RHEUMATOID
ARTHRITIS
What
is Rheumatoid arthritis?
Rheumatoid
arthritis (RA) is an inflammatory diseases that causes pain,
swelling, stiffness, loss of function an deformity in the
joints.
As
it is a systemic disease, areas outside the joints may also get
involves for example membranes surrounding internal organs, such
as the heart, lungs or eyes. RA tends to run in families,
Moreover Women are three times more prone development rheumatoid
arthritis. But with advanced age the ratio of women to men
becomes almost equal.
What
happen in Rheumatoid Arthritis?
Rheumatoid
arthritis is an autoimmune disorder. Normally, a health immune
system is programmed to protect the body from harmful foreign
bodies like bacteria and viruses but in rheumatoid arthritis the
immune system (defense system) of the body, for unknown reasons,
starts attacking the body’s healthy tissue. The reaction
results in inflammation of joints causing reduction in joints
space and loss of normal joint shape and alignment.
Important
features of Rheumatoid arthritis:
-
It may begin by age 25 and usually before 50 years of age
but some times seen in children too.
-
May develop suddenly within a period of weeks/ months but
is usually gradual (slow onset)
-
Involves the joints symmetrically i.e. joints on both
sides of the body are involved
-
Usually affects the small joints of the hand, foot,
wrist, elbow, shoulder or ankle.
-
Causes inflammation resulting in pain and swelling of
joints where the joint warm and tender.
-
Early morning stiffness lasting for more than one hour
-
Causes symptoms in other organs of body besides the
joints such as lungs, heart & eyes.
-
May cause overall tiredness, weight loss and occasional
fever
-
Finger deformities (‘swan neck’ deformity and
‘boutonniere’ deformity) are characteristics of RA.
What
are the investigations to be carried out?
Apart
form a detailed medical history and physical examination the
doctor will recommend various tests to evaluate and diagnose the
condition.
These
includes:
·
Blood test for ESR (increase in RA) and blood cell count
(shows increases white blood cells and platelets because of
inflammation)
·
Serology test for Rheumatoid factor (an abnormal antibody),
which is present in 70-80% of RA cases.]
§
X-ray is usually done to find out the degree of damage that
the joint has suffered and later to monitor the progress of the
disease.
§
Synovial fluid examination to rule out
infection.
Management of Rheumatoid
Arthritis
·
Becoming aware about the disease
·
Taking the medications regularly
·
Take a diet low in fat, moderate in sugar, rich in Gamma
linolenic acid (found in nuts and fish, promrose oil) and omega
3 fatty acids like nuts and fishes like salmon, mackerel, and
herring.
·
Controlling body weight
·
Taking adequate rest. Acutely involved joints must be given
rest or splint to reduce inflammation.
·
Regular exercise to strengthen muscles (as advised by the
doctor) surrounding the involved joints.
Yoga and other alternative therapies
have been scientifically documented to complement the use of
drugs. (To see the proper scientific and validated yogic
protocol for Arthritis, log on to www.bestonhealth.com).
Medications:
Nsaids: Disease modifying drugs
D Mards: Methotrexate (Oral & I/V), Salzopyrine, Hydroxychlorognine, Leflunomide. Earlier medicines in this group Gold salts, D-Pencillamine are less used now
Advance treatment of Rheumatoid arthritis.
The Biological: The biologicals are injectible drugs – Tumor necrosis factor Alfa (TNF Alfa) blocking agents and interlenkin – 1 receptor antagonist (IL-1ra) are new drugs for RA treatment. They are expensive but have been found to benefit otherwise inadequate response patients.
The anti TNF Alfa agents – Infliximab, Etanercept and adalimumab have set new standards for RA therapy.
Stem Cell implantation: is another new, promising area for the hopeless patients. It is embryonic and adult type – principle is once implanted stem cell has potential to replicate and grow more healthy cells and hence cure the disease. |
SURGICAL MANAGEMENT
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Intra
articular Injections
Arthroscopy
(One stitch close surgery)
Joint
Replacement (THR, TKR, Shoulder Replacement, Finger
joints)
Medications
NSaids
for pain relief. Disease Modifying drugs are very
helpful in eradicating and controlling the disease. |
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FAQ’s
on Rheumatoid Arthritis
Can
smoking worse Rheumatoid arthritis?
Smoking
tends to increase the Rheumatoid factor (RF) concentration in
blood and high concentration of RF is usually associates with
severe rheumatoid disease. Besides smokers are move at risk of
lung disease. Hence, it is best to quit smoking.
Is
Rheumatoid arthritis a disabling disease?
