Rheumatoid Arthritis | Dr. Vikas Tyagi

Unlike Osteoarthritis where mostly ageing leads to wear and tear of cartilage (a cushion between bones), in rheumatoid arthritis there is lot of swelling in and around joints. This is what is commonly called as “Gathiya”. The most common reason of this arthritis is due to genetics in which patients’ own immune system attacks many joints in the body. This causes a lot of swelling and pain in the joint.

Most patients of RA are between 22 to 55 years of age, when they first get the symptoms, though it can happen at any age. Almost 3/4th patients are women.

Symptoms of rheumatoid arthritis- Most commonly patients have these symptoms-
    Patients complain of severe stiffness in the morning especially of hands, feet, wrists, knees or elbows. It usually lasts for 45 minutes to 1 hour.

• Both sides of body are affected. Both hands and both feet, elbow and shoulder are usually painful.
• Initially patients feel fatigue, muscle pain and weakness in whole body. Though sometimes only one joint or 2 joints are affected, most of the times patients complain of pain in many joints in the body.
• Simple tasks like holding a glass or cup may be very painful. Slowly patients find it difficult to do daily activities.
• If no treatment is sought, then slowly deformity of joints can start leading to deformed fingers of hands and feet.

• Clinical examination and history- doctor asks about the symptoms and their duration. Also at Noida Pain Management Clinic, we examine a patient of rheumatoid arthritis very thoroughly.
•   A few tests like RA Factor and Anti CCP can fairly easily diagnose rheumatoid arthritis.
•   ESR, CRP, CBC etc are other tests that we sometimes advise to our patients of rheumatoid arthritis in Noida. 
•   Patients of RA also suffer from Anaemia especially females.
•   X rays of a joint may be advised when joint erosions may be suspected. Also they may document progression of joints damage.

When patients have lot of pain then aggressive treatment is a must to avoid permanent damage to joints. When patients’ disease goes into remission, then medicines are decreased to a minimum.

• Over the counter (OTC) medications like Acetaminophen can be given to provide some relief. Also some painkiller gels which we can applied locally on the affected joints are also effective.
• Non steroidal anti-inflammatory medications- If patient doesn’t have good relief with above measures then doctors prescribe medicines to reduce inflammation which controls pain. If taken under a trained pain management doctor, they are very effective medicines to control rheumatoid arthritis pain.
• Hydroxychloroquine can also provide symptomatic relief for the patient suffering from mild to moderately active RA. Similarly Sulfasalazine may also be used to treat RA.
• Immunosuppressive drugs like Methotrexate is very effective and quite safe if monitored closely by a qualified doctor. It can prevent joints damage and can be continued till pain is controlled.
• Physical and occupational therapy and exercise are very important when pain is controlled. A normal functioning joint is very important to prevent further deformity.
• The use of orthotic devices to prevent joint deformity is an integral part of the treatment of the patient with RA. The use of night splints to slow the progression of ulnar drift and shoe inserts and careful fitting of shoes can also help preserve function and ease pain.
• Injections of growth factors or Platelet Rich Plasma (PRP) therapy- Sometimes when 1-2 joints are damaged then regenerative therapy can give substantial relief to patients. Growth factor concentrate or PRP therapy both are prepared from patient’s own blood to rebuild a damaged tendon or cartilage by healing and growth.