Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic disease whereby various joints in the body are inflamed, leading to stiffness, pain, swelling and the possible loss of function. It usually affects the joints symmetrically i.e. on both the sides equally and may initially begin in couple of joints only and most frequently attacks knees, ankles, shoulders, wrists and hands.
Rheumatoid Arthritis is an autoimmune disease in which the body’s immune system – which generally protects its health by attacking foreign substances like viruses and bacteria – mistakenly attack the joints and other tissues causing chronic inflammation. The immune system contains complex organization of cells and anti bodies designed normally to find and destroy the invaders of our system, particularly infections. Though inflammation of the tissue around the joints and inflammatory arthritis are characteristics of rheumatoid arthritis, the disease also causes inflammation and injury to other organs of the body. As it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic (body-wide) illness and sometimes is also known as rheumatoid disease. Rheumatoid arthritis that affects children under 16 years of age is referred as juvenile idiopathic arthritis.

• The process of disease leading to rheumatoid arthritis begins with synovium – the tissues that lines the inside of joints and around the joins that makes a fluid that lubricates joints making them move smoothly creating a protective sac.
• In addition of lubrication of joints, this fluid also supplies nutrients and oxygen to cartilage, a slippery tissue that coats the ends of bones; it composes of collagen – the structural protein in the body that forms a network to give support and flexibility to joints.
• In rheumatoid arthritis, an affected immune system produces destructive molecules that cause continuous and harmful inflammation of synovium. Gradually, the collagen is destroyed, hence narrowing the joint space and eventually damaging bone.
• If the disease develops into a form called progressive rheumatoid arthritis, the destruction process accelerates.
• Fluid and immune system cells gathers in synovium, producing a pannus – a growth composed of thickened synovial tissues. With the development of the disease, the pannus produces more enzymes that destroy nearby cartilage, aggravating the area and attracting more inflammatory white cells, thereby perpetuating the process.

Causes

The exact causes of Rheumatoid arthritis are still not known, but this condition is most likely triggered by a combination of factors such as abnormal autoimmune response, inflammatory process, genetic factors and at times environmental or biological factors like viral infections and/or hormonal changes.

• Abnormal Autoimmune Response & Inflammatory Process
  The immune system helps the body to fight and respond to the foreign substance and antigens – a substance that induces the formation of antibodies, since it is recognized as a threat by our immune system – like toxins and viruses. It helps the body fight these infections and accelerates the healing of wounds and injuries. The inflammatory process is an outgrowth of the immune system. There are two main components of the immune system that are associated with rheumatoid arthritis, namely, B cells and T cells, both belonging to a group of immune cells called lymphocytes – a type of white blood cell.
  If the T cell recognizes an antigen as “non self”, it will result in producing chemicals (cytokines) which in turn causes B cell too multiply and release many antibodies (immune proteins). These antibodies spread in the bloodstream, and help identifying foreign substances and ultimately causing inflammation in order to get rid of these invaders of the body.
  For unknown reasons, these T cells and B cells become over active in patients with Rheumatoid Arthritis.
• Genetic Factors
  Genetic Factors may play a significant role in either increasing the chances of developing RA condition or by worsening the process of the disease. The key genetic marker of RA is Human Leukocyte Antigen (HLA). HLA is not responsible is the development of Rheumatoid arthritis, but they can worsen the condition once developed. Other than that, STAT4 – a gene that plays an important role in the regulation and activation of immune system; TRAF1 and C5 – genes relevant to chronic inflammation; and PTPN22 – gene associated with both development and progression of RA, are connected to Rheumatoid Arthritis. Yet not all people with these genes develop RA and not all RA patients have these genes.
• Environmental Factors
  These factors include infectious agents like bacteria and viruses which may trigger the development of the disease in a person who is more likely to get RA. Research shows that factors like obesity, physical or emotional stress, exposure to cigarette smoke, air pollution, harmful chemicals, occupational exposure to mineral oil, silica etc.

Symptoms

Researchers have proven that about 1.3 million Americans e affected by Rheumatoid Arthritis. Although RA can develop in any age from childhood to old
age, it normally begins between the ages of 30 – 50 years. Women are more likely to develop this condition than men.
The symptoms of Rheumatoid Arthritis are:

• Swelling And Pain
  Te inflamed joints are usually swollen and are often warm and spongy when touched. The pain occurs on both sides of the body and may be more severe on either side.
• Building up of certain
  Fluid may get accumulated in joints. The fluid gathered in the joint sac behind the knee forming a tumor like substance called Baker’s Cyst. This cyst sometimes extends down the back of the calf and causes severe pain.
• Nodules
  In some cases of RA, inflammation of small blood vessels may cause nodules or lumps, under the skin. These nodules are often situated near the elbow (it can show up at other places too) and are about the size of pea or slightly larger than that. These nodules can become sore and infected, particularly if their location is where stress occurs, for e.g. Ankles.
• Specific Joint Pain
  Although RA mostly develops in the wrists and knuckles, the balls of the foot and knees are often affected too. Joints like those in the cervical spine, shoulders, jaw, elbows and even the joints between the inner ear, gets eventually affected.
• Flu like Symptoms
  Fatigue, loss of weight and fever are also few symptoms.

