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            Rheumatoid arthritis happens when the body’s infection-fighting system, called the immune system, “attacks” the joints. It causes pain, swelling, and stiffness in the joints. It is one of many different types of arthritis. About 0.5% of the Indian population is affected by this disease. It can affect adults of any age but it commonly starts between the ages of 30 and 50. About three times as many women as men are affected.. RA affects different people in different ways. Symptoms may slowly develop over several years, or the disease may progress quickly. Symptoms may be mild or very severe. In addition to joint pain and stiffness, people with RA may also have symptoms such as weight loss, low-grade fever, and fatigue. Even though symptoms may not appear like RA you should discuss all symptoms with your doctor since RA can affect other organs as well.  RA often affects pairs of joints (both hands, both feet, etc) and can affect more than one joint, including the small joints in the wrists and hands. Joint pain and swelling may happen slowly and may occur over weeks or months. Over time, the inflammation of RA can cause damage to the joints. You may go through phases called “flares” or “flare-ups” when symptoms are severe. At other times, it may seem as if the disease and its symptoms have gone away. This is called “remission.” As this joint damage progresses, in severe cases, it can cause deformity of the joints and loss of function.

            For these reasons, it is important to get an accurate diagnosis and appropriate treatment as early as possible. Early diagnosis of RA is the first step to managing your disease and symptoms. After talking with your family doctor, he or she may refer you to a rheumatologist. Rheumatologists are doctors who can help diagnose and treat patients with diseases in which the immunity is attacking its own body like in rheumatoid arthritis. RA is easily diagnosed by physical examination and blood tests done by a rheumatologist. Blood tests and x-rays will help your doctor assess how fast your arthritis is developing and what the outlook for the future may be. Rheumatoid factor is an antibody produced by reaction in the immune system. The rheumatic factor test is sometimes called the test for rheumatoid arthritis, but a diagnosis can’t be made based on this alone. About 4 out of 5 people with RA have positive tests for rheumatoid factor. However, about 1 in 20 people without RA have positive results as well, so having positive rheumatoid factor test doesn’t confirm that you have RA. On the other hand, only half of all people with RA have rheumatoid factor when the condition starts, so having a negative rheumatoid factor test doesn’t rule out RA. Some people with RA never develop rheumatoid factor. Another antibody test known as anti-CCP (anti- cyclic citrullinated peptide) is also available. People who test positive for anti-CCP are very likely to have RA. This will also help your doctor to decide which form of treatment to recommend.

            The goal of treatment are to reduce pain, decrease or stop further joint damage and improve physical function. The details of your treatment plan will depend on the progress of the disease. Your rheumatologist can suggest various treatment options, such as lifestyle changes, medications, and sometimes surgery. Life style changes which your doctor may suggest to you  that can help in the management of RA include- rest if required initially, exercise, stress reduction, joint care and a healthy diet. Smoking has been linked to development of RA and increases its severity, hence, stopping it is an important lifestyle modification required in RA patients. Medications that may be used by your rheumatologist are- pain killers, steroids, DMARDs (disease modifying anti-rheumatic drugs) and in some cases biologics. Many people are worried about the possible side-effects of drugs. All drugs have side-effects, but for most people with rheumatoid arthritis the benefits of drug treatment far outweigh any possible side effects. Treatment is more effective and drugs are checked for safety more carefully than ever.

Initially you will be required to visit your doctor once a month till the disease is under control and then every 2-3 months. You will be required to get routine blood tests before each visit to see the activity of the disease and to make sure you are not having any side effects of the medication you are on.

            If you want to get pregnant while you are on treatment, talk to your doctor about it before you start trying. Some of the medicines used to treat rheumatoid arthritis are not safe for a baby, so you might need to switch medicines before you get pregnant. Plus, there are things you should do to help prevent problems during the pregnancy. The symptoms of rheumatoid arthritis often get a lot better during pregnancy. However, they can get worse again after the baby is born.

 

            Although RA is a relatively common disease, patients often present to the doctor late, referral to an appropriate doctor is delayed and treatment compliance is not good. It is important to understand that RA is a controllable disease not a curable one. You should question anything which claims to be a cure. Treatment is prolonged and requires regular doctor visits. However, most patients are able to live a comfortable and fruitful life if they take medicines as prescribed and follow up regularly.

 

 

 

 

 

 

OUR DOCTORS

Dr. ( Maj Gen) D S Bhakuni

Dr. ( Maj Gen) D S Bhakuni

Consultant
Rheumatology
(Delhi)
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