Dr. Laxmi Waprani

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Rheumatoid Arthritis treatment in Pune

Rheumatoid Arthritis: Symptoms, Diagnosis, and Treatment

Rheumatologist in Pune

Understanding Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is the most common type of autoimmune arthritis. The term “autoimmune” refers to the body’s immune system mistakenly attacking its own tissues.
RA affects around 1% of the world’s population and primarily targets the joints of the hands and feet, causing pain and swelling. In India, it is commonly known as Sandhivata, Amavata, or Gathiyavaat in different regions. A key characteristic of rheumatoid arthritis is its symmetrical joint involvement, meaning the same joints on both sides of the body are affected. For example, pain and swelling in both wrists, ankles, or knees. If left untreated, RA can cause permanent joint damage and deformities, which cannot be reversed.
Studies show that joint damage and cartilage degeneration begin as early as three months from symptom onset. Therefore, early diagnosis and treatment are crucial to prevent disability and joint replacement surgeries in the future.

Expert Rheumatologist in Pune

Dr. Laxmi Waprani, an experienced rheumatologist in Pune, specializes in Rheumatoid Arthritis treatment in Pune. She provides comprehensive care with a patient-focused approach to manage RA effectively.

Symptoms of Rheumatoid Arthritis

RA symptoms can vary, but the most common signs include:

  • Early morning stiffness: Stiffness in joints lasting more than 30 minutes after waking up or after periods of inactivity.
  • Fatigue: Constant tiredness and lack of energy.
  • Unexplained weight loss
  • Malaise: A general feeling of discomfort or illness.
  • Joint pain and swelling: Persistent pain, redness, and inflammation in multiple joints.

Diagnosis :

Diagnosis of Rheumatoid Arthritis

RA diagnosis is based on clinical signs and symptoms. There is no single test to confirm RA, but certain investigations can help support the diagnosis:

1. Rheumatoid Factor (RF)

  • RF is a blood test that measures the presence of rheumatoid factor antibodies.
  • It is present in 80% of RA patients, but 20% of RA patients do not have a positive RF.
  • Some people have a positive RF but do not suffer from RA.
  • RF may also be elevated in:
    • Other autoimmune diseases like SLE and Sjögren’s syndrome.
    • Infectious diseases like tuberculosis, syphilis, and malaria.
    • Chronic liver diseases and 5% of people over 65 years of age.

2. Anti-Citrullinated Peptide Antibody (ACPA or Anti-CCP)

  • This test is highly specific for RA.
  • A positive ACPA test indicates a 96–98% chance of having RA.
  • A negative test does not completely rule out 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 e.g: 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:
E.g 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.
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