Published in Panorama
Rheumatoid Arthritis …. A winter malady.
We are into the winter months and with it come certain health disorders that range from being minor irritants to ailments causing considerable discomfort and pain. Rheumatoid Arthritis (RA) is one of these cold-related maladies, affecting about 20% of people at any point of time in any given population, according to Dr.Jamil Ahmed, Director and Consultant Orthopedic Surgeon, Prime Medical Centre, Dubai.
Dr.Jamil explains, “It is an autoimmune disorder, chronic and inflammatory in nature, that chiefly affects the synovial membranes of multiple joints in the body. Basically we have a defense mechanism in our body where any foreign particle is engulfed by phagocytes, a type of white blood cells. In RA, this mechanism is altered whereby the body’s own tissues are treated as alien and the phagocytes start engulfing them and set in progress the inflammatory process. This is followed with the erosion of the cartilage on the joints which further leads to swelling and inflammation. This process normally begins with the synovium which is the lining within the bag of tissues around the various joints in the body.”
With the erosion comes the reduction of the joint spaces and consequent loss of movement attended with pain. The first symptoms of RA, says Dr. Jamil, are pain, swelling, tenderness and redness around the affected joints with classical morning stiffness. Usually, the small joints of the hand, wrist, and foot are the first to be affected and in most cases the joint involvement in the limbs becomes relatively symmetrical, affecting both, right and left sides of the body, simultaneously. The disease can affect many joints in the body, including the knee, ankle, elbow, and wrist.
The main problem associated with RA is the loss of mobility, deformity and dislocation of joints in the more severe cases which are a source of cosmetic concern besides making for functional loss. “Untreated RA can cause situations worse than death, leading to a person becoming crippled, confined to a wheelchair with mobility severely restricted when multiple joints are involved.”
Dr. Jamil elaborates on the more serious effects that RA can bring on. “Being a systemic disease, it can attack other parts of the body besides the joints. Because of this systemic involvement, patients may experience fatigue even though there are no specific joint complaints. The complications from RA include problems in the nervous system causing sensory loss, spinal cord compression, eye lesions particularly in children, leading to blindness, rheumatoid nodules and other skin problems whereby the patient’s skin can become fragile and bruise easily. Some patients may develop obstructive lung disease, making for breathing difficult, have recurring infections in the lungs, inflammation of the pericardium in the heart, spleen enlargement and consequent anaemia.”
Who are the people likely to suffer from RA and what factors cause the disease? Genetics certainly plays a major role in the disease but RA need not necessarily be hereditary, opines Dr.Jamil. While the cause of RA is yet unidentified, Cold Weather, emotional or psycho somatic disorders, sedentary lifestyles are found to aggravate the symptoms of RA. The malady usually affects adults in their mid forties and is more common among women than men. Of course, there is a variant of the disease which is quite rare, says Dr.Jamil, called Juvenile Rheumatorid Arthritis which affects young children, generally between the ages of 6 and 15, which is also one of the causes of childhood blindness. In this juvenile case, there is generally an involvement of the heart and liver besides the eyes, according to the specialist.
How is RA diagnosed? Clinical and physical examination of the patient presenting classical symptoms are followed up with blood tests and investigation for the RA factor which returns positive in 80% of the cases.
In most cases of RA, the patient has remissions and exacerbations of the symptoms whereby there are periods of time when the patient "feels good" and times when he "feels worse". What is important to know about RA, says Dr.Jamil, is that “there is neither a preventive nor a curative for it! Since the cause is unknown, you can only control it or prevent its harmful effects to some extent. And this can happen with an early diagnosis.
Having diagnosed the problem, what would be the course of action to follow? Dr. Jamil emphasizes that “since the disease is a chronic one involving a long term treatment, we do not overdrug the patient in the early stages. We can initiate treatment with the first stage of management which is using basic anti-inflammatory medication with analgesics like paracetamol, splinting and physical therapy. Physical therapy may be the sheet anchor in the treatment of RA involving exercises to keep the joints mobile.”
Treatment with steroids, says Dr.Jamil may be taken recourse to when the patient does not respond to the initial treatment. “Nowadays we also use immuno-modulators like the ones we use in cancer therapy, to treat RA victims. Surgery is done when there are local joint afflictions involving severe arthritis in the hands, for example. We replace or fuse the joints and correct the deformity.”
Management of RA involves patients and families understanding the nature of RA, understanding the fact that it can lead to systemic problems involving many areas of the body. They should understand the cyclical nature of the disease, its highs and lows and not abandon treatment during the “feel good” phase.
Further, since emotions are a factor aggravating the problem, these should be tempered even if they cannot be done away with. Besides, those following sedentary lifestyles are likely to have their RA aggravated more by comparison to those affected with the disease but following active lifestyles. Hence it’s important that exercises and sports activities of the non contact form, like swimming, be undertaken on a routine basis.
Dr.Jamil emphasizes the positive attitude that requires to be adopted by the patients. “It is important that they do not go in for high treatment with drugs in the beginning itself. They should keep the joints supple and moving with physiotherapy and exercises. They should avoid participating in sports or activities which affect the weight bearing joints in the body. When the temperatures dip, it is important that patients keep their joints warm to reduce the intensity of the attack.