Rheumatoid Arthritis (RA) - Dr. Ayman Nashashibi

Rheumatoid Arthritis (RA) - Dr. Ayman Nashashibi

Introduction

Dr. Ayman Nashashibi - Rheumatoid arthritis (RA) is a long term autoimmune and inflammatory disease that causes stiffness and swelling of the joints around the body, but normally affects the wrist, hands, and feet.

The manifestation of the disease occurs when the patient’s immune system attacks healthy cells. This causes inflammation of the organ(s) that leads to pains. However, the affect isn’t mainly affecting the joints. RA can also spread to affect tissues such as the heart and lungs

In joints, RA mainly attacks many joints at the same time, where the lining of the joint becomes inflamed, causing long-term damage to joint tissue, leading to chronic pain, and deformity.

Commonly affected joints are:

·         Hands

·         Wrists

·         Knees

SIGNS & SYMPTOMS

Flares and remission are 2 statuses of the RA. Flares is when symptoms gets worse, and remission is when these symptoms get better

Some of the signs and symptoms can be summarized below

• Pain or aching.
• Fatigue when the joint inflammation is active.
• Symmetrical occurrence, where both sides of the body are affected
• Joint tenderness and swelling
• Joint redness as a sign for inflammation
• Loss of joint function and range motion associated with weakness
• Polyarthritis or Multiple joints affected
• Anemia
• Fever
• Muscular Stiffness.
• Depression, although reported in some cases

RISK FACTORS

A number of factors that causes RA were examined in patients population, including environmental and genetics. They are summarized in the below list:

Age: RA increases with age, but can start at any age. Juvenile RA is one form that starts at a very young age.

Genetics and family history: People with a specific gene deformity are likely to develop RA during adulthood or childhood. Moreover, those with human leukocyte antigen class II genotypes will have a higher risk of developing RA and with advanced symptoms.

Live birth & Breastfeeding: women who gave birth and breastfed are at a “lesser” risk

Obesity and eating habits: obesity can increase the risk of developing RA in the adult population

Smoking: one major study showed that children whose mothers smoked mother have a higher risk of developing RA at adulthood

DIAGNOSIS

·         Physical examination

·         A simple x-ray

·         Laboratory tests

Treatment that start within 6 months of RA diagnosis especially treatments that controls and reduces inflammation has proven to slow or stop disease progression in organs such as joints

COMPLICATIONS

·        Obesity.

·        Cardiovascular disease: patients with RA are at a higher risk of developing cardiovascular disease (CVD) including strokes.

·        Cervical myopathy: patients with a long onset RA are at a higher risk of developing cervical myopathy, a condition caused by dislocation of cervical joints.

  

·        Environmental and work-related.

TREATMENT

Treatment for RA is essential as it can help reduce inflammation in the joints, relieve pain and reduce joint tissue damage

A group by the name of the National Institute for Health and Care Excellence has put together a guide on how to manage RA in adults. This guide serves as an excellent source for patients with RA.

There are different Disease-Modifying Anti-rheumatic drugs (DMARD) used to treat adults with RA. These drugs are:

·         Methotrexate

·         leflunomide

·         hydroxychloroquine

·         sulfasalazine

Patients should understand that there are common side effects for drugs such as Methotrexate. These side effects are:

·         Sore throat

·         Loss of apetite

·         Headache

·         Nausea

·         Hair loss

A newer approach in the treatment of RA is known as “Biological Treatment” which is normally taken in combination with Methotrexate or other Disease-Modifying Anti-rheumatic drugs (DMARD). These include the following:

·         ETANERCEPT

·         INFLIXIMAB

·         ADALIMUMAB

·         CERTOLIZUMAB

·         GOLIMUMAB

·         RITUXIMAB

·         ABATACEPT

·         TOCILIZUMAB

·         SARILUMAB

Drugs that relieve pain in RH patients

These drugs can relieve pain in joints and reduce inflammation, but they arent meant to stop RA Paracetamol or Paracetamol with Codeine

Non-Steroid Anti Inflammatory Drugs (NSAID): such as naproxen, ibuprofen, declofenac as well as other COX-2 inhibitors such as etoricoxib and celecoxib.

It must be noted here that due to the function of these drugs in breaking down the lining of the stomach, although uncommon, but there are associated symptoms of stomach aches and increasing risk of internal bleeding.

Most patients that are prescribed NSAID are also given Proton Pump Inhibitor (PPI) to protect the stomach, such as the following drugs:

   

·                       Omeprazole (i.e. Prilosec, Prilosec OTC)

·                       Lansoprazole (i.e. Prevacid, Prevacid IV, Prevacid 24-Hour)

·                       Dexlansoprazole (i.e. Dexilent, Dexilent Solutab)

·                       Rabeprazole (i.e. Aciphex, Aciphex Sprinkle)

·                       Pantoprazole (i.e. Protonix)

·                       Esomeprazole (i.e. Nexium, Nexium IV, Nexium 24 HR)

·                       Esomeprazolemagnesium/naproxen (i.e. Vimovo)

·                       Omeprazole/sodiumbicarbonate (i.e. Zegerid, Zegerid OTC)

SUPPORT ORGANIZATIONS

Arthritis Foundation (AF) (https://www.arthritis.org)

Rheumatoid Arthritis Support Group (https://www.rheumatoidarthritis.org/)

Rheumatology Research Foundation (https://www.rheumresearch.org/)

Facebook https://www.facebook.com/ayman.nashashibi.9

Twitter at https://twitter.com/aymannashashibi