‘Rheumatoid arthritis patients should seek early treatment

Patients can benefit from a “window of opportunity” and avoid permanent joint damage if treatment of Rheumatoid Arthritis (RA) is started early on, according to doctors. They also add that discovery of new drugs and constant monitoring have given a new lease of life to several patients. Supported by new and highly effective drugs, as well as unique disease monitoring methods, patients can benefit from treatment techniques that have become much stronger over the last 10-15 years, they say. “Diagnosis of RA is based on the sum total of signs, symptoms and results of blood tests and x-rays. No single test can give a definite diagnosis of rheumatoid arthritis in the early stages of the condition,” says Dr Sukhbir Uppal, senior consultant in Rheumatology at University Hospital in Sharjah. The ultrasound examination, as an extension of the clinical examination, permits not only diagnosis but also allows easy explanation and demonstration of abnormalities to the patient at the same time, he says. Dr Uppal also adds that ultrasound is proving to be increasingly handy in the evaluation of the musculoskeletal system for pinpointing presence of fluid in joints, joint erosions, inflammation in and around joints and injuries in the early stages of the disease. “Ultrasound evaluation, if done at the right time, can help us locate that ‘window of opportunity’ that can enable us to start the treatment at the right time,” he explains. “Compared to X-rays, CT scans and MRI, ultrasound has several advantages such as ready availability, quick scan time, low cost, and absence of radiation,” he points out. Interventional procedures using ultrasound guidance such as joint aspirations, joint injections, and soft tissue injections can also aid in the treatment of rheumatologic conditions. RA is an autoimmune disease, meaning that the body’s immune defenses attack the body’s tissues, mainly the joints for reasons that are still largely unknown. RA is also known as “multi-factorial” disease - partly caused by our genes and partly due to certain environmental factors. Worldwide, approximately three out of every 10,000 persons are afflicted with RA each year. Females are three times more likely to get RA than males, though this difference becomes less distinct in older age groups. However, the disease can affect adults of all ages but is more common between 40-50 years of age. In children, the disease is known as juvenile Idiopathic Arthritis. Like all chronic diseases, treatment for RA is life-long and patients are often required to take more than one drug to treat the disease. “Treatment options are increasing day by day, and most people can live normal productive lives with appropriate treatment,” says the expert. A new and highly effective group of drugs known as “biologics” has made the treatment armamentarium much stronger over the last 10-15 years. “Biologics are a group of drugs that can block the action of chemicals called cytokines (i.e. anti-tumor necrosis factor (TNF) and they represent an exciting advancement in the treatment of rheumatologic diseases over the conventional disease modifying anti-rheumatic drugs (DMARDs),” explains Dr Uppal. “They are not only effective in controlling inflammation, but also in stopping joint damage evidenced by erosions of the joints.” To date, there is no cure for chronic diseases like RA. However, the use of biologics results in good disease control and/or remission, in addition to an inhibition of further disease progression. “Serial ultrasound scanning is also effective in monitoring treatment response to some biologics,” he adds. Studies have shown that joint damage develops in 65 per cent of the patients over first three years with the majority of the damage, about 75 per cent, appearing already in the first year. Thus, patients with RA are at substantial risk for progressive joint damage, disability, and a shortened life span, adds Dr Uppal. Dr Ghalib Abdulhameed Tuama, rheumatologist at Umm Al Quwwain Hospital and Gulf Medical University Hospital, reiterates that early detection of the disease can lead to better treatment and a higher chance of achieving and maintaining remission. “Patients can act as their own doctors in diagnosing the disease in the early stages,” he says. Pain in three or more joints, early-morning joint stiffness of greater than 30 minutes and pain on squeezing of the knuckles of the hands on both sides indicate a great possibility of RA, says Dr Tuama, urging patients to refer to a rheumatologist if symptoms persisted. ( from the gulf today )