Rheumatoid arthritis is an autoimmune disease characterized by chronic erosive arthritis that can affect joints throughout the body. The disease affects the small joints of the hands, wrists, and feet. In the early stages, the joints may become red, swollen, and painful with “morning stiffness,” which may resolve on its own with appropriate activity. If not treated, when the disease progresses to an advanced stage, the bones and cartilage tissues will gradually suffer damage, and the joints may become stiff and deformed to varying degrees, making it very easy to become disabled. In addition, rheumatoid arthritis can affect other organs and tissues such as the lungs and eyes.
Therefore, rheumatoid arthritis should not be ignored, but the early symptoms are not obvious, which often causes patients to ignore it. When there is joint pain, redness, swelling, stiffness or fatigue, or low fever, do not take it lightly. It is recommended to visit the rheumatology department to determine if you have rheumatoid arthritis. Early treatment can shorten the course of rheumatoid disease and even delay bone destruction.
The onset of the disease is related to genetics
The cause of rheumatoid arthritis is still not known and therefore cannot be prevented. It is not a gene-specific inherited disease, and the prevalence in the immediate family of people with rheumatoid arthritis is three to five times higher than in the general population. In addition, environmental factors can trigger the disease. Patients are predominantly female, with a prevalence about three times higher than that of men. The peak age of onset is between 35 and 45 years.
The diagnosis is currently based on these points: first, abnormalities in the joints; second, inflammation of the joints, with clinical symptoms such as redness and swelling of the joints, and some inflammation indices in the blood test results; third, testing for rheumatoid factor; plus imaging tests including X-rays or magnetic resonance imaging. These methods can be added together to make a judgment in the early stage of the disease.
Don’t ignore sudden joint swelling and pain or early signs of rheumatoid arthritis
Rheumatoid arthritis can present with varying degrees of symptoms in the body. Patients’ joints are mainly symmetrical and polyarthritic. More than 70% of patients have an initial onset in the joints of the hands, with the fingers and wrists being particularly susceptible. The inflammation can spread all the way from the hands to the cervical spine and even to the vocal cords. Some patients also have an initial onset of wandering arthritis, which is a localized joint swelling and pain that moves to another joint over time. Repeated episodes of joint swelling and pain continue to migrate. In other cases, patients may develop fulminant arthritis, in which swelling and pain occur in more than 20 joints throughout the body, causing unbearable suffering.
In addition to joint pain, another common symptom of rheumatoid arthritis is “morning stiffness”. Morning stiffness refers to the stiffness of the joints when the patient wakes up every morning. After a little movement, blood circulation is improved, joint edema is reduced, and the resulting stiffness is relieved.
In addition, if the patient’s inflammatory condition is severe, he or she may have a low fever and fatigue. Due to the high inflammatory index of the body, it is easy to cause poor appetite and absorption capacity, which in turn causes wasting. It is worth mentioning that the effects of rheumatoid arthritis are not only limited to the joints, but also affect other organs of the body. For example, iritis, scleritis, pulmonary fibrosis, pericardial inflammation, heart valve reflux, etc. can occur. Thanks to drug innovations, these complications have decreased in the last decade, but the effects on the eyes are still relatively common.
Two years after diagnosis is a critical period for treatment. Hybrid therapies are effective in improving the disease.
The earlier rheumatoid arthritis is treated, the better. All inflammation should be managed as early as possible because the inflammatory process is like a snowball that, if left unattended, can progress geometrically rather than as simply as 1+1=2. Therefore, the ideal mode of treatment is early control to slow down the progression of the disease. Numerous studies have shown that the earlier some of the more aggressive approaches to rheumatoid arthritis are used, the better the prognosis for the patient’s overall condition, something rheumatologists need to do. If rheumatoid arthritis is left untreated for two years from the time it is diagnosed, 90% of patients will have erosion of their joints. This is why the first two years of disease onset are a more important period for treatment.
Drugs for rheumatoid arthritis can be divided into two types: “symptomatic” and “curative”. The drugs for treating the symptoms include non-steroidal anti-inflammatory drugs, painkillers to suppress central pain, and steroids. There is some international controversy over the use of steroids, and the question is whether they can help to ‘treat the root cause’ or not. Many anti-inflammatory painkillers are now strong enough to “treat the symptoms”. As for the ‘cure’, steroids themselves have certain side effects, so they are not the best choice.
