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Rheumatoid arthritis is the most dangerous of all rheumatic diseases. It cannot be prevented, it cannot be cured. However, you can stop it and learn to live with it.
In Poland, almost 400 people suffer from rheumatoid arthritis (RA). people, and doctors are increasingly calling this disease a social problem. Unfortunately, many of us still do not understand what it is and how to recognize it. Pain in the hands, feet, morning stiffness in the joints can be attributed to the history of flu, contusions, muscle strain or joint overload. Meanwhile, doctors emphasize that the most important thing is the earliest diagnosis of RA and appropriate treatment. The course of the disease and the smooth life of the patient depend on it.
Time is of the essence
Rheumatoid arthritis is a chronic, immune-mediated connective tissue disease. What does this mean in practice? Well, the human immune system, instead of protecting the body, begins to produce substances that attack and destroy its own cells, recognizing them as foreign. In RA, the joints are the primary target of attack. Most often, it all starts with symmetrical pains in the same parts of the joints of the right and left hands, swelling of the small joints of the hands and feet, morning stiffness of the joints, which lasts longer and longer, and all this may be accompanied by weight loss, lack of appetite, low-grade fever, or ailments that generate depression. Symptoms may last for weeks, sometimes months, or may appear suddenly.
Rheumatologist, Dr. Janusz Jaworski, MD from the Institute of Rheumatology in Warsaw claims that “statistically, three years pass from the moment of developing RA to the moment of visiting a rheumatologist. Unfortunately, there are still patients who go to the right specialist in a bad condition, with an advanced inflammatory process caused by a disease that has not been treated for many years. That is why it is so important that each of us has at least a general understanding of RA. Thanks to it, we will be able to catch the symptoms of the disease earlier “- appeals the rheumatologist on the portal for people suffering from RA” Move the world “(www.poruszycswiat.pl).
Why me?
Millions of people around the world suffer from RA, and the disease can affect virtually anyone. Why is this happening? Doctors are not able to precisely answer this question so far. They suspect that genetic factors (RA has been observed in monozygotic twins with a frequency of up to 50%), environmental factors, such as high stress, physical exertion, viral infections and hormonal factors, e.g. endocrine disorders in women after childbirth or in menopause. It is known that the disease affects more women than men (3: 1), with the peak incidence in the fourth and fifth decades of life, although adolescents also suffer from RA.
– There is no good time for any disease – explains Dr. Małgorzata Bykowska, MD, a consultant in the field of rheumatology of the Pomeranian Voivodeship. – We’re not expecting her. It throws us out of our normal lifestyle, disrupts it, disturbs us. After all, it is difficult to admire the pain, swelling, and reduced efficiency. We get angry and often insult the doctor who makes the diagnosis. However, you can never give up, you have to fight. The patient should give himself a chance to stop the disease process. By running away from the disease, negating it, and not healing it, it reduces that chance. And it is worth knowing that as much as 80 percent. patients with RA responds very well to treatment, i.e. it achieves remission, inhibition of inflammation and disease progression, explains Dr. Bykowska.
It’s not worth the wait
We have been suffering from joint pain for weeks, but we blame it on age or fatigue and postpone the visit to a rheumatologist? Wrong. Let us remember that it is always better to know the truth and take appropriate action than to live in ignorance. The disease will not go away by itself. Instead, it will go into an advanced state where the changes in the joints are no longer reversible. During this time, the pain will increase and your daily activities will become a serious problem. Fastening buttons, tying shoes, washing yourself, lifting a cup of tea to your mouth, and finally moving around will become more and more difficult.
Doctors emphasize that in 2/3 of patients, treated incorrectly or untreated, RA leads to joint deformation and disability. In addition, rheumatoid arthritis also carries a high risk of dangerous organ complications. Changes in the lungs (e.g. pleurisy), cardiovascular system (e.g. leading to circulatory failure), kidneys (e.g. interstitial nephritis), eyes (e.g. dryness syndrome), or haematological disorders (e.g. anemia). Fortunately, a large part of these disorders can be prevented, and the disease itself can be slowed down and give yourself a chance to live an active life. However, nothing can be done without proper treatment.
Helpful research
Before the doctor makes an appropriate diagnosis and assesses the activity of the disease, we have a few additional examinations, tests and an honest conversation with the rheumatologist. Let us provide as many details as possible about the symptoms: let’s not be ashamed to admit the pain, let’s try to assess its intensity on the appropriate scale, and pay attention to how long the morning stiffness of the joints lasts. Let’s answer questions, even if they seem personal. Remember that each answer will help the doctor diagnose the condition of the disease.
