Understanding and identifying RD

RD is the leading cause of disability in India and many other countries.

Image used for representational purpose only.

KOCHI: The Indian Rheumatology Association (IRA) has designated April as Rheumatic Disease Awareness Month (RDAM) to draw attention to the painful autoimmune and inflammatory diseases that affect all age groups. RD is the leading cause of disability in India and many other countries. So, awareness about the symptoms, risk factors, early diagnosis and specialised treatment can equip patients to handle their condition better as well as improve their quality of life.

What is rheumatic disease:

RD causes damage to joints, muscles, tendons, ligaments, bones and also vital organs like lungs, the nervous system, heart, kidney, eye and skin. There are more than 100 types of RD. Some of the most common are rheumatoid arthritis (RA), osteoarthritis (OA), fibromyalgia syndrome (FMS), lupus (SLE), psoriatic arthritis (PSA), Sjogren’s syndrome (PSS), gout and scleroderma (SSc).

The lack of awareness about RD increases the risk of long-term pain and damage to the joints, bones, vital organs and body systems. In RD, the immune system confuses the body’s healthy organs with foreign bodies and attacks them. Understanding the symptoms and getting timely treatment is therefore essential.

The goal of RDAM is to educate people about the risks and treatment options. It also considers the effects of economic impact on lifestyle and subsequent health care challenges.

Symptoms

The symptoms of RD can be difficult to recognise and are generally confused with other features that are indicative of ageing. Unfortunately, many people live with these diseases for years before being diagnosed correctly. RD is believed to be triggered by a combination of genetic and environmental factors. Though the exact cause cannot be pinpointed in an individual patient. The risk of RA and OA increases with age, but these conditions can occur at any stage of life. Paediatric RD affects children of all ages and many of the symptoms persist in adulthood. RD is generally a chronic disease and new symptoms can develop during its course. The symptoms can worsen and lead to severe complications. While pain is the most common symptom, it must be remembered that “not all pains are due to RD”.

Chronic and debilitating pain

• Swelling, tenderness, redness, restriction of movements, local rise in temperature of joints and body parts
• Early morning and rest stiffness
• Muscle pain
• Pain and stiffness of back, neck and spine
• Joint deformities
• Rashes, sores
• Numbness and tingling sensation of hands and legs
• Easy fatigability
• Difficulty to move joints, pain in the eyes and redness

Risk factors

• Women are more prone to develop diseases like RA, SSC, PSS, FMS and lupus.
• Family history increases risk
• Smoking, especially in genetically predisposed people, can increase the risk of contracting RA
• Environmental exposure to certain chemicals like asbestosis or silicosis
• Higher levels of oestrogen
• Higher levels of stress induce flaring up of RD

Types of RD

RA, OA, gout, FMS, spondyloarthritis (SpA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), FMS, SLE, PSS, SSC, osteoporosis, polymyalgia rheumatica (PMR), myositis, vasculitis, bursitis, tendonitis etc are some of the common RDs. Each RD has got different patterns and a specialist can very easily diagnose them in most of the cases during the first consultation itself.

Diagnosis

Timely diagnosis and treatment will help in slowing the progression of the disease, prevent irreversible damage and attain early remission. The sooner the patient is identified and referred to the specialist, the better the chance of managing the disease. Some diseases like gout can be diagnosed easily but are challenging especially in the early stages.

Elements for diagnosing RD

• A carefully detailed history
• Detailed examination including range of movement of joints, reflexes, other system examination
• Investigations including blood, urine tests, tissue biopsy in specific cases
• Imaging to assess the progression of diseases.

Treatment

Treatment aims to decrease pain and stiffness, decrease the progression of the disease and achieve remission. Affordability is a major concern for patients and so many cases are aggravated due to a lack of timely intervention.

Medication

Disease-modifying antirheumatic drugs (DMARDs) include conventional DMARDs, small molecules and biologicals. These medicines can be given through oral, subcutaneous or intravenous routes. Painkillers and steroids may be needed in individual cases which may be given through oral, intravenous, topical or intra-articular routes.

Lifestyle modifications, including diet, exercises, physiotherapy and meditation have been found to complement medication. In some cases, once the damage has already set in, surgical correction may be needed. Patients who experience musculoskeletal (MSK) symptoms usually consult a general practitioner, general physician or orthopaedician. Alternate medical practitioners are more commonly consulted in Kerala. However, the lack of specific treatment can lead to the quick progress of inflammation, subsequently causing permanent damage.

The author is Consultant Rheumatologist at Medical Trust Hospital in Kochi