What is rheumatoid arthritis? What are the symptoms and treatment of rheumatoid arthritis?

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What is rheumatoid arthritis? What are the symptoms and treatment of rheumatoid arthritis?

Rheumatoid arthritis is the most common form of rheumatoid arthritis and causes inflammation of the lining (synovium) inside the joints and/or other internal organs. The joint line thickens and can lead to increased warmth, swelling and pain in the joint. Rheumatoid arthritis  is a chronic disease that lasts for years. It affects many different joints in the body. It damages cartilage, bone and joint structures.

The cause of rheumatoid arthritis  is not yet known and the disease differs from person to person. It can affect anyone, including children and the elderly. However, the disease usually begins in the young and middle age period. Among patients with rheumatoid arthritis  , the female to male ratio is 3/1. 2/3 of the patients are women. The disease can be seen in all races and in all parts of the world.

What causes rheumatoid arthritis?

When the immune system, that is, the defense system, works properly, the body defense fights against bacteria, viruses and other foreign cells. In rheumatoid arthritis,  the immune system does not work properly and the body attacks its own joints and other organs. In rheumatoid arthritis, inflammatory cells (white blood cells, or white blood cells) move from the blood to the joint tissues and attack the joints. Joint fluid increases and swelling occurs in the joint. Inflammatory cells in the joint tissue affect the joint and cause damage.

Can infections cause rheumatoid arthritis?

Many scientists and doctors believe that rheumatoid arthritis  is triggered by infection. But for now there is no proof of this. Rheumatoid arthritis  is not contagious. A previous infection can lead to the onset of RA.

Role of Genes:

Rheumatoid arthritis  is not passed from mother or father to children. Instead  , genes that predispose to developing rheumatoid arthritis can be passed on to children. A predisposition to RA disease develops in children.

How does rheumatoid arthritis differ from other types of rheumatism?

An important way to distinguish rheumatoid arthritis  from other forms of arthritis is the feature of joint involvement. For example, Rheumatoid arthritis  affects the wrist and many small joints of the hands. It usually does not affect the joints close to the nails. On the contrary, osteoarthritis, in other words, calcification, mostly involves the joints of the hand close to the nail. Other joints most commonly involved in rheumatoid arthritis  are elbows, shoulders, neck, jaw, hips, knees, ankles, and toes.  Spinal joints are not usually involved in rheumatoid arthritis . Sometimes neck vertebrae are involved, causing neck and neck pain.

In a person with rheumatoid arthritis , the joints are usually symmetrical, meaning that both sides tend to be involved (like both knees or both wrists). So if the knuckles of the right hand are swollen, often the knuckles of the left hand will also swell. The location of swollen joints and some blood tests play a key role in differentiating RA from other rheumatic diseases.

Diagnosis and tests for rheumatoid arthritis

 To diagnose rheumatoid arthritis , your doctor will listen to your history and perform an examination. The doctor will look for swelling in your joints, increased warmth, limited range of motion, and other signs of rheumatoid arthritis (such as a rheumatoid nodule). In addition, your doctor will ask you if you have signs of RA such as weakness, fatigue, morning stiffness (limited movement, feeling of stiffness when you wake up in the morning). The characteristics of the involved joints are fundamental in differentiating RA from other rheumatic diseases.

Your doctor will also order certain blood tests and X-rays. A positive (+) (positive) test called rheumatoid factor (RF) supports RA. RF is a rheumatism test. However, a positive (+) RF test in a patient who does not have joint complaints does not mean that that person also has RA, so RF test alone does not diagnose rheumatism. The frequently used ASO test is never a rheumatism test, and the ASO test is definitely not checked and used in rheumatic diseases, especially in RA. ASO is only an indicator of a previous microbial throat infection and is only a helpful test in diagnosing acute rheumatoid arthritis. In rheumatology outpatient clinics, the ASO test is used only in the suspicion of acute joint rheumatism.

Sedimentation (ESR) and CRP tests are also examined in terms of observing the severity of your disease, exacerbation and monitoring the disease. These tests are elevated in the presence of inflammation in the body. They are very useful tests in the follow-up of the disease-related inflammation and very useful in the regulation of treatment.

Anemia, impaired kidney and liver functions may develop in patients with rheumatoid arthritis  due to long-term chronic disease and continuous use of painkillers. Your doctor will follow these blood tests at regular intervals and take necessary actions when necessary. In this regard, you; Go to your regular check-ups on the dates your doctor recommends, use the medications your doctor gives you without interruption, consult your doctor without delay when you have a complaint.

