What is Rheumatoid Arthritis (RA)?
Our human body has an immune system that protects it from foreign substances like disease-causing bacteria and viruses. A person gets Rheumatoid Arthritis when this immune system mistakenly attacks our joints.
Rheumatoid Arthritis, or RA for short, is an autoimmune disease. There is a tissue lining in our joints called synovium.The synovium generates a fluid that lubricates our joints to keep them flexible.
When the immune system attacks the joints, the synovium gets thickened, causing inflammation and pain around the joints.
If left untreated, RA can harm the cartilage and even the bones, resulting in loss of mobility or even joint deformity. Joint damage is usually irreversible in this case.
The commonly affected joints are
- elbows, and
- finger and toe joints.
RA usually develops between the ages of 30 and 60.
What is known about Rheumatoid Arthritis is that it is caused by the attack of our own immune system, but not the why.
However, certain studies have shown that factors like genes, hormones as well as the environment play a part in it. With respect to genetic markers, it has been observed that people with an RA genetic marker have five times more chances of getting the disorder than those who don’t.
Many other factors like obesity, female hormones, bacteria, virus, physical and mental trauma, etc. are under study to understand their effect, if any, in causing this disease.
At times, certain infections (and quite controversially, immunization) can also cause Rheumatoid Arthritis. Like most autoimmune disorders, RA affects more women than men around the world.
Also, smokers have a higher risk of getting RA and evidence also suggest that smoking influences the course of RA. Consumption of certain foods like high quantities of red meat and low vitamin C also increase the risk of RA.
Few of the commonly seen symptoms are given below:
- Joint pain
- Tenderness in the joints
- Swelling or inflammation in the joints
- Stiffness and lack of flexibility in the joints
- Joint stiffness in the morning
At times, people may also experience fatigue, loss of appetite and even a low-grade fever. The symptoms may appear and disappear in flares.
Warning Box: At times, untreated RA can also cause issues across the body like dry eyes, or impaired vision, dryness in the mouth, rheumatoid nodules (lumps under the skin), shortness of breath caused by lung inflammation, or even anemia.
The symptoms of RA are more or less similar to that of regular arthritis, Hence, it is possible that a person may be referred to a rheumatologist. The specialist studies the family as well as medical history, and then the symptoms (physical examination), periodicity and severance of occurrence, etc.
Some tests can also conclusively prove the presence of Rheumatoid Arthritis
- Blood Test: This is used to measure the inflammation levels and also look for the genetic biomarkers linked with RA.
- Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level are checked to understand inflammation levels. While these by themselves do not indicate RA, when studied along with other test results, could indicate RA.
- The Rheumatoid factor (RF) is another aspect studied based on the blood test. This is an antibody that is present in 80% of the people with RA. While this again is not conclusive of RA, this along with another antibody called, anti-cyclic citrullinated peptide (anti-CCP), helps in RA diagnosis. CCP is primarily only found in RA patients.
- Imaging Tests: Imaging tests like X-ray, ultrasound, or MRI scans may be done to check for the extent of joint damage.
- However, one point to be noted is that the absence of joint damage does not indicate absence of RA.
- It is quite possible that the disease is in early stage, where the damage has not yet occurred.
Treatment (Medication) - Allopathy, Homeopathy, Ayurveda
The treatment for RA could be an early treatment aimed at reducing the disease, achieving remission through targeted treatment, or controlling it to reduce joint damage.
Treatments are aimed towards:
- Stopping of inflammation
- Providing relief from symptoms
- Preventing joint as well as any other organ damage
- Improving mobility and overall well-being
- Reducing any long-term complications
Allopathic drugs for RA are of two types aimed at easing symptoms as well as slowing the disease activity.
Drugs for easing symptoms
For this purpose doctors use, nonsteroidal anti-inflammatory drugs (NSAIDs) that are available as over-the-counter medicines and by prescription. They help in easing pain and inflammation.
Such drugs include ibuprofen, ketoprofen and naproxen sodium, and a few more prescription drugs. These are oral medicines, while a few ointments can also be applied directly to the swollen joints for relief.
Drugs for slowing the disease
- Corticosteroids: Drugs such as prednisolone, prednisone, and methylprednisolone are highly effective and quick-relief anti-inflammatory medications.
- They may be used to control the inflammation until NSAIDs and disease-modifying antirheumatic drugs (DMARD) take effect.
- There are side effects associated with the usage of these drugs. Hence, these are usually prescribed only for a short period and in low doses.
- DMARDs: Drugs such as hydroxycholorquine, methotrexate, leflunomide, sulfasalazine, cyclophosphamide and azathioprine are used to modify the course of the disease. They may be oral or injectable.
- A subset of DMARD are Biologics, derived from living systems, that are usually injected to wipe out the immune response.
- Another category of DMARDs called JAK inhibitors are also administered orally to block the Janus kinase pathways that are involved in the immune response.
- Surgery: At times, surgery like joint replacement surgery is done, so that the patient gets back their mobility. This is done only for such patients who suffer from permanent, irreversible damage.
In a study sponsored by the World Health Organization (WHO), the efficacy of Ayurveda on RA was studied at Ayurvedic Trust, Coimbatore, India.
290 patients were studied over a period of 7 years and evaluated as per the American Rheumatism Association’s criteria. The results from the study suggested that there was significant improvement in RA patients, even in those with severe mobility issues.
According to Ayurveda, RA is “Ama Vata” and it is treated in three different ways, namely:
- Langhanam (Fasting) – A complete fasting or eating only foods like green gram / rice / barley soups.
- Sodhana chikitsa (Purification of the body) – In this form of treatment, various long-drawn procedures depending on the condition of the patient are used to cleanse the body.
- Shamana chikitsa (Treatment for the symptoms) – This includes oral consumption of many proven Ayurvedic preparations.
Along with the above forms of treatment, diet inputs as well as lifestyle suggestions are also provided to patients.
There are no conclusive studies that provide evidence to indicate that homeopathy is effective in treating RA. However, as per an article published in the British Homeopathic Association by Dr. Fisher, a wholesome approach is used.
This means that the patients’ problems, symptoms, and any other life issues that could have led to the development of RA are studied. The patient is then treated for mental as well as constitutional issues.
RA patients are usually advised to follow a healthy, balanced as well as an anti-inflammatory diet. Following a Mediterranean diet rich in good fats and fresh produce can help immensely. Some foods you should consume include
- Fresh vegetables
- Fresh fruits
- Olive oil
- Nuts and seeds
- Red wine, in measured quantities
RA patients are also advised to avoid fast food or processed foods.
Low-impact aerobics, and muscle strengthening exercises aimed at improving and maintaining flexibility, can help you immensely. However, when there is swelling and pain, rest is advised and not resting can cause grave injuries.
Suggested exercises are:
- Arthritis Friendly Yoga
Be sure to consult with a physiotherapist to understand how and at what intensity each of these exercises can be performed.
As with most autoimmune conditions, lifestyle changes can help you immensely, not just in reducing the severity of symptoms but also in improving your quality of life. Here are a few suggested changes:
- Regular exercise
- Consuming a healthy diet with high antioxidant foods
- Avoiding processed and fast foods
- Balancing between rest and activity
- Staying mentally fit and active
How to prevent Rheumatoid Arthritis?
In order to prevent RA, especially if you are genetically predisposed, try and avoid all possible risk factors.
- Quit smoking as there is scientific evidence to suggest that smoking increases your chances of getting RA by up to 2.4 times.
- Obese people, especially women, are again found to be a higher risk of getting RA; hence, it is good to maintain an ideal body weight.
- Seek help early if you suspect RA as that can help halt the progress of the disease.