RHEUMATOID ARTHRITIS

“JOINT PAIN” - MANAGING RHEUMATOID ARTHRITIS BASED ON HOLISTIC APPROACH

The word arthritis means inflammation of the joint ("arthr" meaning joint and "itis" meaning inflammation). Inflammation is a medical term describing pain, stiffness, redness and swelling. Rheumatoid arthritis (RA) is a chronic disease in which various joints in the body are inflamed, leading to swelling, pain, stiffness, and the possible loss of function. Rheumatoid arthritis is an autoimmune disease in which the body's immune system attacks joints and other tissues. The pattern of joints affected is usually symmetrical, involves the hands and other joints, and is worse in the morning. Rheumatoid arthritis is a systemic (body-wide) disease, involving other body organs, whereas osteoarthritis is limited to the joints. Both forms of arthritis can be crippling.

Causes of Rheumatoid arthritis:

Don’t know exactly what causes rheumatoid arthritis. The condition is most likely triggered by a combination of factors including an abnormal autoimmune response, genetic susceptibility, and some environmental or biologic trigger such as a viral infection or hormonal changes.

Rheumatoid arthritis is considered an autoimmune disease. In autoimmune disorders, the body’s immune system mistakenly attacks and destroys healthy cells and tissue. The immune system determines the body's responses to foreign substances (antigens) such as viruses and toxins. The immune response helps the body to fight infection and heal wounds and injuries. The inflammatory process is a byproduct of the immune response.

·        Genetic factors may play some role in RA either in terms of increasing susceptibility to developing the condition or by worsening the disease process. The main genetic marker identified with rheumatoid arthritis is HLA (human leukocyte antigen).

·        Environmental Triggers like Infections - Although many bacteria and viruses have been studied, no single organism has been definitively identified as a trigger for RA.

Risk Factors

·        Age - Although rheumatoid arthritis can occur at any age from childhood to old age, onset usually begins between the ages of 30 - 50 years. Juvenile rheumatoid arthritis is the term used for arthritis that affects children. Juvenile rheumatoid arthritis often resolves before adulthood. 

·        Women are more likely to develop RA than men.

·        Some people may inherit genes that make them more susceptible to developing RA, but a family history of RA does not appear to increase an individual's risk.

·        Heavy long-term smoking is a very strong risk factor for RA, particularly in patients without a family history of the disease.

·        People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.

Clinical Manifestations

Most commonly, the onset of symptoms takes place over the course of weeks or even months. But sometimes, rapid onset with more severe symptoms may also occur. The hallmark symptom of rheumatoid arthritis is morning stiffness that lasts for at least an hour, where Stiffness from osteoarthritis, in contrast, usually clears up within half an hour. Even after remaining motionless for a few moments, the body can stiffen. Movement becomes easier again after loosening up.

·        The inflamed joints are usually swollen and often feel warm and "boggy" (spongy) when touched. The pain often occurs on both sides of the body (symmetrically) but may be more severe on one side of the body, depending on which hand the person uses more often.

·        Although rheumatoid arthritis almost always develops in the wrists and knuckles, the knees and joints of the ball of the foot are often affected as well. Many joints may eventually be involved, including those in the cervical spine, shoulders, elbows, tips, temporomandibular joint (jaw), and even joints between very small bones in the inner ear. 

·        Inflammation of small blood vessels can cause nodules, or lumps, under the skin. They are about the size of a pea or slightly larger, and are often located near the elbow, although they can show up anywhere. Nodules can occur throughout the course of the disease, although they are usually a sign of more severe disease

·        Fluid may accumulate, particularly in the ankles. In some cases, the joint sac behind the knee accumulates fluid and forms what is known as a Baker's cyst. This cyst feels like a tumor and sometimes extends down the back of the calf causing pain.

·        Flu-Like Symptoms Symptoms such as fatigue, weight loss, and low-grade fever may also be present.

·        In children, juvenile rheumatoid arthritis, also known as Still's disease, is usually preceded by high fever and shaking chills along with pain and swelling in many joints. A pink skin rash may be present.

Diagnosis

Rheumatoid arthritis can be difficult to diagnose. Many other conditions resemble RA. Its symptoms can develop insidiously. Blood tests and x-rays may show normal results for months after the onset of joint pain.

