Rheumatoid arthritis (RA) is a term many have heard, yet few truly understand. Beyond the common misconceptions, this autoimmune disorder affects more than just the joints.
In this article, we discuss RA, exploring its causes, symptoms, and ways to manage this complex condition with Dr Lui Nai Lee, a specialist rheumatologist and founder of Lui Centre for Arthritis & Rheumatology.
Question: What are the early signs of RA that people should be aware of, and how does it differentiate from other forms of arthritis?
Dr Lui: The first sign of RA is joint pain. The joint pains commonly affect the peripheral joints like the finger and wrist joints. It tends to affect both sides of the limbs. In the mornings or after inactivity, the patient may experience significant stiffness and weakness in the affected joints. For example, one may find it difficult to open a bottle cap in the mornings.
It is difficult to differentiate early RA from other types of arthritis e.g. Osteoarthritis, but some tell-tale signs include recurring patterns of joint pains and stiffness in the mornings for more than 1-2 weeks. The second telltale sign is joint swelling and inability to remove or insert the ring. One may also have weakness in the affected joints.
Question: How has the treatment paradigm for Rheumatoid Arthritis evolved over the last decade?
Dr Lui: There are many new therapies for RA. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) are still the mainstream therapy and remain effective for most patients. Examples of csDMARD include Methotrexate, sulphasalazine, hydroxychloroquine and leflunomide. Newer therapies eg biological DMARD (bDMARD) and targeted synthetic DMARD (tsDMARD) have shown good results in sufferers with the refractory or persistent disease despite the usage of csDMARDs.
bDMARD and tsDMARD usage allows for weaning of steroidal and csDMARD in patients with moderate or high disease activity. Very often, patients in this group require moderate to high doses of steroids to control the disease activity. They may suffer from steroid-related complications (eg. central obesity, cataract, osteoporosis etc) or adverse reactions with high dose csDMARDs.
With better control of RA disease activity, rheumatologists are now able to retard disease progression even in patients with very active disease, hence, significantly reducing risk of joint damage and loss of function and risk of systemic disease eg lung inflammation.
What are the implications if left untreated?
Dr Lui: Uncontrolled RA leads to joint damage and loss of function of the affected joint(s). In every patient, there is an active inflammatory phase when treatment (if given early, correctly and in adequate doses) will help to reverse the inflammation and limit the damage, if any.
Are there any lifestyle changes or interventions that can reduce the severity or progression of RA?
Dr Lui: Treatment of RA requires combined effort with your doctor, your family and yourself!
Apart from medication, non-pharmacological intervention is important as well. Lifestyle changes include smoking cessation, weight reduction, balanced diet as well as stress reduction. Based on recent findings, you may drink small quantities of alcohol provided it does not interfere with your medications. Patients often do better when they receive support from family and friends. Do not be demoralised if you are not seeing results, as lifestyle modifications take time to effect.