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1 On 1 With Rheumatoid Arthritis

Updated on September 20, 2015

Rheumatoid Arthritis Images

Rheumatoid Arthritis


When we think of the second word used in the naming of the disease ''Arthritis'', it might seem just as a mere inflammation of the joints. But what if its Rheumatic ? well, lets find out below.


Rheumatoid Arthritis

Rheumatoid arthritis is an auto-immune disorder in which receptors at the surface of The Synovium Known as the HLA-DR4 triggers the immune system which reacts by becoming hyperactive; this results into the immune system attacking the joints since it considers them as ''foreign bodies''. The process starts when the leucocytes gets attracted to the immune complexes of IgM(rheumatoid factor) and IgG.

NOTE: The two immunoglobulins; IgM and IgG fuse or come together since IgM is an antagonist to Fc Region or the (Fragment Crystallisable Region) of the IgG hence forming a complex in the process of fusing to attack the region. This process begins to form deposits over the Synovium and around the joints due to their reaction.

Once this is achieved, the leucocytes which adhere to the surface of the immune complexes start ingesting fibrin and the immune complexes formed as deposits. The leucocytes further release lysosomal enzymes that cause acute inflammatory response and tissue necrosis as well as inflammatory mediation.(IL-1, IL-6 and TNF(alpha).

The chondrocytes then respond to stimulation by the TNF, IL-1, IL-6 and other inflammatory Mediators causing then Chondrocyte cells to become activated and produce more metalloproteinase which lead to Cartilage damage. The synovium then becomes hypertrophied (Pannus) granular formations that were earlier blood vessels and tissue indicating initial hyperplasia and infiltration by plasma cells and Lymphocytes.

This process recurs overtime and when uncontrolled, the inflammatory process glides into a Chronic level.


Diagnosis

Rheumatoid Arthritis diagnosis is based mostly on clinical imaging such as X-rays and CT scans which are more accurate. Pathognomonic types of diagnosis is NEVER used because the finding are never accurate reason being, the signs that may seem as major symptoms suggestive of Rheumatoid Arthritis; also manifests themselves in other diseases such as Arthritis and other Auto-immune disorders such as Systemic Erythematous Lupus Disease.

Other diagnostic methods Include:


  • Detection of elevated levels of Rheumatoid Factor(IgM) in the blood plasma or serum. (The higher the concentration the more severe the Inflammation is) It is produced by the plasma cell as an antibody against the Fc Region of IgG which is produced during (RA).
  • Elevated levels of Interleukins-1 in the Synovial Fluid.

If the patient has only one inflamed joint and Rheumatoid arthritis is suspected then the best diagnostic measure to take would be analysing the patient's synovial fluid from the Inflamed Joint and check for elevated WBC's (5,000-50,000)


Overview of the Signs and Symptoms Of the disease

Here is a pneumonic for remembering how the signs and symptoms manifests. {S.L.I.C.E}

S= Systemic; Patients have history of fatigue, malaise, nausea, weakness prior to onset of joint pain. Multiple Systemic complications including; ACD(anaemia of chronic disease), Felty's syndrome; which is a combination of rheumatoid arthritis, splenomegaly and neutropenia, Bakers cysts are also notable.

L= Location; Primarily affects the hands especially the proximal interphalangeal joints sparing the distal interphalangeal joints: Affects shoulders, hips, knees but not lower back because it is usually symmetrically distributed.

I= Inflammation; Prominent or swollen joints, erythemous(reddish) joints that are often warm.

C= Chronicity; Chronic, progressive, pain is usually worst in the morning.

E= Evidence of trauma?; No trauma incurred usually.


Things to note about Felty's Syndrome mentioned above

  • It is rare and it is formed of a triad of three diseases or rather conditions I.e. Rheumatoid Arthritis, Neutropenia and Splenomegaly
  • Patients who develop infection and with Felty's Syndrome has to be treated with antibiotics whether the infecting agents possess Gram(-) or Gram(+) rods.


Management of Rheumatoid Arthritis


Firstly, we have to understand that there is not yet an exact known cause found for RA, its treatment or prevention. The only way to deal with it is through its management. The following are some of the common remedies both medical and natural in dealing with Rheumatoid arthritis or rather reducing your chances of contracting it later in life especially in the 40's.


  • Quit Smoking if you are a Smoker
  • Exercising frequently helps a lot to reduce the pain and generally keeping fit helps you for the present and for the future on health basis.
  • If you are already suffering from the disease; you should keep taking the Disease Modifying anti-rheumatic Drugs(D.M.A.R.D) drugs that helps to ease away the pain by blocking away the chemicals that the immune system releases when activated to attack the joints. Other anti inflammatory Drugs such as Acetaminophen or Ibuprofen could be administered during the acute stage of the disease.
  • Nowadays a recombinant human interleukin-1Ra can be administered which is also a D.M.A.R.D to help ease the pain. It is sometimes combined with Methotrexate and taken alongside some corticosteroids. Other D.M.A.R.Ds include leflunomide, hydroxychloroquine and sulfasalazine.
  • Biological agents especially T.N.F (Tumor Necrotic Factor) alpha administered as inhibitors greatly reduce inflammation. NOTE; Before starting your patient on any biological agent you must first do a P.P.D(Purified Protein Derivative) is a type of skin test used to rule out or test for Latent T.B.

NOTE: We rule out Latent TB before we administer Biological agent drugs to prevent Immunosuppression which can be fatal overtime.

NOTE: Administration of certain drugs such as Methotrexate can cause hepatic fibrosis and in this case patients should be brought in after 1-2 months for a Comprehensive Metabolic Panel check where they check your Blood parameters and other tests like Liver and Kidney functions.

NOTE: Newly diagnosed patients may be treated with an initial dosage of Corticosteroid(prednisone) since Methotrexate and Biological Agents take approximately a month to show effect and reduce symptoms.

NOTE: The drug hydroxychloroquine can have some adverse effects on the patients such as retinopathy; so a doctor should use this in great moderation or stay way clear from using it.


Facts To Note About Rheumatoid Arthritis

1.Mostly the pain is worse during morning times when one wakes up.Mostly affects women more than men in a ration of 3:5 basis

2.More common especially to people of the Caucasian descent than The Blacks.

3.The disease has two main Components: Immunologic Reactions and Degradative Enzymes

4. Carpal Turner syndrome is often seen in Rheumatoid Arthritis and in this case the patient should be treated carefully by casting and immobilization or else they will develop Atlanto-Axial Subluxation which causes Infringement around the C1 and C2 which can result into paraesthesia and anaesthesia of hand and foot. If a patient comes with hand and foot paraesthesia, Put then on a stretcher with a C-spine Collar position holder to the neck to avoid Movements that may cause Further complications.

Shriya Napoleon Fernandes

S.N.F

Raynold Grahams Omondi

R.G.O







Video On Rheumatoid Arthritis.

Deeper Insight on Rheumatoid Arthritis

Comments

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    • RaynoldGrahamsooo profile imageAUTHOR

      Raynold Grahams Omondi 

      2 years ago from Luton, UK, England.

      Hey I am deeply sorry to hear that..But am hopeful that one day a solution of this will be found for this.. Am positive that there will be a breakthrough so let us keep Hoping.

    • peachpurple profile image

      peachy 

      2 years ago from Home Sweet Home

      That is a scary disease. My mom in law hand and feet are bound and crooked too.

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