RHEUMATOID ARTHRITIS IN ENGLISH

                                                   

                                 RHEUMATOID ARTHRITIS IN ENGLISH

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RHEUMATOID ARTHRITIS-

Ø Rheumatoid Arthritis is an autoimmune disorder of unknown origin means causative factors are not known. and affects 1% of the population worldwide. In RA, the autoimmune reaction   mainly occurs in the synovial tissue. Phagocytosis produces proteolytic enzymes within the joint.  

Ø The proteolytic enzymes break down collagen results in  edema and proliferation of the synovial membrane and pannus formation. Pannus destroys cartilage, erodes the bone and results in swelling of the joint.

CLINIACAL  MANIFESTATIONS-

Ø Main clinical manifestations of rheumatoid arthritis are-

Ø Joint pain.

Ø Joint swelling.

Ø  Redness around the joint

Ø Warmth around the joint.

Ø Movement is reduced and painful.

Ø Deformities of the hands and feet are common in RA. The deformity may be caused by misalignment resulting from swelling, progressive joint destruction.

Ø Rheumatoid Arthritis symptoms begins in the small joints of the hands, wrists, and feet. As the disease progresses, the knees, shoulders, hips, elbows, ankles, cervical spine, and temporomandibular joints are affected

Ø Rheumatoid nodules formation-  Nodules may be noted in patients with more advanced RA. These nodules are usually non tender and movable in the subcutaneous tissue. They usually appear over bony prominences such as the elbow, are varied in size, and disappear spontaneously.

Ø Extra articular symptoms appear due to progressive autoimmune activities and Includes lymph node enlargement, dry eyes and mucus membrane, fever, weight loss, fatigue, anemia, Raynaud’s phenomenon (cold- and stress-induced cyanosis of fingers or toes.)

 

DIAGNOSTIC INVESTIGATIONS-

Ø History taking and Physical examination ( presence of sign and symptoms of RA )

Ø X-ray examination of affected joint. (narrowing of joint space is detected and bone nodes may be seen)

Ø  MRI may be done but not needed in all cases.

Ø Synovial fluid aspiration may also be done.

Ø Blood tests includes CRP, ESR and CBC.

TREATMENT-

Ø The main goal of management of rheumatoid arthritis is to slow down the progress of disease and minimize discomfort and pain.

Ø Medical management includes pain killers such as salicylates or NSAIDs. And in severe pain opioid drugs may be used.

Ø Systemic corticosteroids are used when the patient has unrelieved inflammation and pain, such as prednesolone

Ø For Single large joints that are severely inflamed and fail to respond promptly to the measures outlined previously may be treated by local injection of a corticosteroid.

Ø For advanced, unremitting RA, immunosuppressive agents are prescribed because of their ability to affect the production of antibodies. These include high-dose methotrexate, cyclophosphamide, azathioprine, and leflunomide

Ø Nutrition therapy is very important for RA Patients. The frequently experience anorexia, weight loss, and anemia.  Food selection should include the daily requirements from the basic food groups, with emphasis on foods high in vitamins, protein, and iron for tissue building and repair.

Ø In moderate to severe RA, when pain is severe or  loss of function and if the medications fail to prevent or slo don the joint destruction, surgical intervention may be used. The procedures most commonly used are synovectomy, tendon repair, joint fusion and total joint replacement.

Ø apart from medical management health education is very important for the patient. Patient needs regular gentle exercise to strengthen the muscles around joint. Application of heat and cold ay help to reduce pain and relax tense and painful muscles. Deep breathing and muscle relaxations also help to control pain.