Conquering Rheumatoid arthritis

That Rheumatoid Arthritis is a serious & disabling condition is fairly well known. However, it often comes as a surprise to many when informed that it is also controllable. We should consider ourselves blessed when compared to our forefathers given the recent treatment options & outcome of rheumatoid arthritis.

One can achieve conquest over Rheumatoid Arthritis when diagnosed & treated early with definite medicines (DMARDs).

The problems with early diagnosis are manifold. Joint complaints are often ignored in the initial stages. The current medical educational system lays emphasis on obvious emergencies & life threatening diseases like heart attack, stroke & infectious diseases like tuberculosis. Thus many of the Family physicians are not well trained in early diagnosis of Rheumatoid arthritis. I’m sure it remains a big responsibility of the Rheumatologist fraternity along with the academic bodies to look after training of the family physicians in musculoskeletal ailments.

Many patients thus end up wasting precious time at this first step of contact with the primary caretaker. Frustration over their complaints & inappropriate guidance may lead them to alternative systems. The Indian system is plagued with numerous ‘so called traditional system doctors’ who administer steroids & spoil the long term prognosis for them. Quick suspicion & immediate referral by a family physician to a Rheumatologist will definitely change their life.

The second step for these patients is accessing a Rheumatologist. I must confess that Rheumatologists are too few & everyone has a long waiting list. A 6- 8 weeks appointment delay obviously eats into the therapeutic window of RA patients. Time is lost at the cost of joint function in these patients. It remains a collective responsibility of us Rheumatologists to bear this in mind so as to maintain the least possible waiting period for a new RA patient.

The next step at the Rheumatologist’s can be plagued by its own set of problems. The first & foremost is the self denial of diagnosis. The myths about arthritis in the society, the so called uncontrollable nature of RA plays an important role in this denial. A gentle reassurance by the Rheumatologist & interaction with old patients in the clinic generally allay the initial fears. The general fear that treatment is based on steroids often plays a spoilsport at this step. All recent research studies have shown that early & aggressive treatment with DMARDs (like Methotrexate, Leflunomide etc) leads to remission.

The time from onset of symptoms to control of RA activity remains the main determinant of the conquest over Rheumatoid Arthritis. Many patients falter at each of these steps & fall into the nadir of the never ending pain of rheumatoid arthritis. The family physician, Rheumatologist & the society share their own set of responsibilities in helping these patients achieve conquest over their arthritis.

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10 Responses to Conquering Rheumatoid arthritis

  1. Samina says:

    Truely Doc,
    I am a RA since 10 years. Was diagnosed too late.. 5 years after the problem started. I am already having deformities. Life is a hell with persistent aches & pains. I feel I should have been diagnosed early n treated early.

    Like

  2. Barbara says:

    My mother has RA, and became very ill and disabled with it while doctors were figuring out what was wrong with her (she finally got diagnosed after a couple of years).

    Luckily for me, her experience made me vigilant, and I talked to my doctor at the first, smallest signs of RA. If I didn’t have the history, I would have ignored the symptoms too long.

    Like

  3. Jamie Herr says:

    Dear Dr.,

    I just discovered your web site today after reading one of your comments on the Arthritis Warrior site. I am happy to see your comments there and encourage you to write more.
    While reading the Conquer Rheumatoid Arthritis article I realized the fatal mistakes I made that may now determine the success of conquering this disease. I am a pharmacist and was lucky enough to get a diagnosis within 4 months of onset by pushing. I had moved to Canada from the US and did not know any physicians here. A friend referred me to a “genius” of a rheumatologist. The fellow is in his 60’s in solo practice. He is very bright but very “old school”. He is definitely in the conservative “wait & watch” rheumatologist category. I did get a second opinion from a younger rheumatologist and he wanted to start MTX right away but did not discuss or even mention the new aggressive treatment theory. Unfortunately, I stayed with my old rheumatologist and now in 1 1/2 years my RA has basically spread to every joint in my body. Last month I pushed for MTX therapy. I have been on it for 4 weeks now and am feeling so much better. I wish I had started it much sooner…….perhaps the RA would not have spread everywhere so quickly. My rheumatologist said he just didn’t think that I would have such an aggressive form of RA because I am seronegative.

    That leads me to ask, isn’t that an “old school’ theory too? Everything I have read does not support that seronegative RA is any less aggressive than seropositive and there aren’t different treatment plans for the two? Correct?

    Should have trusted and listened to my own instincts.

    Like

    • Dear Jamie,

      The rule of thumb for RA is “Do not underestimate any RA, be it seronegative or seropositive; diagnose it early & treat it early with DMARDs like methotrexate.”
      The aim is push it into remission as early as possible.

      Time lost in diagnosis/ DMARDs initiation is magnified into loss of function for the RAer in the long run.
      Thanks for the appreciation/ encouragement to write more & You will definitely see more posts on RA.

      Like

  4. rachel says:

    at the beginning when i was 7 , my jra was also misdiagnosed as some rheumatic fever or smthing that sounds like this…
    that wrong diagnosis made me have so painful injections evry fortnight…..

    Like

    • JRA is commonly misdiagnosed as rheumatic fever. High ASO titers being given undue importance (rather than the pattern of arthritis one has) has been the main reason for this.

      However, things have been changing over the recent years. As the awarenss about various rheumatological illnesses is increasing these misdiagnosis examples are on the decline.

      Spreading information & increasing the awareness regarding arthritis would avoid such mistakes in the long run.

      Like

  5. K V Rao says:

    My wife had all the symptoms typical of RA / gouty arthritis but without any indications in blood tests and X rays. Uric acid level mostly with in the limits but in occasional test was shown slightly above limits. For some time she was prescribed Zyloric but she had swollen joints while still being on zyloric. So they discontinued. She was on and off on pain killers. So far there is no permanent cure for her. Recently, while she was in Bangalore, she visited a rheumatologist who diagnosed her to be case of palindromic rheumatic disorder. She was given a shot depomedrol stat and asked to take HCQS for 3 months. I seek your opinion on the treatment strategy.

    Like

  6. Gaurav Gupta says:

    Dear Sir,
    My Mom is 46, she’s diagnosed with RA six months back.Recently the pain in her hand crossed her toleration limit,and when consulted to a doctor he’s advised her PREDNISOLONE for 16 days.I want to know whether it could create any side effects in the body and what pecautions to take.She’s neither a patient of BP nor of diabetes.

    Thanks

    Like

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