Rheumatoid arthritis (RA) is a chronic inflammatory condition that affects the joints of the body, as well as the lungs, heart, eyes, and other parts. The prevalence of rheumatoid arthritis is more in women compared to men. The onset is most common in the fourth and fifth decades of life. Hereditary factors play a role in producing and perpetuating this disease. Thus, one generation after another in a family can suffer. There is immunologically mediated damage to joints, causing intermittent or persistent pain and stiffness. It is mostly the small joints of the body, particularly the hands and feet which are affected. In the morning, one feels stiffness in the joints and finds it difficult to do even small tasks like writing or holding a glass. Gradually there may develop contracture of the affected joints thus crippling one. It also damages multiple body parts. Nodules may develop in the skin. Inflammation of small blood vessels can cause small bleeding spots on the skin. Lungs can be affected, causing chronic cough, breathlessness, and chest pain. Fluid can accumulate in the covering of the lungs, causing severe breathlessness and chest pain. Such a damaged lung becomes susceptible to infections also. Similarly, inflammation and effusion can occur in the pericardium, leading to pericardial effusion (fluid in the sac covering the heart), causing breathlessness and swelling throughout the body in advanced cases. Patients may also experience angina and cardiac failure. Inflammation of various parts of the eyes may result in pain, redness, and diminished vision. The sound box can be damaged in rheumatoid arthritis due to involvement of the cartilage within, and as a result, the affected person may develop chronic hoarseness of the voice or aphonia i.e. difficulty in speaking. The spinal cord can also be affected by rheumatoid arthritis, causing paraesthesia and paralysis of the limbs in various degrees. Women who suffer from rheumatoid arthritis also suffer from chronic anaemia. The disease is diagnosed easily by the typical joint involvement and deformity. It is confirmed through serological tests, relevant X-rays, and biopsy of affected parts. However, in case of systemic involvement, it requires a high degree of suspicion to detect a lung or heart abnormality caused by rheumatoid arthritis. Unfortunately, there is no root medical cure for rheumatoid arthritis. This is the reason why many patients go to traditional healers and other types of therapy like homeopathy, acupressure, etc. in the hope of a cure. But these only provide a transient relief and the disease relapses again after some time. Anti-inflammatory drugs provide temporary respite but over a long time cause peptic ulcer, kidney failure, and other complications. Surgery may be done for joint deformities. However, the patient has to be healthy otherwise to undergo such major surgery. Exercise of the affected joint is very beneficial to maintain the flexibility of the joints. However, exercise should be undertaken only when there is no acute pain; otherwise, pain and inflammation are aggravated. Activities like working on computers for a long duration or writing or knitting continuously are likely to aggravate the pain. Therefore, while doing any of these chores, one should take a short pause in between to avoid pain and cramps in joints. Exposure to the cold tends to aggravate joint pain and hence should be avoided. Hot compression done before sleeping at night over the painful joints helps greatly to reduce the morning stiffness. Osteoporosis is yet another condition prevalent in middle-aged women which tends to aggravate the pain of rheumatoid arthritis. Therefore, calcium supplements should be taken regularly to prevent and cure osteoporosis. Lastly, the most important factor is to eat a balanced diet rich in iron and calcium. Milk, green vegetables, fish, and fresh fruits are useful in this regard. Soft beverages and alcoholic drinks should be avoided along with smoking and other intoxicants. Once somebody develops rheumatoid arthritis, they should learn to live with it. The aim should be to adopt a lifestyle that would allow maximum quality of life with the disease. Dr Rachna Pande is a specialist in internal medicine.
