Rheumatoid Arthritis

FAST FACTS

  • RA is very well treatable like diabetes, high blood pressure
  • Diagnosed by a rheumatology checkup, no lab test confirms or rules out RA
  • Can cause serious damage to joints and internal organs
  • Timely and Proper treatment can prevent long term complications
  • Most patients can lead a near normal life
  • Rheumatologist specialize in diagnosing and treating RA

WHAT IS IT
Rheumatoid arthritis or RA is a chronic (long term) disease which mainly affects the joints.  It causes pain, swelling, and stiffness of joints. If not treated properly it causes joint deformities and can also affect various internal body organs.  RA is the most common inflammatory arthritis.

CAUSE
RA is an autoimmune disease. Immune system is the defence system of body. In RA the immune system becomes confused and begins to attack its own joints. Although the exact reason for this is not clear it takes place because of a combination of hereditary (familial) and environmental factors. We don’t know all the environmental factors but the known factors are smoking, pollution and stress. The attack causes inflammation of the joints. The word inflammation comes from the Latin word inflammare which means to light on fire. In people with RA, inflammation causes the joints to become warm, swollen, and painful. In other words, the joints can feel like they’re “on fire.”

WHO GETS AFFECTED
Approximately 1% of the population is affected. So, India with a population of more than 100 crore you could expect about 1 crore people to have RA. In the city of Ludhiana with a population of 35 lakh there could be more than 30 thousand RA patients. So this means RA is not uncommon and most of you might have come across a patient with arthritis. Unfortunately however many times RA is not diagnosed and hence remains unrecognized due to which patients are not able to avail the benefit of proper treatment.
RA can affect any age group but most commonly starts between 25 and 50 years of age. It is about three times more common in women than men.

Having a family member with RA increases your risk but there are a lot of chances you will not get the disease. Most people who develop RA do not have a family member with the disease. Similarly all family members of a RA patient don’t develop arthritis.

HOW IS IT DIAGNOSED?
RA is best diagnosed by a rheumatologist.  A rheumatologist is a specialist in arthritis and autoimmune diseases. The rheumatologist will first do a proper checkup which then is followed by tests. 90% information comes from a good check up and only 10% information comes for tests. In fact no test can confirm or rule out whether you RA or not.

DOES POSITIVE RHEUMATOID FACTOR (RF) MEAN I HAVE RA?
One commonly done test is Rheumatoid factor (RF). This test is positive in 70% of RA patients but can be positive in up to 5% of normal people and many other diseases like TB, infection, malignancies, hypothyroidism, hepatitis etc. So a negative Rheumatoid Factor (RF) does not rule out RA and a positive RF doesn’t mean you have RA. Also in patients who have already been diagnosed RA repeating the value of RF is of no value because RF value doesn’t indicate how active your arthritis is.

SIGNS & SYMPTOMS
Joint pain, swelling and stiffness of joints are main symptoms. Joint stiffness is more marked on getting up in the morning. Usually it initially affects a few joints and then progresses to involve other joints. It can also cause fatigue, mild fever and weight loss.

CAN IT CAUSE DAMAGE
Unfortunately YES. If RA is not treated properly it can cause serious irreversible damage to the joints leading on to various deformities and activity limitation. It can also damage various other organs of the body including eyes, heart, kidneys etc.

PREGNANCY
RA doesn’t affect fertility. However active RA can affect menstrual cycle. Also certain medicines used to treat RA can be harmful for the baby. So if you have RA and want to get pregnant discuss this first with your doctor. There are medicines that can be given safely while planning for pregnancy and during pregnancy. If RA is well controlled before getting pregnant the outcome is better for mother & child health.

WHAT CAN I DO
Being diagnosed with a chronic disease like RA can come as a shock. First thing is to accept it. Don’t panic or try to avoid it. It is not an uncommon disease and you are not alone. Although RA cannot be cured there are very effective treatments available. With proper treatment you can live a near normal and comfortable life.
If you have or are suspected of having RA consult a Rheumatologist. A rheumatologist is a specialist in diagnosing & treating arthritis.

