Pain, burning, swelling, joint stiffness are the most typical symptoms of rheumatoid arthritis. Let’s see how to treat it.
Rheumatoid arthritis, an autoimmune inflammatory disease, afflicts about half a million Italians.
Among these, many are still young (the peak of onset is between 35 and 50 years), with a strongly negative impact not only on the quality of individual and family life, but also on the socio-economic level.
The most frequent symptoms are:
- pain
- joint stiffness
- burning
- swelling.
However, known cases represent only the tip of the iceberg because, not infrequently, rheumatoid arthritis occurs without giving obvious signals.
But even when these are present and recognizable from the onset, they are still too often neglected or endured for a long time by those who suffer from them, who tend to consider them a trivial annoyance or a discomfort inevitably associated with aging.
Nothing could be more wrong: postponing diagnosis and therapy means not only suffering unnecessary and avoidable pain, but also precluding the possibility of dampening joint inflammation in the bud and preventing the permanent damage that inevitably follows.
The stages of the disease
It is not easy to recognize it immediately: rheumatoid arthritis can in fact appear acutely, with inflammation with well-defined characteristics affecting different joints (in particular, those of the hands, wrists, feet and knees).
But it can also start in a subtle way, with generalized and non-specific symptoms, such as not too high fever, malaise and fatigue, to which are added in short also pain, swelling and joint stiffness.
In both cases, the disease progressively evolves towards irreversible joint damage and, in the absence of treatment, can lead to significant disability within a few years.
It affects the joints…
The inflammation associated with the disease is not constant, but has a typical “pousses” trend, or characterized by the alternation of phases of spontaneous exacerbation and remission, substantially unpredictable and for now unexplained. Joint damage, on the other hand, is progressive and accumulates over time.
After a few years from the onset, the transient swelling linked to the inflammatory phases gives way to evident and permanent deformations: the fingers of the hands take on a characteristic shape, called “swan neck” and deviate externally “with a gust of wind”.
Cysts may appear on the wrists, which correspond to fluid-filled bulges of the synovial membrane lining the joints.
Even the ankles and feet undergo alterations (such as flat foot and “gust” deviation of the fingers) that can even prevent you from walking normally.
… and not only
In a minority of cases, extra-articular manifestations are also observed, affecting other organs or systems.
Here are some examples.
Localization | Disorders |
---|---|
Eyes | Less tearing, leading to the development of “dry eye” syndrome
Inflammation of the sclera (the white part of the eyeball) |
Skin lining the elbows and hands | Appearance of “rheumatoid nodules” (thickenings of variable size given by localized accumulation of inflammatory cells), the presence of which reports a particularly popular form of arthritis aggressive and with a poor prognosis |
Lungs | Appearance of “rheumatoid nodules”
Pulmonary fibrosis Respiratory failure |
Blood vessels supplying the ends of the fingers | Vasculitis
Formation of small ulcers, can promote the onset of pathologies cardiovascular and can increase the propensity to meet other diseases of various kinds |
With the exception of joint damage that may already be present, all manifestations of rheumatoid arthritis generally subside thanks to appropriate therapy.
Treatment of rheumatoid arthritis
Until the seriousness of the disease and the repercussions it could have on the body as a whole were clearly understood, rheumatoid arthritis therapy was based on a “pyramid” approach that reserved the use of the strongest drugs for the most advanced stages of the disease, in order to avoid patients the side effects associated with them.
It started, therefore, with non-steroidal anti-inflammatory drugs (NSAIDs) and cortisone, passing to principles with more marked and specific activity only later.
While continuing to prescribe NSAIDs to the majority of patients in the first instance, as recommended by all national and international treatment guidelines, today doctors adopt a different strategy.
Clinical experience has shown that to prevent too rapid evolution of the disease it is essential that specific therapy with drugs capable of counteracting joint damage is undertaken early.
From anti-inflammatories to Dmard
Then, as soon as the NSAIDs show signs of a reduction in activity and in the forms of arthritis very active from the beginning, we switch to Dmard (Disease modifying anti-rheumatic drugs), such as methotrexate, lefunomide, sulfasalazine. These drugs, so-called background, are able to act on the mechanisms underlying the disease by modifying its course over time.
Unfortunately, these drugs have several side effects especially in the liver. It must be said, however, that these are known reactions that can be managed with your doctor, within a personalized treatment plan.
Always in view of the possible adverse reactions, until a few years ago it was believed that only one active ingredient could be used at a time. In fact, it has been shown that in many cases it is more advantageous to administer different drugs in combination because the effectiveness increases, while the side effects remain substantially the same.
Biological drugs
When even Dmards are not able to offer adequate control of symptoms and disease progression, it is possible to switch to biological drugs, so called because they consist of proteins that interact selectively with elements of the immune system that support joint inflammation.
They are substances such as cytokines (in particular, Tnf or interleukin-1) or cells such as T lymphocytes. These are mostly monoclonal antibodies designed in the laboratory that, over the last decade, have represented a real turning point in the treatment of rheumatoid arthritis.
Compared to traditional background drugs, biological drugs are better tolerated, not causing nausea or malaise, but they can still have side effects of different types. In particular, they increase the risk of infections.
Administered alone, they have an efficacy comparable to Dmard, while combined with the latter they allow to significantly improve signs and symptoms of the disease and, above all, to curb the progression of joint damage.
Physiotherapy helps
Without prejudice to the key and irreplaceable role of drugs, in the treatment of rheumatoid arthritis the importance of learning to know and manage the disease in everyday life should also be emphasized. First, remembering that stiffness and pain should not discourage movement.
In the phases of remission, the joints must continue to be used as much as possible, without subjecting them to excessive strain. Supporting the immobility caused by the disease is counterproductive because it worsens joint stiffness and weakens the muscles that must support the movement, greatly reducing the possibility of being autonomous and leading a normal life.
To unlock the joints and learn alternative gestures, you can turn to experienced physiotherapists and plan functional rehabilitation plans.
Another important aspect of therapy concerns periodic check-ups by the rheumatologist, which should be carried out every 3-4 months. Clinical evidence shows that those who are constantly followed are able to obtain better results because they are more encouraged to adhere to the treatment which, moreover, can be calibrated and defined with greater precision.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.