Rheumatoid arthritis

Diagnosis

Early stages of rheumatoid arthritis can be challenging to detect as the signs and symptoms tend to imitate other various diseases. No blood test or physical examinations can assure the diagnosis. Doctor will examine joints to see if there are any swelling, redness or warmth. Muscle strength and reflexes are also essential to be checked.

Rheumatoid arthritis patients generally have an increased level of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). This is often a sign of inflammations in the body. An additional sign is the presence of rheumatoid factor and anti-cyclic citrullinated peptide antibodies (anti-CCP).

Imaging tests

X-rays may be used to indicate the progress of rheumatoid arthritis in the joints that have been growing over time. With the help of Magnetic Resonance Imaging (MRI) and ultrasound, doctors will be able to detect the level of severity.

Treatment

Rheumatoid arthritis has no cure. However, clinical studies have demonstrated that symptoms tend to be stable when treatment starts early with the help of medications. The medications prescribed by the doctor will vary on the severity of the symptoms and the duration of having the disease.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are given for pain relief and reducing inflammation. Ibuprofen and naproxen sodium are over-the-counter drugs. More powerful NSAIDs can be given according to doctor’s prescriptions. Patients may experience irritations in the stomach, heart problems and kidney damage as side effects from this type of medications.
• Steroids are prescribed to ease inflammation and pain, as well as delay joint damage. Corticosteroids are commonly advised for rapid improvement of the symptoms and eventually aim to lower the dosage of medicine. Bone thinning, increase of body weight and developing diabetes are some of the side effects that can occur after the intake of these medications.
• Conventionaldisease-modifying antirheumatic drugs (DMARDs) are medications that are given to delay further development of rheumatoid arthritis. They can also prevent joints and other tissues to be permanently damaged. Common DMARDs consist of methotrexate, leflunomide, hydroxychloroquine and sulfasalazine. Side effects after taking these medications depend on the patients. However, the common effects include liver damage and severe lung infections.
• Biologic agents work by attacking the cells and molecules that trigger inflammations in the joints. Biologic agents are newer versions of DMARDs. The medicines include abatacept, adalimumab, anakinra, certolizumab, etanercept, golimumab, infliximab, rituximab, sarilumab and tocilizumab. This group of medicine becomes more effective when used in conjunction with conventional DMARDs.
• Targeted synthetic DMARDs are the group of medicine that may be considered if conventional DMARDsand biologics are not effective.

Therapy

Physical or occupational therapy program that involves exercises will help maintain the joints to be flexible. New ways of carrying out daily tasks can be learned for the joints to be less pressured.  For instance, picking up an object from the ground with forearms. Assistive devices could be very helpful to avoid putting stress on the painful joints.

Surgery

If medication fail to prevent or slow down the joints damage doctor may consider surgical treatment to repair the joints that are injured. Surgery has the potential to help restore the ability to use the joints. It can decrease pain and result in a better function.

• Synovectomy is a surgical procedure to remove the inflamed synovium. The surgery is done to ease the pain and recover the flexibility of the joints.
• Tendon repair is a procedure that aims to fix the tendons located around the joints. This is because when inflammation and damage of joint occurs, may cause tendons may loosen or rupture.
• Joint fusion is recommended when joint replacement surgery cannot be done. Surgical fusion is the process of stabilizing or realigning the joints to relief pain.
• Total joint replacement is carried out by removing the damaged area of the joint and metal-plastic made prosthesis inserted.