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Rheumatoid Arthritis
Overview and facts
Rheumatoid Arthritis is different from Osteoarthritis which is an age related disorder. Rheumatoid Arthritis has no such known cause, so it is assumed that it is an autoimmune disorder characterized by pain and stiffness in the joints. Its usual onset is between 25-50 years of age but it has also been found in teens, therefore it can happen at any age, with women being 3 times more susceptible to men. Some people might have Rheumatoid Arthritis for a couple of years while some may suffer for lifetime. Rheumatoid Arthritis is common all over the world; making almost 1% people suffer from Rheumatoid Arthritis. Rheumatoid Arthritis affects 1.3 million people.
 
Symptoms
  • Inflamed joints characterized by swelling, heat, redness and pain
  • Bilaterally affected joints
  • Commonly affected joints are of wrists, hands, knees and legs.
  • Fatigue
  • Fever
  • Pain and stiffness lasting more than 30 minutes
  • Nodule formation in the finger joints
  • Skin disorders
  • Local osteoporosis

Causes

The exact cause for Rheumatoid Arthritis is still unknown. But still there are certain factors to which Rheumatoid Arthritis has been linked to, for example: genetic factors, viral or bacterial infections, and use of contraceptive medications.

Diagnosis and tests

For the complete diagnosis of Rheumatoid Arthritis, American College of Rheumatology, has given specific criteria to follow. This all depends upon the following
  • Medical history - Medical history of pain during the day, signs, and family history all play an important role in the medical history. Drug history is also relevant.
  • Physical examination -Physical examination involves the inspection of all the inflamed joints. Signs of swelling, pain and heat should be checked. Symmetry of joint involvement is also very important.
  • Laboratory tests - 
    • Rheumatoid factor will be present in 80% of the patients
    • Abnormal blood antibodies are present
    • Citrulline antibody (also referred to as anti-citrulline antibody, anti-cyclic citrullinated peptide antibody, and anti-CCP) is present in most patients with rheumatoid arthritis.
    • Antinuclear antibody (ANA) is also frequently found in patients with rheumatoid arthritis.
    • Erythrocyte Sedimentation Rate (ESR) will also be raised
    • Artherocentesis is a procedure that involves drawing off the joint fluid and analysis of the fluid. This can be done to check the presence of antibodies
  • Imaging procedures
    • X-rays are not much helpful in the initial cases but in advanced cases, the bone destruction can be seen.
    • CT Scans and MRI can be done in advanced cases to check the extent of joint destruction.

Treatment & care

Medications
Medications are always the first choice rather than jumping to the invasive techniques like surgeries. The commonly prescribed drug groups are
  • Non Steroidal Anti-Inflammatory Drugs (NSAIDs) (aspirin, ibuprofen, indomethacin and COX-2 inhibitors such as valdecoxib and celecoxib) are used to reduce inflammation and relieve pain.
  • Analgesics (acetaminophen, propoxyphene, mepeidine and morphine) relieve pain.
  • Glucocorticoids or Prednisone are prescribed to slow joint damage caused by inflammation.
  • Disease Modifying Antirheumatic Drugs (DMARDs) (methotrexate, injectable gold, penicillamine, azathioprine, chloroquine, hydroxychloroquine, sulfasalazine and oral gold) are used to slow joint destruction.
  • Biologic Response Modifiers (abatacept, etanercept, infliximab, adaliumumab and anakinra) modifies cytokines and help in immune boosting.
  • Protein-A Immuoadsorption Therapy is though not a drug, but a therapy that filter blood to remove antibodies and immune complexes that promote inflammation.

Surgeries
Surgeries though are invasive but are required in some severely damaged cases
  • Joint Replacement Surgery or Arthroplasty is the surgical reconstruction or replacement of a joint. This procedure is usually recommended for people over 50 or who have severe disease progression. Typically a new joint will last between 20 and 30 years.
  • Arthroscopic Surgery involves knees and shoulders treatments. In this procedure, the surgeon take tissue samples, remove loose cartilage, repair tears, smooth a rough surface or remove diseased synovial tissue.
  • Synovectomy is a procedure that involves removal of synovium. It may result in less swelling and pain and the slowing or prevention of further joint damage.
  • Arthrodesis or fusion increase stability of the joints in the ankles, wrists, fingers, toes and spine by fusing two or more bones together within the joint.

Alternative treatment options
  • Preparations made from botanicals (plants and their products, including herbs) can be helpful in controlling of the symptoms and the reversal of the damage.
  • Vitamins and minerals in unconventional amounts are also been observed to help
  • Other products taken by mouth, such as fish oil also increases immunity
  • Dietary approaches are also important as some foods and drugs can increase or reduce the symptoms
  • Preparations applied to the skin, such as balms and liniments
  • Hydrotherapy
  • Items that are worn (for example, magnetic clothing or copper bracelets)
  • Mind-body therapies such as relaxation techniques and meditation. A conscious mental process using certain techniques; such as focusing attention or maintaining a specific posture to suspend the stream of thoughts and relax the body and mind.
  • Ayurveda is a whole medical system that aims to integrate the body, mind, and spirit to prevent and treat disease. Therapies used include herbs, massage, and yoga.
  • Traditional Chinese Medicine (TCM) is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi.
  • Homeopathy can also be very helpful in many cases in reduction of the symptoms.
  • Acupuncture is intended to remove blockages in the flow of qi and restore and maintain health. It is very helpful in reduction of pain
  • Massage therapy also helps in reduction of pain and swelling

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