The brain is the head of the department our body and is the IT head call center of our body.
Ever functions of our body are at the sole discrete decision of our brain empire.
The Central Nervous System which is branched into numerous networks spread throughout the body. Even the Autonomic Nervous System and the Somatic(skeletal muscle) Nervous System which serves as Peripheral Nervous networks too are in some way connected with the Brain Kingdom.
If the brain dies everything will stop and our eternal life starts.
Generally it is very difficult to diagnose RA at the early stages as it is mostly asymptomatic in the beginning.
RA diagnoses are based on their symptoms and laboratory findings as follows.
Diagnoses
1. Joint symptoms such as swelling, abnormal fluid collections in articular cavities, synovial thickening, and edema with pain on motion, indicates the presence of RA.
2. Subcutaneous nodules mostly occur in the sites exposed to external pressure such as elbow, shoulder, and wrist but also in other organs indicates the presence of RA. These nodules are rubbery, round, and firm masses can be identified with fingers.
3. A deeper diagnosis by X-radiation can indicate the presence of asymptomatic early RA by the presence of mild painless soft tissue swellings.
4. A blood test can show the presence of RA factors, heterogeneous antibodies present in most RA patients.
5.ESR test may be high which indicates the presence of early RA.
6. The presence of normochromic, normocytic anemia may indicate the presence of RA.
Treatments
The treatments involve two methodological approaches such as Mechanical and Pharmacological.
Mechanical Methods
The patient should be trained with proper balanced daily exercises and rests as follows:-
1. In the beginning start with how to keep the joints in rest.
2. Start the exercise by step by step movements of the joints without straining them to strengthen the muscles.
3.when return to sleep train how to keep the joints by aligning them by the use of specially designed lightweight splints.
4. Complete immobilization should be avoided.
5. When the above methods fail a mild surgery to improve the functions and movements of hands and knees are advised.
Pharmacological Methods
Analgesics and anti-inflammatory drugs such as aspirin and NSAIDs are beneficial. Paracetamol has not been used as it is not having any anti-inflammatory effects.
Anti-inflammatory drugs at their therapeutic dosage are riskier and the risk factors override the required therapeutic response.
Aspirin
We have already dealt with this drug in detail in another post (9-12-2015) in the same blog under the heading "Paracetamol, Aspirin and other NSAIDs".Please download it.
A piece of additional information is aspirin is the first-line drug to treat rheumatism. Aspirin is used in higher dosage to treat inflammation and it is more economical. But its risk factor overrides its benefits.
Mechanism
Aspirin is acting similar to other NSAIDs but to a lesser extent it is preventing the synthesis and release of prostaglandin.
Dose
4 to 6 gms daily
For side effects please refer to the post "Paracetamol, Aspirin, and Other NSAIDs" in this blog.
Other NSAIDs:-
They are ibuprofen, naproxen, sulindac, and piroxicam. Please refer to the following table.
Actions are similar to aspirin by inhibiting cyclooxygenase 1 and 2 and thereby inhibiting the synthesis and release of prostaglandin.
NSAIDs have the advantage over aspirin by producing the required effects in a much lower dosage than aspirin but are more expensive.
Special Precautions
1. They should be avoided in asthmatic patients as they can elevate bronchospasm. Aspirin is suitable for them.
2. Unlike aspirin NSAIDs reversibly affect the platelet function, hence safer than aspirin but still should be cautious in using them to those who have gastric bleeding.
Misoprostol is used to treat gastric hemorrhages caused by NSAIDs.(Misoprostol dosage:100 to 200 mcg four times daily along with NSAIDs treatment)
3.NSAIDs decrease the renal blood flow and renal failure may ensue in patients who already suffer from less renal flow due to CHF and Diuretic therapy. Sulindac is safer.
4.Liver failure
5.CNS effects such as drowsiness, dizziness, anxiety, tinnitus, and confusion, that disappear on continuous use. Headache is more common with indomethacin
6.Blood dyscrasias(Rare)
7. Naproxen and ibuprofen are safer than other NSAIDs in producing GI effects
Nabumetone causes lesser gastric irritation
Meclofenamate and Mefenamic acid may cause severe diarrhea
Piroxicam which has a longer duration of action may cause higher gastric bleeding. It should be avoided in elderly patients.
Indomethacin can cause more serious CNS effects than other NSAIDs.
Nonacetylated salicylates such as salsalate, choline salicylate are safer than aspirin in aspirin-sensitive patients as they do not have respiratory effects similar to aspirin.
Rheumatoid arthritis is an inflammatory chronic and systemic disease most apparently involved in the synovial joints. The inflammation can spread over extra-articular tendons and organ structures.
Criteria
There are many criteria as follows:-
1.Morning Stiffness
Morning stiffness in any part of our body might have been experienced by somebody else especially at the knees or the feet. This may last for at least one hour.
2.Joints Swelling
At least three joints must have been experiencing swelling with fluid. The possible areas are the wrist, elbow, knee, ankle, and phalangeal (Hand and Feet Fingers) joints.
3.At least One Joint Area
At least one joint area in the hand such as the wrist, metacarpophalangeal(MCP), or proximal interphalangeal(PIP)
4.Symmetric
Simultaneous experience of arthritis in the bone joints at both sides of the body.
5.Subcutaneous Nodules(Rheumatoid nodules)
These nodules must be observed over bony prominences, extensor surfaces, or in juxta-articular regions by a physician.
6.Abnormal Presence Of Serum Rheumatoid Factor
It should be observed by a physician by any methodology
7.Radiological Changes
Bony erosions or decalcifications must be present in the hand or wrist x-ray.
Rheumatoid Arthritis (RA) is more common in women than men with a ratio of 3:1 respectively.
Occurrence
In general, the occurrence is rare (1 to 3%) in early ages, and medial at 30 to 40 years and more common at above 40 years.
Etiological Factors
Although it is still not knowing the exact reasons yet the following might have been observed as the etiological factors.
1. A specific leukocyte antigen is often involving some inflammatory reaction if the individual is exposed to certain environment.75% whites have this antigen while 30% from the rest of the population is suffering from RA.
2. Some infectious diseases may also be as factors to precipitate RA.
Symptoms
1.Synovial swellings with inflammation, with fluid collection and edema. If left untreated the RA becomes chronic and the synovium becomes thick and boggy.
2. The thickened synovium grow inward across the cartilage results in cartilage degradation, loss of adjacent bone, and erosions.
