Arthritis is an umbrella name to cover some 200 conditions of joint inflammation. However, in daily parlance, it has come to represent Rheumatoid Arthritis or RA. RA is an autoimmune disease. In RA, the immune cells attack the internal lining of the joint synovial membrane and cause arthritis. All autoimmune diseases have periodic waxing and waning of the symptoms.
During periods of remittance, disease symptoms would be minimal and not interfere with normal life. It is during the exacerbations the characteristic symptoms of swelling of the affected joint, stiffness and pain become prominent. The joints may be warm to touch and the skin may redden. Symptoms are generally worse early morning. Loss of appetite and tiredness are common. One may experience anemia and may have slight fever too.
The condition is confirmed by analyzing blood for total count, and specific antibody markers like anti-cyclic citrullinated peptide, rheumatic factor, and anti-nuclear antibody. The fluids from the inflamed joint is taken and analyzed to determine the type of arthritis. X-ray, CT scan, MRI are also used to diagnose the condition and eliminate conditions mimicking the symptoms. These images can also determine any previous injury to the joint that causes arthritis.
Treatment is always aimed at reducing the discomforts, preventing further damages to the joint and improves flexibility. Hot and cold compresses or easing the pressure on the joint by using walking aides give relief to many. For acute exacerbations, normally over the counter NSAID medications such as ibuprofen and naproxen sodium are used. Stronger prescription NSAIDs has serious side effects like tinnitus, stomach irritation, cardiac problem and liver and kidney damage. Corticosteroids like prednisone reduce inflammation and slow down joint damage. They are used in short bursts and then tapered off. Disease-modifying antirheumatic drugs DMARDs like methotrexate, hydroxychloroquine etc are the usual ones used. They have side effects like liver damage, bone marrow suppression, and severe lung infections.
Biologic response modifiers are selective immune suppressants suppressing the part that triggers inflammation and tissue damage. Abatacept, etanercept, tofacitinib etc belong to this group and if administered with DMARDs have greater effectiveness.