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If someone is experiencing symptoms like joint stiffness in the morning, pain in joints accompanied by swelling, loss of joint function, or symmetrical joint swelling, they should be investigated for rheumatoid arthritis (RA), says Dr. Abhishek Kumar Mishra, an orthopaedic and joint replacement surgeon at the Apollo Spectra Hospital in New Delhi.
Rheumatoid arthritis impacts people’s joints, commonly in the hands, knees, and wrists, making them inflamed and causing damage to the joint tissue. It can cause tenderness, pain, swelling, fatigue, deformity, and chronic pain. It is estimated that close to 0.5-1% of the population in India suffers from rheumatoid arthritis.
Dr. Mishra answers Femoai’s six important questions about the disease. Edited excerpts:
- What are the symptoms of rheumatoid arthritis? What does it look and feel like?
- We have read that early diagnosis is important for rheumatoid arthritis, tell us about that?
- What are the joints that rheumatoid arthritis impacts?
- Rheumatoid arthritis is an autoimmune condition, does that imply that your immune system is compromised?
- Does rheumatoid arthritis have a link with anaemia?
- Tell us about the treatment of rheumatoid arthritis?
What are the symptoms of rheumatoid arthritis? What does it look and feel like?
There are the usual, typical symptoms, and something called the American College of Rheumatology criteria. The patient usually has to fit in this criteria to qualify as someone with rheumatoid arthritis. An important early symptom of RA is that it may impact the small joints of the body first, like wrists, and joints in the hands and feet. Other common symptoms include stiffness in joints especially in the mornings, pain accompanied with swelling, and symmetrical joint swelling (joints on both sides of the body are impacted). In some patients, however, symmetry may not be seen especially at the beginning of the disease. It can also cause low-grade fever, weight loss, fatigue, joint redness and tenderness, and a decrease in range of motion. If someone is experiencing these symptoms, they should be investigated for rheumatoid arthritis.
An important early symptom of RA is that it may impact the small joints of the body first like wrists, and joints in the hands and feet. Other common symptoms include stiffness in joints especially in the mornings, pain accompanied with swelling, and symmetrical joint swelling (joints on both sides of the body are impacted).
We have read that early diagnosis is important for rheumatoid arthritis, tell us about that?
It absolutely is. There is a group of drugs called disease-modifying antirheumatic drugs (DMARDs). The sooner a patient starts these, the more the chances of remission of the disease, and more of a chance of having a milder disease. Right now, there are many new drugs available, which are also injectable. Basically, the sooner you start the patient on drugs, the more the chances that the disease will go into remission quickly. And even if the patient has the disease, it will not be very severe.
What are the joints that rheumatoid arthritis impacts?
Rheumatoid arthritis is a type of connective tissue disease. It impacts your connective tissue system (this includes joints, bones, ligaments, tendons and muscles) and haematological system (consists of blood and bone marrow). Mostly these are the two organ systems which are affected. It can also lead to damage to any system that has got connective tissue in it (tissue that connects and supports all other types of tissues in the body).
Rheumatoid arthritis is an autoimmune condition, does that imply that your immune system is compromised?
Autoimmune does not mean your immune system is compromised. In an autoimmune disorder, the immune system mistakenly attacks healthy cells in the body.
Autoimmune disorder has got nothing to do with being immunocompromised. These two conditions shouldn’t be confused with each other. Being immunocompromised means an impaired or weakened immune system; it can result from conditions like cancer or some drugs can cause it; certain infections can also lead to compromised immunity. Sometimes both the conditions might coexist; if somebody has an autoimmune disorder, they may be also immunocompromised. But, in general, it’s not that if you have one you have to have the other.
Does rheumatoid arthritis have a link with anaemia?
Rheumatoid arthritis patients generally tend to be anaemic. It is just like other connective tissue disorders in which most of the systems that have connective tissue get affected. Anaemia can happen to people with conditions that cause inflammation in their body; apart from RA, some of these conditions include Crohn’s disease and ulcerative colitis. RA interferes with the body’s ability to absorb iron from food and recycle red blood cells.
Tell us about the treatment of rheumatoid arthritis?
The treatment includes administration of non-steroidal anti-inflammatory drugs (NSAIDs), combined with DMARDs. In a later stage or severe disease, patients are often given immunomodulators. Immunomodulators are newer drugs, they are injectables; some are available in oral form too. They’re usually expensive. The important thing is that before starting immunomodulators, you have to check if the patient is immunocompromised. This is conflicting with what I said earlier but this check is done to see whether the patient’s immune system is already compromised, and, if they will be able to tolerate immunomodulators. These are reserved for patients with severe disease. Sometimes the patient may be administered steroids; these are often used as a first line treatment in patients with a severe condition.
Dr. Abhishek Kumar Mishra
Dr. Abhishek Mishra is a New Delhi-based orthopaedic, joint replacement and spine surgeon with more than 22 years of experience. A renowned surgeon, he is now serving as a full-time Senior Consultant & Head of department in Orthopedics at Apollo Spectra Hospital.
Ph: +91-9310656999; 011-41655490
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