Rheumatoid Arthritis - Why Should It Be Treated On Time?

Rheumatoid arthritis is a chronic inflammatory arthritis with a prevalence of 0.5-1% in India. It is characterized by joint pain and swelling associated with morning stiffness lasting for more than 30 minutes. It generally has a slow onset - over weeks to months, though the onset can be acute also. Most common joints involved are small joints of hands and feet. Larger joints like knee and shoulder can also be involved. The incidence of RA increases with age. It is twice more common in females than in males. Early treatment is necessary to bring down the inflammation, avoid joint deformities and prevent other complications ( lung, heart, vasculitis). 

CAUSE: 

Predisposition to RA is multifactorial. It has a genetic component (family history of RA increases the risk). Environmental factors like smoking also play a role. 

SYMPTOMS: 

Initial symptoms start with fatigue, malaise, generalised bodyaches, low-grade fever. The onset is generally slow and eventually patient develops joint pain and swelling. Though the joint involvement is symmetrical in most cases, asymmetric onset is common (involving joints predominantly on one side). 

DIAGNOSIS: 

Diagnosis is made by a physician after detailed history, clinical examination and supportive lab tests. Rheumatoid factor and anti-CCP antibody are positive in 75-80% patients with RA. They have raised inflammatory markers (ESR, CRP) during active inflammation. 

TREATMENT:

RA treatment options are wide and quite effective. It starts with patient education regarding nature of the disease and the risk of complications. The need of early aggressive therapy should be emphasized. The patient should put in efforts for physiotherapy which play a very important role in muscle strength and joint mobility. Pharmacotherapy options are wide and include disease-modifying antirheumatic drugs ( DMARDS). These can be conventional DMARDS like methotrexate ( usually the first line drug), sulfasalazine, hydroxychloroquine, leflunomide. Failure to adequately respond to these drugs should lead your Rheumatologist to consider Biologic DMARDS ( TNF antagonists, Rituximab, Abatacept, Tocilizumab). Your Rheumatologist is the best person to guide you about dose, indications, monitoring and side effects of the drugs used in RA. Treatment duration depends on patient's response but is generally long ( 5-10 years or lifelong). 

COMPLICATIONS BEYOND JOINTS: 

RA patients can have rheumatoid nodules in skin, lungs, heart and other sites. These patients are at risk of accelerated bone loss, so calcium and vitamin D intake should be optimized. Eye complications include dryness, redness ( scleritis and episcleritis) and certain eye threatening complications. Lung involvement can be seen in various forms ( fluid in lungs, nodules, interstitial lung disease). 

These patients are at high risk of atherosclerosis ( heart and blood vessel disease). They also have a tendency to have frequent infections. 

NEED OF THE HOUR: 

All patients with joint pains should be seen early by Rheumatologist for diagnosis and treatment. With so many treatment options, no patient should suffer from joint deformities and other complications associated with long standing, untreated RA. LEAD A HEALTHY LIFE!