Rheumatoid Arthritis : Causes and Treatements

Today we have with us, Doctor Srinivas JV , Consultant Orthopedic Surgeon, Wockhardt Hospitals,Bangalore who will be explaining about Rheumatoid Arthritis, its causes and treatments.Doctor Srinivas has done his MS in (Orthopedics) from AIIMS, New Delhi, followed by a Fellowship In Joint Replacement Surgery And Arthroscopy From Charite, Hambolt University, Berlin, Germany.

Rheumatoid Arthritis is a chronic autoimmune disease that causes inflammation of the Joints and in some cases inflammation of the tissue around the Joints as well as other organs of the body. Autoimmune diseases occur when the bodies own immune system attacks tissue and cells in the body due to a failure to recognize its own constituent parts.

The disease is chronic in nature and requires prolonged periods of treatment. Medication is generally regulated according to the progress made by the patient. If Rheumatoid Arthritis is not detected in the early stages and treated accordingly irreversible joint damage could occur. Untreated cases could lead to major complications effecting the eyes, nervous system, lungs and kidney.

Joint replacement surgery may be necessary for joints that have been irreparably damaged, however this is only possible for the major joints i.e. hip, knee, shoulder and some times elbow.

Symptoms of Rheumatoid Arthritis

Rheumatoid Arthritis is characterized by Joint pain generally in the hands and feet accompanied by stiffness which is worse in the mornings, swelling in the joints and loss of proper function. The disease can affect people of all ages. In some cases the symptoms develop gradually over the years and in others there is rapid progression.

Causes

The exact cause of Rheumatoid Arthritis is unknown. The disease is thought to be a combination of genetic and environmental factors, hormones could also be involved. Rheumatoid Arthritis is an auto immune disease where the bodies own immune system attacks the joints and organs. The cartilage wears down, the space between the bones narrows and in advanced stages the bones rub against each other causing the bones to erode. The joints become very painful and inflamed.

Rheumatoid Arthritis is not hereditary however it is more prevalent in some circles of society than others

Diagnosis:

A simple blood test would be enough to diagnose the disease. However blood tests in the early stages may not detect it. Generally a 6 week period is given before the patient is treated to rule out other diseases.

Treatment:

Rheumatoid Arthritis needs to be treated with specific medication to help control and slow down the disease. Poor awareness of the disease among the general public and the medical community often leads to late or wrong diagnosis. Patients are generally treated symptomatically with pain killers, anti-inflammatory drugs and steroids that merely give temporally relief. However, the disease it self is not treated leading to complications and possible irreversible damage.

In recent times there has been a breakthrough in the treatment of the disease with biological therapy (designed to restore the ability of the body’s immune system). This new therapy has yielded good results and is increasingly being used for patients where conventional medication fails to work or where there are too many side effects.

What does the doctor say?

It is important to diagnose and treat the disease in the early stages to avoid complications later on in life. With the right treatment the quality of life can be improved.

The lack of awareness about the symptoms of Rheumatoid Arthritis among the medical fraternity often results in late diagnosis. In children the disease is often confused with Rheumatic fever where the children are treated wrongly, many children suffer from the disease for months and even years before the disease is diagnosed and the proper treatment is given.

Orthopedic Surgeons View

As earlier said, the disease has to be diagnosed at early stages and medical treatment instituted in these patients. In spite of treatment or due to inadequate treatment, people with rheumatoid arthritis develop severe joint destruction. The symptoms of severe destruction would be that the patient experience severe pain in the joint, restricted movements at the joint and difficulty to carry out the daily activities. Most common joints would be knee joints, hip joints, shoulder joints, elbow joints. Patient also develops pain and deformity of small joints of hands and foot making them difficult to carry out their daily activities.

The role of joint replacement surgeon comes only when there is severe destruction of major joints. Most commonly done joint replacements are for hip and knee. Very rarely shoulder and elbow replacement are done. Hip and knee replacement are indicated when patient is not able to walk and do their daily activities, joint pain is severe and not controlled by medications or when patient has developed deformities(commonly flexion deformity in hip and flexion, varus and valgus deformity in knees). By performing joint replacement surgeries these patients do experience complete pain relief in joints and there deformity completely corrected. They are able to move around and do their daily activities. It is seen that a procedure called synovectomy along with joint replacement will reduce the disease load in the body and requirement for medication is also reduced.

If the patients can over come the fear of surgical intervention and the financial burden for the surgery than they can have better quality of life after surgery.

Dr JV Srinivas,
M.S. (Orthopedics)
Consultant Orthopedic Surgeon
Wockhardt Hospitals, Bangalore

To Schedule an appointment with Dr JV Srinivas please write to enquiries@wockhardthospitals.com