Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that can cause joint pain and damage throughout the body. The joint damage that RA causes usually happens on both sides of the body. So, if a joint is affected in one of the arms or legs, the same joint in the other arm or leg will probably be affected, too. In rheumatoid arthritis, the body’s immune system attacks its own tissue, including joints. Rheumatoid arthritis affects joint linings, causing painful swelling. Over long periods of time, the inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity.

As RA progresses, the body changes. Some changes you can see and feel, while others you cannot. Each stage of RA comes with different treatment goals.

Stage 1

Stage 1 is early stage RA. Many people feel joint pain, stiffness, or swelling. During Stage 1, there is inflammation inside the joint. The tissue in the joint swells up. There is no damage to the bones, but the joint lining, called the synovium, is inflamed.

Stage 2

Stage 2 is moderate stage RA. In this stage, the synovium’s inflammation causes damage to the joint cartilage. Cartilage is tissue that covers the end of bones at the site of joints. When cartilage is damaged, people may experience pain and loss of mobility. Range of motion in the joints may become limited.

Stage 3

Once RA has progressed to Stage 3, it is considered severe. At this point, damage extends not only to the cartilage but to the bones themselves. Since the cushion between bones is worn away, they will rub together. There may be more pain and swelling. Some people may experience muscle weakness and more mobility loss. The bone can be damaged (erosion), and some deformity may occur.

Stage 4

At Stage 4, there’s no longer inflammation in the joint. This is end-stage RA, when joints no longer work. In end-stage RA, people may still experience pain, swelling, stiffness, and mobility loss. There may be reduced muscle strength. The joints may become destroyed and the bones fused together (ankylosis).

Rheumatoid arthritis requires a medical diagnosis. The common symptoms of RA include Pain in the joints, back, or muscles; Joint stiffness, swelling, tenderness, or weakness; fatigue, anaemia, or malaise; lumps or redness in skin; bump on the finger or swelling. Flare, dry mouth, physical deformity, or sensation of pins and needles are also common manifestations of RA. It also affects lungs, heart and causes early osteoporosis.

The initial treatment involves a class of medications called anti-rheumatic drugs DMRDs. The treatment is low in cost and easily accessible and the patients can easily be managed by orthopaedic surgeons trained in the field of rheumatoid arthritis, yet most patients lack proper treatment and diagnosis leading to gradual damage of the joints and ending with completely damaged or deformed joints and secondary osteoarthritis.

Replacement of knee, hip, elbow, or shoulder is the mainstay of treatment for end-stage osteoarthritis that promises a pain free and independent life. Giving an example of my own patient, A 62-year-old lady came to NH MMI Narayana Superspeciality Hospital, Raipur in Feb 2020, she was totally bed-ridden due to severe pain in all joints and damaged knees (both) and hip joints. She was so weak due to severe osteoporosis that she would have not tolerated any surgery. Her treatment was planned in two stages. We started the DMRDs for her, which takes 2-3 month to totally control RA. She was given iron infusions to increase her Hb. Specific both hormonal and non-hormonal injections were given for 4 months to treat osteoporosis and to make her bones strong. When she was strong enough to bear the mammoth surgery, she was admitted, and all the 3 surgeries, bilateral total knee replacement (TKR) (the replacement of both the knees) and right total hip replacement (THR), were performed in single sitting. Making her able to walk painlessly and independently after 7 days on 2 July 2020.

Rheumatoid arthritis is a subset of arthritis with special problems which needs specific planning. And all rheumatoid arthritis patients should be treated under orthopaedic guidance from the beginning to prevent end-stage disease and unnecessary complications.

Dr Ankur Gupta | Orthopaedics and Joint Replacement Surgeon | NH MMI Narayana Superspeciality Hospital, Raipur