Do you know that according to a WHO study, more than 23 million people worldwide suffer from rheumatoid arthritis? Do you know that if Rheumatoid Arthritis is left untreated for ten years, you will be unable to work? Most importantly, if you believe arthritis is a disease of the elderly, you are mistaken. More than three out of every five people diagnosed with RA are under the age of 65, and women are two to three times more likely than men to develop the disease. According to 2021 reports, more than 1.3 crore people in India suffer from rheumatoid arthritis, making it a serious issue that must be addressed.
So, it is critical to diagnose the disease and receive appropriate treatment to get your life back on track. However, a lack of proper awareness about rheumatoid arthritis and its consequences, as well as the treatment methods available and the costs associated with treatment, causes people to pay little attention to the disease or to follow a local treatment plan rather than a well-structured one. Which makes it critical to educate people and provide them with a clear picture of various aspects of the disease.
In this blog, I will address several varieties of Rheumatoid Arthritis, the causes of the disease, efficient treatment approaches, and a variety of other issues, with a special focus on Rheumatoid Arthritis of the Hand. Therefore, before we go any further, let’s go through the fundamentals.
What is Rheumatoid arthritis(RA)?
It is an autoimmune disease in which our immune system mistakenly attacks healthy cells in our own bodies, causing inflammation in the affected area. It commonly affects the joints, particularly the joints in the hands, wrists, knees, and in severe cases, the internal organs. If not appropriately treated, rheumatoid arthritis causes tissue damage in the affected joints, resulting in chronic pain, loss of balance, and joint deformity.
Mistakenly? How our immune system commits such a mistake?
So now let’s understand how the mistake happens and the causes of Rheumatoid arthritis
Causes of Rheumatoid Arthritis(RA)
If we look at the specific reason for developing Rheumatoid arthritis is still unknown and the study says the disease probably develops due to certain genetic and environmental factors. So let’s understand the genetic and environmental risk factors.
- Genetics – After examining variations in dozens of genes, particularly those involved in immune system function, the researchers concluded that the majority of genetic risk factors for developing RA are due to variations in the human leukocyte antigen (HLA) gene, particularly the HLA-DRB1 gene. The protein produced by the HLA gene helps our immune system in distinguishing between our body’s protein and that of external agents entering our body (viruses, bacteria). Variations in the HLA gene, on the other hand, cause our immune system to become confused and affect our body tissues. Changes in other genes are expected to have a smaller impact.
Together with genetic factors environmental factors increase the risk of developing Rheumatoid Arthritis. These non-genetic factors can trigger the condition in people who are at risk of developing these diseases.
Environmental risk factors
- Smoking – A person with a smoking habit is a higher chance of developing the disease and even making it worse.
- Obesity – It is one of the most important risk factors for rheumatoid arthritis that must be addressed right away. According to research, the more overweight a person is, the more likely they are to develop the disease. As a result, it is important to stay healthy through regular exercise and a nutritious diet. We will go over it in greater detail in the following section of the article.
- Gender – Women are two to three times more likely than men to develop the disease.
- Age – Rheumatoid arthritis does not necessarily develop in old age, and it can begin at any age, but the likelihood increases with age. According to research, more than half of new cases occur between the ages of 40 and 70.
Now it’s time to move on to the more significant parts of the piece. How can I tell if I’m developing rheumatoid arthritis? The primary analysis can be performed by observing some of the hallmark symptoms associated with the specific disease.
Symptoms
- Pain and aching in more than one joint. This is because rheumatoid arthritis affects more than one joint at once. Sometimes face pain in the same joints on both sides of the body like in both hands or knees.
- Stiffness in the joints after getting up in the morning may last for some time or may experience hardness in joints after sitting for a long period of time.
- Swelling in the joints, tiredness, or fatigue.
- In severe cases can affect the internal organs, causing dry eyes, or chest pain due to inflammation.
- If Rheumatoid arthritis affects your knees you may not be able to walk properly or may experience losing balance.
- Severe fatigue, and loss of motion in the affected area.
As we learn more about the symptoms. Let’s move on to the different stages of Rheumatoid Arthritis
What are the four stages of Rheumatoid Arthritis(RA)?
