One way to distinguish RA from other types of arthritis is by the pattern of the affected joints. For example, RA affects the wrist and many of the joints of the hand but, in general, does not affect the joints that are closest to the nails. Conversely, osteoarthritis, a more common type of arthritis, most often affects joints closer to the nails than other areas of the hand.

Other joints that may be affected by RA include:

• the elbows
• shoulders
• the neck
• the jaw
• the hips
• the knees
• the ankles
• the feet

The spine is usually not directly affected by RA, with the exception of the neck. Another essential feature of RA is that the joints on both sides of the body tend to be affected. That is to say, if the knuckles of the right hand are inflamed, it is probable that some knuckles of the left hand are also knuckles.

The general pattern of the affected joints, together with certain results in laboratory tests or X-rays, make it possible for a doctor to distinguish RA from other conditions.

• The symptoms of RA vary from one person to another and in almost all people also vary from one day to the next, although there is always a certain degree of arthritis. In some people, the disease can be mild, with periods of activity (in which the inflammation of the joints worsens) known as periods of exacerbation. In others, the disease remains active continuously and worsens, or progresses with the passage of time.

  Joints that can be affected by rheumatoid arthritis:

  If you have RA, you may feel the following symptoms in some joints:

• burning
• swelling
• hypersensitivity
• redness
• frequent pain
• difficulty in mobility

• These physical signs of arthritis are due to inflammation of the lining, or synovium, of the joints. If this inflammation persists or does not respond well to treatment, it can cause destruction of adjacent cartilage, bone, tendons and ligaments, leading to deformities of the joints.

  Rheumatoid arthritis can make you feel completely sick, particularly during periods of aggravation and you could:

• lose your appetite
• lose weight
• have low energy
• present fever of low temperature (febrile)
• become anemic (have a lower number of red blood cells than normal);
• develop rheumatoid nodules (lumps of tissue that form under the skin)
•  
• Rheumatoid arthritis can affect different parts of a joint, such as:
•  
• the membrane
• the joint capsule
• bone
• the muscle
• the bag
• the tendon
• Synovial fluid
• the cartilage

• Often rheumatoid nodules are formed over bony areas exposed to pressure. These are often found around the elbow, and also in other parts of the body, such as the fingers, on the spine or on the feet.

  Occasionally, people with RA have inflammation of:

• the linings that surround the heart (pericarditis) and the lungs (pleuritis).
• lung tissue
• tear glands and salivary glands (syndrome of sica / dryness or Sjögren’s syndrome)
• blood vessels (vasculitis)

It affects around 1% of population worldwide. It affects females more commonly and can affect any age group from children to adults to old aged individuals.

The cause of RA is still unknown; however, the body’s immune system plays an important role in the inflammation and damage that RA causes in the joints. The immune system is the body’s defence against bacteria, viruses and other foreign cells. In RA, the immune system attacks the joints themselves and may affect other organs of the body. In RA, the cells of the immune system invade the tissues of the joints and cause inflammation. These cells in the tissue and fluid of the joint produce many substances, including enzymes, antibodies and cytokines, which attack the joint and can damage it.

The role of genes

Genes play an important role in the development of RA. The genes that are associated with RA are more frequent in the Anglo-Saxon population. However, not all of these people will develop AR. It is believed that these genes generate, in some people, a susceptibility or tendency to increase the risk of developing RA.

The reason why some people who possess these genes are at higher risk of developing RA and others are not yet known.

 

Clinical history and physical examination

To diagnose RA, your rheumatologist in Agra will take your medical history and perform a physical exam. The doctor will look for certain characteristics of RA, including:

• swelling, heat and limited mobility of the joints
• nodules or lumps under the skin
• the pattern of the affected joints

Your arthritis doctor in Agra may also ask if you have experienced fatigue or a general feeling of stiffness, especially when getting up in the morning since these two symptoms are associated with RA.

Blood test

Your arthritis specialist in Agra may also recommend that you have some blood tests. Certain tests detect the presence of an antibody called rheumatoid factor, which may be an AR signal. However, the rheumatoid factor is also found in many people who do not have RA. Other abnormalities that are discovered through laboratory tests include anaemia and a high rate of average globular sedimentation (ESR) or C-reactive protein (CRP), which indicate the presence of inflammation.

Although these blood tests may be useful in establishing a diagnosis, there is no single test that can establish or exclude a diagnosis of RA.

X-rays

Although radiographs are usually normal during the first stage of RA, joint damage that may occur as the disease progresses helps confirm the diagnosis. Among the results that usually suggest the presence of RA include:

• bone loss in the margins of the joint called erosions
• loss of articular cartilage

Consult a rheumatologist whenever there are doubts about the diagnosis.

There is a genetic component to disease but it does not really predict the chances your relative might get the disease. In fact, even in identical twins, chances of getting RA in other twin, if one has the disease, is only 15-20%. So it is not necessary that you will transfer the disease to your future generations.

One must take a healthy diet. Avoid high fats, high sugar and refined and processed foods. If one particular food item worsens your joint pain every time you consume, you may stop it. Certain food are considered anti-inflammatory like those rich in omega 3 fatty acids. These are avocado, flax seeds, chia seeds, almonds walnuts, soyabean and fish.

Some people recollect a period of stress or trauma before the advent of these symptoms or may relate to disease flare during periods of stress. It is not clear whether such stressful events are more common or is it a recall bias.

This is another difficult question and there is no straight to answer. Generally, it is lifelong like any diabetes or hypertension. But with early diagnosis, treatment and after a period of sustained remission, it is possible to come down to minimum number of drugs(s). In a few patients medicines can be stopped completely also.

Remission or low disease activity means your disease is under control with no or minimal pain or swelling in the joint and normal blood reports.

Entire world is realising the importance of yoga and physiotherapy in general. It boosts your immune system, unnerves and relaxes it. In fact, it forms the most important part of your treatment. It is free of cost but needs lot of discipline as we often neglect this mode of treatment. Yoga, aerobics, deep breathing exercise are all very important.

Management can help attain a state similar to cure. Currently there is no cure but remission or low disease activity with available drugs are achievable. What is most important is timely diagnosis and management.

As discussed briefly, RA can affect other internal organs in the body. Discuss your symptoms with your doctor. Remember to check your blood pressure, sugar and cholesterol as long standing disease can affect your general health. With good disease control and monitoring, these can be prevented or very well taken care of.

Yes, you can get pregnant but discuss your medications with doctor. Some drugs like methotrexate, Leflunomide are not safe during pregnancy. Ideally disease should be in remission or a low disease activity status for six months before you conceive. Monitoring of fetal growth should be done.