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Saturday, May 20, 2017

Decoding the disease - Autoimmune Arthritis- An expert insight into the disease by Dr. Sandeep Wasnik



The most frustrating experience in each patient's life is the period between visiting a doctor and reaching the ultimate diagnosis and giving a name to all the pain and suffering you have been living with in the form of Diagnosis of Disease. 
This journey can be quite frustrating and lonely. What better way to understand about the disease than from the expert himself.
On World Autoimmune Arthritis Day we help you decode the disease with the help of Dr. Sandeep Wasnik. 

Q. What it is?
A. This disease causes your body’s immune system to mistakenly attack normal cells. In this disease, our own immune system starts attacking synovium (lining of our joints) which causes inflammation (swelling, pain, deformity).
Q. Who gets the disease?
A. No age is immune to the disease; people of all ages can get affected.
Q. What are the symptoms of autoimmune arthritis?
A. There is a slow onset of symptoms, and sometimes there is waxing and waning of symptoms too. There is an asymmetrical onset of symptoms on both sides of the body.
Major presenting features as follows
1.       Deformity of joints
2.       Presence of hard nodules under the skin of arms
3.       Decreased  range of motion in affected joints
4.      Weight loss
5.       Eye symptoms:  inflammation, dry eyes, itchy eyes, eye discharge
6.       Fever
7.       Anemia (decreased Hb %)
8.       Chest pain (because of involvement of lining of the lung)


Q. What is the prevalence of the disease?
A. Globally 0.5% in us 1% in Europe and 0.75 %in India.

Q. What are the risk factors?
A. The likelihood of you having autoimmune arthritis is influenced by certain risk factors
·         Gender: women have a higher prevalence
·         Age: symptoms can start at any age but most pt comes to the OPD between 40 to 60 years.
·         Positive family history: the chances of having RA increases if you parents or family member have RA
·         Smoking: cigarette smoking can increase your chances of developing RA. Quitting can lower your risk.

Q. How it can be diagnosed?
A. Autoimmune diseases tend to share symptoms with other conditions so diagnosis can be difficult, particularly in the early stages.
So there’s no one test that can specifically diagnose RA. In fact, diagnosis involves clinical examination, patient-reported symptoms, and medical tests, mainly:
1.       Rheumatoid factor test (RF)
2.       Anti-cyclic citrullinated peptide antibody test(Anti-CCP)
3.       Blood count
4.       Erythrocyte Sedimentation Rate (ESR)
5.       c-reactive protein(CRP)
6.       x-ray
7.       ultrasound
8.       MRI scan
You can help with diagnosis by telling your doctor the complete medical history and keeping a record of the symptoms

Q. What is the treatment?
A. Treatment varies according to disease symptoms and age. The treatment may go lifelong in some cases. Eg:-
1.       NSAID’s (nonsteroidal anti-inflammatory drugs)
2.       DMARD’s (disease modifying anti-rheumatic drugs)
3.       Corticosteroids
4.   Biological agents(tocilizumab, certolizumab, etanercept, adalimumab, anakinra, infliximab, rituximab)
5.       Immunosuppressant drugs
6.       Tnf-alpha inhibitors.

Q. What is the importance of physical therapist?
A. The physiotherapist helps you keep flexible and avoiding stiffness. Physical therapy goes a long way to avoid joint deformity.
Q. Will I require a joint replacement surgery?
A. A patient who have severely deformed knee and hip joints, can’t be treated completely by medical and physical therapy alone. This pt with advanced arthritis requires total hip replacement and total knee replacement surgery.

After replacement surgery, the patient becomes complete pain-free in that particular joint.

Q. What are other complications of autoimmune arthritis?
A. Autoimmune arthritis has a varied presentation like:-
1.       Carpel tunnel syndrome,
2.       Osteoporosis,
3.     Lung related complications like(blockage of small airways-bronchiolitis obliterans, high blood pressure in lungs-pulmonary hypertension, fluid in chest-pleural effusion, scarring in lung tissue-pulmonary fibrosis)
4.  Heart-related complications like(hardening of arteries, inflammation in lining of lung-pericarditis, inflammation in muscle of lung-myocarditis, inflammation of blood vessels-rheumatoid vasculitis and heart failure)

To sum up autoimmune arthritis is manageable with newer modalities of treatment newer biological treatment and joint replacement surgeries can bring a patient back on their feet’s.

If you want to know more about the disease or seek an expert opinion feel free to contact us anytime at 022-67676738/67676739
Or have a look at our expert Dr Sandeep Wasnik, from the department of Orthopedic surgery at SevenHills Hospital, Mumbai.

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