RHEUMATOID ARTHRITIS
Rheumatoid arthritis is a disease in which the body develops an ‘allergy’ to some components of the blood. These components accumulate in the joints and some other parts of the body. The body’s natural defence mechanism reacts adversely to this accumulation. The result is swelling and pain. Rheumatoid arthritis can cripple a person rapidly, often extensive and sometimes even life-threatening. It is more common in women twenty to forty years of age and may run in families.
SYMPTOMS
Early symptoms of rheumatoid arthritis are fever with vague aches and pains in the body, including the joints. After about four to six weeks, the symptoms are more severe, and the pain is present in several joints, especially the joints of the hands and feet. The knee is a significant joint and is, therefore, usually affected. Walking may become difficult. Your thigh muscles may become wasted or thin if you do not walk enough. Rheumatoid arthritis may affect various body systems, such as the eyes, lungs and heart. The severity of the symptoms of rheumatoid arthritis is not constant. The symptoms may completely disappear and appear again after some time.
You should consult a doctor as soon as possible if you have pain and swelling in one or more joints. It is important to remember that all joint pains and bumps are not due to rheumatoid arthritis.
What is the difference between osteoarthritis and rheumatoid arthritis?
Osteoarthritis usually begins after the age of forty years over several years. It usually starts on joints on one side of the body. It usually affects joints in the knee, hips, hands, feet and backbone. There are no associated symptoms such as fatigue, fever or loss of weight.
Rheumatoid arthritis starts between 25-40 of age, and the symptoms may appear and disappear without warning. It affects joints on both sides of the body at the same time. It affects most joints, including knuckles, wrists and elbows. Rheumatoid arthritis is usually accompanied by fever, weight loss and fatigue.
LABORATORY TESTS
Your doctor may recommend a test called the R.A. factor. Although this test often helps in diagnosis, it is not always reliable. This is because it is occasionally positive in people who do not have rheumatoid arthritis. Therefore, Your doctor will diagnose your condition based on history, physical examination and laboratory tests.
MANAGEMENT
The basic principles for the management of rheumatoid arthritis and other associated diseases. These include:
Correct diagnosis: Since rheumatoid arthritis is just one type of arthritis that involves multiple joints, you need to consult with a doctor, incredibly a joint-disease specialist (Rheumatologist) and trust their judgment. Your doctor may not be able to make the diagnosis before six weeks.
Patient education: Since rheumatoid arthritis is potentially crippling, you must avoid anxiety. Your doctor will give you details about the course of the disease, such as its fluctuating course, long-term treatment options, the need to use more than one medicines which may have several adverse impacts, the cost of treatment and the need to consult the doctor regularly. You can limit the adverse effects of the disease by following your doctor’s recommendations.
Avoid treatment from doctors who are not qualified :
Several self-styled doctors may promise you a magic cure for rheumatoid arthritis. It is important to remember that although some medicines may be partially effective for other types of arthritis, rheumatoid arthritis requires a well-planned management schedule.
Avoid steroids: Steroids are chemical substances produced by some glands in the body. They are also available as medicines. Although steroids may give immediate relief, you will require alive and larger doses to relieve symptoriod over time. They have severe side effects on almost all parts of the body. Of these, weight gain, swelling of the face, excess hair growth on the front, reduced vision due to cataracts, ulcers and weakness of bones are more common.
Diet: Rheumatoid arthritis does not require any particular diet. Avoiding some food items is not likely to cure the disease. You may, however, have a loss of appetite and anaemia. Therefore, It would be best to eat a balanced diet, preferably as small and frequent meals.
Moderate activity: Bed rest is unnecessary, except in the early painful stages of the disease. Once this phase is over, you should start regular joint movements.
Physiotherapy: It is essential to start physiotherapy after the disease is controlled a little by medicines. Physiotherapy helps to regain joint mobility and strength. After learning the correct technique from a qualified person, you can do the recommended exercise and heat therapy yourself.
PRINCIPLES OF MANAGEMENT
• Correct diagnosis, preferably by a rheumatologist.
• Education regarding the course of illness, the disease’s adverse effects, and its management options.
• Acceptance that the disease is not curable.
• Avoid steroids.
• Eat small frequent balanced meals.
• Do simple exercises after the painful stage subsides and gradually increase its duration.
• Learn the correct physiotherapy technique, including exercise, from a trained professional.
• Avoid exercise from which you cannot recover within one hour.
• Normal sexual activity can be practised significantly when the painful stage subsides.
• Avoid pregnancy during the active phase of the disease.
• Consult your doctor regularly for modifications in your treatment schedule depending on your condition.
• Surgery such as knee replacement if all other methods for joint mobility have failed.
EXERCISE
Exercise helps to relieve and prevent joint stiffness, muscle weakness, joint deformity and dependence on others. It would be best if you are, however,r avoided excessive bending of the joints. Increase the intensity and duration of the exercise gradually, as you may feel tired after doing exercises to regain joint mobility and muscle strength. A simple rule is to recover from the strain within one hour of exercise. It is essential to find a correct balance between rest and exercise.
Three types of exercises help:
• Those which maintain or increase joint mobility.
• Those which improve muscle strength.
• Those which increase general health and benefit the heart and lungs.
Marriage, sexual activity and motherhood: Rheumatoid arthritis is a chronic disease that limits your ability to do regular work over the years. You can be sexually active, although it may be difficult when you have joint pains. Although pregnancy is not contra-indicated in rheumatoid arthritis, it is better to avoid pregnancy during the active phase of the disease when you require long-term medicines. Rarely the hip joint may be affected, so sexual activity and delivery may be challenging.
Regulate treatment schedule under doctor’s guidance: There is no standard treatment for rheumatoid arthritis. Your doctor is likely to recommend a combination of medicines depending on the severity of your disease, your body’s acceptance of the drugs and their side effects. Your doctor may have to modify the treatment schedule frequently in the initial stages till the correct combination and dose are achieved.
Surgery: Your doctor may recommend surgery after other methods of preserving the joint and making it usable have failed. Knee joint replacement has become a standard operation as it makes you mobile even after a prolonged illness.
MODERATE TREATMENT
When we use the term moderate, it implies that it is a scaled-down version of a radical treatment so far discussed.
In the morning, keep the bowel clean with the help of a non-violent enema.
Herbal paste/juice can be combined with the vegetable juice of banana stem and ash pumpkin.
If time permits, a spinal bath combined with a hot foot bath may take 15-20 minutes. A full bath in bearable cold water is to be followed.
With the above oral medicine, the patient may proceed to their place of work/studies or continue with their light household chores. At 10-11 a.m., depending upon the convenience of the work/studies business, the patient may take some tender coconut water, fresh non-citrus fruits, or vegetable juice. If none of the above is available plain cold water is sufficient.
Lunch at home: Some fresh vegetables and some conservatively cooked vegetables, with the usual garnishings of coconut scrapings, coriander leaves etc., may be taken. Better to avoid cereals.
If going to work, some fruits or fresh vegetables are prescribed. Cooked food would have become very stale. Further, they are expected to continue the work in the afternoon.
A spinal bath with a hot water foot bath at home may be taken in the afternoon. Those who go out for work/studies are advised to take a spinal bath with/without a hot water foot bath without fail on return. Whatever help is needed to get into the tub and get up should be obtained. A glass of tender coconut water is an ideal drink in the evening.
Night dinner may consist of some unrefined cereals and conservatively cooked vegetables.
Before retiring to bed, they may apply some herbal oil on the affected joints. This will be followed with an alternate hot and cold fomentation, and at the end of it, use a stimulating wet pack on the affected joint(s).