Rheumatic Arthritis (RA) is basically a chronic inflammatory disorder which can affect much more than just joints. This condition in some people can also damage a variety of body systems including heart, blood vessels, lungs, eyes & skin. Rheumatoid arthritis is an autoimmune disorder where the patient’s own immune system mistakenly indulges in attacking his/her own body tissues. Unlike wear & tear damage of osteoarthritis, rheumatoid arthritis generally affects the lining of joints so as to cause painful swellings which can often result in joint deformity & bone erosion. Inflammation, which is commonly associated with cases of rheumatoid arthritis, is what generally damages various other parts of the body as well. Although newer types of medications have dramatically improved treatment options, severe bouts of rheumatic arthritis can still cause physical disabilities in patients.
Signs & Symptoms of Rheumatoid Arthritis
Signs & symptoms of rheumatoid arthritis generally include the following.
- Warm, tender and/or swollen joints
- Joint stiffness which is worse in mornings & after inactivity
- Fever, fatigue & weight loss
Early cases of rheumatoid arthritis are found to first affect the small joints, particularly those joints which attach fingers to hands & toes to feet. With progression of the disease, signs & symptoms spread to wrists, elbows, shoulders, ankles, knees & hips. Moreover, in most cases symptoms are usually found to occur in same joints on both sides of the body. Almost 40 percent of rheumatoid arthritis patients also experience signs & symptoms which do not involve joints. Rheumatoid arthritis can also affect several non-joint structures including the following.
- Blood Vessels
- Bone Marrow
- Nerve Tissue
- Salivary Glands
Signs & symptoms of rheumatoid arthritis can vary in severity & may also often come & go. Periods of increased disease activity which are known as flares can alternate with periods of relative remission, when pain & swelling are found to fade or completely disappear. Nevertheless, over time rheumatoid arthritis may eventually cause joints to deform or even shift out of place.
Causes of Rheumatoid Arthritis
Rheumatoid arthritis is found to occur when the patient’s immune system attacks the synovium, or the lining of membranes which surround joints. Resulting inflammation in this condition thickens synovium & can eventually destroy cartilage & bone within the joint. Ligaments & tendons which together hold joints begin to stretch & weaken. This may gradually even make joints lose shape & alignment. Orthopedists still do not know as to what starts this process, but involvement of a genetic component seems to appear most likely. Although, genes do not actually cause rheumatoid arthritis, they generally make people more susceptible to environmental factors like certain bacteria & viruses, & infections which can trigger rheumatoid arthritis.
Risk Factors Associated with Rheumatoid Arthritis
Factors which normally increase risk of rheumatoid arthritis include the following.
- Gender – Women are found to be more prone than men to develop rheumatoid arthritis.
- Age – Although rheumatoid arthritis can occur at any age, it is most commonly found to occur between 40 – 60 years of age.
- Family History – When a member of the family is having rheumatoid arthritis, other members have an increased risk of developing this disease as well.
- Smoking – Cigarette smoking can increase risk of people developing rheumatoid arthritis, particularly among people who are having a genetic predisposition for developing this condition. Smoking is also associated with greater severity of this disease.
- Obesity – People who are obese & overweight seem to be at higher risk of developing rheumatoid arthritis, especially women who were diagnosed with this disease were 55 years of age or younger.
- Environmental Exposure – Though this is uncertain & yet poorly understood exposure to asbestos & silica may increase risk of developing rheumatoid arthritis. Emergency workers who are exposed to dust from collapse of buildings like the World Trade Center are at higher risk of developing autoimmune diseases like rheumatoid arthritis.
Complications Associated with Rheumatoid Arthritis
Developing following complications are most often associated with rheumatoid arthritis.
- Osteoporosis – Condition of rheumatoid arthritis itself, along with some medications which are used in treatment for rheumatoid arthritis are found to increase risk of developing osteoporosis. Osteoporosis is a condition which weakens bones & makes them prone to fractures.
- Rheumatoid Nodules – These are firm bumps of tissue which commonly form around pressure points like elbows. These nodules however can also form anywhere else in the body, including lungs.
