- Likelihood increases with age
- Highest among adults in their sixties
Women are affected 3 or 4 times more commonly than men
- People born with specific genes are more likely to develop RA.
- HLA (human leukocyte antigen) class II genotypes, can also make your arthritis worse.
Increases a person’s risk of developing Rheumatoid Arthritis
The role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.
Stage of Synovitis (Stage 1 & 2)
- Most commonly affected are Fingers (Meta Carpo Phalangeal Joint and Proximal Interphalangeal joint), Wrist, Tendon sheaths around the joints (wrist – feet – knee –shoulder)
- Bilateral symmetrical polysynovitis
- Pain, fusiform swelling, stiffness, loss of mobility
- Constitutional symptom:
- Low-grade fever
Stage of Destruction (Stage 3)
- Spread to other joint – wrist, ankle, knee, shoulder (in order of frequency)
- Morning stiffness (more than 30 min) – improve with activity
- The activity of daily living will be affected – the quality of life affected
Stage of Deformity (Stage 4)
- Pain, deformity, instability, decreased ROM
- Joint deformity – movement restricted and painful
- Thumb – Z-deformity
- Fingers –Swan neck deformity/ Boutonniere’s deformities, ulnar deviation
- Wrist – radial and volar displacement
- Elbow – limited extension
- Shoulder – limited abduction
- Knees – swollen, flexion a vulgus
- Toes – clawed
When to see a doctor:
- Swollen Joints
- Fever, Malaise
- Morning Stiffness
- Rheumatoid Nodules
- Loss of Appetite
Rheumatoid arthritis can be difficult to diagnose in its early stages because the early signs and symptoms mimic those of many other diseases.
Physical examination plays a significant role in diagnosing the disease
a. Vital Signs
Low Garde Fever
b. Skin Examination
- Rheumatoid nodule found over bony prominences
- Erythema nodosum
- Atrophy of digital skin
- Palmar erythema
- Diffuse thinning (rice paper skin), and of
- Beading on the nails
c. Examination of the Eyes
- Dry Eyes
d. Pulmonary Examination
- Decreased breath sounds on both sides
- Crackles may be present
- Redness & Swelling of the affected joints
- Painful Movement
- Decreased range of movement
- Morning Stiffness
- CBC- normocytic hypochromic anemia (due to abnormal erythropoiesis from chronic inflammation), WBC
- Inflammatory markers- ESR, CRP elevated (its use as an indication of disease progression monitoring, treatment response)
- Rheumatoid factor(RF)- anti-IgG auto Ab 80% will have it
- Anti- cyclic citrullinated peptide(CCP)Ab
b. Joint aspiration
- There is no cure for rheumatoid arthritis
- Aim to delay the progression of the disease, alleviate symptoms, reduce functional limitation
- Supportive and palliative
The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you’ve had rheumatoid arthritis.
a. Disease-modifying antirheumatic drugs (DMARDs)
- To slow down the progression of rheumatoid arthritis
- To save the joints and other tissues from permanent damage
- Common DMARDs include methotrexate (Trexall, Otrexup, others), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine)
Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.
b. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- To relieve pain and reduce inflammation
- Common NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve).
- Side effects may include stomach irritation, heart problems and kidney damage.
- To reduce inflammation, pain & slow joint damage
- Common Corticosteroid medications include prednisone
- Side effects may include thinning of bones, weight gain and diabetes
- Synovectomy: Surgery to remove the inflamed lining of the joint (synovium) can be performed on knees, elbows, wrists, fingers and hips.
- Tendon repair: Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
- Joint fusion: Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn’t an option.
- Total joint replacement: During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic
Helps in reducing RA related pain & other symptoms
It can help reduce muscle tension & promote good circulation
3. Transcutaneous Electrical Nerve Stimulation (TENS)
It works by blocking pain signals & helps in decreasing muscle spams
It creates warmth using sound waves to enhance circulation and reduce joint pain, inflammation & stiffness
5. Strengthening Exercises
To improve range of motion & helps in building muscle strength
6. Aerobic Exercises
It helps in managing rheumatoid arthritis symptoms