Rheumatoid Arthritis progress in our body through four different stages. As the disease progresses some changes in our body are visible, while others may not. The treatment for RA is based on the stage the patient is in. The four stages of RA:
- Stage 1 – This is the early stage of RA where the person experiences pain, stiffness, and swelling of the tissues in the joints. If a person has stage 1 RA, he may have stiffness in his finger joints and knuckles. Because the symptoms are usually not visible at this stage, individuals may ignore them initially, and become difficult to diagnose.
- Stage 2 – This is the mild stage of RA. The symptoms are more visible at this point. The inflammation in the joint causes cartilage and bone damage. Cartilage is a tissue found at the ends of bones at joints that aids in the smooth movement of bones. Those who have cartilage damage may endure pain and loss of mobility. If your RA affects your hands, you may find it difficult to move your hands or flex your fingers by this stage. Despite the symptoms, the blood test may not show any trace of RA antibodies at this time, making it difficult to identify, but it can be identified with an x-ray or other testing.
- Stage 3 – The condition is more severe at this point. By this stage, the cartilage that served as a cushion between bones has been entirely worn away, causing bones to rub together, and resulting in bone degradation causing severe pain and swelling. At this point, the client may feel acute muscle weakness and loss of mobility. By this time, the bones may deform, resulting in twisted fingers, thicker knuckles, and squeezed tendons at the twist, which may be permanent damage.
- Stage 4 – There will be no inflammation in the joints during this stage of Rheumatoid Arthritis. The joints in this area no longer function properly. The joints are irreversibly damaged, and the person may progress to a stage of ankylosis, where the bones fuse together and produce complete immobility.
There is no set timeline for the growth of RA, and it may take years for RA to advance through all four stages. As a person progresses through the stages of RA, they experience symptoms that differ from one another. It is possible that some persons will not proceed through all four stages. Appropriate treatment helps to reduce the progression of the disease, which aids in disease management. Yet, without effective treatment, the illness tends to deteriorate with time, eventually becoming painful.
Now let’s move to more core areas of discussion
What are the types of Rheumatoid arthritis?
There are mainly two types of rheumatoid arthritis in adults they are seropositive and seronegative arthritis. Sometimes kids below 17 years of age develop a type of arthritis that is similar to rheumatoid arthritis which can cause inflammation and pain called Juvenile Idiopathic Arthritis (JIA)
Let’s understand the types in detail
Seropositive RA – You are seropositive if your blood test is positive for rheumatoid factor (RF) or the antibody anti-cyclic citrullinated peptide (anti-CCP), which is used to identify antibodies that attack our body’s healthy cells, causing inflammation. Even though 80 percent of people with RA are RF positive, having these proteins does not necessarily mean you have Rheumatoid Arthritis. However, if both of your parents have rheumatoid arthritis, you are more likely to develop the disease. This blood test does not provide 100% confirmation that you have the disease, but it does assist doctors in determining the type if you have rheumatoid arthritis.
Seropositive RA is more severe and progressive than Seronegative RA and causes more joint damage, deformity, lung issues, and extra-articular manifestation.
Seronegative RA – This happens when even if you test negative for RF and anti-CCP, there is a chance of having a milder form for RA than those who tested positive. They are often less severe and unpredictable. Diagnosis of seronegative arthritis is on symptoms which include swelling, pain, morning stiffness, and joint stiffness.
Juvenile Rheumatoid Arthritis( Juvenile Idiopathic Arthritis ) – It is a common type of arthritis in children below 17 years of age. It can cause pain, stiffness, and fatigue. Children from JRA have a severe fevers, rashes, and swollen lymph nodes.
So, as you can see, the RF test or anti-CCP test discussed above is intended to determine the type of RA affecting you if you are affected by the disease but does not reveal the extent of the inflammation or swelling. Moreover, these blood tests are only indicators of a possible RA diagnosis, not a confirmation. A proper clinical evaluation, x-rays, and a series of lab tests are required for a proper diagnosis of Rheumatoid Arthritis.