- Dry Eyes & Mouth – People having rheumatoid arthritis are also more likely to experience Sjogren’s syndrome. This is a disorder which decreases amount of moisture in eyes & mouth.
- Infections – Rheumatoid arthritis itself & many medications which are used to combat this condition are found to impair the immune system & which can eventually lead to increased risk of infections.
- Abnormal Body Composition – Proportion of fat when compared to lean mass is often found to be higher among people with rheumatoid arthritis, even in people who are having normal BMI (body mass index).
- Carpal Tunnel Syndrome – When rheumatoid arthritis affects the patient’s wrists, associated inflammation can compress nerve which serves most of the fingers & hand as well.
- Heart Problems – Rheumatoid arthritis also increases risk of hardened & blocked arteries & inflammation of the sac which encloses the heart as well.
- Lung Disease – Rheumatoid arthritis patients have increased risk of developing inflammation & scarring of lung tissues & which can also lead to progressive shortness of breath.
- Lymphoma – Rheumatoid arthritis is found to increase risk of lymphoma. Lymphoma is a group of blood cancer which develops within the lymphatic system.
Tests & Diagnosis of Rheumatoid Arthritis
Rheumatoid arthritis can be quite difficult to diagnose in early stages because early signs & symptoms generally mimic that of many other diseases. Moreover, there is no single blood test or physical examination which can confirm diagnosis. However, during a physical examination for diagnosing rheumatoid arthritis, doctors will check joints for warmth, redness & swelling. They may also check reflexes & muscle strength of patients.
- Blood Tests – Rheumatoid arthritis patients often have elevated ESR or Sed rate (erythrocyte sedimentation rate) or CRP (C-reactive protein). This will indicate presence of inflammatory process within the body. Other blood tests which are commonly performed will look for anti-cyclic citrullinated peptide antibodies (anti-CCP) & rheumatoid factor.
- Imaging Tests – Doctors usually recommend x-rays to help track progression of rheumatoid arthritis within joints over a period of time. Ultrasound & MRI tests can also help doctors’ judge severity of disease in the body.
Preparing for Initial Appointment for Rheumatoid Arthritis
People should make an appointment with the doctor in case they experience persistent discomfort along with swelling in joints. While they may first discuss symptoms with the family doctors, he/she may refer them to a rheumatologist specializing in treatment of arthritis & associated inflammatory conditions for further investigation.
What Patients Can Do In Preparation for Initial Appointment
Patients seeking initial appointment for rheumatoid arthritis can make a list including the following points.
- Detailed description of all signs & symptoms.
- Information regarding medical problems they have had in the past.
- Information about medical problems of siblings and/or parents.
- Complete list of all medications & dietary supplements the patient is taking.
- List of questions patients would like to ask rheumatologists.
What Rheumatologists Would Like to Know From Patients
Rheumatologists may like to ask many questions including some of the following.
- When did these symptoms first begin?
- Have these symptoms been changing over time?
- Which are the joints that are affected?
- Is there any activity which makes symptoms better or worse?
- Are these symptoms interfering with normal day-to-day tasks?
Treatment Options for Rheumatoid Arthritis
Presently, there is no cure known for rheumatic arthritis. Recent discoveries however indicate that remission of symptoms is more likely when treatments begin in early stages with strong medications which are known as DMARDs (Disease-Modifying Anti-Rheumatic Drugs).
Medications for Rheumatic Arthritis
Types of medications recommended by doctors for rheumatoid arthritis patients will depend upon the severity of symptoms & as to how long this condition had been in existence.
- NSAIDs – Non-steroidal anti-inflammatory drugs can effectively relieve pain while reducing inflammation at the same time. Common over-the-counter NSAIDs include naproxen sodium (Aleve) & ibuprofen (Motrin IB, Advil). However, stronger NSAIDs are also available by prescription. Side effects of NSAIDs include heart problems, stomach irritation, ringing in ears & damage to liver & kidneys.
