Rheumatoid Arthritis
Rheumatoid arthritis (RA) is the most common type of chronic progressive systemic inflammatory disorders that can affect many organs throughout the body, with the joints usually most severely affected. The specific cause of rheumatoid arthritis is unknown. Approximately 1 in every 100 individuals has rheumatoid arthritis. The risk of RA is increased in women who have never been pregnant and in women who have recently given birth. Women to men ratio for RA are about 3:1.
Risk factors for RA include
- Genetic factors.
- Infections (bacteria or viruses).
- Cigarette smoking.
- Stress and age.
Signs and symptoms
Early signs: fatigue, muscle pain, a low-grade fever, weight loss, Joint pain, stiffness (worse in the morning for more than 1 hour), and swelling in the hands, wrists, elbows, shoulders, knees, ankles, feet, hips and neck. Gel phenomenon is defined as stiffness and immobility after sitting still for a period of time. RA nodules are painless lumps under the skin on the dorsal aspect of the fingers, around the elbows or Achilles tendons. Other organ involvement in RA patients: Pleural and pericardial fluid collection. Inflammation of the lung may cause shortness of breath and a dry cough. Inflammation of the eyes may cause vision problems. Dry eyes and dry mouth. Blood tests positive in RA: Rheumatoid factor (RF), anti -CCP Antibody, positive ANA, high C-reactive protein and anemia.
Treatment
Nonsteroidal anti-inflammatory medication (NSAIDs) used to reduce the inflammation in the joints and subsequently to relieve the pain. NSAIDs do not reduce the long term damaging effects of rheumatoid arthritis on the joints (do not stop the disease progression). Disease-modifying antirheumatic drugs (DMARDs) may reduce the inflammation of RA and can slow disease progression and prevent joint damage. Drugs in this class include hydroxychloroquine, methotrexate, sulfasalazine, leflunomide. These medications act slowly, in several weeks to months. The biologic medication is an advanced therapeutic option for severe RA working as a down-regulator of the immune system to prevent tissue damage. Anti-TNF agents bind the immune cytokine molecule named tumor necrosis factor (TNF) and include: Etanercept (Enbrel), Adalimumab (Humira), and Infliximab (Remicade). Abatacept (Orencia) interferes with the activation of T cells. Abatacept is now approved for use in moderate to severe RA treatment as first line therapy or if failing the DMARD therapy. Rituximab (Rituxan) depletes a subpopulation of immune cells named B cells. Rituximab is usually recommended only for people with moderate or severe RA that is not controlled with methotrexate and an anti-TNF agent. Steroidal medication like Prednisone and Prednisolone has rapid and strong anti-inflammatory effects and are usually used in emergent situations. Due to severe and multiple side effects (bone loss, hypertension, weight gain, skin fragility, diabetes, cataracts etc) steroids are usually used at the lowest possible dose for the shortest period of time. Simple analgesics relieve pain, but they have no effect on inflammation and include: Acetaminophen (Tylenol), Tramadol (Ultram), and Voltaren gel or Diclofenac (Flector) and Lidoderm patches. Narcotic analgesics such as codeine, oxycodone, and hydrocodone are generally not recommended long term because of the risk of dependence and addiction.