There is no test that diagnoses RA or makes a definitive diagnosis. X-rays are completely normal in the early stages of rheumatoid arthritis . As the disease progresses, joint damage begins to be seen on X-rays. These damages seen on joint x-ray films are very helpful in making the definitive diagnosis and confirming the diagnosis.

What are the symptoms of rheumatoid arthritis? 

Symptoms of rheumatoid arthritis vary from person to person. Joint inflammation is usually permanent in every person with RA. In some people, the disease may progress with bouts of exacerbation, with a moderate and slower course. But usually the disease is constantly active if left untreated. If not treated successfully, the disease progresses day by day and may cause permanent disability.

If you have rheumatoid arthritis , you will experience warmth, swelling, tenderness, pain and limitation of movement in your joints, that is, joint inflammation. These joint inflammation (arthritis) symptoms are caused by inflammation of the joint membranes (synovium). Inflammatory cells that enter the joint membrane of the immune system maintain inflammation and cause tissue damage. If this inflammation persists or is not treated, it causes permanent damage to cartilage, bone, tendon and joint ligaments. This often causes injury to the joint.

Rheumatoid arthritis  flare-ups can make you feel sick and unwell. It can cause loss of appetite, weakness, fatigue, weight loss and fever. Anemia (anemia) may develop. In about 1/5 of patients with rheumatoid arthritis  , small, painless bumps called rheumatoid nodules may form under the skin. These often occur in the elbows, knees, areas of flat bone that are more exposed to pressure. They mostly occur around the elbow, but can be found anywhere else in the body and even in internal organs.

Sometimes patients with rheumatoid arthritis  may develop inflammation in the lungs and heart. Dry eyes and dry mouth may also occur due to inflammation of the tear and salivary glands.

Rarely, inflammation of the vessel wall (rheumatoid vasculitis), which causes inflammation in the skin, nerves and other organs, may develop.

Treatment of rheumatoid arthritis

There is no complete cure for rheumatoid arthritis as of now  . With current treatments, it is possible to stop the progression of the disease. Current treatment methods are aimed at relieving pain, reducing inflammation, preventing or slowing joint damage, and maintaining patient well-being. Modern treatments have improved the quality of life of patients with rheumatoid arthritis . Your treatment program; It is tailored to your needs, your individual lifestyle, your other medical problems, and the severity and severity of your illness.

In the treatment of rheumatoid arthritis , ROMATOLOG is the leader of the healthcare team. Rheumatologists are specialist physicians specially trained in muscle, bone and joint diseases. The rheumatologist acts as the person responsible for the medical treatment of RA. Other healthcare professionals, such as the PTR physician, physiotherapist, nurse, psychiatrist, orthopedic physician, and social worker, play important roles in helping to beat the disease.

The drugs used in the treatment of rheumatoid arthritis are divided into two: drugs that help relieve your complaints (symptoms) and drugs that stop the damage done by the disease and help maintain (modify) this condition. Your doctor may suggest that you use two or more medications at the same time. Each of these in the treatment of rheumatoid arthritisare drugs that serve specific purposes. Some of these drugs require careful monitoring during treatment. All drugs have side effects, but RA is a disease that must be treated. Therefore, the patient should be informed as much as possible about the treatment options and the risks of the treatment against the wounds. Ask your doctor, nurse or pharmacist any questions you might have about treatment. Tell your doctor if you suspect a treatment-related side effect or if you think the treatment is not working well. Despite all the treatment, you should not forget that you may have minor complaints from time to time, even if everything is going well.

rheumatoid arthritis medications

The following medicines relieve symptoms (complaints) of rheumatoid arthritis .

NSAIDs (non-cortisone pain relievers and anti-inflammatory drugs) and aspirin:

NSAIDs (such as voltaren, cataflam, apranax, naprosyn, majezik, endol…) and aspirin are used to treat inflammation and pain. NSAIDs alone are never enough to treat RA. Patients with RA must also take drugs that suppress disease activity. NSAIDs and aspirin can cause side effects such as stomach bleeding. These drugs should be used with or after meals. In addition, your doctor will prescribe additional drugs (such as stomach protectors – Lansor, Omeprol, Protonex, Nexium) to prevent these side effects. Aspirin is used by some doctors to treat RA. To be effective, it must be used in much higher doses than the normal dose. Aspirin causes stomach problems and stomach bleeding more than other drugs, and it needs to be used in high doses, so aspirin is not preferred in the treatment of RA. Many rheumatologists today do not use aspirin as a pain reliever or anti-inflammatory.

NSAIDs are also used as adjunctive therapy to cortisone therapy, as they help the pain reliever and anti-inflammatory effect of cortisone and help minimize or even cut the cortisone dose.