- Steroids – Corticosteroid medications include prednisone, which effectively reduce pain & inflammation, while slowing damage to joints at the same time. Side effects of steroids however include diabetes, weight gain & thinning of bones. Rheumatologists often prescribe corticosteroids in order to relieve acute symptoms with a goal to gradually taper-off these medications.
- DMARDs (Disease-Modifying Anti-Rheumatic Drugs) – DMARDs are useful in slowing progression of rheumatic arthritis & for saving joints & other tissues from permanent damage. Common DMARDs used in treatment of rheumatic arthritis include sulfasalazine (Azulfidine), methotrexate (Rasuvo, Otrexup, Trexall), hydroxychloroquine (Plaquenil) & leflunomide (Arava). Side effects of DMARDs vary, but may include severe lung infections, bone marrow suppression & damage to liver.
- Biologic Agents – This is a newer class of DMARDs which are also known as biologic response modifiers. These drugs are designed to target parts of the immune system which trigger inflammation going on to cause tissue & joint damage. However, these drugs are also capable of increasing risk of infections. Common newer DMARDs prescribed for rheumatoid arthritis include tofacitinib (Xeljanz), abatacept (Orencia), tocilizumab (Actemra), adalimumab (Humira), rituximab (Rituxan), anakinra (Kineret), infliximab (Remicade), certolizumab (Cimzia), golimumab (Simponi) & etanercept (Enbrel). Biologic DMARDs are generally most effective when they are paired with non-biologic DMARDs like methotrexate.
Therapy for Rheumatoid Arthritis
Quite often rheumatologists may send rheumatoid arthritis patients to occupational or physical therapy for exercises designed to keep joints flexible. These therapists may suggest newer ways to perform daily tasks & which may also be easier upon the joints. Like for example when fingers are sore, patients may like to pick up objects using forearms. Many assistive devices may also make it easier for patients to avoid stress upon painful joints. Like for instance, kitchen knives equipped with saw handles can protect fingers & wrist joints. Moreover, certain tools like buttonhooks can make it easier for the patient to get dressed. Many catalogues & stores supplying medical items can be good places to look for such ideas.
Surgical Options for Rheumatoid Arthritis
When medications fail to prevent or even slow joint damage, rheumatologists may consider surgical interventions to repair damaged joints for rheumatoid arthritis patients. These surgeries are meant to help restore ability to use joints. They can also reduce pain while correcting deformities in specific cases. Surgery for rheumatoid arthritis may involve one or more than one of the following procedures.
- Synovectomy – This is surgery which is meant to remove inflamed lining of the joint (synovium). Synovectomy can be performed on hips, knees, fingers, wrists & elbows.
- Tendon Repair – Joint damage & inflammation may cause tendons around joints to rupture or loosen. Orthopedic surgeons can effectively repair such tendons around joints.
- Joint Fusion – Surgical fusion of joints may be recommended so as to realign or stabilize joints for pain relief in cases where joint replacement cannot be an option.
- Total Joint Replacement – Orthopedists generally remove damaged portions of joint & insert prostheses made of plastic, ceramic or metal during joint replacement surgery.
All surgeries however carry risks of pain, infection & bleeding. Rheumatoid arthritis patients must therefore discuss risks & benefits of surgical interventions before undergoing surgical procedures.
Alternative Medicine for Rheumatoid Arthritis
There are many alternative treatments available for rheumatoid arthritis patients. However, some of the most common complimentary & alternative treatments which have shown promise rheumatoid arthritis conditions include the following.
- Fish Oil – Quite a few preliminary studies have shown that fish oil supplements can reduce pain & stiffness in rheumatoid arthritis patients. Side effects of fish oil however include belching, nausea & fishy taste in mouth. Moreover, fish oil can interfere with medications, therefore rheumatoid arthritis patients must check with the doctors first before consuming fish oil.
- Plant Oils – Seeds of borage, evening primrose & black currant contain certain type of fatty acids which can help with pain & morning stiffness among rheumatoid arthritis patients. Plant oil side effects include diarrhea, nausea & gas. Some plant oils are also found to cause damage to liver or interfere with some types of medications. Therefore, it would be sensible of patients to check with doctors before consuming plant oils.
