Rheumatism

When a number of painful conditions occur in bones, joints, muscles and tendons then it is termed as rheumatism. This condition is categorized as regional (in a larger region, for example, pain in chest wall), generalized (affecting diverse and many parts of the body, such as in fibromyalgia), or localized (restricted to a particular location, like tendonitis and bursitis). The disease and its conditions are characterized by symptoms that include the musculoskeletal system. Many of them also feature abnormalities in their immune system.

Symptoms

The symptoms of rheumatoid arthritis come and go, depending on the degree of inflammation of tissue. The disease is active when body tissues are inflamed. The disease is inactive (in remission) when tissue inflammation subsides. With proper treatment remissions can occur unexpectedly, which can last for weeks, months or even for years. People generally feel well when symptoms of the disease disappear during remissions. The symptoms return on relapse of the disease, which means when the disease becomes active again. This activity of the disease is known as a flare. The rheumatoid arthritis course varies among the individuals affected and periods of remissions and flares are typical. The stiffness of joint and muscle are mostly noticed in the morning and after periods of inactivity. This is referred to as post-sedentary stiffness and morning stiffness. During disease flares arthritis is common. Joints frequently become painful, warm, swollen, tender and red during flares. It is because the joint lining tissue becomes inflamed, which results in the production of excessive joint fluid. Inflammation also causes thickening of the lining tissues of the joint.

Both sides of the body get affected due to inflammation of multiple joints. Therefore, it is referred to as a symmetric polyarthritis in its most common form. The symptoms of early rheumatoid arthritis may be subtle. The small joints of both the wrists and hands are often involved. The initial symptoms of this condition, especially in the morning, can be prolonged stiffness of joints and pain. Rheumatoid arthritis in the hands shows symptoms of difficulty with simple daily living tasks, like opening jars and turning doorknobs. After waking up from bed it becomes painful to walk due to rheumatoid arthritis in small joints of the feet. The body tissues, including bone and cartilage, get damaged due to chronic inflammation, leading to a loss of erosion and cartilage. It also causes weakness of the muscles as well as the bones, resulting in destruction, joint deformity, loss of function and loss of range motion. Children affected with rheumatoid arthritis show symptoms, such as:

-  Crying

-  Poor appetite

-  Limping

-  Irritability

How is it diagnosed?

It is difficult to diagnose the disease in its early stages as the initial signs and symptoms are similar to those of many other diseases. There are various parameters to confirm the diagnosis so that you may know the causes of rheumatoid disease . Your doctor will check your joints for swelling, warmth and redness during a physical examination. They may also check your muscle strength and reflexes.

- Blood test- People affected with rheumatoid arthritis often have an elevated rate of erythrocyte sedimentation (sed rate, or ESR) or C-reactive protein (CRP) that indicates an inflammatory process present in the body. There are other common blood tests that look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

- Imaging test- You may be recommended to do X-rays by your doctor so as to help in tracking the progression of the disease over time in your joints. The ultrasound and MRI tests can help your doctor to know the severity of rheumatoid arthritis in your body.

Prevention

To know what is the preventive measure for rheumatism follows the below-mentioned points:

-  Do gentle exercise regularly to help strengthen the muscles around your joints. It helps to fight fatigue that you might feel. You need to consult your doctor before starting. You can try walking or swimming to start off.

-  You can apply heat, as it helps to ease your pain and relax painful, tense muscles, and cold to dull the sensation of pain.

-  According to some studies, fish oil acts as a supplement to reduce the pain and stiffness in rheumatoid arthritis. Check with your doctor before using it.

-  Plant oils, such as seeds of black currant, evening primrose and borage, contain a fatty acid type that helps to prevent morning stiffness and pain due to rheumatoid arthritis. The may include some side effects, like diarrhoea, nausea and gas. These may also cause liver damage, so check with the doctor first.

-  Tai chi is a type of therapy that involves stretches and gentle exercises combined with deep breathing. This therapy is used by many to help relieve stress in their lives. Restrict your movements to cause any pain.

-  Know your capacity and limit your activity. Arthritis from rheumatism can make you prone to fatigue and muscle weakness. Take rest and short nap when you are tired so that you get sound sleep at night.

Treatment

Till now there has been no discovery made to cure rheumatoid arthritis. However, some recent studies indicate that remission of signs of rheumatoid arthritis is more likely when treatment is initiated early with strong medications.

- Steroids- The inflammation and pain are reduced by corticosteroid medications, like prednisone, and slow the damaging progression of joint. You might experience certain side effects, including weight gain, diabetes and thinning of bones. This type of medication is often prescribed to relieve the acute symptoms, with the motive to gradually reduce the medication.

- Disease-modifying antirheumatic drugs (DMARDs)- The progression of rheumatoid arthritis is reduced by these drugs that save the joints and other tissues from getting permanent damage. Some of the common DMARDs include leflunomide (Arava), sulfasalazine (Azulfidine), hydroxychloroquine (Plaquenil) and methotrexate (Trexall, Rasuvo, Otrexup). The side effects may include bone marrow suppression, severe lung infections and liver damage.

- Nonsteroidal anti-inflammatory drugs (NSAIDs)- These medications can help in relieving pain and reduce inflammation. The drugs include naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB). You will need a prescription for stronger NSAIDs. The side effects you may experience include stomach irritation, damage in liver and kidney, ringing in your ears and heart problems.

