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.
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