Rheumatoid arthritis
RA is a common inflammatory condition of joints. It is more common in females than in male as per estimate female to male ratio is 3:1. The prevalence of RA in Europe Is approximately 0.8-1% in Europe whereas it is least found in South-east Asia. The highest numbers are present in the world are in Pima Indians.
Signs and symptoms
The majority of the patients present with pain, swelling and joint stiffness of small joints of hands and feet. Moring stiffness that subsides within an hour is a key feature of the patients of RA. The patients may present with large joints pain, systemic or extra articular signs and symptoms. The criteria of diagnosing RA is given below in table.
Systemic symptoms such as anorexia, weight loss and fatigue may also present. Osteoporosis is a common complication of RA whereas muscle wasting may also present in the patients.
Extra- articular symptoms such as cardiac and pulmonary involvement, serositis, vasculitis, spinal cord compression and peripheral neuropathy are present in long standing seropositive RA.
Examination of these patients may reveal sawn neck deformity, boutonniere or button hole deformity etc.
Investigations
Although it is a clinical diagnosis, Rheumatic factor (RF) and anticitrulinated polypeptide antibodies (ACPA) are positive in majority of the patients of RA. Round about 70% patients of RA are RF or ACPA positive, but there absence doesn’t rule out RA. ESR and CRP are also raised in the patients of RA. A physician may also advice CBC, Rfts, BSR and urine complete to assess systemic involvement of RA. A physician may advise following investigations.
- RF
- ACCP level
- ESR
- CRP
- X-Ray
- Base lines
Management of Rheumatoid Arthritis
Management of RA aims at reducing joint inflammation, pain management and prevent further joint damage. It includes pharmacological as well as non-pharmacological measures.
Pharmacological Treatment
DMARD therapy is the treatment of choice in RA patients. Steroids and analgesics are also used along with DMRDs. Methotrexate, is a first line DMARD, which dose is gradually increase over 12 weeks to reach maximum dose of 30mg whereas steroids are reduced from 30mg per day to 5mg over 12 weeks. If results are not satisfactory then combination of two or three DMARDs is recommended.
Non Pharmacological Treatment
The non-pharmacological measures includes physiotherapy and surgical treatments. Synovectomy, joint replacement surgery and excision of the metatarsal heads are the commonly used surgical measures in the patients of RA.