Rheumatoid Arthritis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

Rheumatoid arthritis is a medical disorder that is the most common autoimmune form of arthritis.
Autoimmune diseases are illnesses that happen when the body tissues are wrongly attacked by its own immune system which consists of cells and antibodies whose purpose is normally to seek and destroy invaders of the body, especially infections.
Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disorder featured by an inflammation of the synovial joints resulting in joint and periarticular tissue damage, as well as a wide range of extra-articular features.
Joint inflammation creates typical changes:

1. Heat and sometimes redness,
2. Swelling,
3. Pain,
4. Stiffness (especially in the early morning or after inactivity),
5. Progressive joint destruction and
6. Loss of joint function.
   RA is a systemic disease with other manifestations of the disorder:
7. Eyes: secondary Sjogren's syndrome, scleritis and episcleritis.
8. Skin: leg ulcers especially in Felty's syndrome (association of rheumatoid factor positive rheumatoid arthritis, neutropenia and splenomegaly).
9. Rashes, nail fold infarcts.
10. Rheumatoid nodules: these are common, and may occur in the eyes, may be subcutaneous, and may be in the lung, heart and occasionally the vocal cords.
11. Neurological: peripheral nerve entrapment, Atlanto-axial subluxation, polyneuropathy, mononeuritis multiplex.
12. Respiratory system: pleural affliction, pulmonary fibrosis, obliterative bronchiolitis, Caplan's syndrome.
13. Cardiovascular system: pericardial affliction, valvulitis and myocardial fibrosis, immune complex vasculitis.
    Two lab tests that often help in the diagnosis are:
14. Rheumatoid factor
15. Anti-CCP antibody
    X-rays may show soft tissue swelling, peri-articular osteopenia, loss of joint space, erosions and deformity.
    There is no known curative treatment for rheumatoid arthritis.
16. Symptom modifying aids to relieve the symptoms but do not alter the natural history of the conditions.
    These medicines are Non-steroidal Anti-inflammatory Drugs (NSAIDS) like diclofenac, iboprufen.
17. Disease modifying drugs such as:
    a. Steroids
    b. Methotrexate,
    c. Sulphasalazine,
    d. Redaura,
    e. Hydroxychloroquine
    They have been shown to slow down the damage caused by Rheumatoid Arthritis.

TABLE OF CONTENT
Introduction
Chapter 1 Rheumatoid Arthritis
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Prognosis
Chapter 7 Gout
Chapter 8 Osteoarthritis
Epilogue

There was a young woman in the 1970s who had just graduated from Nanyang University who developed this severe condition and swollen joint pains.
After x-rays and blood tests it was confirmed that she had Rheumatoid arthritis.
She was referred to Tan Tock Seng Hospital for treatment.
She was given steroids and painkillers.
Sometimes the pain was so bad that she had to call me for house calls to give her injections to relieve her pain.
It was depressing to see her becoming worse by the year with deformities of her wrists and ankles.
Finally she had to be admitted to hospital for a new anti-cancer medicine which did relieve her pain.
Unfortunately the deformities could not be remedied.
It was sad to see a young woman ready for work becomes a recluse with deformities unable to work or help herself.

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