Rheumatoid Arthritis

About Rheumatoid Arthritis

Arthritis is the swelling and tenderness of one or more of joints. The main symptoms of arthritis are joint pain and stiffness. Common type of arthritis are Rheumatoid Arthritis, Osteoarthritis, AnkylosingSpondylitis and Gout.

Rheumatoid arthritis is the most common type of autoimmune arthritis. It affect multiple joints of the body with some systemic symptoms. Many joints of body start aching and swelling at a time. It can affect any age group from children to old age. But more common in young adults and female. In this disease body’s own immunity system start affecting membranes present on the joint surface which leads to erosion on joint surface with reactive collection of fluid in joints which in turn causes swelling and pain in joints. If this process remains unchecked then it also starts destruction of surface which causes movement restriction and deformity in joint. Ultimately joint becomes completely destroyed. Patients can also have fever. This problem occurs more in females than males and can affect any age group. This disease can affect single joint to multiple joint in the body. In starting, it affects small joints of limbs and ultimately it affects all the joints in body in absence of proper treatment.

The patients feels difficulty in his daily activities. Usually diagnosis is being made on the basis of detail history and physical examination. Blood investigations are required to see the status of liver, kidney, and blood. Rheumatoid factor is positive only in 30 % of rheumatoid arthritis patients. Titer value of rheumatoid factor indicate severity of disease.  Blood investigation like Anti CCP antibody can detect this disease very early. X-ray is required only in few of patients. Two decade back, affected people were totally unable to do their activities of daily living in the absence of modern investigation and treatment facilities but today this disease can be controlled totally due to modern effective medicines.

Today disease modifying drugs are used in place of pain killers. Many of these drugs are used together even in initial phase of the disease so that joint destruction can be prevented and disease can also be controlled. By the use of these medicines under supervision of specialist, we can prevent the long term bad effects of the disease. These drugs has some side effects on liver and bone marrow, therefore we need to get blood investigations done at every 3 to 4 months, so that we can correct the side effects by changing medicines. Steroids are also very effective in this disease and is being advise only in acute flare-up & not responding to DMARD. But steroids must be used for only for few days with doctor’s advice because of various long term side effect like osteoporosis, blood sugar level fluctuation, flaring of infection etc.  Yoga and exercises also play a very good role in maintaining movements of joint in this problems & boosting up immunity. Bones are also weaken in this disease therefore affected persons should also take calcium, vitamins and medicines for osteoporosis. The affected person may need joint replacement if joint is badly damaged besides stick, walker and braces. In more than 2/3 cases it remain for whole life. In pregnancy its severity decreases but after delivery it again flare-up so strict follow-up and treatment during pregnancy and after delivery is necessary. if females are planning for pregnancy then few of the medicine should be start before planning pregnancy to prevent teratogenic side effect of few drugs.

                  If this disease is treated in early phase then we can control it completely and we can prevent future serious consequences. Even if the disease is advanced then also it can be treated with use of correct medicines. The treatment must not be stopped.

Osteoarthritis is the kind of degenerative arthritis.Mainly occurs in old age. In most of cases, it starts around 45 to 50 years of age and affects knee joints. Sometimes it also affects other joints like hip and thumb joint. Most of time it is familial, more commonly occurred in females. High risk factor are injury to joint, limb deformity, heavy weight, osteoporosis, heavy weight athletics etc. In osteoarthritis, surface cartilage are damaged and thinned out resulting in reactive fluids. In response to damage of joint surface, new formation (osteophytes) at joint margin develop which leads to joint pain, swelling and instability. Progression of joint destruction can be prevented by the weight reduction, exercise, precaution and deformity correction of limbs. Tibia Vara& post traumatic joint deformity is the common limb deformity that cause osteoarthritis of knee joint.  Both deformity can be corrected by surgery (HTO) that can prevent progression of arthritis. A combination of drugs, exercises, yoga, weight reduction and precautionis very effective measurein the initial phase of arthritis. Knee brace and stick are required in advance case. Knee replacement is the last resorts but improve quality of life.

Ankylosing spondylitisaffect axial joint of body which include spine, sacroiliac and hip joint etc. there is inflammation and calcium deposition near vertebral bones which reduces joint movement and patient feel sever pain in forward and backward bending, turning the neck, breathing difficulty  and sever pain in vertebral bones. In initial phase it affect firstly to sacroiliac joint followed by spine. When disease progress to great extent then vertebral column becomes straight like a bamboo and there is complete restriction of movement. For treatment of this disease it is very important to do exercises to maintain joint movement. Some medicines also help in preventing progress of disease. 

 Gout occurs because of deposition of uric acid crystals in joints. Cause of hyperuracemia include diseases of metabolic activities, kidney problems, anticancer drugs and genetic in some cases.Gout patients should avoid taking food with excessive proteins. In initial phase’ssteroid, anti-inflammatory medicine are advised along with drugs to reduce uric acid formation in body/ increased excretion of uric acid in urine. In chronic problem diet control with medicine which reduce formation of uric acid in body is very important.

Many other diseases affect joints besides these main problems like Reiter syndrome. This can occur at any age after having diarrhea. In few days patient start having problem in big joints, waist joints and eyes. Another disease is Systematic Lupus  erythematosus which also affects joint besides affecting skin.

Lastly we can say that if we treat arthritis problem in initial phases the we can prevent many future complications.

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Dr. Jitendra Kumar Jain is a famous name in the field of childhood physical disability pediatric orthopedic problems in North India. He has been an MS Orthopedics, DNB Orthopedics, Pediatric orthopedic surgeon & also a cerebral palsy specialist for over 21 years.

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