Doctor in BBR Super Speciality Hospital
Submit a review for BBR Super Speciality HospitalYour feedback matters!
Rheumatoid arthritis is chronic inflammatory arthritis with a prevalence of 0.5-1% in India. It is characterized by joint pain and swelling associated with morning stiffness lasting for more than 30 minutes. It generally has a slow onset - over weeks to months, though the onset can be acute also. Most common joints involved are small joints of hands and feet. Larger joints like knee and shoulder can also be involved. The incidence of RA increases with age. It is twice more common in females than in males. Early treatment is necessary to bring down the inflammation, avoid joint deformities and prevent other complications ( lung, heart, vasculitis).
Predisposition to RA is multifactorial. It has a genetic component (family history of RA increases the risk). Environmental factors like smoking also play a role.
Initial symptoms start with fatigue, malaise, generalised body aches, low-grade fever. The onset is generally slow and eventually, the patient develops joint pain and swelling. Though the joint involvement is symmetrical in most cases, asymmetric onset is common (involving joints predominantly on one side).
Diagnosis is made by a physician after detailed history, clinical examination and supportive lab tests. Rheumatoid factor and anti-CCP antibody are positive in 75-80% of patients with RA. They have raised inflammatory markers (ESR, CRP) during active inflammation.
RA treatment options are wide and quite effective. It starts with patient education regarding the nature of the disease and the risk of complications. The need for early aggressive therapy should be emphasized. The patient should put in efforts for physiotherapy which play a very important role in muscle strength and joint mobility. Pharmacotherapy options are wide and include disease-modifying antirheumatic drugs ( DMARDs). These can be conventional DMARDs like methotrexate ( usually the first line drug), sulfasalazine, hydroxychloroquine, leflunomide. Failure to adequately respond to these drugs should lead your Rheumatologist to consider Biologic DMARDs ( TNF antagonists, Rituximab, Abatacept, Tocilizumab). Your Rheumatologist is the best person to guide you about dose, indications, monitoring and side effects of the drugs used in RA. Treatment duration depends on a patient's response but is generally long ( 5-10 years or lifelong).
COMPLICATIONS BEYOND JOINTS:
RA patients can have rheumatoid nodules in skin, lungs, heart and other sites. These patients are at risk of accelerated bone loss, so calcium and vitamin D intake should be optimized. Eye complications include dryness, redness ( scleritis and episcleritis) and certain eye threatening complications. Lung involvement can be seen in various forms ( fluid in lungs, nodules, interstitial lung disease).
These patients are at high risk of atherosclerosis ( heart and blood vessel disease). They also have a tendency to have frequent infections.
NEED OF THE HOUR:
All patients with joint pains should be seen early by Rheumatologist for diagnosis and treatment. With so many treatment options, no patient should suffer from joint deformities and other complications associated with long-standing, untreated RA. LEAD A HEALTHY LIFE!
The human spine has 33 vertebrae. However, some conditions can fuse these vertebrae. Ankylosing Spondylitis is one such condition. This disease may also be known as AS or Bechterew's disease. It is an inflammatory disease that can make the spine less flexible by fusing the vertebrae of the lower back together. In some cases, it can also affect the rib cage and make it difficult to breathe. This disease typically affects more men as compared to women. Most patients begin showing symptoms in early adulthood.
Ankylosing Spondylitis affects sacroiliac joints. These joints are located just above the tailbone. It causes inflammation of the spinal bones that in turn cause pain and stiffness. With time, this inflammation spreads to the entire spine and the vertebrae begin fusing together. This can make movement difficult and painful. In severe cases, it can also lead to the development of a hunchback. This disease also affects the other tissues of the body. For example, it can affect other joints and aggravate arthritis or affect organs such as the kidney, heart, lungs, and eyes.
A specific cause has not yet been identified for Ankylosing Spondylitis. However, studies show that genetic factors can be a trigger. In particular, the presence of the HLA-B27 gene increases a person’s risk of developing symptoms pertaining to this condition. However, it is important to note that merely the presence of this gene does not make Ankylosing Spondylitis inevitable. Other genes that are associated with this disease are ARTS1 and IL23R. These genes influence the functioning of the immune system. While it can affect people of all ages, adults are at a higher risk of suffering from this condition.
In many cases, the initial inflammation of the spine is due to a bacterial infection of microbial infection. Though the infection itself may be treated and cured, it may cause the immune system to react and trigger inflammation. Once activated, if the immune system cannot be turned off, this inflammation will continue and can trigger Ankylosing Spondylitis. In each case, the disease presents a unique pattern of progression.
There is presently no cure for this condition, but with early diagnosis and treatment, the symptoms can be managed and progression can be slowed. This treatment usually takes the form of medication to relieve pain, inflammation and discomfort and physical therapy. Surgery cannot be used to treat Ankylosing Spondylitis but in cases where it has caused severe joint damage, surgery may be advised to replace the damaged joint.