Rheumatoid Arthritis

Rheumatoid Arthritis
What is Rheumatoid Arthritis?

It is an autoimmune disease affecting primarily the joints but it can also involve multiple other organs or systems in the body. It affects approximately 1% of population.

What causes it?

Exact triggering event for the autoimmunity is not known; there may be environmental injury in a genetically susceptible individual. But the pathological processes are fairly well known, which help us to treat the disease.

What happens in Rheumatoid Arthritis?

The immune systems which normally fights external invasion by bacteria, viruses etc behave erratically in Rheumatoid arthritis and tends to fight one's own healthy system including the joints. In other words, the immune system losses the capacity to differentiate self from non-self in Rheumatoid Arthritis.

Is it curable?

Rheumatoid arthritis is an incurable disease; but this should not frighten the patient; because, hypertension and diabetes are also not curable. Just like hypertension and diabetes, regular treatment started early should control the disease to a large extent. In fact, at times, patient may feel as if they are cured; but the treatment has to be continued lifelong with close monitoring by the treating doctor. Only less than 10 % of patients, if lucky can stop treatment for ever.

What are the treatment modalities available?

The disease modifying drugs are many; one of the most popular, effective combination is that of Sulphasalazine, Methortrexate and Hydroxychloroquin. They can be easily monitored by blood counts, blood for Liver function tests and eye checkup. They are well tolerated and being used by large majority of the patients of Rheumatoid Arthritis. The other alternatives can be worked out by the treating Rheumatologists, if necessary from a big list of other drugs. Biological agents are expensive but effective.

How frequently patients should come for follow up?

Initially every month and after 3 months once in 3 months as per the guideline, we follow.

Is there any role of diet?

No food can cause Rheumatoid Arthritis; similarly no strong evidence is there that any diet can control Rheumatoid Arthritis significantly; however, Omega 3 fatty acid present in fish, has got a mild protective role against inflammation, as well as against Cardiovascular complications. Most spices in Indian diet have positive benefit in inflammation. Restrict saturated fat.

Is it hereditary?

It is not fully hereditary, however, there is a likelihood that some of the offsprings of patients with Rheumatoid Arthritis may have some form of autoimmune disease.

What is the cost of treatment?

The triple therapy mentioned above may cost about Rs. 700/- per month; but even Methotrexate alone can give good response and it costs not more than Rs. 50/- per Month.

Is there any role of alternative system of Medicine?

As far as evidence based medicine goes, there is no data to support this. Infact, unpredictable harm done by the unknown agents is often that you see Including heavy metal poisoning, crude steroids related toxicity, bone marrow suppression, renal failure, neurotoxicities. These are often noticed in patients taking so called 'natural therapy' and can pose confusion picture for the treating physician. Don’t be victim of unscientific traditional medicines.

Do the drugs used in Scientific medicines have the side effects?

Yes. There are no medicines without side effects; but all side effects by the scientific medications in Rheumatoid arthritis are known to us and we can monitor them before any major side effects can happen. Also you should know that all forms of medications including traditional ones have side effects & can be unpredictable in traditional medicines.

What are the other modalities of treatment apart from drug therapy?

Short term benefit with intra articular steroids, short term courses of NSAIDS (Non-Steriodal Anti Inflammatory Drugs) are also needed at times especially during active phase of disease. There is important role of physiotherapy, occupational therapy, Podiatrist and in advanced disease with damage, joint replacement has got very good role to play to improve the quality of life. Joint replacement surgeries are safe & effective.

When is steroid needed for Rheumatoid Arthritis?

Steroids are often misused in Rheumatoid Arthritis. High dose steroids are needed only for Vasculitis. ILD (Interstitial Lung Disease) and such serious systemic complications. Very low dose steroids (< 9mg/day of deflazacort) can be useful in very early Rheumatoid Arthritis or as a bridge therapy for tiding over a crisis, like an examination. Because drugs are available over the counter in our country often patients are unable to stop steroids and buy them on their own and this spoils the patient's chances of recovery.

Is the life span shortened in Rheumatoid Arthritis?

In an average, life span may be 2-5 years shorter than expected and this is often in untreated or Poorly treated patients.