Rheumatoid arthritus

Question 1

What is rheumatoid arthritis?

Answer 1

Rheumatoid arthritis is an autoimmune condition and a chronic inflammatory disease.

Question 2

What causes rheumatoid arthritis?

Answer 2

• genetics
• hormones as it is 2-4 times more common in women
• smoking

Question 3

How does rheumatoid arthritis affect the body?

Answer 3

• oral health conditions like gum disease
• heart inflammation and failure
• inflammation of the lungs resulting in a difficulty breathing
• bumpy skin
• finger pain
• hip pain
• rheumatoid vasculitis (inflammation of the blood vessels causing organ and tissue damage)
• an uneven stance
• dry eyes
• chest pain due to the inflamed lung lining
• knee weakness and swelling.

Question 4

How can the symptoms of
rheumatoid arthritis be managed?

Answer 4

It’s incurable.
• anti rheumatic drugs
• biological medications
• physiotherapy
• pain relief
• steroids
• surgery

Question 5

How do anti rheumatic drugs manage symptoms?

Answer 5

These reduce inflammation, relieve pain, slow joint damage and enable activity through suppressing the immune system.

These take a few months to relieve symptoms.

Types of drugs include DMARD’s and biological treatments. A combination of DMARD (disease modifying anti rheumatic drugs) drugs will be offered to block the effects of the chemicals.

Examples of anti rheumatic drugs are methotrexate, leflunomide and sulfasalazine. Methotrexate is typically prescribed first along side steroids.

Question 6

What are the side effects of anti rheumatic drugs?

Answer 6

Side effects:
• sickness
• loss of appetite
• sore mouth
• diarrhoea
• hair loss
• headaches

These can also affect your blood cells and liver so regular tests will be done to monitor them.

They can also affect the lungs, not commonly, so x-rays and breathing tests may be done.

Question 7

How do biological treatments manage arthritis symptoms?

Answer 7

Examples include monoclonal antibodies such as adilamumab. This binds to and inhibits the protein TNF-alpha that is released when the immune system attacks the joints.

They are typically taken with methotrexate and if other DMARD’s aren’t working on their own.

These are injections which stop the chemicals that cause the immune system to attack the joints.

Question 8

What are the side effects of biological treatments?

Answer 8

Side effects:
• injections site skin reactions
• infections
• sickness
• high temperature
• headaches

These also make you at a higher risk of getting tuberculosis if you had it in the past.

Question 9

How does physiotherapy manage arthritis symptoms?

Answer 9

This improves overall fitness, muscle strength and flexibility.

This is a face to face session with a professional where hand/leg exercises may be done.

They can also use heat and ice packs to soothe the affected areas. They also offer transcutaneous electrical nerve stimulation (TENS), which is a small pulse of electricity sent to the affected joint, numbing the nerves in the joint to ease pain.

Question 10

How does pain relief manage arthritis symptoms?

Answer 10

Paracetamol and codeine may be given as a form of pain relief.

They may also be prescribed a non-steroidal anti-inflammatory drug like ibuprofen and naproxen instead of or in addition to paracetamol and codeine.

They may also be prescribed a COX-2 inhibitor which also handles pain and inflammation.

Question 11

How does steroids help manage arthritis symptoms?

Answer 11

These reduce pain, stiffness and inflammation.

They can be given in the form of a tablet or an injection into the joint or muscle. If they are injected into the muscle it helps multiple joints and provides short term pain relief.

Question 12

What are the side effects of steroids?

Answer 12

Side effects:
• indigestion
• heartburn
• increased appetite
• insomnia
• mood changes
• increased risk of infection
• alopecia
• confusion
• hypoglycaemia
• hypotension
• skin thinning
• osteoporosis
• weight gain

Question 13

What surgery’s help manage arthritis symptoms?

Answer 13

This can treat joint damage

Examples include carpal tunnel surgery, arthroscopy and an arthroplasty.

Question 14

What is carpal tunnel surgery?

Answer 14

A ligament in the wrist is cut to relieve pressure on a nerve.

Tendons in the fingers can also be released to treat abnormal bending.

Question 15

What is an arthroscopy?

Answer 15

The removal of inflamed joint tissue.

A thin tube with a light and camera (an arthroscope) is inserted into the joint through a small cut.

This does not require a hospital stay.

Question 16

What is an arthroplasty?

Answer 16

This joint replacement surgery.

This can be done in the hip, knee and shoulder.

This requires several days in hospital and rehabilitation. It lasts 10-20 years and function may not be restored.

Question 17

Explain how rheumatoid arthritis works.

Answer 17

The immune system mistakenly sends antibodies to the lining of the joints, where they then attack the tissue surrounding the joints. Specifically the synovial membrane and the cartilage of synovial joints.

This causes thin layers of cells (synovium cells) to covers the joints, causing them to become sore and inflamed.

This releases chemicals which damage nearby bones, cartilage, tendons, and ligaments. If this is not treated the chemicals can eventually cause the joints to loose shape and alignment, destroying them completely.

Question 18

How does early treatment and support benefit RA?

Answer 18

It can reduce the risk of joint damage and limit the impact of the condition on their life.