Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body.RA mainly attacks the joints, usually many joints at once. RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).
It is a systemic disease, which means it can also affect internal organs of the body such as the heart, eyes and lungs. With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.
Signs and symptoms of RA include:
• Pain or aching in more than one joint.
• Stiffness in more than one joint.
• Tenderness and swelling in more than one joint.
• The same symptoms on both sides of the body (such as in both hands or both knees).
• Weight loss.
• Fatigue, or tiredness.
People with RA usually experience swelling in at least two joints, often the small joints of the hands, feet and wrists.There can also be stiffness in the joints, particularly first thing in the morning or after sitting for some time. RA morning stiffness is distinguished from other types of morning stiffness because it usually lasts for 30 minutes or longer. RA patients can also wake up in the middle of the night with joint pain and stiffness.For some people, the disease is moderate or less severe and remains reasonably well controlled, but others experience chronic disabling pain, inflammation, stiffness, extreme fatigue, reduced joint function and impaired mobility. For these people, earlier diagnosis and effective treatment could have helped to reduce the long term impact of the disease by slowing or halting its progression at a stage when long term outcomes can be significantly influenced.
RA is the result of an immune response in which the body’s immune system attacks its own healthy cells. The specific causes of RA are unknown, but some factors can increase the risk of developing the disease.Researchers have studied a number of genetic and environmental factors to determine if they change person’s risk of developing RA.
Characteristics that increase risk are-
1) Age - Although RA can affect anyone from the age of 16 upwards, three quarters of people with RA are first diagnosed when of working age - with the largest cohort being over40 years old. RA is thus a major cause of sickness absence and worklessness
2) Sex - New cases of RA are typically two-to-three times higher in women than men.
3) Genetics/inherited traits - People born with specific genes are more likely to develop RA. These genes, called HLA (human leukocyte antigen) class II genotypes, can also make your arthritis worse. The risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese.
4) Smoking - Multiple studies show that cigarette smoking increases a person’s risk of developing RA and can make the disease worse.
5) History of live births- Women who have never given birth may be at greater risk of developing RA.
6) Early Life Exposures - Some early life exposures may increase risk of developing RA in adulthood. For example, one study found that children whose mothers smoked had double the risk of developing RA as adults. Children of lower income parents are at increased risk of developing RA as adults.
7) Obesity - Being obese can increase the risk of developing RA. Studies examining the role of obesity also found that the more overweight a person was, the higher his or her risk of developing RA became.
The lack of disease-specific diagnostic features means diagnosis is usually based on the opinion of a rheumatologist using relevant physical examination, classification criteria, blood tests and imagingand the patient’s own self reported history – because there is no single diagnostic test for RA, a clinical diagnosis by a skilled specialist is required.It’s best to diagnose RA early—within 6 months of the onset of symptoms—so that people with the disease can begin treatment to slow or stop disease progression (for example, damage to joints). Diagnosis and effective treatments, particularly treatment to suppress or control inflammation, can help reduce the damaging effects of RA.
A doctor or a team of doctors who specialize in care of RA patients should diagnose and treat RA. This is especially important because the signs and symptoms of RA are not specific and can look like signs and symptoms of other inflammatory joint diseases.
In accordance with NICE Guidelines, research shows there is a ‘window of opportunity’ for RA patients. Those diagnosed and started on optimal treatment using DMARDs within twelve weeks of symptom onset stand a much better chance of achieving remission or a low disease activity state. RA can be effectively treated and managed with medication(s) and self-management strategies. Treatment for RA usually includes the use of medications which slow disease and prevent joint deformity, called disease-modifying antirheumatic drugs (DMARDs); biological response modifiers (biologicals) are medications that are an effective second-line treatment. In addition to medications, people can manage their RA with self-management strategies proven to reduce pain and disability, allowing them to pursue the activities important to them.
Rheumatoid arthritis (RA) has many physical and social consequences and can lower quality of life.
1) It can cause pain, disability, and premature death.The disease can affect mobility. Many RA patients have severe difficulty walking because of foot pain and deformity, resultant foot operations, toe straightening, foot fusions,ankle replacements or knee and hip replacement operations, which are all common complications of the disease. It is estimated that 90 per cent of people with RA experience foot pathology, which creates restricted mobility and concomitant pain
2) Premature heart disease.
4) RA can make work difficult. Adults with RA are less likely to be employed than those who do not have RA. Work loss among people with RA is highest among people whose jobs are physically demanding.
Hence, RA affects many aspects of daily living including work, leisure and social activities.Fortunately, there are multiple low-cost strategies in the community that a person should follow to increase his/her quality of life.
• Get physically active.
• Go to effective physical activity programs.
• Join a self-management education class.
• Stop Smoking.
• Maintain a Healthy Weight.
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