What
is Rheumatoid arthritis ( RA)?--
It is an auto immune disease which mainly
involves the joints.
What
is the cause of RA ?--
The exact cause of RA is not understood. However
it has an auto immune mechanism leading to destruction to destruction.
How
does RA manifest?---
Pain & swelling of the small joints of the
hands & feet is the most common manifestation.
The onset in most cases is slow. However some
may have a sudden onset of symptoms.
As the disease progresses, slowly deformities
begin to appear. This leads to limitation of movements &
functional loss.
Nodules called as rheumatoid nodules may appear
especially on the back of the forearm & other pressure areas.
Severe cases may also have fever , lymph node
enlargement, lung involvement.
What
is Juvenile Rheumatoid Arthritis?--
This is the form of RA seen in children.
What
is Rheumatoid factor?--
Rheumatoid factor is an antibody seen in the
blood of many RA patients.
Absence of this factor does not rule out RA.
How
is RA diagnosed?--
After the clinical assessment , X ray of the
affected joints can provide useful information for the diagnosis.
Rheumatoid factor, if present is an important
marker of the disease.
Other investigations like ESR & Hb are
mainly important for monitoring the progress of the disease.
What
is the treatment of RA?--
***** NSAIDs--
This group involves drugs like Aspirin,
Diclofenac etc.
These are the most common group of drugs used.
However they do not alter the course of the
disease.
Side effects include acid peptic disease( For
details click here)
Newer agents like Nimesulide, Meloxicam are
devoid of these side effects.
*****Antimalarials--
Chloroquine belongs
to this group.
It can modify the course of the disease.
They have a mild disease suppressing activity.
Side effects include eye toxicity; however it is
not very common at the doses prescribed.
*****Soluble
Gold salts--
Aurothiomalate is the most commonly used drug of
this group.
It can also modify the course of the disease.
These are administered in the injection form.
The side effects are many & troublesome.
*****
D-Penicillamine--
It belongs to the disease modifying group of
agents.
Does have a good disease suppressing activity.
However it has many auto immune side effects.
*****
Sulphasalazine--
The beneficial effects seen after 2 to 3 months.
Side effects include nausea, abdominal pain
& at times dizziness.
*****
Methotrexate--
This disease modifying drug is slowly becoming
the drug of choice.
It is a rather rapid disease suppressing agent.
The patient acceptance is excellent.
Most common side effect is gastrointestinal
intolerance, but it is not severe.
Complete blood count, liver enzymes & serum
albumin are done at 6 -8 weeks to monitor for toxicity.
*****
Azathioprine & cyclosporine--
These are generally reserved only for severe
cases.
*****
Glucocorticoids
( steroids as known commonly)
It is the most effective & predictable drug
to obtain immediate symptomatic relief.
However the long term side effects are many
& serious.
Intra articular injections are used if the
disease is refractory to the above agents. But the risk of introducing
infection in the joint cavity.
Changing
trends--
What can be expected in years to come--- as the
research continues to find out the exact causative factors for
rheumatoid arthritis, we can hope for a more target oriented treatment
in the future.
Research is also oriented towards biological
agents rather than only drugs for the management.
That can make whole lot of difference to the
management of Rheumatoid arthritis.
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