Analgesics (Simple pain relievers):

In addition to aspirin or NSAIDs, simple pain relievers (analgesics) may be helpful to relieve pain. These drugs include paracetamol (vermidone, parol, tamol, etc.), and metamizole (novalgin, adepirone). Paracetamol and metamizole can be used with or without food. It has no side effects on the stomach. Side effects on kidneys and liver are very rare. In this respect, they can be easily used as an auxiliary pain reliever for cortisone and NSAIDs.

Narcotic painkillers are not recommended for the treatment of rheumatic diseases because of their side effects, addiction and non-inflammatory properties. In some special cases, they can be used under the supervision of a physician.

Glucocorticoids (Cortisone):

Glucocorticoids (cortisone, prednisone) (prednol, deltacortril, ultralan, flantadine) are very effective in reducing and relieving RA-related complaints. They have a fast and strong painkiller, anti-inflammatory effect. However, they have serious side effects in long-term and high-dose use. These drugs are related to the hormone cortisol. Cortisol is a hormone found naturally in the body and has very important functions that control important bodily functions such as blood pressure and heart rate. Life without cortisol is not possible. If you take high doses of cortisone for a long time, side effects begin. Easy to use high-dose cortisone for a long time, bruises, bruises, cracks, acne, accumulation of fat in the neck, shoulders and abdomen, early atherosclerosis, early development of coronary artery disease, tendency to diabetes, osteoporosis, It can lead to muscle wasting, bone necrosis, early cataract development, increased eye pressure (glaucoma), weight gain, lunar face (round face), susceptibility to infections and psychiatric problems. Rarely, severe bone damage may develop after a short period of treatment with high-dose cortisone. In general, high-dose cortisone is not necessary in the treatment of RA. Sometimes, high-dose cortisone can be used in cases of severe organ involvement or inflammation of the vessel wall (rheumatoid vasculitis). Low-dose cortisone can be used with NSAIDs to control joint inflammation. Especially in the initial stages of the disease, cortisone can be used in the 1-3 months period until the effects of the drugs that suppress the activity of the disease appear. In some patients, it may be necessary to use cortisone continuously in order to suppress the symptoms related to the disease. In these cases, it is necessary to keep the side effects of cortisone under constant control and to give preventive treatments if necessary.

Many of the benefits and side effects of cortisone are dose dependent. The aim is to find the lowest and most effective cortisone dose, avoiding side effects as much as possible. The use of low-dose cortisone minimizes the risk of cortisone-related side effects. At the same time, its use as a single daily dose is also very effective in reducing the side effects of cortisone. Since patients with RA receive long-term treatment, cortisone treatment should not be considered as the main drug of treatment. If you use cortisone regularly, you need to take calcium and vitamin D. In addition, you should increase your daily consumption of milk and dairy products (at least 1 glass of milk or 1 bowl of yogurt or 1 matchbox size cheese per day). If you regularly consume milk and dairy products, you may not use calcium and vitamin D supplements.

If you use Prednol over 16 mg per day or Deltacortril over 20 mg per day, you should reduce the salt you take with meals. In high doses, cortisone can cause water and salt retention in the body, causing your blood pressure to rise.

Contrary to popular belief, cortisone does not cause weight gain, but increases appetite. You may experience weight gain due to this. You should keep your appetite under control while you use cortisone.

Long-term use of cortisone has the effect of reducing or stopping the body’s cortisol production. It is extremely dangerous for a patient using cortisone to significantly reduce or cut cortisone without the knowledge of his doctor, because the body cannot immediately start producing the necessary and sufficient cortisol for itself.

Cortisone dose should be increased as the cortisone requirement of the body will increase during high stress periods such as surgical intervention or traffic accident. In addition, you should tell every doctor you consult for any reason that you are using cortisone.

Ampoule forms of cortisone drugs (prednol vial, kenakort, etc.) can be administered as an injection into one or more joints. Such treatments can provide rapid recovery. It can relieve joints that are constantly sore and swollen or that often flare up. Since the effect is in a specific area (local), injection into the joint temporarily controls inflammation and prevents unwanted side effects caused by daily cortisone pills. If injections are given more than a few times a year, it can cause harmful side effects in the joints. Joint injections should not be repeated in less than 3 months.

Disease Modifying Drugs (Drugs that prevent disease progression and exacerbation)

GOLD TREATMENT:

Gold, in the form of injectable gold salts, has been used to treat RA for more than 60 years. Gold injections are made into the buttocks or arm muscles. Pill forms (Ridoura) have been used for the past 15 years. In recent years, gold treatment is not preferred by many rheumatologists due to newly developed treatments.

