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“Rheumatology is one of the last bastions of clinical medicine.”
It is this specialty where a clinical examination plays as important a role as laboratory investigations, most of which must be chosen carefully on the basis of the former, in order to arrive at a proper diagnosis, formulate a management plan and titrate the doses of the medications and non-pharmacotherapy employed for the treatment.
In this module, we shall learn how to identify an inflammatory back pain, approach a case of poly arthritis and investigate the same, and the results we might anticipate from such investigations. Classification, prognostication and determination of disease activity shall also be discussed, and a brief overview of the cytokines playing a key role in the disease propagation and joint destruction shall be looked into. The latter shall help us in understanding the basis for the use of the various disease-modifying molecules in its treatment, which shall be covered in a later module. Lastly, we shall see some clinical scenarios where knowledge of the above can be practically applied.
Learning Objectives --
- To identify a case of Inflammatory Arthritis
- Approach to diagnosis and investigations
- Understand the molecular basis of inflammatory joint damage
- Understand the biomechanical basis of joint deformities
- Determination of disease severity and learn about the risk-factors
FAQs
1. What is Rheumatoid Arthritis (RA)?
Rheumatoid Arthritis (RA) is a chronic autoimmune disease in which the immune system mistakenly attacks the body’s joints, causing inflammation, pain, and progressive damage to joint structures. This can lead to deformities and reduced joint function if left untreated.
2. How is RA different from other forms of arthritis?
RA differs from other forms of arthritis, like osteoarthritis, because it is an autoimmune disease. In RA, the immune system targets joint linings, causing inflammation. Osteoarthritis, on the other hand, is primarily due to the wear and tear of cartilage from aging or injury.
3. What causes RA?
The exact cause of RA is unknown, but it is believed to result from a combination of genetic, environmental, and immune factors. Certain genes may increase susceptibility, while environmental factors like smoking or infections may trigger the immune response that leads to RA.
4. What are the early symptoms of RA?
Early symptoms of RA include joint pain, stiffness (especially in the morning or after periods of inactivity), swelling in the hands and feet, and fatigue. RA usually affects joints symmetrically, meaning both sides of the body are often involved.
5. How does RA progress over time?
RA progresses through several stages:
- Early Phase: Symptoms are mild, with minor joint pain and stiffness.
- Clinical Phase: Symptoms become more pronounced, and imaging may show signs of inflammation.
- Established Disease: Inflammation becomes chronic, and there is visible joint damage.
- Advanced Stage: Severe joint deformities and limitations in mobility occur due to extensive damage.
6. What happens at the cellular level in RA?
In RA, immune cells like T-cells mistakenly attack the synovium, the lining of joints. This triggers an inflammatory response, where immune cells release cytokines (chemical messengers) like TNF, IL-1, and IL-6. These cytokines cause the synovium to thicken and form a tissue called pannus, which invades and damages cartilage and bone in the joints.
7. What are cytokines, and why are they important in RA?
Cytokines are proteins that help regulate immune responses and inflammation. In RA, specific cytokines, such as TNF, IL-1, and IL-6, play a key role in promoting inflammation and joint damage. Many RA treatments work by targeting these cytokines to reduce inflammation and slow disease progression.
8. How is RA diagnosed?
RA is diagnosed through a combination of patient history, physical examination, blood tests, and imaging studies. Blood tests commonly look for rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), and markers of inflammation like ESR and CRP. Imaging, such as X-rays or MRIs, can help detect joint damage and inflammation.
9. Can RA affect parts of the body other than joints?
Yes, RA can affect other organs and systems, including the lungs, heart, eyes, and skin. People with RA are also at higher risk for cardiovascular disease, osteoporosis, and certain types of lung disease due to the systemic nature of the inflammation.
10. Is RA curable?
Currently, there is no cure for RA. However, early diagnosis and appropriate treatment can control symptoms, slow the progression of the disease, and significantly improve quality of life for those affected.
11. What treatment options are available for RA?
Treatment options for RA include medications like DMARDs (disease-modifying antirheumatic drugs), biologics, and corticosteroids, as well as physical therapy and lifestyle modifications. Early and aggressive treatment can help manage symptoms and reduce joint damage.
12. How important is early diagnosis in RA?
Early diagnosis is crucial in RA, as starting treatment early can slow disease progression, reduce symptoms, and prevent joint damage. Delayed diagnosis can lead to irreversible joint changes and increased risk of complications.
13. Are there lifestyle changes that can help manage RA?
Yes, lifestyle changes can complement medical treatment in managing RA. Regular low-impact exercise, a balanced diet, stress management, quitting smoking, and maintaining a healthy weight can all help reduce symptoms and improve overall health in people with RA.
14. What is the prognosis for someone with RA?
The prognosis varies by individual. With early and effective treatment, many people with RA can manage symptoms and maintain a high quality of life. However, without treatment, RA can lead to severe joint damage, disability, and increased risk for other health conditions.