Rheumatoid Arthritis (RA) is an inflammatory ailment that affects multiple joints. However, this is too simple a picture. RA has systemic manifestations & can involve other organs like eyes, lungs, nerves as well. In fact, we now call it Rheumatoid Disease as it is more than just arthritis.
Unchecked rheumatoid inflammation in the joints damages the joints (as seen previously on this blog). It can destroy the cartilage in the joints & leads to secondary osteoarthritis. This is common in the knee due to the weight bearing.
Surgical intervention like TKR (Total Knee replacement), THR (Total Hip replacement) are used to take care of the damaged joint. Once severely damaged, knee replacement surgery remains the best option. TKR, THR thus take care of the mechanical problem in the involved joint. It does not take care of the RA activity. Hence the surgery will have no implications on the inflammation in the other joints.
Whenever a patient with an autoimmune disease (Rheumatoid arthritis,Ankylosing spondylitis, Lupus) on DMARDs (Disease Modifying Anti rheumatic drugs like Methotrexate, Leflunomide) or biologics gets an infection, the DMARDs/ biologics are always blamed. The patient tends to get into a reflective mode thinking whether these drugs should have been prescribed in the first place.
What exactly happens in an autoimmune ailment is that the self immunity, that is actually meant to protect the body; instead starts attacking the body joints & organs. It, in fact, starts behaving like a bad cop. The bad cops; instead of protecting the city, start robbing its own citizens.
DMARDs/ biologics suppress the immunity & do not let the immunity attack the self organs. This is akin to locking the bad cop for what he is doing (mind you there are not one but too many bad cops in autoimmune ailments). Now, when the city cops themselves are in jail, it is a difficult situation when real robbers actually arrive. There are not many good cops to protect it. Robbers then have an easy task set out.
This is exactly what happens when an infection strikes. The immunity that is suppressed by DMARDs/ biologics is not able to mount a strong response. However, as you must have understood, blaming them is not the solution.
It is always a tight rope walk for all the Rheumatologists to keep the disease activity under check with DMARDs/ biologics & avoid too much of an immunosupression at the same time.
So, when on DMARDs/ biologics:
1. In case of any fever/ infection, contact your Rheumatologist immediately.
2. In case of any fever/ infection, stop the DMARDs/ biologics immediately & seek Rheumatologist’s opinion.
Image cortesy: http://www.1clipart.com/