Specific findings or presentation more likely to suggest the diagnosis of rheumatoid arthritis include morning stiffness, involvement of three joints at the same time, involvement of both sides of the body, subcutaneous nodules, positive rheumatoid factor, and changes in x-rays.

Various blood tests may be used to help diagnose RA, determine its severity, and detect complications of the disease.

·        Rheumatoid Factor. In RA, antibodies in the blood that collect in the synovium of the joint are known as rheumatoid factor. In about 80% of cases of RA, blood tests reveal rheumatoid factor.The presence of rheumatoid factor plus evidence of bone damage on x-rays also suggests a significant chance for progressive joint damage.

·        ESR test is used not for diagnosis but to help determine how active the condition is.

·        C-Reactive Protein. High levels of C-reactive protein (CRP) are also indicators of active inflammation. Like the ESR, a high result does not indicate what part of the body is inflamed, or what is causing the inflammation.

·        Anti-CCP Antibody. The presence of antibodies to cyclic citrullinated peptides (CCP) can identify RA years before symptoms develop. In combination with the test for rheumatoid factor, the CCP antibody test is the best predictor of which patients will go on to develop severe RA.

·        X-rays generally have not been helpful to detect the presence of early rheumatoid arthritis because they cannot show images of soft tissue. However, x-rays can help track the progression of joint damage over time. Imaging tests, such as ultrasound, or magnetic resonance imaging (MRI). Dual energy x-ray absorptiometry (dexa scans), also called bone densitometry, may be used to check for signs of bone density loss associated with osteoporosis.

Complications

The course of rheumatoid arthritis differs from person to person. For some patients, they disease becomes less aggressive over time and symptoms may improve. Other people develop a more severe form of the disease, which can lead to serious complications that affect not only the joints but other areas of the body including organs. Fortunately, for many patients newer treatments are helping slow the progression of the disease and preventing severe disability.

Many complications of rheumatoid arthritis are the result of chronic inflammation. These may include Joint Deterioration and Pain, Peripheral Neuropathy, Anemia, Eye Problems, Infections, Skin Problems, Osteoporosis, Lung Diseases, Vasculitis, Heart and Circulatory Diseases, Lymphoma and Other Cancers, Periodontal Disease, Kidney and Liver Problems, Emotional Complications & Pregnancy Complications.

MANAGEMENT

Lifestyle changes and home treatments also can help reduce rheumatoid arthritis symptoms.

Exercise - It is important for patients with RA to maintain a balance between rest (which will reduce inflammation) and moderate exercise (which will relieve stiffness and weakness). Studies have suggested that even as little as 3 hours of physical therapy over 6 weeks can help people with RA, and that these benefits are sustained.

The goal of exercise is to: Maintain a wide range of motion, Increase strength, and endurance, and mobility, Improve general health, & Promote well-being

Start with the easiest exercises, stretching and tensing of the joints without movement.

Next, attempt mild strength training. The next step is to try aerobic exercises. These include walking, dancing, or swimming, particularly in heated pools. Avoid heavy impact exercises, such as running, downhill skiing, and jumping. Tai chi, which uses graceful slow sweeping movements, is an excellent method for combining stretching and range-of-motion exercises with relaxation techniques. It may be of particular value for elderly patients with RA.

Diet - in recent years, a number of studies have suggested that the omega-3 fatty acids contained in fish oil may have anti-inflammatory properties useful for RA joint pain relief. The best source of fish oil is through increased consumption of fatty fish such as salmon, mackerel, and herring.

Pain management - Patients can learn strategies to cope with the stress and frustration of living with chronic pain. Relaxation and stress management techniques such as guided imagery, breathing exercises, hypnosis, or biofeedback can be helpful.
Although there is no definitive evidence to support their efficacy, some patients report relief with modalities such as acupuncture, massage, and mineral baths.

Herbal remedies - Researchers are currently conducting studies to determine if supplements extracted from the turmeric spice can help prevent joint inflammation. 

