Rheumatoid Arthritis: Is there a Solution, Doctor?
বাংলায় পড়তে এখানে ক্লিক করুন I
To find a solution, let's Know What is Rheumatoid Arthritis?
Rheumatoid Arthritis (RA) is one of the various types of Arthritis that you may suffer. It is an autoimmune kind of arthritis.
Autoimmune means your immune system( the body's defense mechanism or the bodyguard of our system) attacks your bones, joints, or tissues instead of attacking the outside foreign objects like bacteria and viruses for which they were meant to act.
So Why such a thing occurs?
It is yet clearly not know what is the exact cause behind such an Anomaly.
It's said to be Genetic most of the time with few genes responsible for the such outcome has already been discovered. And research is going on.
We have a much better understanding of the disease and as a result, better medicines are coming up quite rapidly.
Doctor, am I alone with this disease?
No, the latest study done in India states that the Prevalence is 0.75%. That means nearly 70 lakhs Indians are currently suffering from it.
What are the Symptoms that patients have?
In Rheumatoid Arthritis, these are the following things you may experience.
- Pains in Fingers or small Joints of the Hand or foot.
- Swelling with redness in The Joints.
- The Pain or stiffness increases tremendously in the Morning after getting up from Bed.
- Your Wrist, Elbow, Shoulder, and knees all can be Painful with noticeable Swelling and Redness as well as your Knees.
- Generally there is No Back Pain in the early stages of the disease.
- You may experience excessive Tiredness/ Fatigue
- Fever in the initial stages may also occur.
To Sum-up: There will be Pain in various joints of the body and Increase mainly after Rest.
In Late Stages or if not diagnosed early,
- There may be Eye Redness with itching ( though occasionally seen early also).
- Problems in breathing because of heart or Lungs getting Involved.
- Decreased bone strength due to Osteoporosis.
- Skin Problems like Rashes or Nodules.
How this genetics play role in Arthritis?
The immune system of your body protects you by attacking foreign substances — like bacteria and viruses — that enter the body. But sometimes, the immune system may mistakenly attack parts of the body like bones, cartilage, and the heart.
And research shows that people who have certain genes have higher chances of having rheumatoid arthritis as these genes control your Immune responses.
But Relax! Not everyone with these genes will have RA.
Examples of these Genes are:
- HLA: This gene site generally helps in differentiating your own cells against cells of viruses or bacteria. A person with HLA Genetic Markup has more chances of developing RA.
- STAT 4: This gene determines the immune response.
- PTPN22: This gene determines the onset and progression of the disease.
So, as you can see now it's a lot easier for your doctor to predict the disease outcome and progression.
If my parents have this disease will I have it too?
Sadly, the answers are quite complex. Rheumatoid arthritis is not considered a hereditary disease.
If your 1st-degree relative ( Mother, father, siblings) has this disease you are Three times more likely to have this disease than people with no family history of RA.
Do females have more chances of having Rheumatoid Arthritis?
Yes, Females are Two-Three folds more likely to have it than Males.
Then will it cause a problem in Pregnancy?
RA, generally directly doesn't have any effect on Pregnancy. But the Pain or Stress related to the disease may have an indirect effect.
Secondly, some drugs that are given to patients are highly toxic to developing babies as well as for Males it is toxic to the sperms.
Hence if you are pregnant or planning Pregnancy please inform your Doctor immediately.
N:B If you are a healthcare worker and wish to know more on the effect of RA on Pregnancy, Please click here.
Are there any Environment Related Risk Factors?
Yes, it tremendously affects RA. Like, Smokers are likely to have much more severe diseases as well as more prone to having the disease, and People who have been breastfed are less likely to suffer from the disease.
The following factors are said to trigger Rheumatoid Arthritis.
- Exposure to Air Pollution.
- Obesity.
- Cigarette Smoking and even Passive Smoking.
- Insecticide Exposure.
- Persons with a high intake of calories and low fiber in the diet.
- Even trauma can act as a trigger as well as emotional stress.
So, if you have a family history of the disease it's better to avoid the triggering factors to the extent possible.
What are the treatments Available?
Though the disease is yet to be said as curable but there are a lot of medicines available, if taken properly will keep you pain free for a long duration of time and even stop the progression of the disease.
Let's divide the treatment into Medical and Non-Medical Parts.
Medicinal Treatment:
The treatment protocol followed is almost the same worldwide.
Initially, your doctor will put you on some Pain killer drugs (Called NSAIDs), and Depending on your condition may add Steroids for the short term ( Yes Steroids!!, Explained later).
