OVERVIEW: Signs of Rheumatoid Arthritis
Rheumatoid Arthritis is a chronic symmetrical polyarthritis of unknown etiology and it is characterized by chronic inflammation of joints mainly peripheral joints along with systemic manifestation and extra-articular features. It has a long course with increased exacerbations and remissions. Signs of Rheumatoid arthritis are symmetrical, inflammatory polyarthritis, progressive joint damage causing severe disability, and extra-articular involvement. Rheumatoid arthritis has a prevalence of 1- 1.5%, peaks at the age of 22- 40 years, and has a male to female ratio of 3:1.
The synovium which is the joint space shows signs of inflammation that is, swelling and congestion. The underlying cartilage and bone become filtered with cells of inflammation which are plasma cells and macrophages. The Synovial membrane then proliferates which causes erosion and destruction of cartilage causing pain and joint stiffness.
CAUSES OF RHEUMATOID ARTHRITIS
Following are the major causes of Rheumatoid Arthritis:
- Genetic factors play an important role and it is associated with HLA-DR4 in whites and DRI in Indo Pak
- female gender is an increase risk factor particularly in Postpartum state and in breastfeeding women
- cigarette smoking is an important risk factor
- Autoimmunity, rheumatoid arthritis is considered to be an autoimmune disease as immune complexes are formed in the circulation and in synovial space
- Idiopathic causes
PRESENTATION OF RHEUMATOID ARTHRITIS
Rheumatoid arthritis presents with acute onset of pain and stiffness particularly in small joints of hand and feet which leads to bilateral symmetrical polyarthritis. In 30% of cases, rheumatoid arthritis presents as monoarthritis which means involvement of only a single joint, particularly knee joint.
Classic Rheumatoid Arthritis
The majority of patients presents rheumatoid arthritis insidiously with symptoms like fatigue, anorexia, weight loss, generalized weakness, and nonspecific features for many months and then pain stiffness and swelling of small joints of hand which then progress to large joints of hands over many years.
Acute RA
About 30% of patients present with a rapid onset within days or a week acute onset has a severe pathology and involves multiple joints of the body and is associated with constitutional symptoms which are fever, enlarged spleen, and lymph nodes.
Palindromic
Few patients present with acute episodes of pain and stiffness of a single joint which lasts for a few days and then returns to normal.
Transient
In some people, the disease is self-limiting and lasts less than 12 months. This is type leaves no permanent joint damage and has negative serology of Rheumatoid factor.
Rapidly progressive
The progressive type of disease progresses rapidly over a few years and causes joint damage and disability. It is usually serology positive and has an increased risk of extra-articular manifestations. This type of presentation of rheumatoid arthritis there is a period of several years during which Arthritis is active but then it limits leaving minimal damage and again exacerbates after a few years or months.
17 Major Signs of Rheumatoid Arthritis
- Joint pain: pain is worse on waking in the morning and improves rapidly over the day. The sleep is often disturbed due to pain
- Morning stiffness: there is morning stiffness of more than one hour and its duration indicates this severity of the disease
- Swelling: soft swelling are formed caused by Bony erosions around the joints
- Warmth: the joint is really hot and warm
- Tenderness: There is pain on movements of joints and on pressure
- Restriction of movement: limitation of the moment causes muscle wasting around the joints
- Subcutaneous nodules: nodules are formed in bony prominence and in 20% of patients deformities like Swan neck deformity and Boutonniere deformity is caused in later stages of the disease.
- Joint involvement: proximal interphalangeal joints and metacarpophalangeal joints of fingers, as well as wrist, knee, ankle, and toes, are most often involved and the distal interphalangeal joints are spared
- Spindling of fingers: in early stages of the disease the swelling of metacarpophalangeal joints reduces spelling of fingers
- Carpal tunnel syndrome: inflammation of joint spaces at rest can interact median nerve and cause carpal tunnel syndrome which causes numbness and tingling of thumb index middle and half of ring finger
- Knee: the knees bent outward or bend in word and the joint it becomes unstable quadriceps wasting is an early feature of knee involvement
- Cervical spine: information of cervical spine leads to bone destruction and damage of ligaments which cause atlantoaxial subluxation which damages the spinal cord
- Musculoskeletal muscle wasting can occur and 20% of cases suffering from RA
- Neurological carpal tunnel syndrome, psychosis, and polyneuropathy can result
- Eye Sjogren syndrome is the commonest eye problem and Episcleritis causes Red Eye
- Lungs pulmonary effusion and fibrosis results
- Heart pericardial rub, pericarditis, myocarditis and heart block
HOW TO DIAGNOSE RHEUMATOID ARTHRITIS?
Your doctor will perform a general physical examination of yours to diagnose rheumatoid arthritis. He may check your hands and look for wasting of muscles, carpal tunnel syndrome, redness of hands, dryness and redness of eyes, dry mouth and large parotid gland, cervical spine tenderness, and lymph nodes. In the abdomen, he may check you for enlarged spleen and peripheral neuropathy and my look for signs of spinal cord compression.
Investigations:
- RA FACTOR: status and autoantibody and is present in about 70% of cases
- ANA positive
- Complete blood examination
- X-ray hands
- Synovial fluid aspiration
- Raised ESR and CRP
TREATMENT OPTIONS FOR RA:
- NSAIDs
- Steroids
- Disease-modifying antirheumatic drugs
- COX-2 inhibitors
- Immunosuppressants
- Biological agents
- Combination therapy of methotrexate, chloroquine, and sulphasalazine
- TNF inhibitors
- IL-1, IL-6 Receptor blockers
CONSERVATIVE MANAGEMENT:
- Bed rest for patients with systemic and articular inflammation
- exercise is designed to prevent disease progression and preserve joint motion and muscle strength
- heat and cold packs have muscle relaxant and analgesic properties and may relieve the pain
- splints provide the joint rest, reduce pain and prevent contractures
- weight loss is beneficial especially in RA affecting weight-bearing joints
PROGNOSIS OF RHEUMATOID ARTHRITIS: the progressive prognosis in Rheumatoid arthritis is variable, high levels of Rheumatoid factor, insidious onset of disease, extra-articular manifestations, pannus formation, rheumatoid nodules or bone erosions are associated with poor prognostic factors.
In 25% of patients complete recovery occurs, 40% of patients have a moderate impairment, 25% of patients have a severe disability and 10% of patients are crippled.
WHEN TO SEEK MEDICAL HELP?
When the signs of rheumatoid arthritis are severe and disease is progressive in nature causing immobility you should seek medical help. Earlier the treatment will begin, the shorter will be the course of the disease and the lesser will be the chances of complications and permanent joint damage.
