The treatment of rheumatoid arthritis is mainly based on relieving inflammation and improving symptoms because it is a chronic disease that is not completely curable, especially if it is discovered in advanced stages.
What is the treatment of rheumatoid arthritis?
It is working towards an early diagnosis, allowing the initiation of rheumatoid arthritis treatment protocols, which will enable patients to lead a relatively stable life between flares of the disease and making them less frequent as possible.
Current treatments for rheumatoid arthritis include:
- Medications: Given for long periods to relieve symptoms and slow the course of the disease.
- Supportive treatmentSuch as physical therapy and occupational therapy, to keep patients functional and independent in their lives and work.
- SurgeryTo correct any joint problems arising from chronic arthritis.
There are alternative treatments and folk medicine such as acupuncture, massages, orthotics and osteopathy, and many patients have shown improvement after applying them, despite the lack of research supporting their effectiveness.
An overview of rheumatoid arthritis
Rheumatoid arthritis is an autoimmune disease that affects the joints of the body and is characterized by inflammation that includes the joint itself with the surrounding tissues sometimes, and it occurs especially in several joints of the hand with a morning stiffness that may last several hours.
Autoimmune diseases are usually chronic problems that do not have a direct and clear cause, and the treatment of these cases is usually by managing the symptoms as much as possible and slowing the progression of the condition, because with time the untreated inflammation process will damage the articular cartilage and break up the bone underneath as a result of friction.
Rheumatoid arthritis is a form of arthritis and has a distinctive pattern where the injury begins with pain andStiffness in the small joints of the fingers They are symmetrical and spread to larger joints if not treated in time.
There are more than 100 types of arthritis, so it is necessary to differentiate rheumatoid arthritis from other joint inflammation types, the most common of which are:
- Osteoarthritis.Its symptoms are often less severe, and it also affects the large and weight-bearing joints in the body.
- psoriatic arthritis: On examination of the patient, inflammation of the skin and redness precedes the occurrence of symptoms in the joint, about 10-30% patients with psoriasis suffer from psoriatic arthritis.
- GoutIts symptoms are in the form of sudden, severe attacks of pain and affects the joint of the big toe in a distinctive way, accompanied by kidney problems or eating foods that raise uric acid such as red meat.
- lupusThe disease is systemic, meaning that its inflammatory effects aren't limited to the joints. It may cause anemia, oral ulcers and hair loss, and its diagnosis depends on laboratory tests that require a long time.
Symptoms of rheumatoid arthritis
Symptoms vary greatly among patients, because the patient's normal immune response varies from time to time, according to his general health, psychological state and nutrition.
There are two types of symptoms that accompany rheumatoid arthritis:
- articular symptoms
- Systemic symptoms
The disease begins slowly and gradually, as the early form manifests with stiffness, mild joint pain, and general fatigue. The patient may not notice joint swelling at first, especially if he or she is overweight.
Articular symptoms include:
- Morning stiffness that lasts more than an hour after waking up
- Pain associated with high temperature of the joint when not used for an hour
- The pain is symmetrical as it is felt on both sides of the body
- Swelling of the affected joint
- If the condition is neglected, joint damage occurs, which leads to limited range of motion and deformity
These symptoms are usually concentrated in:
- fingers of the hands
- feet and toes
- The torso and spine in the neck rarely
There is a group of symptoms that are seen in some patients and are not related to the joints, such as chest pain when breathing in, dry eyes and mouth, the appearance of nodules under the skin and reported sleeping problems.
There are distinctive signs indicating that the disease is severe, such as weight loss, joint deformity and high fever.
Causes and risk factors for rheumatoid arthritis
The exact cause of rheumatoid arthritis remains unknown and is believed to occur as a result of the interaction of the genes of the affected individuals with the environment, as for seropositive RA patients there is a 40-65% chance of passing the disease on to their children.
The disease is characterized by being autoimmune, meaning that the immune system becomes dysfunctional, causing it to attack normal body tissues. Immune cells also produce antibodies that target and destroy joint cartilage and ligaments.
Over time and disease progression, chronic inflammation causes the release of chemicals and inflammatory agents that damage nearby bone, tendons and ligaments, making the joint weak and susceptible to injury.
