About Rheumatoid Arthritis
- Rheumatoid arthritis (RA) is one of the most common types of arthritis. It is caused when the immune system (the body’s defense system) becomes hyperactive. RA causes pain and swelling of the joints. Joints commonly affected by RA are the wrists, small joints of the hands and feet (finger and toe joints).
- Currently, excellent medications are available for the treatment of RA. These medications are aimed at reducing the auto-immune process causing the disease, thereby reducing joint pain and swelling. Untreated or improperly treated RA can lead to joint deformities. Joint deformities are not reversible. Early and effective treatment is essential to prevent long-term complications associated with RA (including joint deformities).
- Exercises are an important part of RA treatment. Regular low-impact exercises, such as walking improve your overall health. Specific exercises can increase muscle strength.
- It is important to get the help of a rheumatologist. A rheumatologist is a doctor who treats arthritis and autoimmune disease. There are diseases that can be mistaken for RA. It is important to get the correct diagnosis without unnecessary testing. A rheumatologist will help find a treatment plan that is best for your disease.
The general outlook about RA has changed over the past few years. In the past, people have long feared RA as one of the most disabling types of arthritis resulting in joint deformities. The good news is that over the past 25 to 30 years there has been an improvement in the understanding of rheumatoid arthritis. This has resulted in newer tests for diagnosis and when compared to earlier better use of current medications (also called conventional DMARDs – Disease-modifying anti-rheumatic agents). This better understanding has resulted in the availability of newer medications (biologics and small molecule inhibitors – JAKinibs). The availability of newer medications like biologics and small molecule inhibitors have been game-changers in the treatment of rheumatoid arthritis (especially in individuals who do not respond very well to first-line medications – also known as refractory RA). Overall, the general outlook of RA has changed from a condition commonly causing joint deformities to the current scenario wherein individuals with RA lead normal and productive life. Due to improvement in overall care these days we hardly see any individuals with RA having deformities.
What is rheumatoid arthritis?
It is a type of inflammatory arthritis. It is one of the most common types of arthritis. It is believed to affect approximately 1% of the population (it means 1 in 100 can be affected). If one considers the current population of India which is approximately 133 crores or 1.3 billion, then India has a huge population of individuals affected with rheumatoid arthritis. That means that RA is not that uncommon if one considers the population of India.
It is an auto-immune disease. In autoimmune disease, the immune system (protective system or defense system of the body) becomes hyperactive. A hyperactive immune starts attacking one’s own tissue/organs causing disease.
RA affects women more commonly than men. About 75% of RA patients are women. RA is 2 to 3 times more common in females when compared to males. It is a common myth that RA is a disease affecting the elderly or is a condition affecting older individuals.RA can affect any age. The condition most often begins between the ages of 30 and 60 years.
What are the symptoms?
The three main symptoms are – joint pain, joint swelling, joint restriction (reduced movement of the affected joint).
All joint pains are not rheumatoid arthritis. Rheumatoid arthritis can be differentiated from other types of arthritis / other causes of joint pains based on the joint distribution (joints which are commonly affected), characteristics of pain (what makes the pain better and what makes it worse; variation of pain with respect to time of the day – worse in the morning and better as the day goes by or worsens as the day goes by), joint swelling (presence or absence).
In general, the joint pains due to RA have the following features
- Worse in the morning and get better as the day goes by
- Worse at rest and better with activity
- Stiffness is worse in the morning and after periods of prolonged rest
RA affects multiple joints. Commonly affected joints are – shoulder, elbow, wrist, fingers, knee, ankle, and toe joints.
How is rheumatoid arthritis (RA) diagnosed?
Unlike other conditions, there is no one test to diagnose RA. RA is diagnosed by combining information gathered from symptoms, examination findings, blood test reports. In some individuals, additional tests may be required like X rays, joint ultrasound, or MRI of the joints. The blood tests may include tests for auto-antibodies / antibody test – RA factor / RF / Rheumatoid factor and anti-CCP antibodies (Antibodies to cyclic citrullinated peptides). However, it is important to understand that sometimes these antibodies are found in people without RA. This is called a false-positive result. What it means is that a positive antibody test does not always mean an individual has RA, it could be a false positive also.
How is Rheumatoid Arthritis treated?
Treatment of Rheumatoid Arthritis has improved greatly in the past 30 years. With current treatment options, most patients have good or excellent relief of symptoms and function at, or near, normal levels. With the early and appropriate medications, individuals with RA can lead a normal life without any signs of active arthritis. Untreated or improperly treated RA can lead to joint deformities. Joint deformities are not reversible. Early and effective treatment is essential to prevent long term complications associated with RA (including joint deformities).
There are multiple medications available for the treatment of RA. The treatment is in a step-wise manner. The treatment is to be taken for the long term. The medications are called DMARDs (Disease-modifying anti-rheumatic drugs). They target the autoimmune process causing the disease. The medications of RA are slow-acting and they may take 2 to 3 months to have full effect. Ask your rheumatologist about the need for DMARD therapy, the risks and benefits of these drugs, and which one is best suited for you.
Following are the commonly used first-line medications: Methotrexate, sulfasalazine, hydroxychloroquine sulfate, leflunomide. Other medications include – Azathioprine, cyclosporine, tacrolimus. These three drugs and gold are rarely prescribed for RA these days because other drugs work better or have fewer side effects.
Individuals with RA who do not respond to first-line medications (first-line medications prescribed in appropriate doses) are prescribed second-line medications. The second line medications include – Biologics and JAK inhibitors.
Biologics available in India are as follows: Etanercept and its biosimilar, adalimumab biosimilar, golimumab, tocilizumab, rituximab, and its biosimilar.
JAK inhibitors available in India are – Tofacitinib and saracatinib.
Treatment of RA includes regular visits/checkups through the year with your rheumatologist. These checkups allow the doctor to track the course of the disease and check for any side effects of medications. During these visits/checkups, blood tests will be required to look for any medication-related side effects.