- Tai Chi – This is a movement therapy which involves stretches & gentle exercises combined with deep breathing techniques. Many people normally use tai chi so as to relieve stress in life. Studies have shown that tai chi is suitable for reducing pain which is associated with rheumatoid arthritis. Moreover, tai chi is absolutely safe when performed under a knowledgeable instructor. However, rheumatoid arthritis patients must avoid any movements which generate pain.
Self Management, Lifestyle Changes & Home Remedies for Rheumatoid Arthritis
Rheumatoid arthritis patients can take the following steps for management of signs & symptoms. These self-care measures are very useful along with rheumatoid arthritis medications.
- Regular Exercise – Gentle exercises can help in strengthening muscles around joints & prove helpful in fighting fatigue for rheumatoid arthritis patients. However, it would be sensible for patients to check with their doctors before starting exercise. One good way is to begin with taking walks or try swimming, or indulge in gentle water aerobics. Patients must however avoid exercising when their joints are injured, tender or severely inflamed.
- Heat or Cold Applications – While heat can help ease pain & relax tense muscles associated with rheumatoid arthritis, applications of cold may dull sensation of pain. While providing a numbing effect, cold can also be helpful in decreasing muscle spasms.
- Relaxation Techniques – Rheumatoid arthritis patients must find ways to cope with pain while reducing stress in their lives. Techniques like distraction, guided imagery & muscle relaxation can prove to be very effective in controlling pain.
Coping & Support for Rheumatoid Arthritis Patients
Pain & disability which is usually associated with rheumatoid arthritis will affect the work & family life of the patient. Anxiety & depression are also common, as feelings of self-esteem & hopelessness. Degree of influence rheumatoid arthritis can have upon the daily activities of a patient will in part depend upon how well they are able to cope up with the disease. Patients should therefore talk to nurses & orthopedists about strategies to help with coping. However, over time patients will learn about which strategies will work best for them. Here are some tips which can help people cope with rheumatoid arthritis.
- Taking Control – Patients should sit & make plans with orthopedists for managing rheumatoid arthritis. This will eventually make them feel comfortable & in charge of the disease.
- Knowing the Limits – It is best to rest when feeling tired. Rheumatoid arthritis can make people feel prone to fatigue alongside weakness in muscles. Short naps & rest which do not interfere with nighttime sleep can be helpful.
- Connecting with Others – Rheumatoid arthritis patients should keep their families aware about their feelings. They may be worried about the patient but may not feel comfortable enquiring about pain. Patients can do well about finding a friend or family member with whom they could sit & talk, especially when they are feeling overwhelmed. They should make it a point to also connect with other people having rheumatoid arthritis, either online or through a support group located within the community.
- Sparing Time for Oneself – Keeping busy is easy & not sparing any time for ourselves is a bad idea. Rheumatoid arthritis patients must find time for what they like to do; it can be taking a walk, listening to music or writing a journal. They should utilize this time to relieve stress & reflect upon their feelings.
Excellent & Affordable Treatments for Rheumatic Arthritis in India
It is an excellent opportunity for international patients to undergo treatments for rheumatoid arthritis in India. There are several reasons as to why India has over the past few decades emerged as the favorite medical tourism destination for people all around the world. First & foremost is that Indian healthcare sector features a large pool of specialist doctors & surgeons who are some of the most reputed names in a global context. They are capable of performing the most complex procedures including orthopedic surgeries at par with the best in the world. Then there is an extensive network of nationally & internationally accredited multispecialty hospitals which are adhering to world-class standards & equipped with the most modern state-of-the-art technology to handle any type of medical problems. With rising cost of healthcare services around the world, treatments & surgical procedures in India are still reasonably priced. Last but not the least, highly skilled nurses & professionally trained technical staff is mostly conversant in English & therefore provide a soothing environment for the foreign patient during his/her recovery period. Moreover, Orthopaedic Surgery India is a specialty medical tourism company which can cater a range of seamless hassle-free healthcare services to international patients at affordable costs.