What is Rheumatoid Arthritis?

Arthritis - often called 'wear and tear' arthritis - is the commonest cause of persistent joint pain in the India

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. These are debilitating condition and reduce the quality of life.

Rheumatoid arthritis is a chronic, inflammatory type of arthritis and is also classified as an autoimmune disease. In this condition the synovium (lining of the joint) is primarily affected progressing to multiple organs getting affected as well. Multiple joints are usually involved with rheumatoid arthritis.

The most common symptoms of RheumatoidArthritis are:

1)            Pain is common in the shoulder pain, ankle, and knee and hip .Joint pain is also referred to as arthralgia.

2)            Thereafter you can develop fever, joint swelling, redness, warmth, and stiffness and deformity.

There are four distinct stages of rheumatoid arthritis progression each with their own treatment courses:

Stage 1: This is early stage rheumatoidarthritis. This stage involves initial inflammation in the joint capsule and swelling of synovial tissue. This induces the clear symptoms of joint pain, swelling, and stiffness.

Stage 2: In the moderate stage of rheumatoid arthritis, the inflammation of synovial tissue becomes severe enough that it causes cartilage damage. In this stage, symptoms of loss of mobility and range of motion become more frequent.

Stage 3: Once the disease has progressed to stage three, it is considered severe rheumatoid arthritis. Inflammation in the synovium is now destroying not only the cartilage of the joint but the bone as well. Potential symptoms of this stage include increased pain and swelling and a further decrease in mobility and even muscle strength. Physical deformities on the joint may start to develop as well.

Stage 4: In the end stage of rheumatoid arthritis, the inflammatory process ceases and joints stop functioning altogether. Pain, swelling, stiffness and loss of mobility are still the primary symptoms in this stage.

Diagnosis of Rheumatoid Arthritis:

Some important laboratory tests which are commonly ordered to help diagnose rheumatoid arthritis include that can be advised by a rheumatologist for diagnosis of the disease:

1) Rheumatoid factor:

Rheumatoid factor is an immunoglobulin (antibody) which can bind to other antibodies. Typically, antibodies are normal proteins found in the blood which function within the immune system. High levels or titres of rheumatoid factor are typically associated with severe rheumatoid arthritis.

2) Erythrocyte sedimentation rate:

Nonspecific means that the ESR test does not identify the source of the problem or illness which is causing the inflammation. An elevated (abnormally high) ESR does suggest that there is an ongoing inflammatory process, but not how or why.

3) C-reactive protein:

The CRP (C - reactive protein) test is a blood test that measures the concentration of a special type of protein produced in the liver. The protein is present during episodes of acute inflammation or infection. .An elevated CRP test result is an indication of acute inflammation like inflammatory rheumatic diseases, such as rheumatoid arthritis and lupus.

4) Anti-CCP test:

The anti-CCP test helps to distinguish rheumatoid arthritis from other inflammatory types of arthritis. It is also extremely valuable in diagnosing people who are seronegative for rheumatoid factor.

Other tests could be an X-ray of the knee and MRI to get an idea of the knee joint and deformity.

Treatment of Rheumatoid Arthritis:

1)            Conservative Lines (Stage 1 and 2)

The primary treatment for rheumatoid arthritis is medication. There are five categories of medication commonly used to treat rheumatoid arthritis, including:

•             DMARDs (disease-modifying anti-rheumatic drugs), such as methotrexate

•             Corticosteroids, such as prednisone and hydrocortisone

•             NSAIDs, such as Celebrex (celecoxib) and naproxen

2) Analgesics (painkillers): Along with medication, some forms of alternative and complementary treatment or local steroid injections may help relieve pain for rheumatoid arthritis.

3) Surgery (Stage 4 advancement of the disease)

In advanced disease, total knee arthroplasty has proven to be the most successful intervention that reduces knee pain and improves physical function in rheumatoid arthritis patients. Patients with medically unfit conditions including acute or chronic infections should not opt for knee replacement.

1) The indications for a knee replacement in patients with rheumatoid arthritis are not very different than the indications for a knee replacement in patients with osteoarthritis.  The main indication for a knee replacement is pain.

2) There needs to be a very clear understanding of the degree of discomfort that you are having, the treatment alternatives that you have already tried, and most importantly, the affect that the pain and deformity is having on your quality of life. 

If a patient with rheumatoid arthritis has severe, incapacitating knee pain that significantly interferes with their quality of life then they are most likely an appropriate candidate to consider a total knee replacement.

 At Wockhardt Hospital our Bone and joint speciality have   renowned orthopaedic surgeons for total knee replacement surgery in India, who have vast experience in achieving successful outcomes of the procedure. The hospital is fully equipped with state of the art operation theatre units and provides quality post-operative care knee replacement surgery.

Please visit Wockhardt Hospital for more information on treatment modalities for arthritis.