, Neotrexate etc), Leflunomide (Lefno, Lefra, Arava, Cleft etc), Sulfasalazine (Saazo, Saaz, SSZ etc), Hydroxychloroquine (Hydroquine, HCQs, ZyQ, Plaquenil etc), Azathioprine (Azoran)  .
• Biologic DMARD’s – In last 20 years, field of rheumatology has changed drastically. We initially had very few drugs to treat rheumatology diseases like RA. Biologics drugs were developed after extensive and groundbreaking research. They target very specific molecules or pathways in the body and can give amazing results in controlling rheumatic diseases. They have changed the lives of most RA patients around the world.

RA is a severe and usually lifelong disease which can damage joints and other organs rapidly. Allopathy has now drugs designed to treat RA in a very precise manner. There is no such therapy for RA in Ayurveda and homoeopathy. Proper treatment has to be started very early to achieve best results. Delay in proper RA treatment can lead to more joint damage, need for joint replacements, more medications and more pain. With delay, one might never achieve control to the level, if they had taken proper treatment at the start.

Yes, follow you rheumatologist’s advice, stay active, and eat healthily. Read and get educated about RA. Ask proper questions to your rheumatologist and be a part of your treatment. Stop smoking, as it makes RA worse and increases heart attack risk in RA patients. Doing some form of exercise is good, but avoid doing exercises when RA is flared. Take the advice of physiotherapists for exercise in RA. Occupational therapists can give advice on how to work best even with painful and deformed joints. People with rheumatoid arthritis are at risk for heart disease, so avoid fatty foods. Instead, eats lots of fruits and vegetables. Check your medicine doses properly, report any infections or other medical issues to your rheumatologist at future visits.

Most RA patient can have healthy happy married life and can also conceive and have healthy children. If  a RA patient wants to plan pregnancy they should tell their rheumatologist in advance.