Now that you’ve learned about the different types, let’s look at the treatment plans associated with the disease
Treatment of Rheumatoid Arthritis
Once the disease is diagnosed, the rheumatologist after discussing it with the patient formulates an effective treatment procedure to manage the symptoms and reduce joint damage. While there is no cure for RA, following a proper treatment plan can prevent the disease from further progression.
The effective treatment plan includes:
- Education – It is the most important among the treatment procedure. The doctor should talk with the patient and make him aware of the condition, the treatment procedure, and how it could be effective. This will help the patient to be fully knowledgeable about the treatment he will be going through and his responsibilities.
- Proper exercises – Appropriate amount of range of motion, cardiovascular, and muscle strengthening exercises such as swimming, walking, and cycling are commonly recommended. So that it helps with stretching and strengthening of muscles and tendons around the joints.
- Splinting or braces – provide support and protect the affected joints, reduce deformity, provide joint stability, and promote proper joint alignment.
- Medication – Earlier, prior to 1990, only a few medications were available so it was only able to partially effective in suppressing the disease, but with advancement in the medical and biotechnological field today there is various medication available to treat the condition. Some of the medications include :
1) Disease-modifying anti-rheumatic drugs – to reduce the progression of the disease.
2) Biologic response modifiers – which target the specific part of the immune system
to stop inflammation
- Steroid injections – They are commonly used when medications are not effective or if the inflammation is limited to only a few joints. Injects are given directly to the affected joints.
- Following a proper healthy diet with vitamins and mineral supplements as prescribed.
- Social support – It is a critical component of the treatment plan. If the patient’s body needs to respond positively to the treatment, his mind should be positive and healthy. which requires a lot of help from his family and society for him to recover.
- Take enough rest – Regular rest periods can help you relieve pain and inflammation.
With what has been discussed so far, I hope you have a better knowledge of the various aspects of Rheumatoid arthritis. Now, as I mentioned earlier, let’s get to the heart of the material.
Rheumatoid arthritis affects the hands
Rheumatoid arthritis frequently affects the wrist, hand, and finger joints. We may experience pain, stiffness, and weakness in the wrist and hand joints, making even simple tasks like gripping a pen or turning a doorknob difficult.
Let’s look at certain parts of the hand that are commonly affected by rheumatoid arthritis.
Parts of the hand affected by Rheumatoid arthritis
- The base of your thumb is where your thumb meets your wrist.
- Metacarpophalangeal Joint (MCP) or knuckles – where the fingers and thumb meet the hand.
- The proximal interphalangeal (PIP) joints or the middle joint of your fingers.
- The top joint in the fingers near the nail.
- The joints of the wrist – connect wrist bones with each other and the bones of the forearm.
That being stated, in addition to the normal symptoms listed above, let’s look at some of the symptoms that are an indicator of disease affecting the hand.
symptoms
- Pain and aching in more than one joint. This is because rheumatoid arthritis affects more than one joint at once. Sometimes face pain in the same joints on both sides of the body like in both hands.
- Stiffness in the joints, for example, if the disease affects the hands you may not be able to fully bend your fingers to form a fist. Sometimes experience hardness in joints after sitting for a long period of time.
- Swelling and redness in the joints – The lining of the joints affected by rheumatoid arthritis becomes inflamed, which caused the joints to swell and become hot and tender to the touch.
- Dull or burning joint pain, appearing hours or days after increased use of the hands.
- You may feel grinding, cracking, or clicking sounds when bending the fingers.
- Small bony nodules form at the middle joint or top joint of your finger.
- In severe cases, your finger joints become deformed and abnormally bent which weakens your hand and even everyday tasks seem difficult.
- loss of motion in the affected area.
Now that you’ve learned about the different types, let’s look at how rheumatoid arthritis is diagnosed and who treats it.
Diagnosis of Rheumatoid Arthritis
If you experience any of the symptoms listed above, you ought to consult a doctor. You should talk openly with him about the problems you face and also talk about your smoking or other habits if you have one. Make sure the doctor is aware of any RA history in your family. So, after a preliminary examination by your doctor, if he believes you have RA, you will be referred to a rheumatologist, who is a specialist in arthritis treatment and an expert in diagnosing and treating all forms of arthritis, including rheumatoid arthritis.