- Biological agents- These are also known as biologic response modifiers, which is a newer category of DMARDs. These include abatacept (Orencia), anakinra (Kineret), etanercept (Enbrel), adalimumab (Humira), tofacitinib (Xeljanz),  certolizumab (Cimzia), golimumab (Simponi), rituximab (Rituxan), infliximab (Remicade) and tocilizumab (Actemra). The drugs of this type can target parts of the immune system that cause tissue and joint damage due to triggered inflammation. It can also elevate the risk of infections.

- Therapy- You might be sent to an occupational or physical therapist who will help keep your joints flexible by teaching you exercises. You may also be advised to use assistive devices to avoid stressing your painful joints.

- Surgery- It is considered by the doctor when medications fail to prevent or slow the joint damage. This may reduce pain, correct deformities and help restore your joint ability.

Complications

The inflammation of rheumatoid arthritis can affect areas of the body and organs other than the joints, as it is a systemic disease. The inflammation, related to arthritis, of the eyes glands and mouth, can result into dryness of these areas. This is known as Sjogren’s syndrome. A corneal abrasion can occur, if not prevention, due to dryness of the eyes. Scleritis caused due to inflammation of the white portion of the sclerae (eyes) can pose danger to the eye. A person may incur chest pain due to rheumatoid inflammation of the lung lining (pleuritis) which results in shortness of breath, coughing or deep breathing. Also, the tissue of the lung can become scarred and inflamed. A sometimes inflammation nodule, that is rheumatoid nodules, grow within the lungs. The tissue surrounding the heart is known as pericarditis. Inflammation of this tissue can cause pain in the chest that usually changes in intensity while leaning forward or lying down. An increased risk of heart attack is said to be associated with rheumatoid arthritis. The disease has the potential to reduce the count of white blood cells and red blood cells. A decreased number of white cells can be linked with an enlarged spleen, which is referred to as Felty’s syndrome. It has the tendency to increase the risk of infections.

Patients with rheumatoid arthritis have a higher risk of obtaining lymph gland cancer (lymphoma), especially in those who have sustained active inflammation of joint. Firm bumps or firm lumps can occur under the skin around the fingers and elbows where there is frequent pressure. These nodules can occasionally become infected, but they do not show signs usually. The nerves of the wrists can become pinched so as to cause carpal tunnel syndrome. Inflammation of blood vessel is a rare but serious complication, which is usually with the longstanding rheumatoid disease. An impaired blood supply to tissues is caused due to vasculitis, which can lead to necrosis (tissue death). The initial symptom of this can be seen as leg ulcers or tiny black areas around the nail beds.

Myths

It is important to clear up some common misconceptions about people living with rheumatoid arthritis as there persist some myths about living with the condition despite discovery made in its treatment.

Myth #1: People with this condition are usually told to change their diets and exercise more to cure rheumatoid arthritis.

While an anti-inflammatory diet certainly helps, this condition is an autoimmune disease which has no cure. But these can be included in the treatment plan by consulting a healthcare professional.

Myth #2: Women with this disease are said to not conceive.

But the fact is, before having a child they need to consider their overall health care and discuss birth plans with an ob-gyn, a rheumatologist and other healthcare professionals. There have been instances of many successful pregnancies even with rheumatoid arthritis.

Myth #3: Rheumatoid arthritis is considered a woman’s disease.

The fact is, while women are two to three time more likely to acquire rheumatoid arthritis, men too are prone to this condition.

Myth #4: Arthritis is associated with old age.

But the onset of this condition on an average is between the age of 30 and 60. In fact, children can also get affected by this condition and diagnosed with juvenile idiopathic arthritis that may start as early as the age of 2.

Myth #5: Supplements help to rebuild the joints.

The truth is there is no scientific proof that could confirm that consuming supplements like glucosamine and others that contain gelatin can help rebuild damaged joints. These pills may only give temporary relief from inflammation and pain.

Myth #6: The disease only affects joints.

In reality, rheumatoid arthritis extends beyond the joints and causes serious damage to other parts of the body that includes the internal organs. Other medical conditions are also associated with this disease, like heart problems, cardiovascular disorders, the problem in lungs, issues in eyes, fibromyalgia and depression. The complications may potentially also arise because of multiple medications. These complications may include certain problems like liver issues, kidney problems and anaemia.

Conclusion

If you ever suspect of pain in joints then you should consult a doctor for a medical check-up. Regular self-precautionary measurements and medications prescribed by doctors at an early stage can help you to possibly heal the disease. Most likely the treatments at the initial stage are successful. Consult your specialist in diagnosing the disease. It is important to take preventive measures of this condition in your own hands. You should not ignore your health that may worsen the disease and consult a doctor soon before it is too late. To prevent yourself from acquiring this painful disease it is necessary to be in regular check up with your specialist and do as he says. Avoiding certain habits and bringing change in lifestyle will benefit you for a longer period of time. You should protect yourself from the things that may trigger the chances of incurring with rheumatoid arthritis. Consulting your doctor will educate you regarding this condition and let you take preventive measure beforehand.

Last updated on : 14-09-2018

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