What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic, systemic, inflammatory disease of unknown origin, this disease predominantly affects the peripheral joints of the body, being able to generate inflammation, pain and in a more advanced stage destruction of the articular cartilage, which is the layer that covers the joints of the body.

The evolution of this disease can be very variable, being able to be from very slight; generating pain and inflammation in some joints, mainly in the morning, with fatigue and lack of appetite. Until reaching the impossibility of the patient to carry out his daily activities in life generating intense pain with significant joint deformities. Most of the time it presents as an intermediate course.

Las articulaciones del cuerpo más afectadas por esta enfermedad son las manos y muñecas (80%), caderas, rodillas, tobillos y pies (50%), hombros (47%).

 

It is more common for this disease to start between 30-40 years, although it can occur at any age, it predominantly affects the female sex in an average of 1 man for every 3 affected women.

Generally this begins with tiredness, weakness, pain in the joints and slight inflammation in the same with "prolonged morning stiffness" (more than an hour).

As already mentioned, the origin of this disease remains unknown, although it is postulated as one of the most accepted theories that the origin could be infectious in a genetically predisposed individual, since the genetic load seems to be very clear in this disease.

Rheumatoid arthritis can affect other organs:

  •  Rheumatoid nodules (20-30%): they are palpable, firm, non-painful tumors that generally appear in pressure areas such as the elbow, Achilles tendon, occipital bone (back of the head).
  • Ocular manifestations (20%): dry eyes, watery eyes, conjunctivitis (red eye). In very advanced cases it can cause thinning with perforation of the eyeball.
  • Neurological manifestations: compression of peripheral nerves (most common carpal tunnel syndrome) with numbness and loss of sensation in the hand.
  • It can cause affections in the lungs, heart, liver, kidneys, although they are not as frequent and generally occur asymptomatic.

Rheumatoid arthritis, as we have mentioned, is an autoimmune disease that the main risk factor is hereditary, that is, we cannot do much about this, however there are environmental risk factors associated with this disease, which we can avoid, such as:

  • Tobacco (risk factor mostly associated with this disease, since it practically doubles the possibility of presenting it)
  • Alcohol
  • Caffeine
  • Use of oral contraceptives

These last 3 are still under study on their association with RA.

The objective of the treatment of rheumatoid arthritis is fundamentally based on the control of pain and joint inflammation, in order to avoid deformities and that the patient can have a better quality of life.

The basis of treatment will always be the pharmacological part, however, physiotherapy and rehabilitation are also of great importance since with this we maintain joint mobility and avoid muscle atrophy.

Within physiotherapy, different types of splints can be managed with which certain deformities can be avoided or we can improve them when they have already been presented.

Another very important area is the patient's diet, it is suggested in recent studies that the consumption of foods rich in polyunsaturated fats helps to reduce inflammatory activity.

  • Analgesics and NSAIDs: used in all patients and during many periods of the disease, their mission is to reduce inflammation and pain, however they do not alter the course of the disease. Caution should be taken with these medications since in prolonged use they can cause gastric irritation, exacerbations of rhinitis, asthma).
  • Corticosteroids: they are used in low doses and work as an anti-inflammatory drug, improving the symptoms of patients. Although due to its side effects they should be used with caution and always be supervised by a doctor.
  • Disease-modifying drugs: The role of these drugs is to slow or delay joint destruction. Treatment with these should start from the moment arthritis is diagnosed, since its early use has been shown to modify its progression. There are important side effects of this drug, the most important of which are: gastrointestinal discomfort, oral ulcers, blood disorders, liver disease and development of inflammation in the lungs.

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