Rheumatoid Arthritis

What is rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease that causes inflammation in the body's joints. The chronic condition brings about symptoms of pain, stiffness, swelling and fatigue. Rheumatoid arthritis occurs in a small fraction of the population, approximately 1%, and women are three times more likely to be affected than men.

An autoimmune disease is one where the body's immune system begins to attack the body, specifically at the lining of the joints. This results in inflammation, leading to joint destruction.

What happens at the joint?

Rheumatoid arthritis is often characterized by the swelling of more than one joint, and of the same joints on both sides of the body (symmetrical). It often starts slowly, but spreads over a few weeks to a few months. Symptoms may vary from person to person; some might have mild inflammation and swelling, but there may be times when the pain and stiffness increases.

A joint is the place at which two bones meet. To allow movement, the joint acts as a hinge, and a support system. Each bone is covered by cartilage at the joint. Cartilage makes the joint into a smooth surface, so that the bones can glide against each other. The joint is lubricated by a thick fluid called synovial fluid. This system works together with a membrane, synovium, to hold the joint in place.

In rheumatoid arthritis, inflammation occurs within the synovium (membrane). The swelling produces extra fluid and causes pain. When this irritation increases more than usual at the same joint, patients usually get "flare-ups".

What are the symptoms?

It is difficult for physicians to diagnose rheumatoid arthritis. That's why its recommended to begin treatment immediately and prevent the condition from worsening.

Some of the common symptoms include:

• joint pain and swelling
• stiffness
• tiredness (fatigue), depression, irritability

Some of the less symptoms include:

• weight loss
• inflammation in the eyes
• inflammation of other body parts (such as the lungs and blood vessels, but this is rare)

What causes rheumatoid arthritis?

Doctors don't really know what causes this autoimmune disease. Other types of arthritis, such as osteoarthritis, often occurs due to wear-and-tear and old age. Rheumatoid arthritis can occur in anyone, at any age, but research does show that it begins in middle age. Other forms of arthritis also affect children, such as juvenile rheumatoid arthritis, sharing the same symptoms as the adult version.

There is often a combination of events that lead to the triggering of rheumatoid arthritis symptoms, and the consequently, the onset of the condition:

• unusual autoimmune response
• genetic transmission
• environmental trigger (such as a viral infection, or hormonal changes)

How is it diagnosed?

To test for presence rheumatoid arthritis, doctors have to perform a series of diagnostic tests. The most important thing to do is informing the doctor of any unusual joint pain and swelling.

Doctors often begin with an examination of the joints, followed by blood tests and X-rays. The blood contains specific factors that can identify the presence of inflammation.

Remember, getting tested positive from one of these blood tests does not mean that you have rheumatoid arthritis. Some people that test negative or have normal results can have the condition. This is why a combination of tests need to be done to reach a final diagnosis.

What is the outlook?

There is always hope. Taking control requires team effort, and self-efficacy will only become stronger with the support of family, friends, and most importantly, a doctor.

• Notify your doctor about all your symptoms. Often, morning stiffness is one of the ways to tell apart rheumatoid arthritis from the other types.
• Start treatment early! Once under control, the disease can effectively be managed in the long-term.
• Don't replace current medical treatments with unproven health practices and products. Always check the research behind it! Although family and friends mean well when they suggest some therapy options, they may interfere with a treatment plan. Take them with a grain of salt.
• Protecting the joints from unnecessary strain is very important. Take advice from an occupational therapist to plan out a daily routine, to carry out day-to-day activities without the interference of rheumatoid arthritis.

There is always a positive outlook for people with rheumatoid arthritis. More research is uncovering new and effective treatments that are allowing the improvement of even more patients.

The adverse effects of rheumatoid arthritis

Individuals with rheumatoid arthritis have pain in more than one joint. As a result, there are many unfavourable effects of the condition:

• restricted motion
• low muscle strength
• changes in posture
• overall physical weakness

It is important to continue an active lifestyle so that disease activity can be reduced, and physical function is still maintained. Keeping active, and managing arthritis using physical and exercise therapy will help decrease the harmful effects of the condition.

Maintaining a healthy lifestyle

For patients, maintaining a healthy lifestyle is critical once treatment has begun. Regular physical activity, stretching exercises, or aerobic training gives the body more flexibility and prevents damaging of the joints. Long term studies provide evidence for the benefit of physical activity. It is safe for patients to participate in moderate intensity and weight-bearing exercises. Remember that exerting oneself is not beneficial. Although it is good to boost muscle strength, there is no reason to feel uncomfortable, or bear additional pain to do so.

Making a routine: Meet Sara

Sara is 45 years old and she has been recently diagnosed with rheumatoid arthritis. She was shocked to learn about it, and did not want to change her daily routine, or stop doing her favourite things. She still wants to go for her morning walks, cook, and complete her daily household chores. Right now, she does not have the stamina to go for her morning walk, and gets tired very easily. She is worried that her symptoms will get worse if she stops her routine.