He will also put you on Special Drugs called DMARDs ( Disease Modifying Anti Rheumatoid arthritis Drugs). These drugs take time to start their action and are quite effective if started early ( May even halt the disease permanently as per the latest research).
Depending on your response and outcome of some blood tests the doses of these drugs are increased on subsequent visits.
If the Pain is still not reduced, there are some more powerful medicines called Biologics that may be added.
Is there a Role for Injections?
Yes, Since in this disease mainly joints are involved so Joint specific injections are given often.
Sometimes, the Biologics are too given not as a tablet but as Injections depending on Disease activity.
Finally: if the joint has deformed beyond correction you may require Surgery.
Non-Medicinal Treatment:
Exercises are one of the most important modes of treatment in a lot of diseases including Rheumatoid Arthritis.
For Details on Exercises. Click here.
Orthosis: Sometimes your doctor may suggest you some special belts to improve the joint deformities that have set in.
These belts help to remove excess pressure over a joint and improve its function.
If your foot is involved, you may be asked to wear special or modified Shoes.
During treatment, you mentioned Deformities, What are those?
If early treatment is not started and the disease progresses then many people have permanent deformities mainly in the Hand and Foot.
Deformities if sets in are mostly permanent and difficult to treat. So Never Ever Stop Drugs if not asked by your Doctor.
Steroids, Pain Killers, and then these Strong Medicines, What about Side-effects?
Almost no medicine is Free from Side-Effects !! Even the foods you eat have Side-Effects.
Diseases like Rheumatoid Arthritis which not only cause tremendous joint pain, it silently damage all vital organs like the Heart, Lungs, and Kidneys. Hence all these medicines are very important in preventing these.
The Medicines should not be stopped until and unless asked by your treating Doctors.
The side effects are routinely followed by your doctors and the dose of medicine is adjusted on regular basis keeping in mind the side effects.
Regarding the much talked about Steroids, it's recently said, the patients who were started on steroids early had a much better outcome and often most patients lived a long life completely disease free ( We call it, the Remission stage).
Most medications decrease the power of your immune system so that it doesn't attack the healthy tissues of your body. (So you know how important these drugs are)
Many times, maybe pain doesn't decrease on Medications and without any visible effect, patients tend to stop the Medicines, without realizing the harm as the medicines also work in keeping your Heart and other Vital organs safe and prevent joint deformities.
My doctor gave me a lot of Blood tests, are they really Needed?
This is really an issue, we must understand clearly.
Blood tests can be divided into three categories:
- Helps in diagnosing the disease: There is a criteria called EULAR criteria, it is used to Diagnose the disease, and hence Doctors give you blood tests like Rheumatoid Factor, Anti-CCP, then ESR and CRP.
- Helps in Knowing How much disease will progress: Anti-CCP and RF level in the blood helps in that, if the initial levels are very high, we generally have an idea that the disease is going to be severe.
- Helps in Knowing side-effects or Progression of the disease: ESR, and CRP Reports says us how much disease is in an active state in the body. Then Blood parameters like LFT, Ur, and Cr helps in Knowing if the drugs are causing damage to your Liver or Kidney. Then Blood Parameters like CBC help to know Hemoglobin status.
So, now you know how important these tests are. And hence these tests should be done from Reputed Labs ONLY !!
And what about other Investigations?
Today, with the advancement of Medical sciences we have a lot of advanced machines to see clearly what's actually going inside your body.
Ultrasonography: It's a machine that is used to diagnose the disease much earlier than blood tests become positive ( Still under research) and also helps to see Joint damages much earlier than they appear in X-rays !!
CT Scan of Chest: It helps in knowing the status of your Lungs. And in Patients with this disease for greater than 10 years it may be given if your doctor suspects the involvement of Lungs.
Rheumatoid arthritis is not an easy disease to treat After all!!
So, What are the foods that I should eat or should avoid?
This is a question we hear a lot and we have a separate blog for it. Please click here.
Overall you must drink a lot of water, avoid spicy foods, and have adequate nutrition.
Since rheumatoid damages your heart so it's always good to avoid foods that are bad for the Heart.
And back to our First question, Is there a Solution?
Yes, if treatment is started early (within 3 Months of 1st symptoms), often we are able to stop the disease progression and reduce the pain completely.
Taking medicines properly too can keep you so fit that you won't ever feel there is a disease.
Unfortunately, it is still treated as a disease that doesn't have any cure, and hopefully, in near future, we will have it Soon.
Hopefully, we were able to explain most of the things, yet it's human to miss something, please let us know in the comment section if you would like to know more.