Rheumatoid arthritis, rheumatoid arthritis, RA, is an inflammatory disease that often begins in small joints of the hands and feet. The joints swell, become sore and you get sore. Rheumatism cannot be cured, but with medication and physiotherapy the inflammation can be suppressed and the pain relieved.

The inflammation makes the joints stiff. The stiffness is worst when you get up in the morning or have been quiet for a long time. You should try to move as much as possible even if you are in pain.

The disease varies greatly from person to person and causes various discomfort in periods.

Symptoms of rheumatoid arthritis

If you have rheumatoid arthritis, you may have several problems:

  • You can get pain in the joints on both sides of the body.
  • You may feel stiff and sore as you move, especially in the morning.
  • Your joints can become swollen, sore and sometimes hot and red with severe inflammation.
  • You can get tired.

Rheumatoid arthritis not only includes the joints but is a disease that can affect the entire body. For example, you may get inflammation in organs such as the pulmonary, cardiac, eye, or blood vessels.

When you have ongoing inflammation in the body you often get tired and can feel sick. Sometimes you can lose weight and get elevated body temperature.

The hassles vary from person to person

Rheumatoid arthritis can be very different from person to person. You may have periods of more severe symptoms of rheumatoid arthritis. When the disease is more active, inflammation becomes more prevalent and you can be tired and have more pain. Between these periods, the disease can cause minor problems. For example, you may have more trouble for a few years, after which the disease calms down and stops. The disease can also be more intense and worsen over the years.

In addition to joint, tendon and muscle problems, you may experience other symptoms, such as so-called rheumatic nodules or nodules in the subcutaneous tissue. They can occur where there is pressure on the skin, for example on the elbows or on the fingers. The researchers believe that the nodules are caused by the blood vessels in the subcutaneous skin being inflamed and forming scars. The knots are harmless but can sometimes hurt. They can be operated off, but often come back.

You may also get inflammation in the lung pockets, the heartbeat or in the eyes, but it is rare. You often feel very tired when the inflammation is widespread.

When should I seek care?

Contact a health care provider if you suspect you have arthritis. Then you can book a doctor’s appointment and get an assessment. You should contact the health care center as soon as possible as it is important that you receive effective treatment if you have been diagnosed with arthritis.

What can I do for myself?

Rheumatoid arthritis can be so painful that it can be difficult to do some things. At work, it can often be facilitated by means of changed work tasks or aids and adaptation of the workplace and the equipment. Together with the employer and the insurance fund, you can often find solutions that make it work. An occupational therapist can help you determine what you need.

Together with the occupational therapist, you can also discuss your difficulties and get suggestions on things that can facilitate life even in your spare time.

You can often continue with your hobbies as before despite rheumatoid arthritis. But it is wise to avoid too harsh activities during the periods when the disease is cumbersome, for example some ball sports, slalom skating and gymnastics with jumping exercises, as these activities can put too much strain on the joints.

Train your hands and fingers

In the hands and fingers, the pain and inflammation can interfere with the interaction between muscles and tendons. In the long run, you may find it more difficult to grasp things. Therefore, it is important that you train your hands to maintain muscle strength and mobility in the joints, and reduce the risk of miscarriages in the joints. You can receive treatment in groups or individually.

Important to take care of your feet

You may have trouble with your feet early. Then it can hurt and you can get hard to walk. Therefore, it is very important that you take care of your feet and that you are careful in the choice of shoes. A good shoe is built in the hollow foot and provides the support from below as needed. The shoes should also have a stable heel cap, be sufficiently wide and lace-up.

There are also loose shoe inserts that can be tested out on the foot, possibly with orthopedic help.

If you have rheumatoid arthritis you are entitled to a discount on the cost of shoes and inserts that you buy through an orthopedic technical workshop. But not everyone has to have special shoes, but many find good and comfortable shoes themselves.

To keep your feet moving, a simple gymnastic program for your feet can also be helpful.

Assistive products, support rails, and other practical tips

If you use custom tools in everyday life, your joints will be spared and the pain may be reduced. For example, a support rail, orthosis, can facilitate if the pain makes you weak in the hand or wrist. The rail supports the wrist or thumb so you get less pain when you grab things.

A resting dose can be an option if the hands are highly inflamed. The joints of the hand are relieved and the pain is lessened. The resting dose can also prevent miscarriages.

At home, everyday life can be facilitated, for example, by switching ordinary water taps to the mixer and changing the bathtub to shower. To adjust the housing, you can apply for a grant from the municipality. At work or at school, it can also be easier with different tools, other working methods or remodeling. The occupational therapist can provide suggestions.

In articles on assistive technology, you can read about how it is possible to get aids and find out what aids are available where you live.

Stop smoking and lose weight

If you have rheumatoid arthritis, there is a greater risk of getting diseases that are due to vein obesity earlier in life, such as myocardial infarction and stroke. To reduce this risk, you should check with your doctor if you have other risk factors for such diseases. You should not smoke, and if you weigh too much you should lose weight. You should be treated if you have high blood pressure or increased blood fat content.

