Rheumatoid Arthritis

March 15, 2018 | By | Reply READ MORE...

Rheumatoid Arthritis (RA) is an autoimmune disease (where the body attacks its own cells).

RA is a joint disease that is caused by inflammation (red, swollen, painful, tender) in the tissues that produces lubrication fluid for joints. It also affects different systems of the body thus a systemic disease.

  • Affects women 3 times more often than men at all ages; usually affects in the middle age.
  • RA occurs more if individuals in family are affected, four times higher chances.
  • Rheumatoid Factors (RF) is an antibody that can be found in the blood of 70-80% of individuals with RA.
  • RA occurs in the absence of RF in a substantial number of individuals. In such individuals, who do not have RF have increased frequency of firm lumps under the skin, inflammation of blood vessels and multiple joint involvement.

SIGNS & SYMPTOMS:

  • Usually has a gradual onset.
  • There is swelling of the joints, which causes aching and limited motion. Joint stiffness occurs more in the morning. Usually there is pain on movement, and a slight increase in body temperature can be detected over the joints. Pain and stiffness worsens after strenuous activity.
  • Onset is usually in the smaller joints of the hands and feet. Usually symptoms are in both sides of the body; may start on one side but progresses to both the sides.
  • With progression, the joints become deformed and may dislocate partially.

  • Pain is often felt in adjoining muscles, and eventually muscle atrophy (wasting of muscles) and weakness occur.
  • The person often experiences other symptoms such as low grade fever, loss of appetite and weight, discomfort and fatigue.
  • The generalised involvement in RA leads to limitation in functional activities.
  • Other systems/organs that can get involved are: Musculoskeletal system, Cardiac system, Skin, 
Eye,
Respiratory system, Haematological (blood)

INVESTIGATIONS:

  • There is no pathognomic test.
  • Increased ESR and CRP reflect disease activity.
  • Anti-CCP antibody is more specific than, and as sensitive as, conventional RF in diagnosis of RA.
  • Radiographs of hands play a significant role in diagnosis of RA.

TREATMENT:

  • Treatment includes medications and physical therapy. It includes measures to help control inflammation and complications before the disease worsens. The aim is to stop the progression or reduce the flares and improving the physical function and quality of life.
  • Medications: Anti-inflammatory drugs and biological agents such as TNF alpha inhibitors, IL-1 antagonists etc.
  • Physiotherapy:
    • Patient education: importance of rest during the active period.
    • Joint protection techniques such as distributing the strain over several joints: when holding an item, even a cup, the patient should use both the hands in order to distribute the load over several joints. Balance between activity and rest: patient need to learn the importance of activity and rest and how to achieve a balance between them in daily life.
    • Energy conservation techniques such as work simplification: this is analysis of an activity within an environment to ensure that it is carried out in the most efficient way.
    • Minimize joint stiffness and maintain the available range of motion by active/passive exercises and relaxation techniques, strengthening exercises.

  • Protect the joint structures and prevent deformities by using assistive equipment and splints.

  • Modify any activities of daily living needed in order to protect the joints.
 Examples: use of a book rest while reading; increase grip of pen by enlarging handle with dense foam while writing.
  • Swimming is helpful as it allows exercises without much load on the joints.

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