Life Health Sciences – Science Rules it All

Rheumatoid Arthritis is the most common disease of bones and joints and about 1% population of UK is affected by RA. It usually starts at middle age and affects more females than males. Three out of every four patients are females. It is an immunological disease that is triggered by favorable environmental factors in genetically predisposed people. The disease runs variable course in patients and has remissions and relapses.

Symptoms

More often the disease starts slowly but sometimes it may have acute onset. There is pain, stiffness in the morning and swelling of small joints of hands and feet, and loss of function in hands. Both hands and feet are affected symmetrically. In hands middle joints of fingers become swollen and look like spindles. Finger tips are turned toward palm. The fingers at the bases are stretched opposite to the palm and joints at bases of fingers are dislocated so fingers look like ‘swan neck ‘. Moreover the fingers are pushed towards inner side of arm. Patient cannot grip anything due to decreased power and pain.

In feet there is swelling of joints at the bases of phalanges and phalanges turn toward sole from their tips making ‘claw foot’. Patient feels pain like ’walking on pebbles’. Other symptoms are pain in the neck, wrist, elbow and knee joints. As the disease advances deformities in the joints of hands and feet also increase with more loss of function. Patients also have fever, weight loss, malaise, weakness and feeling of hard rounded bony material under the skin of forearm.

The disease commonly involves heart, lungs, kidney, nerves and small blood vessels causing structural damage and producing associated signs and symptoms.

Investigations

Full blood count, ESR, Rheumatoid factor, joint X-ray

Management

1. Patient Support: It includes provision of information about disease, its treatment and support available regarding disability caused by disease. The patent is provided with disable parking permit and financial support. He/ she is helped in joining disability groups.
2. Physiotherapy:  Exercises help in maintaining mobility of joints and give strength to muscles. Splints and other appliances also help by increasing body mobility.
3. Drug Treatment: Drugs used for rheumatoid arthritis include non-steroidal anti-inflammatory drugs (NSAIDs), steroids and disease modifying anti-rheumatoid drugs (DMARDs). NSAIDs include aspirin, ibuprofen, mefenamic acid, diclofenac and others. Sustained release preparations are also available. These decrease inflammation and pain. Steroids are used when only NSAIDs do not relieve pain and inflammation. Injections for joints and oral forms of steroids are available. DMARDs are used when disease is resistant to other treatments. These include methotrexate, gold, penicillamine and sulphasalazine. These have serious side effects.

Prognosis

Most of the patients have chronic course of disease with remissions and relapses. After 10 years 25 per cent will have complete remission, 35 will have severe disease and 40% moderate form of disease.

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