METHOTREXATE:

Since the mid-1980s, methotrexate (MTX, Emthexate, Trexan) has been a commonly used and effective drug. Metrotrexate is used once a week. There are tablet or needle (injectable) (Metoject) varieties. Methotrexate should never be used every day. It can cause very serious side effects if used every day. Methotrexate is a drug used in high doses in various cancer diseases, but it is used at lower doses and once a week in RA.

The tablet dose of the drug should be taken once a week, in the morning, on an empty stomach, 30 minutes before a meal and with water. Generally, it is started as 3 or 4 tablets and the dose can be increased up to 10 tablets. This decision rests entirely with your doctor. For various reasons, especially in cases such as nausea and vomiting, you can divide the dose you take in the same day into two and use it in the morning and evening.

Usually, when 8 or 10 tablet doses are needed once a week, or if you have a lot of complaints such as nausea and vomiting when you take the drug by mouth, your doctor may arrange your treatment in the form of needle therapy. In needle treatment, it does not matter if you are hungry, but you still need to apply only once a week.

It is thought that MTX can be used safely in those who do not have other important health problems. Very careful investigations are required before doctors begin MTX as a treatment for those with liver, kidney disease, lung problems, bone marrow failure, or heart failure. Those who take MTX should not drink alcohol. Your doctor will check your liver function and blood counts frequently (once a month or every 3 months) to see if there are any abnormalities in liver or bone marrow function while you are taking the medicine.

Lung inflammation may rarely develop while using methotrexate. If you have a dry cough while taking the medicine, tell your doctor right away. Stomach upset, mouth tenderness, headache, dizziness or diarrhea are other possible side effects.

Warning:

MTX can cause problems at birth. Both men and women should stop taking MTX 90 days before a planned pregnancy (at least 3 months before becoming pregnant). This is true for men and women. If a partner is using MTX, the drug should be discontinued before pregnancy. MTX should not be used in pregnant and lactating women, and in patients with severe kidney or liver disease, who drink alcohol, or who have AIDS. Tell your doctor right away about your pregnancy status while taking MTX. You and your healthcare team will determine the best treatment for you.

Hydrocychloroquine and chloroquine (malaria drugs):

Antimalarial drugs produced for the treatment of malaria (malaria) have been used for the treatment of RA for years. An example of this type of treatment is hydrocychloroquine (Quensyl, Plaquenil). Hydroxychloroquine is an effective drug for relieving pain, swelling, stiffness and pain in the joints. It is taken orally as a tablet once or twice a day on a full stomach. Serious side effects are not common. Patients taking hydroxychloroquine should have an eye examination with a visual field test once a year, and patients taking chloroquine once every 6 months. Side effects on the eye are rare and reversible if detected early and do not cause permanent damage.

Sulfasalazine (Salazopyrin En Tab):

Sulfasalazine (Salazopyrin) is a drug consisting of an antibiotic and an anti-inflammatory drug. It is also used in inflammatory bowel diseases. Side effects include rash, stomach upset, headache, decrease in white blood cells and platelets, and liver side effects. If pregnancy is considered, it should be discontinued 3 months before pregnancy. If a man uses it or a woman uses it, both should stop the drug before pregnancy.

Leflunamide (Arava):

 It is a new drug used as a disease modifier in the treatment of rheumatoid arthritis . Certain blood tests are needed to monitor drug effects, including blood counts and liver function tests, while you are taking leflunamide (Arava). Side effects are skin rashes, gastrointestinal complaints, liver enzyme disorders and reversible hair loss. Those with active infections should not use this medicine.

Women who are pregnant or breastfeeding should not use leflunamide. Women who may become pregnant should practice contraception well while using leflunamide, i.e. avoid getting pregnant while using leflunamide. If the woman wants to become pregnant, she should stop taking leflunamide and use other drugs (resin) that will facilitate the excretion of leflunamide from her body. Men who want to have children have to apply the same procedure.

Biological drugs:

A new group of drugs, called biologic drugs, was discovered in the late 1998 for the treatment of rheumatoid arthritis .

Etanerecpt (Enbrel), infliximab (Remicade), adalimumab (Humira) target special chemicals that play a role in the formation of RA without affecting the entire immune (defense) system like other drugs do. These biologics block a chemical called TNF, which plays an important role in inflammation and tissue damage.

Etanercept (Enbrel) is injected subcutaneously by the patient or patient’s relative twice a week. Its application at home is an important advantage of not having to be hospitalized during the application. According to some, the effect of the treatment occurs within a few weeks. In the vast majority, the effect occurs within 3 months. A rash, itching or redness may develop at the injection site. But this usually improves over time. Inform your doctor if you develop injection side effects while using etanercept.

