Health Management

Rheumatoid arthritis – Stages, diagnosis and Treatment

Rheumatoid arthritis

Rheumatoid arthritis is a very serious autoimmune inflammatory disease of joints. In rheumatoid arthritis the body’s immune system is directed against its own cells that results in inflammation. Several joints appear Swollen and painful due to which the movement on those joints becomes nearly impossible. the patient usually complains of Fatigue, fever, loss of appetite, pain, swelling, Redness, morning stiffness, tenderness in joints and Joints are usually warm. This result in destruction in general joint structure. It can occur at any age, but usually starts developing between 30s to 60s and the chance of RA increases with advancing age. RA is more common in women then in men. Rheumatoid arthritis is it condition rather than a disease that means it cannot be fully treated but can be managed. The management of rheumatoid arthritis means to prolong the course of destruction of joints and slow down its progression. Falling are the approaches doctors use for the treatment of rheumatoid arthritis.

Pathogenesis of rheumatoid arthritis

Several environmental factors such as cigarette smoke, industrial Pollutants, GT disturbance and bacterial or viral infections all contribute to the onset of rheumatoid arthritis. These factors lead to the breakdown of immune tolerance, activation of the B and T lymphocytes and production of autoantibodies, that in turn leads to the Inflammation of joints.

Stages of rheumatoid arthritis:

Following are four stages of rheumatoid arthritis.

  •  Synovitis

Synovitis is an inflammation of synovial membrane. First stage of rheumatoid arthritis is synovitis. During this stage, The patient experience mild symptoms such as stiffness and joint pain in small joints of hands and fingers. In this stage the immune system begins to attack joint, As a result, causing inflammation, joint pain and swelling.

  •  Pannus formation

swelling continues Resulting in thinning of Synovial membrane/ cartilage. The cartilage, which was previously acting as the cushion. Stiffness and pain worsens And the disease may progress to next stage.

  • Fibrous ankylosing

In third stage of rheumatoid arthritis, the joint structure Starts getting damaged. The Fibrous connective tissue starts to join Resulting in severe Limitations in ROM (Range of motion). At this point The joints will start appearing Bent and crooked.

  •  Bony ankylosing

It is the last stage of rheumatoid arthritis. During this stage, the bones fused together Making Joint impossible to move. I.e. loss of range of motion. Last stage of rheumatoid arthritis is usually asymptomatic (Without pain).

Rheumatoid arthritis

Diagnosis

at present different diagnostic criteria are available that help in diagnosis of rheumatoid arthritis properly. following are the criteria for the diagnosis of rheumatoid arthritis;

  •  joints involved:

If 3 to 10 large joints or three or more small joints are symptomatic there are greater chances that the patient have RA.

  •  Serology:

if positive RA factor and ACPA (anti citrullinated protein antibody) are present in Serum, then the patient is most probably suffering with RA.

  •  Duration of synovitis:

If the patient is suffering from synovitis for more than six weeks, he\she is diagnosed with rheumatoid arthritis.

  •  acute phase reactants:

abnormal CRP (C reactive protein) and ESR (Erythrocyte sediment rate) Levels also denote Rheumatoid arthritis.

Diagnostic tests

MRI and ultrasound are widely used for accurate diagnosis of disease as these tests can show the joint structure. These tests also help the practitioner to evaluate the damage in the joint in early stages of joint damage. X- rays are also used to check rheumatoid arthritis but they are not accurate. Moreover, x-rays can also show the destroyed joint structure but in late stages.

Treatment

The safest treatment method for rheumatoid arthritis is to control the symptoms such as pain and inflammation of the disease during flares. Though there is no cure for rheumatoid arthritis available at present but medicine such as NSAIDs (nonsteroidal anti-inflammatory drug), DMARDs (disease modifying anti rheumatoid drugs), Steroids and COX-2 inhibitors are widely prescribed by the doctors for the treatment of rheumatoid arthritis.

  •  NSAIDs

non-steroidal anti-inflammatory drugs Are used for decreasing the inflammation pain and swelling in joints. but the biggest drawback with this class of drugs is that it does not slow down the course of disease. the mechanism of action NSAIDs, is they act by decreasing the prostaglandin levels (inflammatory mediator), Which are produced by COX-1 and 2.

  •  DMARDs

Disease modifying anti rheumatoid drugs Also help in decreasing the inflammation. The drawback with DMARDs Is that they are slow acting drugs. that means these drugs cannot provide immediate relief to patients. the mechanism of action of DMARDS is they act by suppressing body’s immune system.

  •  Steroids

Corticosteroid is usually prescribed in immune-compromised patients. they act by modifying the pattern of disease. they usually help patients by relieving their symptoms (specially pain). But like every steroid, corticosteroid also have side effects depending on their dosage and duration of treatment.

  •  COX-2 inhibitors

COX-2 inhibitors are being used currently for rheumatoid arthritis. they effectively reduce the symptoms of rheumatoid arthritis by reducing the secretions of prostaglandins. but like any other drugs COX-2 inhibitor’s also show some adverse effect for example, impaired renal function, hypertension, oedema, ETC.

Research

Currently different research studies are being carried out globally Regarding rheumatoid arthritis. These researchers include development of new medicines to treat disease, Studying the cause of the disease, finding out the risk factors for the disease and studying the effect of Treatment and
Disease itself. The latest of which Showed that the use of new medicines against RA will cause dementia 16% more the those who used older medicine for treatment. With the advancing age, the incidence of disease increases.
Epidemiologists have estimated the prevalence of RA to be around 0.25 to 1% globally at present whereas the incidence of RA shows that 350 million people (mostly women) in the world (greatest in China) have rheumatoid arthritis at present.

Conclusion

Arthritis is a lifelong, serious, autoimmune, inflammatory disease of joints which starts from affecting small joints of hand and progress to multiple larger joints. the progression of disease is usually insidious. the patient experience flares (the time when the symptoms are intense) and remission (the times when symptoms are absent) of symptoms alternatively. there will be some days, when the patient will complain of intense pain and other days when the patient feels fine. This disease has degenerating effect on joints that resulted in destruction of joint structure and function (movement) making it impossible to move. The biggest problem associated with remote arthritis is non availability of suitable treatment or cure.

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