To confirm the presence of rheumatoid arthritis doctor may perform various test, which includes:
- Blood test – to check the abnormal blood antibody level and blood counts.
- X-ray imaging – Done to check joint damage or deterioration.
- Bone scans – There are sometimes used to check joint inflammation and bone density.
- Joint fluid test – in which a small amount of joint fluid is extracted using a needle and analyzed in the laboratory.
Now that you are aware of the general treatment procedure for the disorder, let us look at the treatment with a specific focus on rheumatoid arthritis affecting the hands.
How is rheumatoid arthritis in the hands treated?
The treatment procedure is determined by a number of factors, including the type of arthritis, activity level, stage of arthritis, age, number of affected joints, and other medical conditions. Even if the treatment procedures differ, the ultimate goal of the treatment plan is the same, to improve mobility and function so that the person can enjoy his or her personal and social life.
We have discussed common treatment plans for rheumatoid arthritis like medications, muscle-strengthening exercises, and injections in the above sections. Apart from those we will be discussing the surgical procedure.
Surgery as a treatment method
If non-surgical treatment provides no relief then surgery may be an option. The different approaches in surgical treatments include:
- Joint fusion (arthrodesis) – This type of surgery uses a plate and screws to keep the bones of your joint together. It gives more stability to the bones but less flexibility.
- Joint replacement( arthroplasty) – Similar to other joint replacements, here an artificial implant made of plastic, ceramic, or metal is used to replace your damaged joints.
- Tendon Transfer – Tendons help to connect our bones to muscles. Inflammation caused by arthritis cause tendons to rupture and it affects the movement of our hands and fingers.
The best treatment option for you will be determined following a detailed conversation between you and the hand surgeon, taking into account a variety of factors. Don’t worry, before proceeding with the procedure, your hand surgeon will educate you on the treatment plan and its effects on the body. Your duty is to follow the processes and procedures prescribed by your doctor, and you will be back to your normal life in no time and can enjoy it like any other person.
How long does it take to recover from the hand surgery?
The recovery period varies according to the severity of the ailment, your age, the type of surgery, and other medical conditions. Most patients will be able to resume their normal activities after 3 to 4 months of having joint reconstruction surgery. Don’t be afraid of your recovery; simply follow your doctor’s instructions regarding your medicine and therapy sessions after surgery, and you’ll be back to your usual life in no time.
Is Rheumatoid Arthritis in the hand curable?
There is no known cure for Rheumatoid arthritis, but, early diagnosis and proper treatment with a proper support system( through medicines, exercises, or surgery if required) can reduce the risk of damage and relieve the pain which helps you to be more active as possible.
By this time, I hope this article could add value to your time and that you got a clear understanding amount Rheumatoid arthritis, its different stages of progress, symptoms of the disease, type of RA, and how it is diagnosed followed by treatment procedures.
Conclusion
Even though it is most frequently seen in persons between the ages of 40 and 50, rheumatoid arthritis can affect anyone of any age. As rheumatoid arthritis begins, the condition progresses through four stages with symptoms that can vary from person to person. Some of the typical symptoms include extreme pain, stiffness, and joint swelling. When it comes to hands, Rheumatoid arthritis usually impacts the joints in your fingers and knuckles. Although there is no total treatment for the disease, unlike in the past, nowadays we have better medicines, surgical procedures in severe cases, and other support systems that may help lessen joint damage and the impact of the condition. Most significantly, early diagnosis and proper therapy as directed by your rheumatologist are critical to suppress the disease. Although there is no total treatment for the disease, unlike in the past, better medicines, surgical procedures in severe cases, and other support systems may help lessen joint damage and the impact of the condition. Most significantly, early diagnosis and proper therapy as directed by your rheumatologist are critical to suppressing Rheumatoid arthritis. The most crucial aspect of any treatment is that you are fully aware of your medical condition, the treatment prescribed by your rheumatologist, and the potential consequences. This insight will give the individual the confidence to combat the sickness and live his life to the fullest.