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Rheumatoid  Arthritis

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About Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disorder, it is a condition that occurs when the immune system is overly sensitized and out of control. Instead of protecting the body, the immune system starts attacking the joints causing inflammation. It typically affects the small finger joints, wrists, knees and toes.

What Causes Rheumatoid Arthritis?

It is not known what triggers the immune system to attack healthy body tissue. However, some possible risk factors of Rheumatoid Arthritis are as follows:

  • Middle Age
  • Females
  • Smoking
  • Overweight
  • Genetic family history

What Causes Rheumatoid Arthritis?

It is not known what triggers the immune system to attack healthy body tissue. However, some possible risk factors of Rheumatoid Arthritis are as follows:

  • Middle Age
  • Females
  • Smoking
  • Overweight
  • Genetic family history

Symptoms Of Rheumatoid Arthritis

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Knee Pain and Swelling
Pain and swelling in the joints are major symptoms of rheumatoid arthritis. Early rheumatoid arthritis usually starts at the small joints such as the fingers or the feet. Swelling will ensue together with pain and stiffness in the joints. As the disease progresses pain is also felt in other major joints such as the knees, hips, elbows and neck. Apart from joint pains, the disease can cause damage to other organs such as the heart, lungs, eyes, skin and nerves.
Stiffness
Joint stiffness from rheumatoid arthritis may affect your knee joints, it lasts for several hours after getting up in the morning. The condition can affect your daily function in tasks such as walking, bending, going up or down the stairs, wearing trousers or getting out of the car.
Other Symptoms
Along with swelling and pain in joints, some of the early symptoms of the disease may include fatigue, loss of appetite, weight loss and fever.

A Message About Rheumatoid Arthritis

Rheumatoid arthritis (RA) may present very similar to osteoarthritis (OA), both of which affect joint pain and disability. While RA usually affects small joints, it can also present in isolation as a painful swollen knee. RA pain is not activity related. The pain is independent of movement or stress loading on the joints. The pain is usually not dynamic but constant throughout the day. Morning stiffness may improve through the day, but there will be residual stiffness in the joints. OA on the other hand is often related to the use of joints, standing and walking. The diagnosis of RA often hinged upon certain blood biomarkers eg. ESR, CRP, RA factors, ANA and anti-ds DNA. Radiologic findings are similar between RA and OA, both having joint disease changes, making it difficult to differentiate one from the other.

RA pain does not improve with rest or avoidance of use or activity. It is destructive in nature without a trigger. The immune system attacks the joints causing inflammation and deformity. Apart from simple analgesics, steroids and specific (chemotherapeutic) drugs are needed to control and suppress the overactive immune system. There will be a need for long-term care for RA, with a small percentage of them reaching a “burnt out” stage of remission.

The implication of RA on other organ systems makes it necessary for routine evaluation of the heart, lungs, gastrointestinal and kidneys.

Diagnosing Rheumatoid Arthritis

Here at Singapore Paincare, our team of experienced primary care physicians and pain care specialists together with a rheumatologist will evaluate your condition. This includes a physical exam, questions about your symptoms and an evaluation of your medical history. Blood tests and other laboratory tests may also be needed to diagnose rheumatoid arthritis. Patients with the condition are likely to possess a protein named rheumatoid factor or certain antibodies.

What Treatments Are Available for Rheumatoid Arthritis

Rheumatoid Arthritis has no known cure but there are methods to manage the condition. At Singapore Paincare, we strive to treat your pain with the least invasive option possible after accurately identifying the cause. Our approach to pain resolution focuses on targeting the root of your pain via specialised injection and minimally invasive procedures. Combined with pharmacological treatments and cognitive and physical rehabilitative therapies, we help patients improve functions and prevent pain from recurring.

Non-Surgical Treatment for Rheumatoid Arthritis (RA)

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Physical therapy
The therapy sessions by our physio specialists involve both aerobic and resistance training to reduce pain, however, the intensity and type of exercise may differ based on the conditions of the patient. RA patients walk a tight rope between overactivity and underactivity. Too much exercise can cause a RA flare, while too little exercise may worsen the progression of the deformity in the joints. Each RA patient is different. Prescribed physical therapy is individualized and not the same for each different patient.
Knee brace
Knee braces may be used temporarily to limit the movement of the knee and provide support, this can effectively reduce pain or stimulation of the inflamed muscles.
Platelet-rich plasma (PRP)

If it is a ligament injury, the latest medical method is to inject platelets, which can help in healing. Platelet injections are commonly used for pain caused by a torn meniscus as well as conditions such as osteoarthritis. PRP use in RA is directed at the enthesopathy and synovitis related to the immune over inflammation.

Knee Supplements
Glucosamine, chondroitin, and collagen have been widely used to treat knee cartilage degradation.
In general, glucosamine may have some effect on 60% of patients with knee arthritis.
Injection
Local injection of anaesthetic, anti-inflammatory agents or a low-dose corticosteroid are helpful for patients with rheumatoid arthritis. These forms of injections are effective as early forms of adjunctive therapy together with pharmacotherapy. They bring the pain and inflammation down effectively and quickly and allow the patient to start rehabilitation early.
Pharmacotherapy
Rheumatoid Arthritis requires a combination of medication and other treatments to manage the condition.
Our doctors will prescribe non-steroidal anti-inflammatory drugs (NSAIDS) which have anti-inflammatory and analgesic effects.
Another newly developed class of medication known as disease-modifying anti-rheumatic drugs (DMARDs) are also used to manage the condition. Some of these drugs are also known as biologics drugs (e.g. tumour necrosis factor (TNF) inhibitors).

Surgical Treatments for Rheumatoid Arthritis

Surgery is the last option of treatment for intractable painful Rheumatoid Arthritis, this is only done after careful consideration to see if you are suitable for the procedure. Regardless, surgeries always come with associated risks, complications and downtime – they may not be suitable for everyone.

Surgery
Synovectomy or arthroplasties are done for patients with Rheumatoid Arthritis, these surgeries are done to restore a small extent of the joint function, it is usually determined by multiple disciplines such as the physician, rheumatologist and orthopaedics. In late stage RA, total knee replacement is done to correct the destruction and deformity of the knees. In the situation of hands and fingers, there are no surgeries to correct the joint function lost to RA destruction.

How Can I Prevent Rheumatoid Arthritis?

Although there is no known way to prevent RA entirely, certain behaviours can delay disease onset and minimize its impact on your quality of life.

  • Stop smoking
  • Limit alcohol
  • Eat healthy, especially foods that are rich in calcium and Vitamin D
  • Maintain a healthy weight
  • Stay active
  • Ensure good oral health

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