Balanced diet

Many different diet studies have been done over the years to see if any particular diet can reduce joint inflammation, and today one can also read a lot about so-called anti-inflammatory diets, but it has been difficult to show any certain differences that could have a positive effect on the disease. Therefore, no specific recommendation regarding the diet is given other than that a balanced and nutritious diet is good for everyone.

Surveys

If the doctor suspects that this is rheumatoid arthritis, you will see a specialist in rheumatic diseases, a rheumatologist, as soon as possible. The rheumatologist will decide whether you need to receive antirheumatic medicine.

During periods of more severe symptoms of the disease, it is common to have regular contact with the rheumatologist. If the disease is in a quieter phase, it may suffice for you to have contact with the doctor at the health center.

You also get in touch with a rheumatology care team.

At the doctor

At the doctor, you describe your complaints and answer questions about your health, your lifestyle, if you have any other illnesses and if you are taking any medication.

The doctor does a thorough body examination and examines and feels the joints. The joints are also examined by x-ray. If you have recently had the disease, it is rarely seen in the X-rays. But if the inflammation has been going on for some time, the doctor can sometimes seem that the skeleton next to the diseased joints has thinned out. After an even longer period, sometimes more changes can be seen.

The joints can also be examined with ultrasound and magnetic camera. Then the doctor can see if the joint is swollen if there is fluid in the joint and if the cartilage is damaged.

Blood samples are analyzed

You may have blood tests to allow your doctor to assess how active the inflammation is. There is a so-called antibody called anti-CCP that is especially prevalent in arthritis. More than three out of four people with rheumatoid arthritis have anti-CCP in their blood, and if you have it, the likelihood is that you have the disease. But you can have anti-CCP even though you are not sick and will not be. Thus, the existence of anti-CCP in the blood is not evidencing that you have rheumatoid arthritis but can be a guide.

This is how the diagnosis is made

If you have joint inflammation in multiple joints on both sides of the body, and the inflammation also includes the joints in the hands, you will usually be diagnosed with arthritis. The symptom of rheumatoid arthritis should have lasted for at least six weeks and it should be clear that you do not suffer from any other inflammatory joint disease. The doctor’s diagnosis is based primarily on what studies show. Therefore, the blood tests are not sufficient but can be a help.

Treatment of rheumatoid arthritis

The earlier you receive treatment of rheumatoid arthritis, the greater the chances of affecting the disease and reducing the damage.

The treatment of rheumatoid arthritis is to alleviate the inflammation and pain and at best make them disappear completely. At the same time, muscles and joints should be kept in trim so that you do not get worse function in the diseased joints. It is done with the help of medicines, physical therapy, occupational therapy, and in-house training.

Treatment in the healthcare team

At a rheumatology clinic, you receive treatment from a rheumatologic care team. The team includes doctors, nurses, physiotherapists, also called physiotherapists, occupational therapists and curators. Everyone has their special knowledge of what it means to have a rheumatic disease and a role in treatment.

You set specific goals for the treatment together. The rheumatologist assesses the course of the disease by doing various examinations, by gathering information from others in the team and by telling yourself about your complaints. Thereafter, drugs are prescribed. The nurse provides information and advice on health issues in general and on treatment, takes samples and provides information on drugs. The nurse also coordinates contacts with others in the team and is the one you can contact with questions and problems.

Many rheumatology units organize group teaching on arthritis. It is usually called the rheumatic school and is performed by the team. There you get more knowledge about the disease. For example, you will learn how to avoid incorrect loading and thus reduce the pain. In the group, you can also exchange experiences with others who have the disease and get help finding solutions that facilitate everyday life and work.

You can also get advice and support through the Rheumatic Society.

The curator provides support

The curator of the rheumatology care team can help you find the right among society’s resources, rules, and regulations. The curator can also provide support and assistance with regard to other problems in daily life. You can meet the curator individually or in groups.

Physical therapy prevents and counteracts discomfort

Through the physiotherapist’s treatments and exercise programs, you can prevent the physical problems that the disease can bring. You can also solve any problems that may have already arisen.

During the first visits to the physiotherapist, a thorough examination of your joint mobility, muscle strength, balance, how to coordinate your movements, fitness, and an analysis of the pain are made. This study then forms the basis of the treatment plan that is laid out. You set goals for the training and treatment together with the physiotherapist.

Pain in combination with inflammation makes it difficult to move as usual. It is then easy for you to lose muscle strength, mobility, and balance. But despite the pain, it is not harmful to move but on the contrary very good to keep the body going. All exercise also has a pain-relieving effect. The physical therapist gives you personal advice and a training program that fits into your everyday life.

You can also work out with others in groups under the guidance of a physical therapist. An exercise form is done in a warm pool. With the help of the warm water, you gently train strength, mobility, balance, fitness, and coordination. The temperature in the water is usually around 34 degrees.

If needed, the physiotherapist also provides individual treatments of rheumatoid arthritis. It can be pain relief, where acupuncture, soft tissue treatment and electrical nerve stimulation,  tens, are common methods. It usually gives a good effect. Sometimes some muscles need to be stretched or the mobility of the joints is treated and then there are also treatment methods for this.