However, it is not a cure-all, and when some patients are poorly and cannot afford new drugs, steroids are still needed to control the condition. There are many types of drugs that can be used to “treat the root cause”, including oral medications and injections. Often, we use a cocktail of two or three different oral medications, such as methotrexate, along with augmentation drugs such as lorazepam, or cinchona cream, to control the entire disease.
A more aggressive approach is to combine methotrexate with a new drug called a “biologic”.
Biologics have been shown to provide good control of the disease and have been shown to be safe for long-term use.
In the past, rheumatoid arthritis was known as the “undead cancer” and patients had to watch their disease deteriorate. This is no longer the case. The majority of patients can manage their disease well if they take an aggressive approach as soon as possible after the onset of the disease. The disease will be better controlled if a new generation of drugs, biologics, is used.
Biologics can be categorized as a new generation of rheumatologic drugs to improve the condition, which are immune antibodies developed by using biotechnology to target and inhibit inflammatory tumor necrosis factor or overactive immune cells in the body, reduce inflammation, ease pain, and improve the condition to reduce the degree of joint destruction.
Patients are usually put on the biologics for a year or a year and a half, and the results are monitored. Some patients who use biologics within one to two years of the onset of the disease due to financial problems still do relatively well after two years compared to patients who have not used biologics. This proves that biologics can indeed control rheumatoid arthritis well. In addition to efficacy, the safety of biologics is also a concern.
Biologics have been in use since 1998, and some scholars had done a study in 2008 to investigate whether patients who had used biologics would have some health problems. But looking back at this decade, the patients who have used biologics and those who have not used biologics are actually the same, and there is no increased risk of tumors or serious infections, so biologics are relatively safe.
As early as 2011, it was reported that the risk of tumor in patients who used biologics was relatively lower, why? The first reason is that the use of biologics can make the disease well controlled. If rheumatoid arthritis is not well controlled, lymphoma is the most likely to appear, but if it is well controlled, the chance of developing lymphoma is much lower. In addition, patients who do not use biologics may have an increased chance of developing tumors because of the use of different drugs that suppress the immune system.
Currently, the problem that biologics have to face is hepatitis B. Some scholars point out that the use of biologics can aggravate hepatitis B. Therefore, under the premise of patient safety, patients with hepatitis B should use biologics in combination with some liver protection drugs and actively treat hepatitis B at the same time. In addition, patients with combined tuberculosis should first deal with tuberculosis before using biologics.
Life care is also part of the treatment Tai Chi in water can help relieve the disease
Developing good lifestyle habits will give a boost to the treatment, while on the contrary, poor lifestyle habits can lead to aggravation of the disease. We all know that smoking is bad for health, and smoking can have a particular effect on rheumatoid arthritis. Since rheumatoid arthritis itself has a chance to affect the lungs, smoking can make the lung condition worse and make treatment difficult.
In addition, patients should reduce alcohol and coffee on a daily basis. Alcohol can collide with medications and affect their effectiveness, while coffee can have an effect on bone mass, which is detrimental to disease control. Also, high purine food should not eat more. Clinical observation we found that patients with rheumatoid arthritis, even if the uric acid is not high, but the joints will be painful after eating high purine food, the reason is not known for the time being.
In addition to self-discipline in diet and regular work and rest, proper exercise is also very important. Patients are advised to swim and do Tai Chi properly, preferably in water. Tai Chi in water can ensure that the patient will not be injured, and at the same time can increase the amount of exercise, which is ideal for patients with rheumatoid arthritis and ankylosing spondylitis. Therefore, it is recommended that patients can try to use hydrotherapy to soothe their condition.
Tui na, massage and acupuncture, the specialties of traditional Chinese medicine, are also favored by many patients. However, it is important to choose a regular Chinese medicine practitioner before proceeding with physical therapy, and not to be deceived by some quacks on the street. Some doctors who have not received formal professional training will add painkillers to the needles of acupuncture, so they can naturally relieve pain after acupuncture, but this is not the right way to deal with it. This is not the right way to handle the pain. Some may even stab the patient’s joints, causing irreversible damage. Doctors should always seek qualified people, and not seek medical advice in a hurry.