Rheumatoid Arthritis is the most common type of autoimmune ( auto means self and immune is related to the immune system ) arthritis. It affects around 1 % of the world’s population. It is characterized by pain and swelling in multiple joints of the hands and feet. It is commonly referred to as sandhivata or aamvaat or gathiyavaat in different regions of India.

Rheumatoid arthritis is characterized by symmetrical involvement of joints. Which means the same joints on both sides of the body are involved. For example pain and swelling in both wrists or ankles or knees. Untreated arthritis leads to permanent joint damage and deformities that cannot be reversed. It is now known that joint damage and cartilage degeneration start as early as three months from the onset of symptoms. Early treatment can prevent joint damage and deformities and hence prevent permanent disabilities and joint replacement surgeries in the future. Hence it is very important to start treatment as early as possible.

Dr. Laxmi Waprani is an experienced Arthritis Specialist doctor in Pune. She specializes in Rheumatoid Arthritis treatment and provides comprehensive care to her patients with a wide range of treatments.

Rheumatoid Arthritis Symptoms

• Early morning stiffness: early morning stiffness in joints or stiffness after periods of inactivity lasting more than 30 minutes.
• Fatigue: feeling tired.
• Weight loss
• Malaise – a general feeling of discomfort or illness.
• Joint pain and swelling

Diagnosis :

Diagnosis of Rheumatoid Arthritis is essentially based on clinical signs and symptoms. There is no specific test to diagnose rheumatoid arthritis although there are a few investigations which may support the diagnosis of RA in association with clinical signs and symptoms, few of which are discussed below.

1. Rheumatoid factor (RF): Rheumatoid factor is a blood test that measures the amount of RF antibody present in the blood. Rheumatoid factor (RF) is present in 80% of people suffering from RA, therefore 20% of patients who are suffering from RA do not have a positive RF. On the other hand, few patients have a positive rheumatoid factor but do not have any signs and symptoms of RA. So what do we do in these situations? We should remember we are treating the patient and not the reports.
There are some conditions other than RA where we may find a positive RF, few of which are listed below :

• Other autoimmune diseases like SLE, Sjogren’s syndrome.
• Infectious diseases such as tuberculosis, syphilis, malaria.
• RF may be elevated in chronic liver diseases.
• RF is also positive in 5% of people over 65 yrs of age.

2. Anti-citrullinated peptide antibody ( ACPA or sometimes also referred to as antiCCP ): This is a more specific test for rheumatoid arthritis. Which means there is a 96 – 98% chance that you have rheumatoid arthritis if this test is positive. But again a negative result does not rule out the diagnosis of RA.

Treatment in Rheumatoid Arthritis:

RA is treated with the following groups of medicine:

NSAIDS ( Non steroidal anti inflammatory drugs): These are commonly referred to as pain killers. They provide both anti-inflammatory and analgesic benefits. However, they do not cure or alter the course of the disease and articular cartilage damage may continue despite symptomatic relief. Also, they cannot be taken indefinitely as they will lead to side effects. Hence they are used for the initial management of pain and stiffness until the effect of antirheumatic drugs is seen

Glucocorticoids: They are commonly referred to as steroids. They have earned a bad reputation because of their side effects. Irrational and long term use of these drugs does have serious side effects like osteoporosis, hyperglycemia, premature cataracts, hypertension, osteonecrosis etc. but when used judiciously, they have a great beneficial effect. As always like any other medicine, they should also never be used without being prescribed by a doctor.
Glucocorticoids have a disease modifying role in RA. It has been demonstrated that low dose of glucocorticoids ( < 7.5 mg prednisolone per day) taken for 1-2 yrs in addition to standard DMARDS like methotrexate have a powerful effect on reducing the progression of joint destruction in patients with early RA. Despite the favorable risk benefit ratio of low dose steroids, no dose is absolutely safe. All patients on steroids should be monitored for adverse effects and appropriate steps should be taken to minimize their occurrence for eg: bone protection strategies etc. the need of the hour is to strike a balance between efficacy and side effects while individualizing treatment plan. Thus steroids are not bad. Their inappropriate and injudicious use is. Disease modifying anti-rheumatic drugs (DMARD’S): These are also known as slow acting anti rheumatic drugs (SAARD’S ). They are neither pain killers nor steroids. The qualification ‘disease modifying ‘ is given to any anti rheumatic drug that has a positive impact on the radiological outcome of joint damage. DMARD’S constitute the backbone of pharmacological treatments of RA and all patients with RA are candidates for DMARD therapy. DMARD’S are of following two types.

Conventional DMARD’S: Eg : methotrexate , sulfasalazine, antimalarials ( chloroquine & hydroxychloroquine ), Azathioprine etc.
They need to be chosen wisely considering the contraindications in a given patient. For example, methotrexate cannot be given in a patient with interstitial lung disease. Sulfasalazine cannot be given to a patient who is allergic to sulfa drugs.

Biological DMARD’S : 
Biologics are designed to inhibit specific components of the immune system. They differ significantly from traditional drugs used to treat rheumatoid arthritis in that they target specific components of the immune system instead of broadly affecting many areas of the immune system. However, they are expensive and are reserved for those patients who do not respond to conventional DMARD’S.