Rheumatoid Arthritis

Rheumatoid Arthritis is a disorder of the immune system that affects multiple joints in the body, causing pain, stiffness and swelling of the affected joints. The commonly affected joints are the small joints of the hands, wrists, elbows, shoulders, knees, ankles and the toes. It can also affect other organs in the body like the eyes, skin, heart and lungs.

The body’s immune system which normally takes care of combating foreign bacteria, viruses and diseased cells in the body begins to attack the joints and their surrounding tissues leading to inflammation. Lacking an “off switch”, the continual attack by the immune system eventually causes damage to the joints. As the condition progresses, the inflammation, pain and stiffness of the joints tend to increase in severity, ultimately leading to joint deformity and a loss of function and mobility.

As Rheumatoid Arthritis is a disorder of the immune system and not due to “wear and tear”, patients can acquire Rheumatoid Arthritis at any age, though it occurs most commonly between the age of 25 and 40. It can and does occur in children. It affects both men and women, although women are 3 times more likely than men to develop the condition.

The first symptoms of Rheumatoid Arthritis are pain and swelling in the joints of the fingers and wrists accompanied by joint stiffness, especially in the mornings. The pain and stiffness can last for hours and usually involve the joints on both sides of the body.

Other symptoms include a low-grade fever, tiredness and loss of weight and appetite. These symptoms are related to the amount of inflammation present.

In advanced Rheumatoid Arthritis, much of the joint surface is destroyed leading to deformed joints.

​Although scientists are not certain about the exact cause of Rheumatoid Arthritis, one can prevent the disabilities caused by Rheumatoid Arthritis through early diagnosis and treatment. A healthy balanced diet and moderate regular exercise is helpful. Quitting cigarette smoking is strongly advised.

Rheumatoid arthritis could cripple patients when the diagnosis is delayed or if patients do not take their medications and make lifestyle changes as advised by their doctors.

Scientific research shows that either a disorder in the body’s immune system or an overreaction to an unknown trigger like a virus infection can set off the condition. Once mobilised, the immune system targets the body’s own cells – hence the term “autoimmune disease”.

In the case of Rheumatoid Arthritis, the synovial membrane that covers the joints becomes the target of the immune system, leading eventually to the destruction of the bone and cartilage of the joints. The visible swelling and tenderness of the joints are due to increased fluid in the joint cavity and the thickening of the lining of the joint capsule, the results of on-going inflammation.

A family history with Rheumatoid Arthritis and environmental factors such as smoking are the risk factors.

Diagnosis is made from a detailed history and physical examination for signs of joint inflammation and comprehensive investigation.

Blood tests and X-rays are used to confirm the diagnosis. Blood tests include detection of the rheumatoid factor (RF) and anti-CCP antibody. Joint aspiration may be carried out and the fluid will be sent for special examination. This will help the doctor to differentiate between Rheumatoid Arthritis and other types of arthritis.

There is no cure for Rheumatoid Arthritis.  Nevertheless, there are various treatment strategies focused on alleviating the symptoms, preventing further joint destruction, and regaining lost muscle strength and mobility.

• Medication
• Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to reduce pain, swelling and stiffness. Reducing pain and swelling are important as they make you more comfortable. However, these drugs will only reduce the symptoms and have no effect on stopping the progression of the disease.
• Disease-modifying anti-rheumatic drugs (DMARDs) are often prescribed. These include hydroxychloroquine, methotrexate, sulphasalazine and leflunomide. Low dose steroids may be used initially. Steroids are usually taken as oral tablets. Steroids can also be injected directly into a joint to relieve pain and swelling. However, steroids cannot be used in the long term, especially in high doses because they have significant side-effects.
• There are two relatively new group of drugs called biologic agents and small molecules, which can control the disease quickly and effectively. Depending on the specific drug, these drugs are given as intravenous / subcutaneous injections or oral tablets. Biologic agents and small molecules are expensive. Not all Rheumatoid Arthritis patients are suitable for or need such drugs.
  
  
• Exercise / Physiotherapy

​When you are on medication for Rheumatoid Arthritis and you are preparing for an elective surgery, please consult your rheumatologist if any of your medication should be temporarily stopped.

​When you are on medication for Rheumatoid Arthritis and you have undergone any surgery, please consult your rheumatologist if any of your medication should be reviewed. If your DMARDs, biologic agents, and small molecules for Rheumatoid Arthritis are stopped before surgery, these medication generally are safe to restart if there is no symptoms or signs of infection. Please consult your rheumatologist for your post-surgery care.