Rheumatoid arthritis (RA) is an autoimmune, inflammatory disease, which is usually genetic and happens to more women than men, says Dr. Abhishek Kumar Mishra, an orthopaedic and joint replacement surgeon at the Apollo Spectra Hospital in New Delhi.
In autoimmune diseases, the body’s immune system malfunctions and attacks its own healthy cells, causing various disorders such as rheumatoid arthritis. While some studies suggest that environmental and genetic factors may be behind more women suffering from rheumatoid arthritis, the reasons are still not clear.
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 tells Femoai about what Rheumatoid arthritis is, the different types, and whether it can be prevented. Edited excerpts:
- What is rheumatoid arthritis and how is it different from other forms of arthritis like osteoarthritis or gout?
- You mentioned that women in their 20s and 30s are more vulnerable to it, why is that?
- What are the risk factors?
- Could you also talk about the types of rheumatoid arthritis, and what does seropositive and seronegative mean?
- Is there anything people can do to prevent rheumatoid arthritis, especially if they know they have family history?
What is rheumatoid arthritis and how is it different from other forms of arthritis like osteoarthritis or gout?
Osteoarthritis is a degenerative type of arthritis, which usually happens with age; it’s age-related wear and tear. It can, however, impact some young people in their teens, 20s, or 30s. Rheumatoid arthritis (RA) is an autoimmune condition. In an autoimmune condition, the body’s own cells start working against other healthy cells, resulting in various disorders. Rheumatoid arthritis belongs to the category of these disorders.
RA has got nothing to do with ageing, it can affect young people. It can impact people at any age, but mostly begins at a younger age. Rheumatoid arthritis is usually seen in women in their 20s and 30s; men are also prone to it but the incidence is much higher in women.
Gouty arthritis is completely different from these two. Gout is a type of inflammatory arthritis. It is very painful and usually affects one joint at a time. Gouty arthritis is related to high uric acid in the body caused by the lack of an enzyme. Arthritis is not one disease; there are more than 100 types of arthritis and related conditions. All these conditions impact the joints but the cause is entirely different.
You mentioned that women in their 20s and 30s are more vulnerable to it, why is that?
The phenomenon in which the body’s cells start attacking healthy cells, usually happens at a young age. Honestly, the reason behind it is not known, but this is the normal distribution that has been observed. So, women in their 20s, 30s, or 40s are more likely to have an onset of rheumatoid arthritis.
What are the risk factors?
The risk factor is primarily genetic. It tends to run in families. The second is sex. As we discussed, women are more prone to it. It’s an idiopathic disorder, nobody knows the cause or how it happens. There is some interplay between genes which takes place and anybody can have it. There are some studies which show that obesity and smoking can increase the risk of rheumatoid arthritis in people.
Could you also talk about the types of rheumatoid arthritis, and what does seropositive and seronegative mean?
There is a specific type of marker, which is often found in the blood of patients who have rheumatoid arthritis. It’s called the RA factor. A seronegative test means that the patient has tested negative for rheumatoid factor (RF) and cyclic citrullinated peptides (CCP), but clinically the features or the symptoms are very similar to rheumatoid arthritis. If you compare these with a patient who has got RA factor positive, the features of the disease are the same. So clinically, you can label the patient as being a patient of rheumatoid arthritis even though the RA factor is negative.
Whereas, if some patient has features of rheumatoid arthritis, and at the same time their RA factor is positive, it is called seropositive rheumatoid arthritis. The difference is that usually in patients with positive rheumatoid arthritis, the features and the severity of the disease tend to be more compared to those who have got seronegative rheumatoid arthritis. In seropositive rheumatoid arthritis, we can straight away put the patient on a group of drugs called disease-modifying anti-rheumatic drugs or DMARDs (methotrexate, sulfasalazine, hydroxychloroquine, and leflunomide). Whereas in patients with seronegative rheumatoid arthritis, we have to judge the patient’s pharmacological treatment depending on the severity. If it is very severe, we start the patent on DMARDS.
There is also juvenile idiopathic arthritis, which is seen in children; it usually tends to diminish or becomes very mild as the patient ages.
Is there anything people can do to prevent rheumatoid arthritis, especially if they know they have family history?
There’s nothing you can do to prevent it. What you can do is to start the therapy as soon as possible. It tends to be very long, it can run for years. You can take other measures to ensure that the damage to the joint which happens in this disease doesn’t happen too quickly. Some of these measures are — not smoking, exercising as per your doctor’s advice, being up to date with therapy and seeing your rheumatologist regularly, and losing weight if you are obese.
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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