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What is Rheumatoid Arthritis?

Rheumatoid arthritis (RA) is an inflammatory disease. Rheumatoid arthritis roughly affects one in a hundred individuals in India. Is is a major cause of disability around the globe. Work disability among people with RA is significantly higher than in the general population. A published research has shown that two-thirds of people with RA lose around  40 working days each year from disability caused by RA. Another study demonstrated that nearly a 25% of patients with RA experience a reduction in income from their source of livelihood. 


So what is Rheumatoid arthritis?

Rheumatoid arthritis is a systemic inflammatory disease which manifests itself in multiple joints of the body. The inflammatory process primarily affects the lining of the joints (synovial membrane or synovium), but can also affect other organs. The inflamed synovium leads to erosions of the cartilage and bone and sometimes joint deformity.


What happens to joints in Rheumatoid Arthritis?

In normal joints, end of the each bone is covered with healthy cartilage, which will get  eroded in Rheumatoid   Arthritis. A membrane, called synovium surrounds the joint, which  will be inflamed and thickened in Rheumatoid Arthritis. Inflamed synovium secrets more synovial fluid in to the joints, causing swelling and pain in the joint. In a healthy joint cartilage provides smooth slippery surface, which helps free joint movement and the synovial fluid, acts as lubricant.

Rheumatoid Arthritis typically affects the small joints of the hands and the feet, and usually both sides equally and symmetrically, although any joint with a synovial tissue lining can be affected. It is a systemic disease, which means it is not limited to the bones or joints only and so can affect the whole body, including the heart, lungs and eyes.


When does Rheumatoid Arthritis start?

Rheumatoid arthritis can occur at any age, but usually appears between the ages  of 35 to 65.

Women are affected roughly twice as common as men.  


Who can get this disease?

Anyone can get this disease. This is not a hereditary disease nut it can affect more than one member from the same family. 


What are the Symptoms of rheumatoid arthritis?

The most common symptoms of RA include:  

- Swelling, pain and heat in the joints, usually the smaller joints affecting the hands or feet 

- The joint involvement is symmetrical, that is same joints on both sides are affected.

- Stiffness in the joints, especially in the morning 

- Easy fatiguability 

- Muscle aches and pains

- Sleeping difficulties because of the pain

The course and severity of rheumatoid arthritis varies from person to person and no two cases are the same. The severity of symptoms vary in a cyclical fashion as well. 

Sometimes the symptoms may become very severe ‘ flared up’ and may become minimal at other times ‘ inactive’.


What causes Rheumatoid arthritis?

The exact cause of this disease is not completely understood, but the immune system plays an important role and this disease is probably autoimmune in nature.  Normally the role of the immune system in our body is to fight off and protect

Rheumatoid arthritis is believed to be caused by an aberrant response of the immune system targeting the lining of the joints, called the synovial membrane, which causses inflammation and joint damage. In response to the auto-immune damage, the joints produces too much of lubricating (synovial) fluid, that produces the characteristic swelling associated with this disease. Other parts of the body such as the lungs and eyes may also be affected with a similar process. 


Is there any relation with climate?

Many people think that weather in winter may aggravate the arthritis. This is a popular misconception. Cold weather may cause more stiffness in the joints, but it will not aggravate or precipitate the arthritis.


Why is it important for me to know so much about this disease?

Your treatment and care needs to be individualized based on your needs, disability, and preferences. You need to be actively involved in making decisions for yourself with regards to management options. 

You should be able to understand the treatment goals and likely outcome right from the beginning, as this would help you handle this disease better. The information you get from your healthcare team should include details of the possible benefits and risks of particular treatments. You can ask any questions you want to and can always change your mind as your treatment progresses or your condition or circumstances change. 


Is this disease curable?

No this disease is not curable. However, treatment can help stabilize the disease progress and improve quality of life. 


What are the treatment options?

RA is treated by a team, as it has different implications in physical and psychological forms. There is a range of treatments available to help manage rheumatoid arthritis. 

These include medication, physiotherapy, occupational therapy and surgery. 

Treatment should start early in the disease process as it reduces joint damage. 


What are the medications available for RA?

Medications for RA can be broadly classified into two groups. Some control the disease itself, and some help to ease symptoms which are known as 'disease-modifying anti-rheumatic drugs' (usually known as DMARDs), including methotrexate. DMARDs reduce the immune response of the body towards joints that causes the damage to your joints. You may be offered more than one of these drugs at once; this is called combination therapy.  These drugs may have serious side effects and should be taken with regular consultations from a doctor. 

The other class of drug is pain killers.  There are several different types of pain-relieving medication that you may be offered. These include non-steroidal anti-inflammatory drugs, which are commonly referred to as NSAIDs (such as aspirin, ibuprofen). These help to reduce inflammation as well as relieve pain. 


What are other important interventions for this disease?

Physiotherapy – a physiotherapist can advise based on your symptoms and lifestyle, on activity modification, managing pain and plan an exercise program to help keep your joints mobile and strong. 

Rest – Timely rest between long schedules can help you to manage fatigue and muscle aches.

Occupational therapy – basically means modification of activities as per your disability and needs. An example is walking aids. 


What diet should I take if I have Rheumatoid arthritis?

Just have a healthy, balanced diet to maintain general health and, prevent weight gain and other medical problems, such as diabetes and heart disease. There is no specific diet that you need to take or avoid. 


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