What is Rheumatoid Arthritis?
Rheumatoid Arthritis is a chronic inflammatory condition that causes pain, swelling, and stiffness of the joints, mainly those of the hands, wrists, and feet. Rheumatoid Arthritis affects the membrane lining the joints (called synovium) leading to swelling and pain of the joints. On the long run, erosion of the bones, as well as, deformity and displacement of the joints may occur. Periods when symptoms worsen are known as “flares” or “flare-ups”. Such flares are difficult to predict. Periods of inactivity are called “remissions”. With proper treatment such remissions may extend for months and sometimes years. With treatment the number of flares is reduced and any long-term damage to the joint is prevented or minimized thanks to new types of medications that have dramatically improved treatment. However, severe Rheumatoid Arthritis still causes physical disability.
What causes Rheumatoid Arthritis?
Rheumatoid Arthritis is an autoimmune disease, where the body’s immune system mistakenly attacks itself. Inflammation causes the synovium to thicken and may eventually lead to damage of bones and cartilages (stretchy connective tissue found between bones) within the joint. Tendons (that connect bones to muscles) and ligaments (that connect bones and cartilages) related to the joint weaken and stretch. These changes cause the joints to deform and move out of place.
What are the risk factors for developing Rheumatoid Arthritis?
- Women are more likely to be affected compared to men.
- Middle aged people are most commonly affected. However, it may affect any age.
- Family history of Rheumatoid Arthritis.
- Cigarette smoking is associated with increased risk and with more severe forms of Rheumatoid Arthritis.
- Exposure to silica and asbestos.
Symptoms of Rheumatoid Arthritis
Rheumatoid Arthritis usually affects small joints in the beginning and is commonly symmetrical, meaning that it affects the same joints on both sides and to the same degree. Commonly affected joints are those at the base of the fingers and toes. Symptoms usually progress over several week. With disease progression, wrists, ankles, knees, elbows, shoulders, and hips are affected.
- Fatigue and tiredness.
- Weight loss.
- Warm, swollen, tender joints.
- Stiffness of the joints in the morning and following periods of inactivity.
- Throbbing and aching joint pain that is worse in the morning or after periods of inactivity.
Due to the autoimmune nature of the disease it can affect different parts of the body such as:
- The skin.
- Bone marrow.
- Salivary glands.
- Heart and blood vessels.
How is Rheumatoid Arthritis diagnosed?
Rheumatoid Arthritis is difficult to diagnose as there is no single test or physical sign to diagnose it. However, a quick diagnosis is important so that treatment can start early and thus prevent damage to the joints.
Diagnostic tests include:
1. Blood tests indicating the presence of an inflammatory disease, such as:
- Erythrocyte sedimentation rate (ESR).
- C-reactive protein (CRP).
- Rheumatoid factor.
2. Imaging tests of the joints to assess the progression of the disease, such as:
Possible complications of Rheumatoid Arthritis:
Rheumatoid Arthritis may lead to occurrence of the following:
- Rheumatoid nodules: These are firm tissue bumps usually in the skin around pressure points such as the elbows. They may, however, develop in any part of the skin and within the lungs.
- Osteoporosis: May be caused by the disease itself or as a side effect for medications used in its treatment.
- Infections: These also occur due to the disease itself or as a side effect of medications as they both influence the immune system.
- Dryness of the eyes and mouth: the so called “Sjogren’s syndrome”.
- Carpal tunnel syndrome: Once Rheumatoid Arthritis affects the wrists.
- Arteriosclerosis (hardening or narrowing of the blood vessels) which leads to an increased risk of heart attacks and stroke.
- Lung diseases.
- Abnormal proportions of body fat.
Treatment of Rheumatoid Arthritis:
There is no cure for Rheumatoid Arthritis. However, clinical studies have shown that early treatment with so called “disease-modifying anti-rheumatic drugs” leads to remission of symptoms.
Treatment involves medications, physical therapy, and surgery.
- Non-steroidal anti-inflammatory drugs: to relieve pain and reduce inflammation.
- Steroids: reduce inflammation and slow joint damage.
- Disease-modifying anti-rheumatic drugs: these save joints and other organs from permanent damage by slowing the progression of the disease.
- Biologic drugs: these are new forms of disease-modifying anti-rheumatic drugs that target specific parts of the immune system triggering inflammation and thus causing joint and tissue damage.
2. Physical and occupational therapy may be required. Therapists teach patients exercises to keep joints flexible or suggest different ways to handle regular daily or work-related tasks.
3. Surgery may be required if medications fail to repair joint damage. Forms of surgery include:
- Repair of tendons.
- Removal of the inflamed synovium (synovectomy).
- Surgical joint fusion to stabilize displaced joints.
- Total joint replacement.
4. Lifestyle changes:
- Regular light exercise is advisable. However, it should be avoided during flare-ups.
- Applying cold and heat may be helpful.
Complications of medical treatment for Rheumatoid Arthritis:
Medication used to treat Rheumatoid Arthritis may cause several potential adverse evets:
1. NSAIDs may cause irritation of the stomach and kidney damage.
2. Steroids can cause weight gain, indigestion, insomnia, osteoporosis, cataract, diabetes, and hypertension.
3. Disease-modifying anti-rheumatic drugs may cause liver damage, severe chest infections, and suppression of the bone marrow.
4. Biologic drugs increase the risk of infections and blood clot formation in the lungs.
How to cope with Rheumatoid Arthritis?
Support is necessary for Rheumatoid Arthritis patients. Living with the disease is difficult and challenging. Flare-ups are unpredictable and interfere with work and social life. Anxiety and depression are common symptoms due to patients feeling helpless at times. Local support groups are available to help. Sharing experiences with people suffering from the Rheumatoid Arthritis usually proves helpful.
Possible role of IV Hydration for Rheumatoid Arthritis:
Intravenous (IV) hydration provided at Vida-Flo is a possible safe treatment option for patients with Rheumatoid Arthritis. IV hydration provides the body with large volumes of fluids intravenously which ensures 100% absorption. Vida-Flo fluids also provide nutrients, vitamins, and minerals required by the body and is suitable during periods of anorexia caused by Rheumatoid Arthritis. Specially formulated formulas of IV fluids at Vida-Flo for Rheumatoid Arthritis patients may contain Toradol an effective pain killer that might be useful during flare-ups.