Although
Rheumatoid arthritis may affect you daily in long run, early
detection of disease and judicious management (with medications,
exercise dietary modifications) can easily prevent the progress
of your disease, preserve joint movement and prevent
deformities.
Why
do I need blood tests frequently?
Frequent
Blood tests are required to assess the progress of disease or
side effects of medication on vital organs such as liver,
kidneys and bone marrow. Your doctor may advise ESR, Hemoglobin,
Complete blood count, Liver function test (kidney function test
(KFT) at frequent intervals.
How
do I know that I am responding to the treatment?
Response
to treatment may be observed as a general sense of well-being
through the course of treatment with adequate treatment there
may be decrease in the duration of morning stiffness, decrease
in the number of swollen and painful joints. You will be able to
perform your daily activities with less discomfort. Monitoring
of laboratory parameters such as ESR (Erythrocyte Sedimentation
Rate), Rheumatoid factor, C-reactive protein also helps in
assessing the disease activity and response to treatment.
What
is “seropositive” and “seronegative” Rheumatoid
arthritis?
Rheumatoid
factor is present in blood of approximately 75% of rheumatoid
arthritis patients. Those patients having RF in blood are called
“Seropositive” whereas remaining 25% who do not have RF in
blood are called “Seronegative”. Seronegative rheumatoid
arthritis patients have a better prognosis than seropositive
patients.
What
is the significance of high levels of Rheumatoid Factor?
High
levels of Rheumatoid factor is commonly associates with more
severe rheumatoid disease and non-joint manifestation of
rheumatoid arthritis such as rheumatoid nodules, rheumatoid lung
disease etc.
HEALTHY
EATING
What
is the importance of healthy eating habits in arthritis?
There
are more than hundred forms of arthritis and in most common of
them some dietary modifications are advised to patients. This
not only eases the pain but also reduces the chance of other
associated complications. Some forms of arthritis like Gout has
a close relationship with dietary practices.
What are the general dietary guidelines advised in art
hritis?
·
Maintain your ideal weight – Obese people are more prone to
these disorders because, excess weight puts an added burden on
weight-bearing joints, which can worsen the situation. So, try
to avoid excess calories and make your meals light (low-fat) and
healthy. If you are obese, try to reduce the weight gradually.
Do not practice fasting or crash diet as these practices do more
harm than good.
·
Eat a well-balanced diet – your diet should compromise of
all the major food groups (cereals, pulses, milk, flesh, foods,
vegetables, fruits, fats and sugars). However, the form of meat
consumed can be altered. It has been observed that fish and fish
based oils have some anti-inflammatory properties (due to the
presence of omega-3 fatty acids) and are therefore, beneficial
in arthritis.
·
Fluid intake-Liberal fluid intake (up to 2-2.5 L/day) is
advised.
·
Vitamins and minerals – Sometimes different dietary
supplements are used to correct the imbalance of vitamins and
minerals. Vitamin D, C and Calcium are of utmost importance in
arthritis. Some rich sources of them are milk and milk abased
products, leafy green vegetables, mackerel and other oily
fishes.
·
Regular physical exercises – Regular exercise schedule not
only takes care of obesity but also provides some movement to
joints. Proper exercises can be selected with the consultation
of some good physical trainer.
Are there any dietary restriction for arthritis?
·
Avoid high calorie, deep-fried fatty foods and use
combination of various oils as the cooking medium (rice bran,
sesame, groundnut, sunflower, safflower, cottonseed, corn,
mustard, soybean oils can be used).
·
In gout you have to avoid purine rich food products like
glandular meat (brain, kidney, liver, heart etc), meat extracts,
sea foods, sardines, beans, peas, lentils, spinach, oatmeal,
yeast and yeast based products.
·
Avoid alcohol completely.
Nutrition
FAQ’s
I
have heard that Omega-3 fatty acids are beneficial in Arthritis.
Is it True?
Yes,
some studies have indicate that omega 3 fatty acids (a type of
polyunsaturated fatty acids) have some anti-inflammatory
qualities. Due to this they can help in reducing joint
tenderness and morning stiffness in the arthritis patients.
Some
rich sources of omega-3 fatty acids are fishes (salmon,
mackerel, herring etc.), mustard soyabean., flaxseed and evening
primrose oil.
There
is various supplements available in market for Arthritis
patients. Are they effective?
Supplements
that contains Glucosamine and Chondroitin sulphate can provide
some relief in Arthritis symptoms. Glucosamine not only helps in
protecting joint structure but also provides pain relied and
increased mobility. Similarly, Chondroitin sulphate helps in
repairing the damage articular cartilage.
