RHEUMATOID ARTHRITIS

Dr. Ramkumar © Punarnava Ayurveda May 2008

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Rheumatoid Arthritis Rheumatoid Arthritis (RA) is a chronic multi-system disease of unknown cause.
Rheumatoid arthritis is an autoimmune disorder that causes stiffness and pain in the joints. Although
there are a variety of systemic manifestations, the characteristic feature of RA is persistent
inflammatory synovitis, usually involving peripheral joints. The potential of the synovial
inflammation to cause cartilage destruction and bone erosions and subsequently joint deformities is
the hallmark of the disease. The prevalence of definite RA is approximately in 1 percent of the
population; women are affected approximately three times more often than men.

The prevalence increases with age and sex differences diminish in the older age group. RA is seen
throughout the world and affects all races. The onset is most frequent during the fourth and fifth
decade of life with 80 per cent of all patients developing the disease between the age of 35 and 50.
Characteristically RA is a chronic polyarthritis.

In approximately two-thirds of the patients, it begins with fatigue, anorexia, generalized weakness,
and vague musculoskeletal symptoms until the appearance of synovitis becomes apparent. This
prodrome may persist for weeks or months and defy diagnosis. Signs and symptoms – Pain, swelling
and tenderness may initially be poorly localized to the joints. Pain in affected joints, aggravated by
movement, is the most common manifestation of established RA. Morning stiffness of greater than
1-hour duration is an almost invariable feature of inflammatory arthritis.

The majority of patients will experience constitutional symptoms like weakness, easy fatigability,
anorexia and weight loss. The American Rheumatism Association has developed criteria for the
diagnosis of RA. The presence of seven of these criteria establishes the diagnosis of classic RA,
whereas five criteria indicate definite RA, and three, probable RA.

The criteria are:

1. Morning stiffness

2. Pain on motion or tenderness in at least one joint

3. Swelling in at least one joint

4. Swelling of at least one other joint

5. Symmetric joint swelling

6. Subcutaneous nodules

7. Radiologic changes typical of RA

8. Demonstration of Rheumatoid factor in serum

9. Poor mucin precipitate from synovial fluid

10. Characteristic histologic changes in synovium

11. Characteristic histologic changes in nodules.

(Criteria 1-5 must be continuous for at least 6 weeks. Criteria 2-6 must be observed by a physician)
Clinical course and prognosis –

The course of RA is quite variable and difficult to predict in an individual patient. Five years after the
onset of RA, evidence of disease activity may be found in as few as one-third of all patients.
Remissions of disease activity are most likely to occur during the first year.

Although sustained disease activity of more than 1 year’s duration portends a poor outcome, the
rate of progression of joint abnormalities is not constant; the greatest progression takes place during
the first 6 years of disease and at a much slower rate thereafter.

The median life expectancy of persons with RA is shortened by 3 to 7 years. Of the 2.5 fold increase
in mortality rate, RA itself is a contributing feature in 15-25 percent. Drug therapy may also play a
role in the increased mortality rate seen in these individuals