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Rheumatoid arthritis is a symmetric, inflammatory, peripheral polyarthritis of an unknown cause. In typical conditions, it leads to deformity of joints due to the erosion of cartilage and bone. Most times, it can be controlled through anti-inflammatories and therapy. If the symptoms are unresponsive to these solutions, joint destruction can lead to a loss of physical function, and in some cases, even carrying out daily tasks and maintaining employment.
Early recognition of RA and treating it with disease-modifying anti-rheumatic drugs (DMARDs) is essential in gaining control over the disease and further preventing joint injury and disability. However, in patients with early stage, it is often difficult to distinguish from other forms of inflammatory conditions. There are some more distinctive signs of RA like rheumatoid nodules, +ve RA Factor, joint erosions, but those signs are only seen at an advanced stage of the disease.
Rheumatoid Arthritis Symptoms:
The initial indication of RA can either include one or all the signs given below depending on a particular case. The initial evaluation of patients with these signs requires a precise physical examination along with selected laboratory tests.
Some common signs are given below:
1. Morning Joint Stiffness-
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A prominent sign of RA is the presence of joint stiffness as soon as your morning clock strikes. This is because the joints which are affected by RA are stiffer in the morning as compared to during the day.
The level of stiffness in the morning is one of the measures to understand the severity of RA in a patient. This stiffness reduces as the patient responds to the various anti-inflammatories.
2. Low-Grade Fever-
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When RA is actively causing inflammation in some patients, fever doesn’t occur. Patients with RA require frequent medication that causes the strength of your immune system to reduce. Hence, whenever the patient has a low-grade fever, infections should be suspected and one should try to find the underlying cause.
3. Little Joint Swelling-
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Swelling of joints from RA is caused by the inflammation present especially when the flare is active. The pain can persist even when the flare is in remission, but that happens only if the joint has been permanently damaged. It causes the joint to swell for two primary reasons, one is thickening of the joint lining tissue and the other is excess joint fluid.
So the joint destruction can be caused by damaged cartilage, bone, and ligaments. If the affected joint is used even after the destruction, it can cause intense pain.
Image Credit: The Chopra Centre
With much of inflammation sticking around in the body, it is only natural to experience fatigue. In RA, the healthy cells in the system are misinterpreted as foreign invaders hence the body is fighting for its survival, but affecting the overall health in the progress.
5. A range of Motion Decreased-
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The most common sign of RA is swollen joints which further reduces the range of motion of our body. At the times when the swelling is minimal, the motion can be stretched, but most times, the motion of the affected joint is severely affected.
For an example: Join swelling in the finger can make it hard for the person to wear or take off rings.
Low Positive/High Positive for Rheumatoid Arthritis:
The points given below are used to diagnose if the confirmation is low-rise or high-rise
- 2 to 10 large joints= 1 point
- 1 to 3 small joints= 2 points
- 4 to 10 small joints= 3 points
- Low positive = 2 points
- High positive = 3 or more than 3 points.
Tests to confirm Rheumatoid Arthritis:
Symptoms of arthritis that have been present for only quite some time may be due to some other condition other than RA. The longer these signs persist, the stronger the diagnosis get. Along with the physical examination, certain tests can be utilized to thorough the diagnosis.
1. RF and anti-CCP antibodies-
Both these tests are done in patients with a suspicion of RA. A positive result of either of these increases the overall diagnostic, while the specificity of RA, is confirmed only when both the tests are positive.
2. ESR & CRP Level-
Both ESR & CRP Level are elevated in RA.
Abnormal CBC with anaemia is common when there is chronic inflammation in the body. Liver and Kidney abnormalities can also point to a disorder other than RA.
4. Radiographs of the hands, wrists, and feet-
Radiographs are also to know the progression of the disease. Also, there can be erosion in the joints even in the initial stage which can be used to provide aid to the patient.
Treatments for RA
The treatment of RA is directed towards mitigating the inflammation and further preventing joint injury. The treatment is also partially dependent on the progression of the disease. Early diagnostic can help prevent any joint erosion, however, if the joint has already been affected, the course of treatment can be different.
Types of Medication:
- DMARDs- These antirheumatic drugs have a potential to slow/stop the radiographic progression. The initiation of therapy is done using DMARDs.
- NSAIDs- Use of anti-inflammatory therapies, including nonsteroidal drugs for patients not responding to DMARDs.
- Biologics- For moderate to severe RA, Biologics can help prevent joint deformity. These genetically engineered proteins are made from human genes. Some likely options include Orencia, Anakinra, Cimzia, Erelzi, etc.
- Steroids-Steroids reduces inflammation in the body but they also reduce the activity of the overall immune system making you more prone to infection/bacterias. They can be given by mouth or through an injection.
Non-Drug Treatment for RA:
- Physical therapy- The main goal of physical therapy is to keep the patient moving. We take our healthy moving joints for granted, while, when you have RA, that’s not so much obvious. However, daily physical therapy can make those movements smooth.
- Surgery- When there is a clear damage to the joint and medicines can’t fix it, surgery is the next step. Any surgery can have complications, so you should speak to your rheumatologist before moving on that track.
- Natural Remedies- Food with anti-inflammatory properties can help in patients with RA. Some of the anti-inflammatory food include turmeric, green vegetable, nuts, etc.
- Acupuncture- Form of ancient Chinese medicine, acupuncture is done through very fine stainless needles to stimulate the energy-carrying channels in the body.
While there is no specific ‘diet’ or ‘medicine’ which can completely eliminate RA from your system or reverse the autoimmune disorder, self-care and conscious living are the way to handle the flare-ups.
With diet and medicine in check, resting, especially when RA is active is paramount.