What
is the role of antioxidants in the management of Arthritis?
It
has been observed that high intake of antioxidants specially
vitamin C reduces the progression of osteoarthritis. However,
antioxidants cannot prevent the onset of diseases. Other
antioxidants, which can be useful in Arthritis, are vitamin A
and E.
Some
rich sources of these vitamins are wheat, papaya, pineapple,
mango, citrus fruits, carrots, pumpkin, dark green leafy
vegetables and tomatoes.
FITNESS
Exercising
forms an integral part of the arthritis control plan and helps
in lifting the sprits. It helps to maintain:
·
Normal muscle strength
·
Joint structure
·
Function of joint
The
type and pattern of exercises have to be individualizes
depending on the type of arthritis, the joints involved, the
range of mobility and extent of joint damage.
Some tips for exercising include:
·
Before starting an exercise programme always consult your
doctor and get and individualized exercise plan made for
yourself.
·
Identify the type of exercise you feel more comfortable.
·
Massage or apply heat/cold application to the sore joint
before starting the exercise.
·
Warm up before exercising by starting exercise at a slower
pace.
·
Know your limit and don’t over do the exercise
·
Do exercise at a comfortable pace and allow the muscles to
relax in between.
·
Doing exercise exactly as per the instruction is more
important than doing it number of times.
·
Wear comfortable clothes and shoes while exercising
·
While exercising avoid jerky movements
·
Cool down for
5-10 minutes after the exercise. To cool down, simply do
exercise activity at a slower pace, such as walking slowly
·
Avoid exercising during flare ups i.e. when you are having
symptoms
·
Stop exercising immediately if you have:
·
Servere pain in chest
·
Severe breathlessness
·
Dizzy feeling or sick feeling in the
stomach
Note
: In osteoarthritis of knees or hip, all exercises need to
be done in non- weight
bearing
position (i.e. not in standing position).
LOW
BACK PAIN
Low
Back Pain
Over
85% of the population in the industrial world will experience
low back pain sometimes in their lives. In fact back pain is the
most frequent cause of activity limitation in people younger
than 45 years.
It
generally remains a benign condition. Some 60% of patients
recover in a week and about 90% in 6 weeks.
Causes of low back pain
·
Faulty posture habit especially seen in people who tend to
sit around for long time at one place (e.g. those working with
computers).
·
Osteoarthritis (especially in old people).
·
Osteoarthritis (especially in post-menopusal women)
·
Tuberculosis
·
Injury to spine
·
Cancer prostate (especially in old age).
Stress also plays an
important in causing low back pain
What is
dangerous?
Usually low
back pain resolves within a few days to 1-2 months. Following
symptoms may be suggestive of serious low back pain:
·
Weight loss, fever and chill (indicative of infection &
sometimes malignancy)
·
Intolerable pain, patient tosses about in bed and is unable
to lie still due to pain (indicative of kidney stone or ruptured
organ)
·
Evolving nerve problems such as bladder/bowel problems (e.g.
repeated urination without adequate control)
·
Early morning stiffness (for more than 30 minutes) in a
person less than 45 years of age (indicative of rheumatoid
arthritis)
·
Unresponsive pain (lasting for more
than 2 months)
What
are the investigations to be done?
X-ray
of spine, MRI (for tumor), CT (for tumor), Bone densitometry
(for thinning of spine), Radionuclide scanning (for tumor and
osteomyelitis – infection of the inner part of bone i. e. till
bone marrow) may be advised.
Management of low back pain
Key elements
of the conservation treatment for low back pain include:
·
Taking medication for pain regularly as advised.
·
Maintaining proper body weight
Education and
activity alteration. Certain precautions need to be taken in low
back pain:
·
Avoid lifting
heavy objects
·
Use the legs rather than the back lifting
·
Maintain proper posture while sitting and standing, do not
slouch
·
Use a chair with arm rests
·
Rise from the bed by first rolling to one side and then using
the arms to push to an upright position
Surgery
may be needed in cases of tumors or evolving neurological
problem.
UNDERSTANDING
MEDICATION
Gout
Presents a
Swelling in one joint, Gr Toe commonly a metabolic disorder of
Drugs of Gout
·
Colchicine is very effective for pain relief in acute gout
but not used frequently due to its side effects.
·
These drugs decrease in blood uric acid levels by increasing
excretion of uric acid in urine (Probenecid and Sulfinpyrazone)
or reducing production of uric acid (Allopurinol) inside the
body.
