Rheumatoid Arthritis

Mr. Jain woke up early to get ready for his morning walk when suddenly he felt severe pain in his feet. He had felt such twinges earlier too but that day the pain was unbearable and he could not stand on his feet. Suspecting Rheumatoid Arthritis his family physician referred him to a Rheumatologist for further investigation and treatment.

What is Rheumatoid Arthritis?

It is a chronic inflammatory disorder that mainly affects the joints but it can also affect other parts of the body, including the eyes, lungs, and heart. It causes a person’s own immune system to attack the body’s healthy tissue. If not treated early it can spread to other parts of the body.

In the joints

Though rheumatoid arthritis can affect any joint in the body, it mainly affects the hands, feet and the fingers causing the lining between them to become inflamed and swollen. It can affect joints in the:

• Neck
• Spine
• Knees
• Ankles
• Hips
• Shoulders

Swelling can lead to stiffness in the joints, pain and immobility. Stiffness and Joint pain in the early hours of the day can be one of the first signs of rheumatoid arthritis.

The skeleton

Rheumatoid arthritis causes cartilage (which prevents the bones from rubbing against each other) to break down and damage the bones. It also leads to bones becoming less dense, thin and brittle, making them prone to fractures.

The skin

In people with Rheumatoid arthritis, small nodules form near the inflamed joints. They are generally painless and not a cause for concern, but when pressure is applied on them – like while kneeling – they may cause discomfort.

Rheumatoid arthritis can also cause inflammation in the skin, leading to:

• Red patches
• Swelling
• Ulcers and lesions

It can make red dots appear on one’s skin or ulcers on the legs or under the nails and make healing of wounds slower. Vasculitis/inflammation of the small blood vessels in the skin aggravates the condition. Certain medications can also cause skin rashes.

The mouth

People with Rheumatoid arthritis often experience dry mouth. It also increases a person’s chances of developing Sjogren’s syndrome, an autoimmune disorder leading to dryness in the eyes and mouth. This inflammation also causes saliva ducts to narrow or get choked, leading to dryness in the mouth and difficulty eating and swallowing.

The eyes

Rheumatoid arthritis can lead to inflammation in the parts of the eyes causing dry eye syndrome. This can irritate the eyes and eventually damage the cornea.

Complications include:

• Dry eyes syndrome
• Inflammation of the white portion of the eyes or Scleritis
• Inflammation of the inner eye or Uveitis
• Blocked eye blood vessels or Retinal vascular occlusion
• Glaucoma, or optic nerve damage
• Cataracts due to inflammation in the optic lens

The lungs

The condition can cause pulmonary fibrosis, which can lead to scarring and breathing difficulties. Nodules can also form in the lungs, however, these are not very serious.

Side effect of medications: Medications for Rheumatoid arthritis can make the immune system less effective ultimately leading to respiratory infections, including pneumonia and tuberculosis.

The heart

Rheumatoid arthritis can lead to inflammation which can damage the heart and blood vessels which can be fatal
Complications caused by Rheumatoid arthritis:
Anaemia: Inflammation from Rheumatoid arthritis can lead to iron-deficiency. Low red blood cell count in the body can also lead to frequent headaches and fatigue.

Atherosclerosis: Rheumatoid Arthritis can cause inflammation of the artery walls and damage them making the body absorb more cholesterol, leading to plaque build-up inside the arteries. This is called Artherosclerosis. This can result in a Heart attack or stroke

Pericarditis: Inflammation in the lining of the heart or the pericardium, can lead to chest pain.

The nerves

Swelling and Inflammation of the nerves can lead to their compression which can result in a feeling of numbness or tingling in the hands or feet and Carpal tunnel syndrome.

The feet

Rheumatoid arthritis can develop in the joints of the toes. This can limit a person’s movement as it bears the entire weight of the body. Rheumatoid arthritis often develops in the joints of the toes and, less commonly, the ankles.

Common related conditions:

Inflamed bursae: fluid-filled sacs on the balls of the feet causing chronic pain.

Nodules: Firm small lumps on the pad of the heel, the Achilles tendon, and other bony areas.

Calluses and corns: Hard, thick patches of skin tend to develop as the shape of the foot changes. If a person does not receive timely treatment, it can lead to ulcers.

Nerve compression: Damaged joints due to rheumatoid arthritis compress the surrounding nerves and cause numbness and tingling.

Circulation problems: Inflammation in the blood vessels and joints can cause blocks in the flow of blood to the feet leading to a numbness or development of a bluish tinge.

The mind and brain

Rheumatoid arthritis can cause psychological symptoms due to side effects of medication or body-wide inflammation like:

• Brain fog
• Depression
• Cognitive issues
• Behavioral changes

The kidneys and liver

Medications for rheumatoid arthritis can cause complications of the liver and kidney damage. As this is a progressive disease, it means if a person does not receive treatment, the symptoms usually get worse. Medications can help to slow down the progression of the disease. With time the pain is likely to get worse.

Symptoms of Rheumatoid Arthritis progression:

• Increase in pain and swelling
• New symptoms arising and lasting for longer time
• Symptoms start to appear in other areas
• Blood tests show an increase in rheumatoid factors

Contact a doctor when you notice one or more symptoms of Rheumatoid Arthritis. People with progressive Rheumatoid Arthritis often require a customised treatment plan depending on the person’s symptoms and previous history.