Dr. Fahim Khan, Consultant Rheumatologist at Aut Even Hospital and the Beacon Hospital Dublin gives his advice on Rheumatoid Arthritis.
Rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. It is caused when the immune system (the body’s defence system) is not working properly. RA causes pain and swelling in the wrist and small joints of the hand and feet.
Treatments for RA can stop joint pain and swelling. Treatment also prevents joint damage. Early treatment will give better long term results.
Regular low-impact exercises, such as walking, and exercises can increase muscle strength. This will improve your overall health and lower pressure on your joints.
Studies show that people who receive early treatment for RA feel better sooner and more often, and are more likely to lead an active life. They also are less likely to have the type of joint damage that leads to joint replacement.
It is important to get the help of a rheumatologist. A rheumatologist is a doctor who treats arthritis and autoimmune disease.
There are diseases that can be mistaken for RA. It is important to get the correct diagnosis without unnecessary testing. A rheumatologist will help find a treatment plan that is best for your disease.
What is rheumatoid arthritis?
RA is the most common form of autoimmune arthritis. It affects more than 1.3 million Americans. About 75% of RA patients are women. In fact, 1 – 3% of women may get rheumatoid arthritis in their lifetime. The disease most often begins between the ages of 30 and 50. However, RA can start at any age.
RA is a chronic disease that causes joint pain, stiffness, swelling and decreased movement of the joints. Small joints in the hands and feet are most commonly affected. Sometimes RA can affect your organs, such as eyes, skin or lungs.
The joint stiffness in active RA is often the worst in the morning. It may last one to two hours (or even the whole day). It generally improves with movement of the joints. Stiffness for a long time in the morning is a clue that you may have RA, as this is not common in other conditions. Other signs and symptoms that can occur in RA include:
- Loss of energy
- Low fevers
- Loss of appetite
- Dry eyes and mouth
- Firm lumps, called rheumatoid nodules, which grow beneath the skin in places such as the elbow and hands.
What causes rheumatoid arthritis?
The cause of RA is not known. There is evidence that autoimmune conditions run in families. For instance, certain genes that you are born with may make you more likely to get RA.
RA is an autoimmune disease. Your immune system is supposed to attack foreigners in your body, like bacteria and viruses, by creating inflammation. In an autoimmune disease, the immune system mistakenly sends inflammation to your own healthy tissue.
The immune system creates a lot of inflammation that is sent to your joints causing joint pain and swelling.
How is rheumatoid arthritis diagnosed?
A rheumatologist is a physician with the skill and knowledge to reach a correct diagnosis of RA and to recommend a treatment plan.
RA is diagnosed by examining blood test results, examining the joints and organs, and reviewing x-ray or ultrasound images.
There is no one test to diagnose RA.
X-rays can help in detecting RA, but may be normal in early arthritis. Even if normal, initial X-rays may be useful later to show if the disease is progressing. MRI and ultrasound scanning can be done to help confirm or judge the severity of RA.
Blood tests are run to look for antibodies in the blood that can been seen in RA.
How is rheumatoid arthritis treated?
Therapy for RA has improved greatly in the past 30 years. Current treatments give most patients good or excellent relief of symptoms and let them keep functioning at, or near, normal levels.
With the right medications, many patients can have no signs of active disease. When the symptoms are completely controlled, the disease is in “remission”.
RA patients should begin their treatment with disease-modifying antirheumatic drugs — referred to as DMARDs. These drugs not only relieve symptoms but also slow progression of the joint damage. Common DMARDs include methotrexate, leflunomide hydroxychloroquine and sulfasalazine.
Janus kinase (JAK) inhibitors are another type of DMARD. People who cannot be treated with methotrexate alone may be prescribed a JAK inhibitor such as tofacitinib (Xeljanz) or baracitinib (Olumiant) Common Injection Therapy.
Include Etanercept (Enbrel), Adalimumab(Humira), Certolizumab( Cimzia,), Tocilizumab(RoActemra), Rotixumab and many more available and many other novel therapies on the horizon.
Living with rheumatoid arthritis
It is important to be physically active most of the time, but to sometimes scale back activities when the disease flares. In general, rest is helpful when a joint is inflamed, or when you feel tired. At these times, do gentle range-of-motion exercises, such as stretching. This will keep the joint flexible.
When you feel better, RA patients are encouraged to do low-impact aerobic exercises, such as walking, and exercises to boost muscle strength.
This will improve your overall health and lower the pressure on your joints. A physical or occupational therapist can help you find which types of activities are best for you, and at what level or pace you should do them.
The rheumatologist's role in the treatment of rheumatoid arthritis
RA is a complex disease, but many advances in treatment have occurred recently. Rheumatologists are doctors who are experts in diagnosing and treating arthritis and other diseases of the joints, muscles and bones. Thus, they are best qualified to make a proper diagnosis of RA. They can also advise patients about the best treatment options
The best treatment of RA needs more than medicines alone. Patient education, such as how to cope with RA, also is important. Proper care often requires a team of providers, including rheumatologists, primary care physicians, and physical and occupational therapists.
You will need frequent visits through the year with your rheumatologist.
These checkups let your doctor track the course of your disease and check for any side effects of your medications.
Also, you likely will need to repeat blood tests and X-rays or ultrasounds from time to time under the expertise of rheumatologist who will monitor your disease aiming to keep the arthritis in remission thus preventing further joint damage from Rheumatoid Arthritis.