Joint-friendly activities

Inactive joints can become stiff in a short time period. Participating in physical activity can help in decreasing morning stiffness and overall pain. These include: walking, swimming and household tasks. This makes the patient more productive, and increases your endurance and stamina.

Stretching helps improve your range of motion and flexibility. It is important to stay within limits! Perform these exercises in a comfortable position - there's no reason to overdo it.

Research has found that aerobic training lessens pain that is usually a result of the inflammation process. The muscles become stronger and the quality of life is improved.

Goals of physical therapy

Managing rheumatoid arthritis is critical for pain relief, inflammation control, maintenance and improvement in function, and to boost self-confidence. There are a few goals that can be achieved:

• Weight bearing exercises decrease bone mass
• Healthy weight is crucial since excess weight places additional strain on joints
• Stress is easily managed, especially with activities like t'ai chi
• Depression reduces your confidence - physical activity is important for a positive mental outlook on life
• Sleep disorders are common with rheumatoid arthritis, and exercise improves overall sleep patterns

What to remember

To obtain the greatest benefits of physical activity, remember to:

• Be consistent - follow a schedule
• Slowly build-up - from a low intensity, and increase depending on how you feel
• Exercise - only when the pain is not overpowering
• Repetition is important - but avoid intense workouts during flare-ups
• Know the limits - don't let exercise cause pain that can't be handled
• Do not over-do it - stop if discomfort continues
• Avoid exercise if your joint feels odd - the joint is swollen and should be taken care of
• Be realistic - although determination is good, avoid unnecessary pain
• Coordinate - avoid jerky exercises, and exercise at a normal rate so that there's no stress
• Rest is important

Eating healthy

Eating healthy can help an individual with rheumatoid arthritis feel better about themselves, and maintaining a healthy weight is important. That is the only real relationship between nutrition and rheumatoid arthritis. Putting extra weight on the joints means an extra burden, resulting in an increase in symptoms and pain. Research shows that obesity can worsen symptoms. By over-working these joints, undue stress and pressure is placed on them while walking. It's important to make continuous measurements of one's body mass index (BMI) and waist circumference (WC).

Occasionally, diagnosed individuals can try to introduce a new diet into their lifestyle as an attempt to reduce the symptoms of rheumatoid arthritis. Nutrition therapy is important to maintain an ideal body weight and put less stress on the body's weight-bearing joints. The foods one eats shape their mobility and productivity, and the immune system needs this energy to fight common illnesses.

Nutrients help in the regaining of energy and allow the completion of daily tasks. A balanced diet will also reduce the risk of other health problems, due to a weakened immune system, like cardiovascular disease, diabetes, etc.

Rheumatoid arthritis and weight

• Reducing fat intake - Omega-3 fatty acids have been widely investigated, and are known to provide symptom relief. These fatty acids must be obtained from foods. Research has shown a decrease in inflammation by taking fish oil supplements. Limiting saturated and trans fats, which include animal products, and processed foods is important.
• Taking supplements - Supplements are useful on a low calorie diet. Calcium and vitamin D are two of the most important nutrients, and help the body with food absorption. An iron deficiency can also develop due to inflammation, and research shows that iron should be taken to meet the minimum requirements. Selenium supplements are also recommended.
• Eating more vegetables and fruits - Brightly coloured fruits and vegetables have lots of antioxidants, which prevent the body from being damaged by harmful molecules, and reduce inflammation.

Trying diets

Individuals with rheumatoid arthritis can attempt a new diet to try and improve their symptoms.

Most people go for vegetarian (or vegan), Mediterranean (fish, fruits, vegetables and olive oil), elemental (liquids) or elimination (limit foods that may be source of symptoms) diets. These diets are often difficult to fulfill, and research shows debatable results.

What to remember

• Don't forget to eat a variety of foods and balance those foods with physical activity
• A balanced plan includes choosing fruits and vegetables and reducing the amount of saturated fats and sugars
• There is no consensus on the effect of diets on the condition, although some trials do show successful results
• Always remember to check with a doctor before going on a diet, or before taking nutritional supplements

Heat and cold

Always speak to a health practioner about how to manage flare-ups and inflammation in rheumatoid arthritis. Sometimes they have better suggestions for helping with pain relief.

Mind and body practices

All individuals with rheumatoid arthritis are prescribed to their personal and independent medical treatment plan. Doctors take a different treatment approach based on: how long the patient has had the condition, how strong the symptoms are, and whether the patient has any other health problems. Treatment plans also change based on the body's side effects to certain medicines, such as disease-modifying anti-rheumatic drugs (DMARDs) that can cause kidney and liver damage, and non-steroidal anti-inflammatory drugs (NSAIDs) that decrease inflammation, but do not affect the course of the disease.

This is exactly why it is important to talk to the health-care practitioner about any alternative and complementary therapies that the patient is planning to use. Although they may not have a direct effect on drug action, they may not be suitable for the body. Some medicines decrease the body's immune susceptibility, and make the individual more prone to infections and also bring about overall weakness.