Rheumatoid arthritis (RA) is the most common inflammatory joint disease. It begins with inflammation of the tissue (membrane) called "synovium" that lines the inner surface of the joints and can cause damage to cartilage, bones, tendons (beams) and ligaments. The progressive disease can affect internal organs as well as joints. It usually affects more than one joint and is long-lasting (chronic), but long silent periods between attacks may also occur. This disease, the cause of which is unknown, can vary greatly from person to person. It is generally a disease of young-middle-aged adults and is 3 times more common in women than in men.
How is it different from other joint diseases?
The most important feature that distinguishes rheumatoid arthritis from other joint rheumatism is some laboratory tests and which joints it affects. RA usually affects many joints of the wrist and hand, but the joints closest to the nails (except the thumb) are not affected much. On the contrary, in osteoarthritis (calcification) and inflammatory rheumatism that develops due to psoriasis, these joints close to the nail become diseased.
Elbow, shoulder, neck, jaw, hip, knee, ankle and foot joints can also be affected in RA. Involvement in other parts of the spine other than the neck is rare. Often, joints on both sides of the body become diseased together. So, if several joints in the right hand are swollen, there will most likely be swelling and limited movement in the left hand joints as well.
What is the cause of rheumatoid arthritis?
The immune system is impaired in RA. Our body perceives its own tissue as foreign and starts a war against it. Inflammatory cells collect in the joints and substances (enzymes, antibodies, cytokines) that damage the tissues are secreted from these cells.
Do genes play a role?
RA is not a genetic disease that is passed directly from parent to child. However, susceptibility to RA may be transmitted through genes. A specific genetic marker called HLA-DR4 has been shown to be present in many patients with RA.
Does infection start rheumatoid arthritis?
Many researchers and physicians think that infection may play a role in the onset of RA, but it has not been proven. It is not a job. RA is not an infectious disease. It is assumed that a microbe that is very common in the environment causes the disease by disrupting the immune system in people who are predisposed to RA.
What are the symptoms of RA?
RA can vary greatly from person to person. In almost all patients, joint symptoms fluctuate but continue chronically. In some people, the disease has a milder course; There are only occasional attacks. In some cases, it progresses more severely and causes progressive damage over time.
If you have RA disease, you will have increased temperature, swelling, tenderness, redness and pain in your affected joints. You may feel difficulty and stiffness in your joint movements, especially in the morning hours. We call this morning stiffness. A long duration indicates that your disease is active. You will find that you are generally better during the day. If your disease lasts for a long time, deformities may occur in your joints.
RA can cause general weakness, especially during attacks. Decreased appetite, weight loss, sometimes mild fever, decreased energy, and anemia may occur. Approximately 20% of patients may develop hardnesses called "nodules" under the skin in areas of the body that are exposed to pressure. Although it can often occur in the elbow, it can also be seen in other parts of the body, even internal organs.
How is RA diagnosed?
It is very important to diagnose RA at an early stage. Because starting treatment during this period keeps permanent joint damage to a minimum. To diagnose RA, a detailed history must be taken by the physician and a physical examination must be performed. Certain laboratory tests and x-ray examinations may be ordered. The positivity of the test called "rheumatoid factor" supports the diagnosis. High erythrocyte sedimentation rate and low hemoglobin (anemia) are among other laboratory findings. It should not be forgotten that these tests are only guidelines. The definitive diagnosis is made by evaluating the patient as a whole by the physician.
How is RA treated?
There is currently no definitive treatment for RA. The methods used are aimed at relieving pain, reducing or stopping inflammation and joint damage, and improving the patient's functions and quality of life.
Drug treatment in RA can be divided into two groups;
1. Short-acting drugs to relieve symptoms.
2. Long-acting drugs.
All of these drugs need to be monitored at regular intervals; It has side effects such as low blood cells and kidney and liver changes. Most of these effects are controlled by adjusting the type of medication and its doses. It is of great importance that the patient is aware of this issue.
Treatment is planned specifically for the patient; In this, the severity of the disease, accompanying health problems and individual characteristics and needs are prioritized. Rest is the most important part of treating RA patients. Resting of the relevant joints is recommended, especially during periods of acute inflammation. Except for the acute period, balanced exercises when the patient feels well are beneficial to the patient.
Some simple tools and equipment called "splints" can be used to protect the functions of the joints and prevent their deformities. Splints are very effective in preventing deformities. You can also help prevent deformities by following some rules:
a. Be careful to use your large joints rather than small joints when doing work. For example; When opening a door, push it with your arm, not your hand, or when opening a jar, open it with your hand, not your fingers.
b. Try to distribute the load across multiple joints rather than a single joint. For example; When lifting a book, hold it with both hands, not one.
c. Try to use your joints in their most "natural" position. Avoid excessive bending and straining. In some patients, surgery may be required to correct deformities, reduce pain, or make the joints usable.
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