Q1. What are the common forms of arthritis in the country?
Ans. Rheumatoid arthritis ( RA ) is the commonest form of arthritis in a country which affects around 1% of the population of various age group. Children are also affected and then it is known as juvenile rheumatoid arthritis ( JRA ). People generally beyond the age of 50 years have osteoarthritis ( OA ) which is the degenerative form of arthritis.
Q2. What are the common symptoms of rheumatoid arthritis?
Ans. Pain and swelling of the small joints of hands and feet with early morning stiffness around the joints which may last up to 45 minutes or more. The symptoms increase with the rest and relieved by physical activities. All the symptoms are attributed to inflammation. However medium and large joints like elbows, shoulders, knees, hips and ankles joints can also be involved.
Q3. Can the patients have systemic symptoms?
Ans. Yes. Feverish feeling or low-grade fever, malaise and easy fatigability can also be associated with joints pain. Being the autoimmune disorder RA can also involve other organs like eyes, lungs, kidneys, peripheral nerves and blood vessels.
Q4. What happens to the joints in rheumatoid arthritis?
Ans. RA is a disease of the synovial membrane which covers the joints. There is inflammation of synovial membrane followed by the destruction of the joints which starts as erosions causing deformities if not treated appropriately and timely.
Q5. Can it be diagnosed early?
Ans. Yes, it can be diagnosed very early if the patient reports rheumatologist and certain tests are done including rheumatoid factor and anti-CCP antibodies.
Q6. Is rheumatoid arthritis curable?
Ans. Yes if the patient reports very early to the rheumatologist and follows the advice regarding the medication.
Q7. What are the treatment modalities available?
Ans. There are two groups of medications available. Initially use of disease-modifying antirheumatic drugs ( DMARDs ) is recommended either as a single-agent or in combination. The combination therapy is preferred to get prompt relief in symptoms and reduced morbidity. The cost of these drugs is quite affordable. These drugs include methotrexate, hydroxychloroquine, leflunomide and sulphasalazine.
However if the patient does not get relief with DMARDs, the other group of drugs are used known as biologics like infliximab, rituximab, etanercept, tocilizumab, abatacept and adalimumab are some of the drugs as injectable agents. Orally effective drugs are also available as tofacitinib and baricitinib. However, the disadvantages are high cost and possible side effects.
Q8. How long the treatment is required?
Ans. In the case of early rheumatoid arthritis, the treatment may be stopped after a few years if the patient goes into the remission. However, if the patient gets the treatment late then almost lifelong treatment is required.
Q9. Are the steroids also used in the treatment?
Ans. Yes. Since the DMARDs take a few weeks to get the relief, low-dose steroids are used for short durations only to give the prompt relief from pain and swelling of the joints. Long-term steroid therapy is avoided.
Q10. Can the deformities of joints be treated?
Ans. Yes. By definitive surgery by orthopaedic or reconstructive surgeons.
Q11. Can rheumatoid arthritis patient continue his job?
Ans. Yes. The patient should continue his medications and regular follow up with the rheumatologist.
Q12. What are the challenges faced by the patient and the doctor?
Ans. Patients often report to an orthopaedic surgeon rather than a rheumatologist, failure to accept rheumatoid arthritis as a lifelong disease, non-adherent to the therapy and prohibitive cost of newer drugs.
Dr ( Maj Gen retd ) Darshan Singh Bhakuni
Consultant Rheumatologist & Clinical Immunologist
Manipal Hospitals, Dwarka, New Delhi
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