DIET
Lots of dietary modifications advices are prevalent in society about arthritis. There is no proven connection between diet and RA. A lot of research has been done on diet. So far apart from smoking which can cause worsening no other diet has been shown to worsen or improve RA. However the importance of a healthy diet cannot be overemphasized.

ALTERNATIVE DRUGS
Most of the alternative drugs have not been properly researched or tested scientifically. Therefore the data on toxicity and efficacy of these agents is often lacking. Arthritis symptoms can vary over time and spontaneous remissions are known to occur. In arthritis treatment trials placebo or inactive substance treatment results in improvement in nearly 30% of patients. Therefore in the absence of adequate data analyzing the efficacy of these agents is not possible. Moreover there is a lack of quality standards for most of these agents. Finding an effective and safe medication for arthritis pain is a complex task that may take years. Trying to shortcut standard practices may lead to harmful effects and wasted money, time and effort.

A common misconception is that allopathic medicines have a lot of side effects which is not true. In contrast to other forms of treatment available allopathy is a transparent and scientific system. Any treatment that is offered to a patient has undergone rigorous research based on stringent criteria. It has to be proved that the medicines are safe for human use and their benefit far outweighs the potential side effects. Majority of patients do not experience any side effects with allopathic treatment if taken under supervision of a qualified medical practitioner. Allopathy is the most effective form of treatment available as a result of which it is the most widely accepted system across the world. However owing to the lack of awareness lot of patients including educated people get misguided and lured by false promises fall prey to unscientific therapies which can lead to serious side effects and irreversible damage to the body.

TREATMENT
Now is the best time in history to get RA. With the recent scientific advances we understand RA better and have much more effective & safe treatment options. Unlike past days when most of the patients with RA used to become severely disabled now majority of RA patients can lead active and productive lives with right treatment.
It is important to diagnose and treat your disease at the earliest. Patients who start treatment early and take medicines regularly not only tend to do better but also require lesser medicines in the long run.

MEDICINES
Two broad categories are symptom modifying and disease modifying. Symptom modifying medicines (For e.g. Pain killers) only control the symptoms but do not control the disease process or potential complications. These medicines have rapid onset of action but little long term benefit. Hence there usage has to be limited for a short term only.
Disease modifying medicines on the other hand control the disease process from within. They have a slow onset of action and can take a few months for their benefit to begin. However these are the medicines which prevent long term benefit and hence should be given to all RA patients. Examples include methotrexate, sulfasalazine, hydroxychloroquine, leflunomide.

Biologics are the newest class of medications. These medications have been specifically created to target the biology of disease i.e. to target the specific abnormality in the immune response. These are very effective and have made a huge difference for RA patients. Biologics like disease modifying oral drugs control disease process from within and prevent long-term damage.

SELF HELP

  • Exercise regularly
  • Stop Smoking
  • Maintain a positive attitude
  • Get check up done with your Rheumatologist regularly
  • Take your medicines on Time

MYTHS & MISCONCEPTIONS

  • Positive RF means RA: Not true. Positive RF doesn’t confirm RA and negative RF doesn’t rule out RA
  • RA disease of old age: Not true, can affect any age group including young people
  • Eating cold things causes RA: Not true, RA has no link with diet
  • Alternative drugs are better: majority alternative drugs have not been researched. Hence there is no evidence to support their benefit or safety for human use.
  • Allopathic medicines have lot of side effects: Not true. Allopathic medicines are safest, most effective and have undergone rigorous scientific research
  • There is no treatment: Not true. In fact treatment of RA has become much better recently. RA can now be treated very effectively just like diabetes, high blood pressure.
  • Treatment consists of just pain killers: Not true. The mainstay of treatment is disease modifying medicines. These medicines control disease process from within.