Rheumatoid arthritis is a very common condition that affects up to one in ninety people worldwide. It affects more women than men but it can affect anybody – from children right through to older people. It’s a disease where the immune system suddenly wreaks vengeance upon the joint tissue and other parts of your body.
White cells which normally should be protecting you from viruses, germs and cancer cells suddenly turn feral and will start attacking your joints. Causing those joints to become painful, red, tender and swollen. Sometimes it just affects one joint but often it affects every joint in the body. Generally leaving the spine alone, but every other joint is fair game.
People often think they have just had a bad virus for a few days but the condition gets worse and worse. Typically people feel quite tired and unwell and even get the odd rash and fever, so it’s easy to see why you might think that it is a virus at first. But it just doesn’t go away and it gets progressively worse.
Rheumatoid arthritis can also affect other parts of the body. Sometimes moving on from the joints to the lungs, the eyes and the skin.
When it is most active, the disease can make you very, very tired and just feel awful. Many people have to stop working and often have to stay home as it can be very disabling. Even in young toddlers, it will negatively impact feeding, walking and weight bearing. Older people will have to go to hospital sometimes because they are so disabled by the disease.
The classic signs are that a person will come through the door, or sadly, literally limp through the door, with terribly swollen feet, fingers, wrists and elbows. Feeling very sore and stiff with joints that look warm, pink and red and be very tender to touch. Morning stiffness is most common, causing people to have trouble getting out of bed, have trouble getting up off the couch and just moving once they have been sitting or lying down for a while.
Once upon a time, the treatments for rheumatoid arthritis were not great. When I first qualified as a young doctor in the early 1980s, all we had available for our patients were high dose aspirin and really toxic drugs like Gold.
Medications available to Rheumatologists now are very effective in turning off the disease, enabling people to go back to a normal life. The challenge is to find the right combination of therapies for each person and, at last count, there were over 20 different therapies for rheumatoid arthritis.
It’s like finding a pair of shoes to comfortably fit your feet or a suit to fit you perfectly. The treatments are very individualised now. There are gentle options right through to incredibly powerful treatments. We need to make the choice of medications depending on how severe the disease is, how early we have the chance to intervene in managing the disease and on each person’s individual response to therapy.
Natural therapies do help with options like Fish Oil and Turmeric being helpful in relieving pain. But these natural therapies do not have a role in actively turning off the disease.
We expect now for people to become completely well, although occasionally, even well people will have the odd flare. Similar to conditions like asthma, where people can be very well most of the time, but still need to use their puffers from time to time, folk with rheumatoid arthritis that is stable can still have the odd flare and need a bit of extra treatment.
The term we use now is “treat to target”. And the target is for people to be pain free, fit and well and have no signs of the disease. When people aren’t treated effectively, the disease can damage the joints. In fact, tissue can build up in the joint which actually eats away the bones and the ligaments. Many patients who have had the disease since the 1950’s and 60’s will have very destroyed joints.
In my clinic, I have new patients that look completely well and normal, compared with older patients from 30 or 40 years ago who have quite damaged joints and have had to go through multiple joint replacement surgeries over the years. There has been a tremendous change in treatments and expectations of outcome in the last 20 or 30 years.
So we very strongly encourage early diagnosis and early treatment. The faster we start treatment, the quicker people get better and our expectation is that people will fully recover from the pain, swelling and stiffness and lead a normal, healthy life. Having children, playing sport and travelling widely. But still having to keep in touch with their doctor regularly to make sure things continue to go well.