Arthritis is a chronic, immune-mediated inflammatory disease in which the joints are affected and extra-articular changes affecting, among others, the circulatory system, lungs, kidneys, and eyesight. Arthritis without proper treatment leads inevitably to their destruction. It is associated not only with the sensation of pain but also with progressive deformation of the joints, leading to disability.
However, early treatment in most patients makes to stop the stage when the inflammatory process has not yet led to permanent damage and deformation of the joints.
It is estimated that 0.8% of adults in Northern Europe suffer from it. In other words, the probability of developing rheumatoid arthritis in the general population is approximately 1%. It is slightly higher among the closest relatives of the sick person, estimated at 2-5%. Women are sick three times more often than men. The peak incidence is between the ages of 35 and 50.
What are the main arthritis symptoms?
In most cases, rheumatoid arthritis develops within a few weeks, less often within a dozen or so days. In 10-15 out of 100 patients, the onset may be acute, lasting only a few days. In a typical course of the disease, symmetrical involvement occurs first in the joints of the hands, wrists, and feet.
Large joints, such as the knee, elbow, and shoulder joints, are often involved in the later stages of the disease. The occurrence of joint pain does not constitute grounds for suspecting the disease.
Some patients may develop general symptoms, such as a feeling of severe fatigue, muscle pain, low-grade fever, lack of appetite, or a slight weight loss.
How does a doctor recognize RA?
Diagnosing psoriatic arthritis with many years, of course, is not difficult, especially if it has not been treated. Changes, especially in the joints of the hands, resulting from their destruction, are very characteristic. Laboratory tests and radiographs only confirm them. Arthritis in hands is easy to diagnose.
However, the most important goal is early diagnosis, that is when the joints have not yet been damaged. There are special criteria for this, created by an international group of experts, based on joint examinations, blood tests, and the duration of ailments. By counting appropriately assigned points, the indications for starting treatment are determined. Although not included in the criteria, ultrasound examinations of the joints can be helpful when it is not long before the symptoms appear. The main thing is what causes arthritis.
How do we treat RA?
After the diagnosis of rheumatoid arthritis is confirmed, so-called disease-modifying drugs are started. Among them, according to the current recommendations, methotrexate is the drug of the first choice. In the case of contraindications to its use, intolerance, or the occurrence of side effects, other drugs are recommended, such as sulfasalazine, leflunomide, or hydroxychloroquine. The same thing is with the arthritis in knee.
In the first months of therapy, glucocorticosteroids are also often used.
Its anti-inflammatory effect occurs quickly after administration, relieving pain and swelling when necessary for the proper drugs to work fully. This is known as bridging therapy for a period, not usually exceeding six months. Patients who do not achieve remission of the disease after treatment with at least two of the drugs mentioned earlier are qualified for drug programs with the use of biological drugs.
What is disease remission?
Remission does not, unfortunately, mean a cure. Currently, no drug has yet been developed that would allow a complete release from the disease if taken for a certain period. Remission is a condition in which the inflammation process smolders so minimally that there is almost no sign of disease. But you should take arthritis medication regularly.
We can compare this time to a break in its duration obtained thanks to the regular use of the drug. However, when an attempt is made to discontinue treatment completely, the inflammatory process exacerbates again in the vast majority of patients. If this happens, remission is much more difficult when medicines are restarted.
Remission without treatment is possible in a small percentage of patients. However, this applies only to patients treated at a very early stage, and no risk factors for the aggressive course of the disease were identified. An absolute condition is also to reduce the doses of drugs very carefully over a long period, with the awareness of the risk of exacerbation.
Additional methods to support the treatment
At each stage of the disease, additional non-pharmacological treatment may bring tangible benefits. Kinesiotherapy prevents the loss of muscle strength, maintain the range of motion in the affected joint, and support coordination and precision of movement. Manual therapies are also helpful in preventing contractures and increasing joint mobility.
Physical therapy, such as thermotherapy, laser biostimulation, electrotherapy or massages and baths used at the right moment of the disease, has an anti-inflammatory, analgesic, and muscle-relaxing effect. It is very important to keep fit and overall physical fitness. This gives a sense of independence and helps to cope with the disease.