Rheumatoid Arthritis

RHEUMATOID ARTHRITIS

The prime target of RA is the synovium considering its vascularity, with subsequent deposition of immune complexes. The cause is not known but few factors can trigger its occurrence, i.e., environmental (smoking, bacterial or viral infection) and in genetically susceptible individuals (HLA DR 4). Gender is another factor with Female : Male ratio being 3:1. Other most important risk factor could be hereditary involvement.

Classic presentation of rheumatoid arthritis is early morning stiffness, pain and swelling in small joints (feet and hands) which is followed later by larger joints (knee and shoulder) with a symmetric pattern, presence of autoantibodies in serum. Occasional cases may have asymmetric involvement as well as single joint disease (mono articular rheumatoid). Over the coarse of time, profuse synovial inflammation forms what is called Pannus, which is an inflamed granulation tissue that starts damaging the articular cartilage resulting in pain and deformity as shown in Fig.1.

Diagnosis is made with the typical presentation of multiple joint pain (particularly small joints), early morning stiffness, presence of Rheumatoid factor or Anti CCP in the serum and radiographic changes of arthritis.

The focus of treatment should be early diagnosis and to keep the disease activity at its low. The stream line of treatment comprises of DMARDS (disease modifying anti-rheumatoid drugs) which is used to combat RA is early stages with significant disease control.

Glucocorticoids pave way for the next line of treatment which rapidly controls the disease process. Recent development is the use of Biologic DMARDS like Anakinra, Rituximab and Abatacept which are infused to control multiple inflammatory mediators in patients not responding to the standard treatment protocol.

Patients with significant synovial hypertrophy (inflammation) of large joints like the knee will definitely benefit from Arthroscopic synovectomy which is considered the most important inflammatory producer. In advanced cases with significant joint erosions as in the knee, hip and shoulder, total joint replacement is the only available effective treatment which would improve the quality and life as well as render the patients pain free.

SYMPTOMS

Symptoms of RA include:

• pain, swelling, and stiffness in more than one joint
• symmetrical joint involvement
• joint deformity
• unsteadiness when walking
• a general feeling of being unwell
• fever
• loss of function and mobility
• weight loss
• weakness