Rheumatoid Arthritis

Rheumatoid arthritis is a condition that causes pain, swelling and inflammation in the joints.

Rheumatoid arthritis is an autoimmune disease. This means that the immune system, which usually fights infection, attacks the lining of the joints, causing them to become inflamed. Over time these joints may become permanently damaged and stop working properly.
The symptoms of Rheumatoid Arthritis tend to develop gradually. The small joints, such as in the fingers and toes are often affected first. It can then spread to other joints e.g. in the shoulders, elbows, hips and jaw. The condition tends to affect several joints at the same time; usually on both sides of the body e.g. it often affects both knees or both hands.

SIGNS AND SYMPTOMS
Symptoms are often more painful in the morning and begin to ease as the day progresses. The most common symptoms of Rheumatoid Arthritis include:
• Swelling, pain and heat in the joints
• Stiffness in the joints, especially in the morning
• Persistent fatigue
• Sleeping difficulties because of the pain
• Weak muscles
• Joints on both sides of the body are usually affected.
• Loss of appetite.
• Generally feeling unwell.
• Skin nodules - one in four people with Rheumatoid Arthritis develop painless lumps under the skin over the elbows and forearms, known as rheumatoid nodules.
• Anaemia - eight out of ten people with rheumatoid arthritis are anaemic.

Flare-ups
The symptoms of Rheumatoid Arthritis often tend to come and go and 'flare ups' can occur. This means that from time to time, the condition will worsen and the symptoms will be more intense and severe. Although Rheumatoid Arthritis can be frustrating, particularly during a flare-up, most people are able to carry on as normal, with some lifestyle adjustments.

TREATMENT OPTIONS
As with all medical conditions it is advisable to consult your Doctor for an accurate diagnosis and treatment. There is no cure for Rheumatoid arthritis but there are many medicines and therapies that can greatly improve your symptoms. If your doctor suspects you have Rheumatoid arthritis, you will be referred to a specialist rheumatologist. This is so the diagnosis can be confirmed and the most appropriate treatment started as soon as possible.

Medication
Many different medicines are used to treat rheumatoid arthritis. Some aim to relieve symptoms and others help to slow the progression of the condition. Some of the different medicines that you may be prescribed are outlined below.
• Analgesics - more commonly known as painkillers e.g. paracetamol etc.
• Non-steroidal anti-inflammatory drugs (NSAIDs) - help to relieve pain and stiffness while also reducing inflammation. Some of the most commonly used include ibuprofen and aspirin.
• Disease-modifying anti-rheumatic drugs (DMARDs) - are a type of medicine that helps to ease symptoms and slow down the progression of the disease. Early treatment with DMARDs leads to a better outcome for the patient.
• Corticosteroids - are a type of medicine that helps to reduce pain, stiffness and swelling. These are usually used when NSAIDs fail to provide relief. They are commonly prescribed on a short-term basis, often during a flare-up. The long-term use of corticosteroids can have serious side effects.

Surgery
Surgery may be required if your Rheumatoid arthritis is particularly severe. The most commonly replaced joints are hips and knees. Osteotomy is another type of surgery that helps to realign joints. You may also need surgery on your hands, to repair damaged tendons

Lifestyle
Staying active is very important as exercise helps to maintain mobility and prevent the muscles around joints from becoming weak. Swimming is an ideal type of exercise as the water supports your weight, taking pressure away from your joints.

A physiotherapist will be able to devise an appropriate exercise plan for you. An occupational therapist can also advise you on ways to adapt your lifestyle to give you more independence, confidence and control.

DIET HINTS
General dietary recommendations for a person with arthritis include:
• Eat a well-balanced diet.
• Avoid fad diets or fasting.
• Increase dietary calcium to reduce the risk of osteoporosis in later life.
• Drink plenty of non-alcoholic fluids.
• Keep your weight within the normal range, by reducing the amount of dietary fats you consume.
Fish oils that contain omega-3 fatty acids have been found to help reduce the inflammation associated with some forms of arthritis, such as rheumatoid arthritis. Foods rich in omega-3 fatty acids include:
• Oily fish (such as salmon and sardines)
• Linseeds and linseed (flaxseed) oil
• Canola (rapeseed) oil
• Walnuts

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Ask your Pharmacist about anti-inflammatory pain relief medication. It is important to ask your Pharmacist to recommend the most suitable pain reliever.
2. Remember to exercise according to the advice of your Doctor or Physiotherapist.
3. Avoid activities that place a heavy amount of stress on the joints.
4. Some relief for Rheumatoid Arthritis may be obtained from applying heat if the joints are inflamed. Massage, relaxation, exercise, liniments and joint wraps may also help to relieve the symptoms of the disease. Some creams may give some relief. Ask your Pharmacist for advice.
5. Some nutritional supplements may be considered if the diet is inadequate e.g. glucosamine sulphate, chondroitin and fish oil

ORGANISATION & GROUPS
Indian Rheumatology Association (http://www.indianrheumatology.org/patient-resource.html)