rheumatoid arthritis clinical overview and tips for management
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Rheumatoid arthritis clinical overview and tips for managementTRANSCRIPT
CLINICAL OVERVIEW AND TIPS FOR MANAGEMENT
RHEUMATOID ARTHRITIS
Rheumatoid arthritis is a chronic ,inflammatory, autoimmune disorder that mainly affects the small joints of the body
Definition
…resulting in pain, stiffness ,deformity and loss of function of the joints involved.
Chronic- symptoms last for several years, with a relapsing- remitting course
Inflammatory- disease process affects the synovial membrane of joints causing bone erosion
Autoimmune-immune system which normally protects the body, attacks its own tissues
Systemic- inflammation may affect other organs such as heart,lungs,blood and blood vessels,nerves etc
Disease Characteristics
Risk Factors
Genetic Factors
• RA has a genetic link, it can run in families
• HLA-DR4 gene may play a role in increasing the risk
• Although, not everyone with this marker has RA, nor everyone with
Gender
• Females are 2-3 times more likely to develop RA than males
• Almost 70% of patients of RA are females
Age
• RA may develop at any age
• More likely to begin in the age group of 40-60 years
Other Factors
Viral and bacterial infections may trigger the faulty auto-immune response
Stress may also precipitate disease activity Hormonal factors females who have given birth or have breast
fed have slightly lower risk . Pregnancy and lactation improve symptoms temporarily
Trauma Smoking increases the risk of developing disease in genetically
predisposed persons Low testosterone level in males may be a predictor of developing
RA in the future
Joint pathology
Small joints like those of wrist and hand are most commonly affected
Chronic Inflammatory process mainly affects the Synovium i.e. the lining of the joints causing joint swelling, bone erosion, and eventually deformity
Signs & symptoms of RA
Bilaterally symmetrical pattern of joint involvement
Small joints of hand and wrist are affected first
As the disease progresses others joints like knee, hip, shoulder, ankle get affected
Pain in joints is the main presenting complaint
Stiffness of joints in the morning or after a period of rest which may last for several hours
Fever Fatigue Weight loss Nodules under the skin of arms,
elbows Symptoms may come and go, and
vary in severity Periods of increased activity or “Flare
ups” are interspersed with episodes of relative remission.
Loss of function of joints and disability
Systemic complications of RA
Anemia Eye: Redness, gritty sensation, corneal damage Skin: fine nodules under the skin, rashes, ulcers Lungs: interstitial lung disease Bones: Osteoporosis Inflammation of small blood vessels called vasculitis Heart and circulatory system: increased risk of Coronary artery Disease,
atrial fibrillation, pulmonary embolism Psychological effects: depression ,anxiety
Diagnostic testsBlood
• Rheumatoid Factor (RF): This antibody is present in almost 80% of patients of RA. some patients of RA may be seronegative for rheumatoid factor
• Anti cyclic citrullinated peptide (anti-CCP antibody) : present in about 50-75% cases. It is useful in diagnosing early cases and more aggressive forms of RA
• Anti nuclear antibody (ANA) : frequently found in RA patients
• ESR and C-reactive proteins: Indicate chronic inflammation and disease activity
Imaging
• X-ray: may be useful in tracking the extent of bone damage over a period of time
• MRI may also reveal evidence of bone and joint pathology
• Bone densitometry: may be used to detect signs of osteoporosis
Objectives of treatment
Reduce inflammation Prevent bone and joint damage Preserve joint mobility Aggressive treatment at an early stage to prevent disease
from becoming severe and chronic Prevent and treat systemic complications Palliative care and rehabilitation in progressive cases
Conventional treatment and adverse effects
Drugs Adverse effects
NSAID’s and other anti-inflammatory drugs Gastritis, G.I bleed
Anti rheumatic drugs (DMARD’s) like Methotrexate
Vomiting, diarrhea, hair loss, abnormal liver function
Anti-TNF drugs Immunosuppression, lymphoma, skin cancer
Immunosuppressants Risk of infection, infertility
Scope of Homoeopathy
• Homoeopathic medicines work by regulating immune system, thereby making them effective in treating auto-immune disorders like RA
• Carefully selected Homoeopathic medicines act as tailor made remedies for an individual patient in contrast to a “one size fits all” approach of conventional treatment
• Symptomatic relief can be achieved with Homoeopathic medicines without any side effects
• The underlying genetic/miasmatic cause is addressed by prescribing an anti-miasmatic remedy
Clinical tips – Homoeopathic management
Actea Spicata- Rheumatism of small joints especially wrist, ankle and toes. Swelling of joints from slight fatigue
Berberis Vulgaris- Rheumatic symptoms with urinary complaints, rapid change of symptoms specially in regard to place and character pain in heels. Rheumatic pain in shoulders, arms, hands and fingers, legs and feet. Pain between metatarsal bones ,Pain in balls of feet on stepping. Intense weariness and lameness of legs after walking a short distance.
