What is Rheumatoid arthritis?
Rheumatoid arthritis (RA) is an autoimmune disorder of an unknown etiology characterized by swelling of three or more joints, involvement of small joints of hands and wrists, symmetry of joint involvement, and morning stiffness lasting for over an hour. It starts with involvement of fewer joints initially & later affects a greater number of joints. Advanced stages of the disease involve deformities such as deviated fingers, swan neck fingers, finger subluxation, hammertoes, flat feet, and fixed contractures of large joints.
Depending on the presence of ACPA, it is classified as Seropositive & seronegative RA.
A variant present in the children below 17 years of age is called the juvenile type of RA.
Investigations
Erythrocyte sedimentation rate (ESR), Rheumatoid Factor (RF- RA Factor is incorrect) and Anti-cyclic Citrullinated Peptide Antibodies (ACPA) are a couple of tests used to diagnose the condition. X-rays are used to note the destructive changes in the joints which can detect the stage of RA.
Following blood tests can help in diagnosis of the rheumatoid arthritis:
- C-reactive protein (CRP) & Erythrocyte sedimentation rate (ESR): High levels indicate the presence of inflammation.
- Few individuals may also have a positive antinuclear antibody test (ANA), which indicates an autoimmune nature.
- Cyclic citrulline antibody test (anti-CCP): This more specific test checks for anti-CCP antibodies, which suggest a more aggressive form of rheumatoid arthritis.
- Rheumatoid factor (RF): Most, but not all, individuals with rheumatoid arthritis have this antibody in their blood. But it can also be present in people who don’t have RA.
Stages of RA as Defined by the ACR
- Stage 1: No destructive changes on x-rays ****
- Stage 2: Presence of x-ray evidence of periarticular osteoporosis, subchondral bone destruction but no joint deformity ****
- Stage 3 : X-ray evidence of cartilage and bone destruction in addition to joint deformity and periarticular osteoporosis ****
- Stage 4: Presence of bony or fibrous ankylosis along with stage 3 features ****
Obesity & RA - A vicious loop
The risk of RA increased by 13% for every 5 kg/m2 increase in BMI. Adipose tissue contributes to physiological and pathological processes associated with inflammation and immunity. It secretes proinflammatory and anti-inflammatory metabolically and hormonally active substances, and produces cytokines and chemokines. These chemicals set in an inflammatory condition of the joints. The inflammation then makes the joints painful & limits the day to day activities. RA patients adapt to a sedentary lifestyle with the fear of pain & thus gain more weight. They are thus trapped into a vicious loop.
Weight loss- A challenge in rheumatoid arthritis
As Obesity is strongly associated with rheumatoid arthritis, weight loss with a calorie deficit diet & physical activity helps in reducing the inflammatory changes of the joints. Active lifestyle, regular exercise (aerobic – walking, swimming, Yoga), weight control, adequate rest, avoidance of smoking and alcohol, and balanced diet (proteins, calories, and calcium ) are crucial for joint health.
Due to severe pain in the joints, exercising on a regular basis becomes very difficult. Also for RA Patients on corticosteroids, restricting calories is a challenging task as the side effect of steroids is increased hunger. Thus, the increased hunger & limitations of physical activity make it difficult for these individuals to lose weight.
One can thus opt for low calorie foods with high fiber which can help remain full for a longer period. Performing water aerobics in a heated pool works best because the warm water can be soothing and help relieve pain and stiffness from arthritis. Also, the water provides some resistance, which helps to tone and build muscle strength. Physiotherapy can help in improving the range of motion and strengthening of the joints. Splints, gadgets, and other appliances can be used to support the joint movements. Supplementation with n-3 PUFAs (such as eicosapentaenoic acid and docosahexaenoic acid) has been shown to change favorably the n-6/n-3 fatty acids ratio, reduce inflammation, and alleviate pain.
Home management
Following strategies can help manage RA:
- Rest, especially during an the flare
- Low-impact exercise, such as swimming, to boost overall health and mobility of a joint
- Managing weight, which can prevent additional stress on the joints
- Applying heat or cold packs to relieve pain
- Meditation, deep breathing, or muscle relaxation techniques to relieve stress
References:
- Abdulrazaq, M., Innes, J. K. and Calder, P. C. (2017) ‘Effect of ω-3 polyunsaturated fatty acids on arthritic pain: A systematic review’, Nutrition (Burbank, Los Angeles County, Calif.), 39–40, pp. 57–66. doi: 10.1016/J.NUT.2016.12.003.
- Feldmann, M., Brennan, F. M. and Maini, R. N. (2003) ‘ROLE OF CYTOKINES IN RHEUMATOID ARTHRITIS’, http://dx.doi.org/10.1146/annurev.immunol.14.1.397, 14, pp. 397–440. doi: 10.1146/ANNUREV.IMMUNOL.14.1.397.
- Feng, J. et al. (2016) ‘Body Mass Index and Risk of Rheumatoid Arthritis: A Meta-Analysis of Observational Studies’, Medicine, 95(8). doi: 10.1097/MD.0000000000002859.
- Kwoh, C. K. et al. (2002) ‘Guidelines for the management of rheumatoid arthritis: 2002 Update’, Arthritis & Rheumatism, 46(2), pp. 328–346. doi: 10.1002/ART.10148.
- Rheumatoid Arthritis (RA) | Arthritis | CDC (no date). Available at: https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html (Accessed: 29 November 2021).