If you have rheumatoid arthritis you do not need to go to a physical therapist continuously. The physiotherapist shows you how to exercise and then you can do your training yourself.

Drug treatment

While waiting for the right diagnosis, you can get medicines for inflammation and pain, called NSAIDs. An alternative is painkillers containing paracetamol. These drugs relieve the symptoms of rheumatoid arthritis, but do not stop the disease itself and do not prevent damage.

When you are diagnosed with rheumatoid arthritis, it is important that a specialist assesses early on whether you need anti-rheumatic drugs that affect the course of the disease. There are several different medicines and sometimes a combination of some of them is needed. Sometimes you may need both pain-relieving and anti-inflammatory drugs.

In severe inflammation, you may need to take cortisone tablets for a limited time to attenuate the symptoms of rheumatoid arthritis. You can also get cortisone syringes in one or more joints.

A newer group of drugs are so-called biological drugs. They are used especially if you have severe inflammation that is not sufficiently suppressed by other medicines.

Calcium and vitamin D against osteoporosis

You have a greater risk of osteoporosis if you have arthritis. Osteoporosis is also called osteoporosis. Therefore, it is important to get enough calcium and vitamin D in the diet and sometimes even supplement with tablets. Sometimes you can also get other medicines to prevent osteoporosis. The risk of osteoporosis is reduced if you are physically active and thus strain your skeleton.

Surgical treatment

Sometimes surgery is used to relieve pain or to prevent injuries and malfunctions. For example, inflamed arthritis can be removed to prevent bone and cartilage destruction. Such an operation is called a synovectomy. The surgery is not that common anymore because it can often be replaced by cortical syringes in the joints.

In the case of more severe injuries, when the leg has been destroyed in, for example, a knee, hip or shoulder joint, the injured joint can be replaced with a new joint, a so-called prosthesis. It usually gives good results. For a long time, it has been possible to improve the movement ability of the hand with silicone prostheses in the finger joints.

It is also possible to get stable and pain-free joints by operating, for example, foot and wrist joints. In some situations, the surgery will cause you less pain and better functional ability. Steel operations have become increasingly uncommon as there are now greater opportunities to prevent a joint from being damaged so severely that it must be operated on.

Sometimes an operation is made to release a nerve that has been pinched or to replace a tendon that has broken.

What happens in the body?

The joints connect the skeleton and at the same time make it mobile. In one joint, two or more legs meet and the joint surfaces that slide against each other are covered by smooth and elastic cartilage.

The joint is surrounded by a joint capsule. The capsule is made up of connective tissue, adheres to the legs and encloses the entire joint. The inside of the joint capsule is covered by the joint that forms joint fluid, which lubricates the joints. The joint fluid also supplies the cartilage with oxygen and nutrients. When the joint, actually the joint capsule, becomes inflamed, the movement of the joint is affected in various ways.

In the joint capsule, there are, in certain places, stronger strokes, ligaments, which hold the joint together and stabilize it.

The path is damaged and can be faulty

In rheumatoid arthritis, the immune system, which normally fights foreign organisms in the body, begins to react to the body’s own joints. When a large number of white blood cells from the immune system accumulate in joints or tendons, they become inflamed. The inflammation causes the joint to become fluid, swollen, tender and warm.

Inflammation begins in the tissue of the joint capsule. If the inflammation lasts for a long time, it can damage different parts of and around the joint. The tendons that run around the joints are an extension of the muscles. Around the tendons are late skis. The mobility of the joint is impaired and the joint can sometimes be misaligned, such as the fingers pointing obliquely at the little finger side. This is because inflamed tendon skis and muscles become unbalanced.

The disease is more common in women

Rheumatoid arthritis can begin at any age, but it is most common that it begins in the 60s to 70s. More than twice as many women get the disease compared to men.

Several different factors may be behind the disease

It is not entirely known what causes arthritis rheumatism. There are probably several factors that work together. There are some hereditary traits which mean that you may have an increased risk of arthritis. The risk of having a more severe variant of the disease can also be hereditary.

In a person who has a predisposition to the disease, certain infections can cause it to break out. Smoking is also an important risk factor, and more smokers than non-smokers get arthritis. Hormonal factors can also be important. Many women get sick in early adulthood and when they enter menopause. This is the stage of life when the hormonal conditions in the woman change.

The disease cannot be prevented. However, the course of the disease can be slowed down and in some cases stopped with the help of drugs.

Pregnancy

Usually, there is no reason to avoid becoming pregnant in rheumatoid arthritis. Many may feel better during pregnancy, but there is a risk that you will have a worse period after childbirth. However, you should be in a quiet phase of the disease before pregnancy to make you and your child feel as good as possible during pregnancy and to require as little medication as possible.

Many drugs for the treatment of arthritis are unsuitable during pregnancy. Therefore, it is important that you consult your doctor well in advance before you plan to have children. It is unclear if breastfeeding affects the course of the disease, and it may be less advisable to breastfeed as you may need to take medicines that pass into breast milk. Many people abstain from medication while breastfeeding and doing well. There are also anti-rheumatic drugs that can be used well during pregnancy.

Ehtisham Nadeem

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