A chronic inflammation of the joints triggered by a disorder of the immune system, rheumatoid arthritis (RA) primarily affects the |cartilage and bone structures but can also damage many other organs leading to significant physical disabilities.
With the mechanisms |underlying the illness now better understood, new therapeutic approaches have greatly improved the long-term prognosis of the |disease. It is however essential to make an early diagnosis to prevent or minimise possible severe complications.
Although RA is encountered in both genders and at different ages, women around the age of 50 are mainly afflicted with the disease. It is estimated that 0.3 per cent of the population suffers from RA, which roughly corresponds to 200,000 individuals in a country such as Thailand.
The joint is the area of junction between bones that allows bone motion. The joint consists of the cartilage, a flexible tissue covering the surface of the bone, and the lining, the synovial membrane, that produces the synovial fluid to lubricate the joint. In RA, the inflammation process lies within the synovial membrane and leads to an excessive production of the synovial fluid, a damaging thickness of the lining and the release of inflammatory substances that further injure the cartilage, the bone and even the nearby tendons.
The initial symptoms include pain, tenderness and swelling on the joints typically on both sides of the body and especially in the hands, wrists, feet and knees. The pains primarily occur in the second half of the night and lead to morning stiffness of these joints that persists at least 30 minutes. Other common complaints include feverish sensations, fatigue and weight loss. The symptoms of RA often vary in intensity over time with alternate periods of apparent remission and boosts in severity, the latter known as flares.
Minor forms of the disease may last a few months or years while the more severe can last a lifetime. Left untreated, about 20 to 30 per cent will suffer serious deformities of the joints and bones that can impair the ability to perform daily domestic and/or professional activities.
In about 40 per cent of patients, the inflammation progresses and starts inducing disturbances on many organs including the lung, eyes, heart, vessels, lymphatic system, kidneys and nervous system. Fortunately the severe forms of RA are rare today thanks to the availability of multiple therapeutic options.
RA is an autoimmune illness in which some antibodies synthesised by the body’s immune system wrongly attack normal tissue structures. These antibodies induce a continual inflammation on the lining of the joints that may eventually destroy the cartilage and the adjacent bone leading to deformities and bone erosion. The exact cause of this phenomenon is still unknown but a genetic predisposition (a family history of RA increases the risk of the disease) and various environmental factors are involved such as tobacco smoking, exposure to asbestos and obesity.
The diagnosis of RA relies on suggestive clinical symptoms, the presence of inflammatory and antibodies markers in the blood and to a later stage, radiologic abnormalities. In its early stages, RA might be difficult to diagnose and it is wise to consult without delay a rheumatologist – a specialist in rheumatic diseases – if you suffer from swollen and painful joints for several weeks.
The core objectives of the treatment are 1, the control of the inflammation process and resulting pain, 2, the prevention or limitation of joints or other organ damage, and 3, the maintenance of satisfactory quality of life. Medications include painkillers, anti-inflammatory agents and multiple therapeutic options of so-called Disease Modifying Anti Rheumatic Drugs that act on the production or on the adverse affects of the harmful antibodies.
People afflicted with RA also need to maintain a healthy lifestyle taking regular appropriate exercise, avoiding smoking, using stress-lowering techniques and sticking to a healthy diet. This combined with the proper drug regimen often allows effective control of rheumatoid arthritis.
DR GERARD LALANDE is managing director of CEO-Health, |which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at firstname.lastname@example.org.