Managing rheumatoid arthritis

What you need to know:

Signs and symptoms include tender, warm, swollen joints, joint stiffness that is usually worse in the morning and after inactivity, fatigue, fever and weight loss.
Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

Rheumatoid arthritis (RA) is a type of arthritis where your immune system attacks the tissue lining the joints on both sides of your body. The main symptoms are joint pains and swelling. RA can affect more than just the joints. It can also damage the skin, eyes, lungs, heart and blood vessels.

Unlike the wear-and-tear damage of osteoarthritis, RA affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

The inflammation associated with RA is what can damage other parts of the body. While new types of medications have improved treatment options dramatically, severe RA can still cause physical disabilities.

How does the condition present?
Signs and symptoms include tender, warm, swollen joints, joint stiffness that is usually worse in the morning and after inactivity, fatigue, fever and weight loss

Early RA tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. Rheumatoid arthritis can also affect many non-joint structures, including the skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow, blood vessels, among others

How is RA diagnosed?

The condition can be difficult to diagnose in its early stages because early signs and symptoms mimic those of other diseases. There is no single blood test or physical finding to confirm the diagnosis.During physical examination, your doctor will check your joints for swelling, redness and warmth. He or she may also check your reflexes and muscle strength.
Blood tests

The blood tests look for inflammation and blood proteins (antibodies) that are signs of RA.

Imaging tests

Your doctor may recommend X-rays to help track the progression of RA in your joints over time. MRI and ultrasound tests can help your doctor judge the severity of the disease .

How is rheumatoid arthritis treated?

There is no cure for RA. But recent discoveries indicate that remission of symptoms is more likely when treatment begins early with strong medications known as disease-modifying antirheumatic drugs (DMARDs).

Medications

The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you’ve had the condition.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation.

Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects may include ringing in your ears, stomach irritation, heart problems and liver and kidney damage.

Steroids: Corticosteroid medications, such as prednisone reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain and diabetes. Doctors often prescribe a corticosteroid to relieve acute symptoms, with the goal of gradually tapering off the medication.

Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage. Common DMARDs include methotrexate (Trexall, Otrexup, Rasuvo), leflunomide (Arava), hydroxychloroquine (Plaquenil) and sulfasalazine (Azulfidine). Side effects vary but may include liver damage, bone marrow suppression and severe lung infections.

Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs includes abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), tocilizumab (Actemra) and tofacitinib (Xeljanz).

These drugs can target parts of the immune system which trigger inflammation that causes joint and tissue damage. These types of drugs also increase the risk of infections.

Biologic DMARDs are usually most effective when paired with a nonbiologic DMARD, such as methotrexate.

Therapy

Your doctor may send you to a physical or occupational therapist who can put you on exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks, which will be easier on your joints. For example, if your fingers are sore, you may want to pick up an object using your forearms.

Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a saw handle helps protect your finger and wrist joints. Certain tools such as buttonhooks can make it easier to get dressed up.

Surgery

If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and correct deformities.

Dr Otieno is consultant rheumatologist at Aga Khan University Hospital, Nairobi