Clinical tips contd.
Bryonia alba- joints are hot, red and swollen. Tearing pain aggravated by least movement, better by rest. Stiffness of nape of neck
Caulophyllum- pain and stiffness of small joints of fingers ,toes, wrist. Pains are erratic, changing place every few minutes
Causticum- Burning, rawness and soreness of joints with contracted tendons. Ailments from long-lasting grief. Aggravation in clear, fine weather while better by warmth and damp weather.
Cimicifuga- rheumatic pains with stiffness of neck and back
Clinical tips contd
Colchicum- Joints are stiff and hot. Shifting joint pains, aggravated at night. Patient screams with pain on touching the joint or stubbing a toe
Dulcamara- Joint pains induced by exposure to damp cold, aggravated by every cold change and somewhat relieved by moving about and by external warmth
Formica rufa – Pains worse from motion cold & before thunderstorm, better by pressure
Gaultheria- Inflammatory rheumatism Guaiacum- Indicated in acute condition with pain and swelling , also
effective for stiffness, contraction and immobility of limbs. Intolerance to heat and pressure
Clinical tips contd
Kali hydroiodicum- Rheumatism of knee with effusion. Pains at night ,and in damp weather. Better by motion , open air
Kalmia latifolia- Intense pain in joints, changing place suddenly, joints are red and hot
Lac Caninum - Affection of joints with alteration of sides; erratic pains. forgetfulness.
Ledum palustre- affected parts are cold to touch but it is not felt subjectively to the patient. Joints are affected from below upwards and or upper left, lower right. Joint pains worse from warmth, at night; better from cold or icy-cold application.
Clinical tips contd
Medorrhinum- Pains are worse from sunrise to sunset, during thunderstorm and from covering, relief in open air
Phytolacca decandra- Joint pains and stiffness are worse in the morning, shift rapidly ,and worse from motion and at night
Pulsatilla- Pains in limbs shifts rapidly, erratic pains aggravation on beginning to move, better in open air, by cold application, chilliness
Rhus tox- Pain and stiffness of limbs, better by motion, aggravated in cold weather
Clinical tips contd
Stellaria media- Synovitis, pain in shoulder, arms, legs, different parts, shifting pains with stiffness of joints morning aggravation, sharp shifting rheumatic pains all over with stiffness better evenings , cold air, by motion
Stillingia- Chronic periosteal rheumatism, Worse, in afternoons, damp air, motion. Better in morning, dry air.
General Measures
Regular exercise within the limit of pain to improve muscle strength
Avoid exercise when joints are acutely inflamed
Hot or cold application as required to ease pain and muscle stiffness
Contributors Dr. Anjali Miglani, S.M.O Dr. Anubha Sikka, M.O Dr. Jithesh T.K, C.M.O Dr. Pradip Kumar Roy, S.M.O
Compiled by : Dr. Deepti Chawla, C.M.O, Dte. Of AYUSH, GNCT of Delhi