If you get a febrile infection while using Enbrel, stop the medication and consult your doctor. Take a break from the medication until your doctor starts again.

The first two doses of infliximab (Remicade) are given every 15 days, the third dose one month later, and the following doses every two months as intravenous serum (infusion). MTX therapy is also given with this drug. Consult your doctor in case of unexpected side effects.

If you have a febrile illness during the period of taking the medicine, you should consult your doctor.

Adalimumab (Humira) is injected under the skin once every 15 days. It has ease and comfort of application at home. It can be easily applied by the patient or the patient’s relative. There may be a slight redness and itching at the injection site, which disappears within a few days. It’s not something to be afraid of.

Before using these drugs, it is investigated whether you have tuberculosis (TB) or whether you have tuberculosis microbes. If necessary, the drug called INH is given to you for 6-9 months to gain resistance to tuberculosis and to be protected.

Although it is easy to apply at home, all patients receiving biological treatment should be seen and followed up by their doctor once a month.

rheumatoid arthritis exercises

For years it was thought that patients with arthritis (arthritis) needed rest to protect their joints. Now, however, doctors and physical therapists know that without harm, you can improve your health and fitness with exercise. According to the 1996 report of general surgeons on physical activity and general health, regular physical activity reduces fatigue, strengthens muscles and bones, increases flexibility and endurance, and improves overall well-being. With this in mind, you can work with your healthcare team to determine your best program of exercise, activity and rest. Therapeutic exercises will be determined by your doctor, physical therapist and physical therapist to improve your ability to perform daily activities. If you have RA, keeping your joints flexible and your muscles strong, Exercise is important to keep your heart and lungs healthy. Rest may be general, such as lying in bed, or may be geared towards a specific joint, such as using a splint.

Depending on your illness, you need varying amounts of exercise, activity, and rest. It is important to learn how to adjust your exercises and rest to achieve physical health. When the joint is painful, swollen, and hot, rest will help reduce joint inflammation, and general (joint-activating) ROM exercises will facilitate joint movements. Your doctor and therapist will guide you in determining what type of rest you need and how much. However, temporarily lowering your activity level does not mean stopping all exercise. You should work on joint mobility by doing ROM exercises and increase muscle strength with isometric exercises.

ROM (Protection of joint range of motion) exercises: It is applied to maintain joint mobility and is done without weight. This exercise is beneficial as it helps to reduce joint stiffness and maintain joint flexibility.

Isometric exercises: Help you strengthen your muscles without moving your joints. Your doctor or physical therapist will teach you how to do these exercises properly.

Since these exercises do not make your joints move, they can be easily performed even when joint inflammation is present. During exacerbations, you can continue to exercise in water because the buoyancy of water helps protect your joints and makes movements easier. Once your symptoms are under control, you should gradually restart a major exercise program that includes aerobic exercises. Cardiovascular (heart-training) exercises are important for your overall health, weight control, muscle strength and energy level. Low-impact conditioning programs (such as walking or stationary cycling) are usually good options. You should consult your doctor or physiotherapist for a program that is suitable for you.

physical or occupational therapy

Therapy can help many people with rheumatoid arthritis . Physiotherapists will evaluate our special needs and teach exercises suitable for joint mobility, muscle strength and aerobic form. Physiotherapists can offer valuable advice on how to use hot and cold treatments effectively to reduce pain, swelling and stiffness and make movements easier. Sometimes they may use special tools to apply deep warmth or electrical stimulation to reduce pain or improve joint mobility. In addition, splints, walking aids, postoperative rehabilitation and orthopedic shoes can be used.

Occupational therapists teach you how to protect your joints. They also show you how to do daily chores to relieve stress on your joints at work and at home, teach you to use your energy wisely and plan your daily activities efficiently. They may also teach relaxation techniques.

When is rheumatoid arthritis joint surgery the best option?

If you experience pain and mobility impairment due to severe joint damage, total (whole) joint replacement may be considered. Joint prosthesis gives you the opportunity to continue to be free. Specially trained orthopedic surgeons can perform these surgeries. The surgeon replaces the damaged joint parts with metal or plastic items. These pieces are attached to the bone with an adhesive or a tight screw. All knee replacements are common. Hand surgery is in second place. Most surgeries require post-operative rehabilitation (maintenance). In this way, it is possible to get the best benefit from the new joint. You may undergo an exercise program to prepare your muscles before surgery.

The joint to which the prosthesis is applied does not hurt, and with good care and exercise, it helps you to lead a very comfortable pain-free life.