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Rheumatoid arthritis - Myths and the Truths

Rheumatoid arthritis is age related....

Unlike osteoarthritis, RA is not due to aging. Its due to an overactive immune system which causes inflammation and subsequent damage in the joints. It typically affects younger individuals sometimes even teens in the form of juvenile rheumatoid arthritis. For unknown reasons, the disease is also more commonly seen in females.

RA is familial, can be transmitted to children..

Not true. It’s a possibility that some types of arthritis run in the family. We now know that even if you have genes that are associated with RA, you may not develop it. The genes are necessary, but not sufficient, to developing the disorder. Something else has to happen - some kind of environmental trigger, like a virus, for example - for someone to develop RA.

There is no cure for RA. I just have to accept my fate & be a cripple

Absolutely not, especially in today's era. We have brilliant therapies which work wonders. The new biologic agents have profoundly altered the personality of the illness. With patients seeking earlier treatment and better therapies we no longer see the kind of fulminant RA patients that we used to see before. With timely interventions, disease remission could be expected and irrepairable joint damage could be avoided.

The pain in RA is just like the OA pain. You just complain too much...cry baby..

RA is a life changing illness. It can be an extremely frustrating problem to deal with for patients who often go through terrible episodes of pain which doesn't seem to end unlike a viral illness, crippling joint stiffness and bouts of depression. A fulminant rheumatoid can be worse than cancer if appropriate timely treatment is not initiated. Fortunately, the percentage of severe reheumatoid illness is rare accounting for less than 10% of all RA patients.

Patients often benefit from strong support from family and friends. Its important to understand the problem and help these patients get treated at the earliest.

RA is just about joints...

No. RA is a systemic disorder. It can affect the internal organs, although that’s not as common as it was in the past. One of those tissues that can be inflamed is the eye, resulting in conditions such as scleritis. The inflammation in the joints can, for example, “spill over” to blood vessels (causing premature coronary artery disease or atherosclerosis), it can spread into the bones (causing osteoporosis), and it can even lead to an increased risk of lymphoma.

There are so many treatments for RA. But are they effective??

There are a lot of amazing medications for RA. The illness can be controlled, along with the spillover effect of the inflammation. Joint damage can be avoided and a joint replacement may not be required. Those who are diagnosed and treated early on can, in particular, do quite well. The efficacy of new medications is outstanding compared to the conventional drugs. Traditional anti-rheumatoid medications like antimalarial drugs and methotrexate can still be effective for many people with milder form of RA. Newer medications like the anti-TNF biologic medications are much better and more effective for a wide range of people.

If I develop RA, I am destined for surgery..

Absolutely not. Previously it was around 25% of people with RA who end up in joint replacement surgeries, which was still less than the incidence in OA patients. The incidence of joint replacement in RA is far less now, as low as 5%.

This is as a direct result of early diagnosis aggressive non-surgical treatment with these new medications and, not unimportantly, aiming at an outcome and achieving it.

It is vital to get your inflammation level down to, or close to, zero, and the patient and physician need to work together to make that happen in order to prevent or minimize joint damage. If, however, a joint is damaged to the point that you can’t stand the pain, the disability, or both, you may need to have surgery. But if it’s just inflammation, you may respond to one of these newer medicines, a local steroid, or other means of treatment. There is a lot we can do before you have to resort to surgery.

Physical therapy doesn't help.

Physical therapy has an important role in the treatment of RA. A well qualified physiotherapist can help you in maintaining joint motion, muscle strength, overcome stiffness and thus maintain overall functionality.

Newer therapies are dangerous..

Definitely not. The medicines that we’re now using are to control the immune process. They’re not a cure, because we don’t yet know the cause of RA. So we’re treating the underlying cause of the illness. Sometimes as we suppress the immune system we introduce some unwanted side effects, and there is no medicine that has no side effects. Risk benefit assessment is the key.

Truths about RA.

Rheumatoid arthritis is a systemic disease, and we have to hit it early on, on all fronts. It also tends to be a chronic illness. However, those with early signs of arthritis who start on medication right away are more likely to go off the medication within a year and will be able to stay off it. There may very well be a “window of opportunity” when it comes to aggressively treating RA early enough. For successful results, there need to be a close relationship between you, your doctor and the physical therapist. Autoimmunity means that a normal immune system, which is supposed to fight invaders to our system, is instead fighting our normal, healthy tissue, inflaming it as a result. We then have to reset that level of inflammation and immunity.

Inflammation can lead to joint problems and tendon damage. For this reason, RA should be considered a medical emergency. Collateral systemic damage from RA can occur in the form of premature atherosclerosis and osteoporosis. Luckily, we now have medications that work very well, and early, aggressive treatment can profoundly improve the outcome. Along with medical treatment, patients should ensure that their health is otherwise in control by quitting smoking and monitoring their lipid, cholesterol, blood pressure, and weight levels. For damaged joints in patients with RA, joint replacement surgeries offer a brilliant long term solution.

On this day attributed to Inflammatory arthritis worldwide, I can say the future looks brighter than ever before for people with RA. We may not have a cure, but have extremely effective medical and surgical treatments and more are coming which offer more than a ray of hope for these patients.

Sunil’s Orthoworld

AG - 63, River view colony III street
Anna Nagar
Chennai – 600040

Monday to Saturday 5 pm to 8 pm


Rela Hospital

7, CLC works road
Chennai – 600044

Monday to Saturday 10 am to 4 pm