HOMOEOPATHIC MANAGEMENT

Homoeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homoeopathy is not only to treat rheumatoid arthritis but to address its underlying cause and individual susceptibility. The unique physical, emotional and mental expression of illness is characteristic and is used to channel the course of Homoeopathic treatment. The remedies work by stimulating body’s natural ability to heal itself, acting as a catalyst for healing. As far as therapeutic medication is concerned, several well-proved remedies are available for rheumatoid arthritis which can be selected on the basis of cause, location, sensation, modalities and extension of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homoeopathic doctor in person.

Some important arthritis remedies are given below which are much helpful in treatment of rheumatoid arthritis:

Indicated Remedies	Indications
Aconite	Sudden onset after exposure to cold dry air. Pains, with formication and numbness. Rheumatic inflammation of joints; pains intolerable. Intense bright-red swelling of parts. Sensitive to contact. High fever. Worse at night. With the rheumatism anxiety, fear, restlessness is well marked in aconite. Arthritic and rheumatic drawing and tearing pains, especially in the limbs.
Actea spicata:	This plant remedy is useful especially for those cases of RA who has small joints affected, especially fingers and toes.
Arsenicum	Acute drawing pains in the arms and in the hands. Swelling of the arms, with blackish pustules of a putrid smell. Acute drawing pains in the night, beginning from the elbow and extending to the armpits acute pulling and shooting in the wrists. Cramps in the fingers. At night, sensation of fullness and swelling in the palms of the hands. Excoriation between fingers. Hard swelling of the fingers, with pain in the finger-bones. Cramp in the legs
Belladonna	Joints swollen, red, hot, shining. Exquisitely sensitive to touch or jar. Red streaks radiate from inflamed joint. Recurrent fever with pains attacking nape of neck. Pains in the joints and bones. Rheumatic pains (in the joints) flying from one place to another. The pains are aggravated, chiefly at night, and in the afternoon towards three or four o’clock. The least touch, and sometimes also the slightest movement, aggravates the sufferings.
Bryonia	Over-sensitiveness of the senses to external impressions. Rheumatic and gouty pains in the limbs, with tension, worse from motion and contact. Tension, drawing pains, acute pullings and shootings, especially in the limbs, and chiefly during movement, with insupportable pains on being touched, sweat of the part affected, and trembling of that part when the pains diminish. Stiffness and shootings in the joints, on being touched and when moved. In the evening, pain, as from fatigue, in the limbs, with paralytic weakness.
Calcaria fluoride:	This medicine works for those patients of arthritis who tend to have large or medium joint affections such as knee joint, spine or shoulders. These patients will have more pain on waking up in the morning or while getting up from a sitting position and they feel better after walking for some time. The joint pains are better by hot application. At the level of emotions, these patients are likely to tough, strong willed, who might look stiff and at times rude. They do not give up easily.
Causticum	Arthritic and rheumatic drawing and tearing pains, especially in the limbs. Acute and violent pulling in the joints and the bones, mitigated by the heat of a bed. Contraction of the tendons, and stiffness in the flexor muscles of the limbs. Cramp-like Contraction of several limbs. Torpor and paleness of some parts, or of the entire left side of the body.
Medorrhinum	Rheumatic pain in top of left shoulder, worse from motion, occasional little darts of pain if kept still. Rheumatic pain in (right) shoulder and arm. Cracking of joints, especially elbows. Much pain in left arm, cannot hold a paper, veins become enlarged, worse raising arm. Trembling of arms and hands.
Natrum Muriaticum:	This medicine is suitable to those patients who may have developed Rheumatoid Arthritis (RA) after prolonged stress in the form of grief, which could be in the form of death of some dear one; or after breaking a relationship. It is the emotional trauma that leads to disturbance of immune system, in turn, leading to the disease like RA.
Rhus Tox	Hot, painful swelling of joints. Pains tearing in tendons, ligaments and fasciae. Rheumatic pains spread over a large surface at nape of neck, loins, and extremities; better motion. Soreness of condyles of bones. Limbs stiff, paralyzed. The cold fresh air is not tolerated; it makes the skin painful. Tenderness about knee-joint. Loss of power in forearm and fingers; crawling sensation in the tips of fingers.
Salicylic acid	Acute, inflammatory rheumatism of one or more joints, especially elbows or knees. Great swelling and redness. High fever. Very sensitive to least jar. Motion impossible.