RHEUMATOID ARTHRITIS

Rheumatoid arthritis is an autoimmune disorder affecting the joints, symmetrically (usually). The joints become swollen, red, hot, painful & tender. The joint movement becomes limited due to pain & swelling

It starts with inflammation of the synovial membrane but may involve the joint capsule and other surrounding soft tissues.

It is a self limiting disease. But by the time it leaves, the patient is crippled due to contractures & deformities.

Acute phase can be managed with medicines.

                                         

Commonly used medicines are Ibuprofen/Paracetamol/Aspirin in therapeutic doses. They help to control symptoms of pain and swelling of the joints in most of the cases by their anti inflammatory properties. Fever is also controlled. 

Vitamins, minerals, anti oxidents & other supportive medicines are also needed. Omega 3 fatty acids have a very definite role to play in improving the response to the treatment.

Physiotherapy helps in preventing contractures & deformities.

The patient should do general exercises & keep active.

He may have to be further investigated

  

In established cases of Rheumatoid arthritis DMARD (disease modifying drugs) e.g. METHOTREXATE, HCQ, LEFLUNOMIDE, SAAZ etc. have to be used.

They all are toxic drugs & can cause bone marrow depression along with other side effects. They should be taken under medical supervision.

Sometimes steroids may have to used.

The dose of these medicines should be adjusted to the minimum required, to control the symptoms.

Blood, urine Tests & other investigative procedures should be done periodically to rule out any side effects.

X rays of the affected part should be done to confirm diagnosis & assess the extent of damage.

Diabetes, vitamin D deficiency or any other metabolic disorder should be ruled out. Sometimes they mimic the symptoms & create confusion in diagnosis. Associated disorders like these, most certainly affect recovery adversely.

It should be ascertained that the patient is not allergic to any of the medicines that he is going to take.

Rheumatoid arthritis is a chronic disorder that lasts over many years with acute exacerbation & remissions. The earning capacity of the family is adversely affected. The cost of medical treatment is high. If the patient needs surgery, it is further escalated. Most of the population in India is not covered by any medical insurance. All these factors put together create an atmosphere of depression in the family. Patient feels morally degraded & may even develop suicidal tendency.

In a situatation like this it becomes essential that a moral support is provided to the patient by his friends & relations. Treating doctor has a very definite role to play in keeping up the moral of patient.