“The easiest way to assess RA activity is to assess the number of sore and swollen joints and how long they have been stiff in the morning. The more painful, swollen joints, the longer the morning stiffness lasts, the greater the disease activity “- explains Dr. Ewa Patrzałek, MD, PhD on the portal” Move the world “and adds that doctors often also use the DAS28 index (then 28 joints are assessed ): “High disease activity is reported with a DAS28 greater than 5,1. With a DAS28 below 2,6, we are talking about disease remission. ” In addition, the doctor may also order additional tests, including blood tests (morphology, biochemical and immunological tests) with ESR, acute phase protein (CRP) and rheumatoid factor (RF) tests.
It may also be necessary to take a radiograph, computed tomography, ultrasound, magnetic resonance imaging, and scintigraphy, during which a small amount of a radioactive element is administered intravenously, which accumulates in places of inflammation. All this is intended to provide the best possible treatment and stop the disease.
Tame the disease
People with RA can lead a normal life – work, study, socialize, play sports: dancing, cycling, swimming, even hiking in the mountains. There are plenty of options, as long as you manage your pain, learn to think positively and live a little differently. How? Much depends on ourselves. It is the doctor who determines the treatment, the physiotherapist selects the appropriate exercises to help stimulate the joints, but we take medicines at home, exercise, eat properly and learn to tame the disease, getting to know, among others, factors that influence it.
Remember: RA may progress from remission to exacerbation. Therefore, we must do everything possible to eliminate potential threats. Any untreated upper respiratory tract infection, infection, joint overload, severe stress can make the ailments come back. Let us not underestimate them, ask doctors for advice, raise our comments and doubts, sign up for rehabilitation, and ask for a consultation with a dietitian. After all, we are fighting for our health.
Let’s also pay attention to everyday amenities. Jolanta Grygielska, the President of the Association of Rheumatics and Their Sympathizers, proposes to start with considering the elimination of minor difficulties. “Will the problem with opening jars and bottles not be solved if we install the opener permanently so that we can grasp the object with both hands? Wouldn’t a thicker potato peeler handle be more convenient than a thin one? Wouldn’t it be better to use pots with two handles, which are easier to hold in both hands, instead of saucepans with one handle? ” – he asks rhetorically on the pages of the “Move the world” portal, and then advises to pay attention to the handles of cabinets and refrigerators (mount wheels where possible), when choosing a new telephone set, put on the speakerphone, visit a rehabilitation equipment store and buy special cups, cutlery, bath benches.
– In order to achieve and maintain remission of the disease, cooperation between the patient and the doctor is necessary – emphasizes Dr. Małgorzata Bykowska, MD, and sensitizes patients not to neglect taking medications (some of them must be taken for the rest of their lives). Without them, it is impossible to control the disease: – It is known from various studies that the longer the disease lasts, the more often we forget about constant medication. Meanwhile, one must not get discouraged.
The drug is unequal to the drug
Pain is the worst symptom of the disease, according to RA sufferers. Continuous, appearing day and night. It is he who makes the sick people tired, sleepy, irritable, and discouraged from life. Pain does not let them rest, causes a lot of problems, sometimes excludes them from everyday life, causes complexes. Therefore, therapy begins not only with drugs that stop or reduce inflammation (so-called disease-modifying drugs, eg Sulfasalazine, Methotrexate), but also those that reduce pain (non-steroidal anti-inflammatory drugs – NSAIDs – eg Ketoprofen). If treatment is unsatisfactory, the doctor may initiate glucocorticosteroids (eg Encorton, Medrol). Their doses are always determined individually and reduced as the patient’s condition improves.
When the applied therapies do not bring the expected results, and the patient feels unwell all the time, biological drugs can be treated – however, they are very expensive and not everyone can prescribe them. This is one of the most modern methods that stops the development of RA, which has been used in Poland for over 10 years.
Biological drugs (they owe their name to the biological method of production) in most cases control the inflammatory process, prevent joint damage, enable the reduction of doses of other drugs, prolong the period of disease remission and, as a result, significantly improve the quality of life. The patient feels an improvement after a few days, so doctors often compare the therapy with biological drugs to extinguishing a fire in the joints.
“However, it must be remembered that there is a risk of reactivating it all the time, because the immune mechanisms that led to RA still exist in the body” – warns Dr. Janusz Jaworski, rheumatologist.
Biological drugs are effective, but they are not a panacea for everything. How the disease will proceed and at what stage it will stop depends largely on the rheumatoid arthritis patients themselves.
The text uses materials and statements made by some specialists from the portal “Move the world”.
Text: Anna Niewiadomska
Consultation: Maria Królewicz, MD, PhD
Source: Let’s live longer,
Read more in Why Poles don’t treat rheumatoid arthritis?