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Rheumatoid Arthritis: Advice Sheet

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Rheumatoid Arthritis

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is a chronic inflammatory joint condition that can affect various tissues in the body and organs. RA is common amongst females, particularly during their forties, and women are three to four times more likely to suffer. Caucasians are prone to suffering from this condition in Western Europe, North America, and certain parts of Africa.

Common symptoms of RA include:
  • symmetrical polyarthritis (left and right side multiple joint inflammation and arthritis)
  • tenosynovitis ( tendon sheath inflammation)
  • morning inflexibility
  • ESR raised (blood test)
  • rheumatoid factor raised (blood test)

Unfortunately, there is no exact evidence to suggest the cause of RA. However, there are links to genetic susceptibility. It can affect first degree relatives of a patient by a human leukocyte antigen (HLA-DR4, related to immune system function), which is found on the sixth chromosome.

There are four stages of Rheumatoid Arthritis:

Stage 1: pre-clinical phase before there are any clinical features, it all begins by the inflammatory markers in the blood CRP (C-Reactive Protein), ESR (Erythrocyte Sediment Rate) and the Rheumatoid Factor years before it affects the joints, tissues, and organs.

Stage 2: synovitis phase in this phase, the vessels become congested, and new blood vessels are formed. Capsular structures start to become thicker, villous (pouches) form within the synovial structure, and rich fluid effuses into joints and tendon sheaths. At this point, the structures are painful. However, they are still mobile and in use.

Stage 3: destruction phase at this stage, the joints are now heading towards destruction due to persistent inflammation. The joint cartilage begins to be eroded by enzymes, by vascular tissue in the folds of the capsule and also by granulation tissue that begins to cover the joint surface. Bones can become affected by this, and margins begin to disappear. Tendon sheaths also begin to degrade, causing inflammation to the tendon sheath and collagen bundles. This leads to a partial or complete rupture of the tendons.

Stage 4: deformity the final stage is severe damage; the destructive phase leads to instability and deformation of the joints. Outside of the joints, there are often nodule formations under the skin, especially near the joint line where the bone becomes wider. (If you feel your finger from the top to the bottom, you should notice areas near the bendy parts/joints of the finger get wider. This is outside the joint itself and this is where these nodules form)

In severe cases, there can be congestion problems from the lymphatic system, which can lead to enlargement of the spleen (located on the left flank of your rib cage between ribs 6 and 10).

Muscle weakness and nerve cell damage are common after the destructive phase. The organs that are typically affected by this condition are the heart, brain, kidney, and gastrointestinal tract.

How will you be treated for Rheumatoid Arthritis?

Unfortunately, there is no one cure but various methods of management can decrease any progression. These include:

  • DMARD, known as Disease-Modifying Anti-Rheumatic Drugs1,3, one of which is methotrexate
  • general anti-inflammatories, for example, ibuprofen/naproxen
  • corticosteroids, like prednisone
  • tumour necrosis factor (TNF) inhibitors, for example, infliximab.

These have to be prescribed by either a GP or Orthopaedic/Rheumatologist consultant.

Osteopathy/Physiotherapy during the early to mid-stages can also be a way of managing the condition and trying to prevent it from worsening rapidly. However, such methods are not advised in the latter stages where there are destruction and instability of the joints.
An Osteopath / Physiotherapist can work with muscle strengthening and joint articulations to gently help with blood flow and various soft tissue methods. Early-stage rehabilitation is useful to keep the strength and stability of joints and help to decrease the rate of progress of stages 3 and 4.
A surgical approach is the last resort whereby the condition is well into the third or fourth stage.

What can you do to help yourself if you have Rheumatoid Arthritis?

You can help to manage your condition by applying cold packs to the inflammatory areas to help reduce the swelling. It is also important to keep moving your joints as often as possible to aid circulation and renewal of oxygen and nutrients and to remove toxins that have built up. Avoid excessive weight bearing on those particular joints, but bear in mind that a little bit is good for circulation into the joint and helps to maintain the structure and remodeling process that occurs in the bone.

For more information about Rheumatoid Arthritis

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References

1. Solomon, L., Warwick, D., Nayagam, S. (2010). Apley?s System of Orthopaedics and Fractures. London, Hodder Arnold, Ninth Ed., pp. 59?65.
2. Barnabe, C., Martin, B-J., Ghali, A.W. (2011) Systemic Review and Meta-Analysis: Anti-tumour Necrosis Factor Alpha Therapy and Cardiovascular Events in Rheumatoid Arthritis. American College of Rheumatology, 63(4), pp. 522?560.

3. Malottki, A., Barton, P., et al. (2011) Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a tumour necrosis factor inhibitor: a systematic review and economic evaluation. Health Technology Assessment, 15(14), pp. 2?8.

 

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