Rheumatoid Arthritis Awareness by Dr. Shama, Consultant Rheumatologist, Tirupati

HealthHOD
Jul 27 ^th, 2024

Introduction

Rheumatoid arthritis is a chronic autoimmune condition that can be managed with medications such as methotrexate. This drug, while effective, may cause various side effects that patients need to be aware of. Dr. Shama, MBBS, DNB, PDF (Rheumatologist) provides valuable insights into the possible side effects of methotrexate and offers guidance on how to manage them. Understanding these potential risks is essential for those undergoing treatment to ensure their safety and well-being.

1. What is RA?

Rheumatoid Arthritis (RA) is an autoimmune disease where in the immune cells of your body are unable to recognize the difference between self and non-self. Hence, they start fighting against the cells of your own body instead of fighting against infections.

It is characterized predominantly by ‘inflammatory arthritis’, meaning, the patient experiences swollen, painful and stiff joints.

It usually occurs in young and middle aged people and is more common in females compared to males.

If not diagnosed and treated at the earliest possible, this disease may lead to complications like deformed joints, involvement of other organ systems like lung, nerves, eyes etc.

2. What are the common symptoms of rheumatoid arthritis?

Symptoms commonly include

Swelling of small joints of the hands, wrists, legs including knees, ankles and small joints of feet.
Pain in the joints associated with limitation of movements in that particular joints.
Characteristic symptom of rheumatoid arthritis is the ‘early morning stiffness’ in the affected joints, which means your joints are very stiff in the early morning hours and the stiffness does not allow you to do routine morning activities. This stiffness gradually reduces over the day as you start doing your activities.
Sometimes it can also affect the tendons and ligaments causing tenosynovitis, tendinitis etc.
The swellings can sometimes compress the nearby nerves causing neurological symptoms in that particular area e.g., carpal tunnel syndrome.

3. Does Rheumatoid arthritis affect other organs apart from joints?

Yes, sometimes it can also affect your lungs, eyes, salivary glands, nerves etc. and cause symptoms.

Patients with rheumatoid arthritis can present with symptoms of dry cough and exertional breathlessness or fatigue, which indicates the involvement of lungs (Interstitial Lung Disease).

Few patients who have long-standing rheumatoid arthritis also complain dryness in eyes and oral cavity (keratoconjunctivitis sicca) because of the involvement of the salivary and lacrimal glands (produce saliva and tears respectively).

When the disease is severe, it can cause any of the following symptoms:

Fever, weight loss, skin rashes, gangrene of fingers and toes, redness and pain in eyes, blurring or loss of vision and neurological symptoms like tingling and numbness of hands and feet.

4. Is it cured with medication or do we need surgery?

Main modality of treatment is with tablets and injections (csDMARDs and Biologics-monoclonal antibodies). Medications provide relief of symptoms but do not cure the disease.

Surgery: Supportive surgeries may be needed in cases of deformities of hands or degenerative joint disease secondary to rheumatoid arthritis e.g., knee osteoarthritis. Again, one should know that these surgeries do not cure the disease but may help improve the quality of life.

5. Is Rheumatoid arthritis curable?

Rheumatoid arthritis is a chronic disease that has no cure as of now. Patient can have both good and bad days called remission of disease and flare of disease respectively.

Treatment and follow-up with rheumatologist is required on a long-term basis.

6. Does it have any effect on pregnancy or the unborn child?

Rheumatoid arthritis can have variable effects on both the mother and the unborn child during pregnancy and it depends on multiple factors like medications, pre-pregnancy disease status etc. Consulting your rheumatologist well before planning pregnancy will help in better understanding of the same.

7. Does rheumatoid arthritis affect children?

Yes, it can affect the children as well and it is known by the name Juvenile Idiopathic Arthritis (JIA).

8. Are there any lifestyle changes or dietary adjustments that could help manage rheumatoid arthritis?

Lifestyle modifications:

While the medicines alleviate symptoms, exercises and physical activity are mandatory on a daily basis for rheumatoid arthritis patients in order to provide strength, avoid stiffness, joint contractures and muscle atrophy.

Diet:

A healthy and balanced diet is need of the hour for any chronic disease. There is no specific dietary restriction for patients with rheumatoid arthritis. However, few patients do complain that their symptoms get aggravated on eating tangy food items. In such scenarios, they can avoid such foods aggravating their joint symptoms.

Patients with rheumatoid arthritis have a tendency to develop weak bones due to loss of calcium from their bones hence they need to take a diet rich in calcium and they may also need additional calcium and vitamin D supplements.

9. Is physical therapy or rehabilitation necessary for this condition?

Yes, definitely.

Physiotherapist and occupational therapist play an important role in managing patients with rheumatoid arthritis. Customized exercises, physical activity, ergonomics and supportive orthotics are advised based on individual needs in patients with rheumatoid arthritis.

10. Whom to consult in case of suspected symptoms of rheumatoid arthritis? (Orthopedician or Rheumatologist)

Rheumatoid arthritis is a multisystem autoimmune disease and treatment decisions are complex based on the involvement of organ systems other than joints. Hence, it is always suggested to consult a Rheumatologist for appropriate diagnosis and treatment.

In case if a rheumatologist is not available at your place kindly, consult your general physician for relevant assessment and subsequent specialist referral.

Conclusion

Rheumatoid Arthritis is a complex autoimmune disease that requires ongoing management and a multidisciplinary approach involving rheumatologists, physiotherapists, and possibly other specialists. While there is no cure for RA, early diagnosis and appropriate treatment can help manage symptoms and prevent severe complications. Patients should maintain regular follow-ups with their healthcare providers and adopt healthy lifestyle changes, including balanced nutrition and physical activity, to improve their quality of life. For anyone experiencing symptoms of RA, consulting a rheumatologist is essential for proper diagnosis and treatment planning. Remember, proactive management and support can make a significant difference in living with rheumatoid arthritis.