Arthritis Foundation Malaysia

Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints.

Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It is different from other kinds of arthritis, and is recognised through its symmetrical pattern, where, if one knee or hand is involved, the other one also is. The disease often affects the wrist joints and the finger joints closest to the hand. It can also affect other parts of the body besides other joints. In addition, people with rheumatoid arthritis may have fatigue, occasional fevers, and a general sense of not feeling well.

Rheumatoid arthritis affects people differently. Most people have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability.

Although rheumatoid arthritis can have serious effects on a person's life and well-being, current treatment strategies--including pain-relieving drugs and medications that slow joint damage, a balance between rest and exercise, and patient education and support programs--allow most people with the disease to lead active and productive lives.

In Malaysia, 5 in every 1000 people suffer from rheumatoid arthritis. It occurs across all racial groups, affecting more women than men, and can occur anytime from childhood to old age, although most commonly, symptoms surface between the ages of 30 and 50.

Early treatment of the disease greatly increases a patient’s ability to manage the disease and its effects, and studies have shown that patients who are well informed and participate actively in their own care have less pain and make fewer visits to the doctor than do other patients with rheumatoid arthritis.

Rheumatoid arthritis can be difficult to diagnose in its early stages for several reasons. First, there is no single test for the disease. In addition, symptoms differ from person to person and can be more severe in some people than in others. Also, symptoms can be similar to those of other types of arthritis and joint conditions, and it may take some time for other conditions to be ruled out. Finally, the full range of symptoms develops over time, and only a few symptoms may be present in the early stages. So doctors use a variety of the following tools to diagnose the disease and to rule out other conditions:

Medical history: This is the patient's description of symptoms and when and how they began. Doctors will need the patient's description of pain, stiffness, and joint function and how these change over time to make an initial assessment of the disease and how it changes over time.

Physical examination: The doctor examines the joints, skin, reflexes, and muscle strength.

Laboratory tests: One common test is for rheumatoid factor (RF), which looks for an antibody that is present eventually in the blood of most people with rheumatoid arthritis. However, not all people with rheumatoid arthritis test positive for rheumatoid factor, especially early in the disease. Also, some people test positive for rheumatoid factor, yet never develop the disease. With patients who exhibit some, but not all symptoms of rheumatoid arthritis, and whose RF tests are negative, doctors may still proceed with a further, more accurate anti-CCP test, which looks for the anti-cyclic citrullinated peptide antibody. The anti-CCP test is very useful in early detection since it identifies patients who exhibit no other signs of rheumatoid arthritis. According to the American College of Rheumatology, about 95% of patients who register positive for anti-CCP develop rheumatoid arthritis later on. Given the high cost of anti-CCP testing doctors in Malaysia are more likely to use it only when patients suffer from arthritis-like symptoms, where early diagnosis can provide doctors with a better chance of successfully reducing the effects and progress of the disease.

There is no single way to treat rheumatoid arthritis. Rheumatologists use different combinations of drug and treatments at different times during the course of the disease, chosen according to the patient's individual situation. No matter what treatment choice, the goals are always to relieve pain, reduce inflammation, slow down or stop joint damage, and improve the person's sense of well-being and ability to function.

People with rheumatoid arthritis need to balance between rest and exercise, resting more when the disease is active and exercise more when it is not. Exercise helps in maintaining strong muscles, preserving joint mobility, and maintaining flexibility as well as reducing stress.

Observing an overall nutritious diet with enough nutrients is important, and some people may need to be careful about drinking alcoholic beverages because of the medications they take. Those taking methotrexate may need to avoid alcohol altogether because one of the most serious long-term side effects of methotrexate is liver damage.

Most rheumatoid arthritis patients take medications. Some medications are for pain relief; others are used to reduce inflammation. Still others, often called disease-modifying antirheumatic drugs (DMARDs), are used to try to slow the course of the disease. The type and length of drug use depends on a person's general condition, the current and predicted severity of the illness, the length of time he or she will take the drug, and the drug's effectiveness and potential side effects

Biologic response modifiers are new drugs used for the treatment of rheumatoid arthritis. They can help reduce inflammation and structural damage to the joints by blocking the action of cytokines, proteins of the body's immune system that trigger inflammation during normal immune responses. Three of these drugs, etanercept (Enbrel*), infliximab (Remicade), and adalimumab (Humira), reduce inflammation and joint damage by blocking the action of TNF-α molecules. Another drug in use is the anti-CD20 biologic ritumixab (Mabthera). Patients should also be aware that there are other biologics medications in the pipeline for the specific treatment of rheumatoid arthritis.

For patients with severe, rapidly progressing rheumatoid arthritis, studies show that early treatment with more powerful drugs, and the use of drug combinations instead of one medication alone, may be more effective in reducing or preventing joint damage. Once the disease improves or is in remission, the doctor may gradually reduce the dosage or prescribe a milder medication.

* Brand names included in this are provided as examples only, and their inclusion does not mean that these products are endorsed by any Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Patients with severe joint damage sometimes opt for surgical procedures like joint replacement and tendon reconstruction. It has to be stressed that surgery is only an option if treatment with medications do not halt severe joint damage. With newer treatments and treatment strategies, especially if started early, surgery is increasingly rare.

Joint replacement: is the most frequently performed surgery for rheumatoid arthritis, and is done primarily to relieve pain and improve or preserve joint function. Artificial joints are not always permanent and may eventually have to be replaced.

Tendon reconstruction: is used most frequently on the hands, reconstructs damaged tendon by attaching an intact tendon to it, to help to restore hand function.

Rheumatoid arthritis patients require regular medical care to monitor the course of the disease, determine the effectiveness and any negative effects of medications, and change therapies as needed.

Patients should also work on preventing osteoporosis - a condition in which bones become weakened and fragile - as part of their long-term, ongoing care. Having rheumatoid arthritis increases the risk of developing osteoporosis for both men and women, particularly if a person takes corticosteroids. Such patients may want to discuss with their doctors the potential benefits of calcium and vitamin D supplements, hormone therapy, or other treatments for osteoporosis.

Alternative and Complementary Therapies: Special diets, vitamin supplements, and other alternative approaches have been suggested for treating rheumatoid arthritis. Although many of these approaches may not be harmful, controlled scientific studies either have not been conducted on them or have found no definite benefit to these therapies. Some alternative or complementary approaches may help the patient cope or reduce some of the stress associated with living with a chronic illness. Patients should consult their doctors before beginning an alternative or new type of therapy.

Tender, warm, swollen joints
Symmetrical pattern of affected joints
Joint inflammation often affecting the wrist and finger joints closest to the hand
Joint inflammation sometimes affecting other joints, including the neck, shoulders, elbows, hips, knees, ankles, and feet
Fatigue, occasional fevers, a general sense of not feeling well
Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest
Symptoms that last for longer than a few weeks
Variability of symptoms among people with the disease