Complications Involved

• Anemia – RA patients tend to develop anemia i.e. decrease in the number of red blood cells.
• Eye Problems – Inflammations of the blood vessels in the eyes, like scleritis and episcliritis that can result in corneal damage. Symptoms include redness of the eye and gritty sensation.
• Skin Problems – Skin problems are common in RA patients, usually on the fingers and under the nails.
• Infections – RA patients are at a higher risk of being affected by infections, because of the disease itself and also due the immune suppressing drugs used in the treatment.
• Peripheral Neuropathy – RA condition affects the nerves, most often n hands and feet.
• Joint Deterioration and Pain – Affected joints become deformed due to the disease.
• Osteoporosis – Loss of bone density, is more common than average in postmenopausal women with RA. The hip is particularly affected. The risk for osteoporosis also appears to be higher in men with RA who are over 60 years old.
• Lung Diseases – Chronic lung diseases like interstitial fibrosis, pulmonary hypertension etc. are also caused in RA condition.
• Pregnancy Complications – Women with RA are more prone to premature delivery. They are also at higher risk of developing high blood pressure than in normal cases.
• Kidney and Liver Problems
• Heart Problems

Treatment

The primary goal of treating RA is:

• Stop inflammation
• Prevent joint and organ damage
• Relieve Symptoms
• Improve physical functions
• Reducing long term complications

The treatment is of different types:

Medications

Different drugs are used in the treatment of Rheumatoid Arthritis. Some are to ease the symptoms of RA, others to slower and eventually stop the different activities of RA.
Drugs used to ease the symptoms – Non-steroidal anti-inflammatory drug (NSAIDs) are used to ease the pain and inflammation involved in the condition of RA. These drugs include ibuprofen, ketoprofen and naproxen sodium. Patients with stomach ulcers are prescribed to take celecoxib, also known as COX-2 inhibitor, which is proven to be safer for stomach. These drugs can be taken by mouth or also can be applied to the skin.

Drugs that slower the RA activity– Corticosteroids medications like prednisolone, prednisone and methylprednisolone are some of the fast acting anti-inflammatory medications used in the treatment.
Disease Modifying Anti-Rheumatic Drugs (DMARDs) are the standard medical treatment for RA. Their ability is to slow down the progression of RA. These include- Methotrexate, leflunomide, hydroxychloroqune, minocycline and sulfasalazine. Unfortunately, all DMARDs tend to lose effectiveness over time and may also produce stomach and intestinal side effects.
Biological DMARDs – drugs made out of living cells are also used in the treatment. They are subsets of DMARDs. They target specific components of the immune system that contribute to the various attributes of rheumatoid arthritis. They include abatacept, adalimumab, anakinra, certolizumab pegol, etanercept, infliximab, golimumab and rituximab.

Surgery

Some people with RA are benefitted by joint surgeries. It can help in relieved joint pains and correcting deformities and at times it modestly improves joint function.

Joint Replacement

Joint replacement (arthroplasty) is usually done for people over age 50 or those whose joint damage is rapidly progressing. The joint replacement can last for 20 years or more.

Exercise

Its’ advisable for RA patients to maintain balance between rest and moderate exercise. Studies suggest that even little physical therapy can help the patients and that these benefits are sustained.

Natural Treatment

Natural Supplements

• Boswellia Serate (Indian Frankincense) – contains anti-inflammatory and pain relieving properties.
• Capsicum Fruitescens – reduces substance P, a pain transmitter. Research suggest that it helps in 50 percent reduction of joint pain. It’s available in the form of topical cream, gel etc.
• Fish Oil Capsules (EPA & DHA) – Omega-3 blocks inflammatory cytokines and prostaglandins, and are converted into effective anti-inflammatory chemicals. EPA and DHA are very effective for treating RA and other inflammatory conditions. Studies prove that fish oil significantly decreases joint tenderness and stiffness in RA patients, helping in reduction or elimination of NSAIDs.
• Gamma Linolenic Acid (GLA) – GLA is an Omega-6 fatty acid that the body converts into anti-inflammatory chemicals. Its intake shows significant improvement in joint pain, stiffness and grip strength. Studies show that a combination of fish oil and GLA reduces the need for conventional pain relievers.
• Ginger – Ginger has the properties of anti-inflammatory components similar to ibuprofen and COX-2inhibitors, without any side effects. Its intake reduces osteoarthritis pain in the knee and other joints. It also reduces inflammatory reactions of RA.
• Pine bark extract, rosehips, green-lipped mussel, devil’s claw, borage seed oil etc. also help in the treatment.
• Change in Diet