Rheumatoid arthritis is a multifactorial disease. The most important risk factors for its occurrence include:
- the ageoccurrence rates rise in the fifties and occur on average between the ages of 30 and 60 years
- sexLike all autoimmune diseases, the disease is more common in women
- genesSome genotypes, such as HLA class II, are associated with higher rates of rheumatoid arthritis
- smokingThe incidence of rheumatoid arthritis is directly proportional to the duration of smoking
- Obesity: Especially the obese, because the additional weight damages the joints
- DietExcessive intake of salt, sugar and red meat
Diagnosis of rheumatoid arthritis
There is no qualitative test for diagnosing rheumatoid arthritis, as some patients show laboratory results that indicate a problem, but the results of blood tests in others are completely normal.
In general, there are two main laboratory tests that are positive in most cases of rheumatoid arthritis:
- rheumatoid factor
- anti-ccp . antibody
When comparing these two analyzes, it was found that the anti-ccp test is the most accurate and specific to determine the extent of rheumatoid arthritis, and being positive will change the course of treatment, its duration, and the drugs that will be given.
Accordingly, the types of rheumatoid arthritis are classified into:
- Seropositive Rheumatoid arthritis: It has a positive anti-ccp test result in the blood, meaning that there are antibodies that attack the joint tissues.
- Seronegative Rheumatoid arthritisA negative anti-ccp test in the blood means the absence of antibodies that will attack the joints, but this does not mean that they cannot be present later, as some patients showed positive results after a period of examination.
- juvenile idiopathic arthritisA disease that affects people under the age of 17, its symptoms are similar to rheumatoid arthritis in adults, but with chronic inflammation of the eyes and developmental problems.
There are some complementary laboratory tests that are less specific for rheumatoid arthritis, such as:
- Complete blood count and blood formula
- Uric acid and metabolic tests
- ESR . blood sedimentation rate
- ANA immunoassay
- Liver analyzes
- Radiographs of the joints
- Echo joints
- articular fluid analysis
Rheumatoid arthritis treatment
The treatment of rheumatoid arthritis requires a long time and is carried out under the supervision of expert specialists, and includes drug and physical therapy and, if necessary, surgery.
Medicines that are given at the beginning of treatment for rheumatoid arthritis are called disease modifying antirheumatic drugs (DMARDs) and should be given to all patients, because they specifically contribute to slowing the course of the disease and preventing deformities in the joints.
The course of the rheumatic disease should be monitored continuously to ensure that the disease is controlled, as the main goal is to prevent the development and progression of the disease.
Basically, anti-arthritis drugs such as aspirin and ibuprofen are given, as these drugs reduce inflammation and reduce joint edema, but side effects may occur when used for a long time, so they should be taken when treating rheumatoid arthritis in small doses and for a short period.
DMARDs that are given include methotrexate and sulfasalazine, which need several weeks to several months to show improvement in symptoms and need close monitoring because they have potentially serious side effects.
Corticosteroids work well in relieving inflammatory conditions, but they are not recommended for long-term use in high doses.
If all traditional medicines fail to treat rheumatoid arthritis, biological and synthetic agents can be resorted to, but they may be an expensive option with cumbersome side effects for patients, some of these medications include:
- Cyclophosphamide and cyclosporine
The physiotherapist trains the patient to do exercises for the treatment of rheumatoid arthritis, as it delays the loss of effectiveness in the joint affected by inflammation, because this inflammation may cause limitation in the movement of the joint later if it is neglected.
Some of the physical therapy methods include:
- Techniques for protecting arthritic joints
- Heat and cold therapy for rheumatoid arthritis
- Orthopedic plates and splints
Treatment for rheumatoid arthritis requires orthopedic surgery when the joints are severely damaged. The surgery usually includes:
- Removing the affected part of the joint
- Total joint replacement in severe cases such as knee and pelvic replacement
Some patients often have allergies to certain foods, so they should avoid them. In general, a balanced diet containing adequate amounts of fish oils and omega-3 is recommended.
Patients who smoke should quit smoking completely because it is one of the most important factors that lead to the exacerbation of symptoms over time, and alcohol should be avoided as much as possible.
Patients can avoid the need for stressful medication for rheumatoid arthritis by maintaining a healthy lifestyle and a balanced diet.
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Treatment of rheumatoid arthritis is based on relieving symptoms, and if medication is adhered to, results will be excellent, especially when using DMARDs, an acute inflammatory attack of 35% may occur if the medication is not taken for a year.
Blood tests are the basis for diagnosis because they detect the immune changes that will cause the disease before its symptoms worsen.
Stress, lack of sleep and psychological stress in addition to other diseases such as cold and flu.
Untreated rheumatoid arthritis can cause entire joints to become damaged and need to be replaced.
Unfortunately, the drug cannot be completely dispensed with because it is a chronic and progressive disease