Rheumatoid Arthritis: Can It Be Cured Permanently?

Rheumatoid Arthritis : can it be cured permanently?

Rheumatoid Arthritis (RA) is a chronic autoimmune disease characterised by systemic inflammation that primarily targets joints, leading to various complications that significantly impact patients’ quality of life. Despite considerable advances in medical science, a permanent cure for RA remains elusive. Current treatment strategies focus on managing symptoms and preventing complications, utilising a range of therapies and medications designed to improve patients’ overall health and wellbeing.

Understanding and Pathogenesis of Rheumatoid Arthritis

The intensity of RA symptoms varies significantly among patients, influenced by factors such as age, gender, genetic predisposition, and environmental exposures like cigarette smoke and air pollutants. Without effective management, RA can cause irreversible joint damage and lead to severe complications such as Rheumatoid Vasculitis and Felty syndrome, potentially necessitating surgical interventions like arthroplasty or splenectomy.

Research indicates that RA initially affects smaller joints and, over time, the inflammatory process extends beyond these to involve the skin, eyes, heart, kidneys, and lungs. This progression underlines the immune system’s critical role in both the disease’s development and its management. The associated damage to tendons and ligaments often results in deformities and bone erosion, further exacerbating discomfort and severely impacting the patient’s quality of life.

Distinctive symptoms of RA include morning stiffness lasting over 30 minutes, fatigue, fever, weight loss, and tender, swollen, warm joints. Recognising these early signs is crucial for timely diagnosis and treatment, significantly improving the prognosis and quality of life for those affected by this chronic condition.

Stages and progression of Rheumatoid Arthritis
Progression of RA

Distinguishing Between Rheumatoid Arthritis and Osteoarthritis through Clinical Manifestations

Rheumatoid Arthritis (RA) and Osteoarthritis (OA) are prevalent arthritis forms, each displaying unique clinical features and underlying pathological mechanisms. Accurately recognising these differences is essential for proper diagnosis and management.

Affected Joints and Symmetry:

  • Rheumatoid Arthritis (RA): RA predominantly affects synovial joints, specifically targeting the proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints. It usually presents symmetrically; if one joint is affected, the corresponding joint on the opposite side is likely also affected.
  • Osteoarthritis (OA): Conversely, OA is a degenerative joint disease that primarily damages cartilage, often affecting the distal interphalangeal (DIP) joints, knees, hips, and spine. OA does not necessarily show the symmetrical joint involvement seen in RA.

Morning Stiffness Duration:

  • RA: Individuals with RA typically experience morning stiffness lasting more than 30 minutes, reflecting the disease’s inflammatory nature.
  • OA: Those with OA generally have a shorter stiffness duration, usually resolving within 30 minutes, indicative of its mechanical and degenerative origin.

Diagnostic Approaches:

  • Blood Tests: RA diagnosis may involve blood tests such as the Rheumatoid Factor (RF) and Anti-Cyclic Citrullinated Peptide (anti-CCP) tests, where elevated levels can indicate RA but may also appear in other conditions.
  • Imaging Studies: Imaging is crucial for distinguishing RA from OA. RA-related changes may include joint space narrowing, erosions, and periarticular osteopenia, visible on X-rays. In contrast, OA images might show joint space narrowing, subchondral sclerosis, osteophytes, and sometimes subchondral cysts, all reflecting cartilage and bone degenerative changes.

Understanding these distinctions helps guide effective management and treatment strategies, improving outcomes for those affected by these conditions.

Treatment Plans for Rheumatoid Arthritis

Rheumatoid Arthritis treatment options
Treatment plans for RA

As a cure for RA is currently unavailable, the primary treatment goals focus on symptomatic relief and preventing or slowing further damage. Therapeutic approaches typically involve a combination of pharmaceutical interventions, weight-bearing exercises, patient education about the disease, and rest. These treatments are often tailored to a patient’s needs and depend on factors such as disease progression, the joints involved, age, overall health, occupation, compliance, and lifestyle changes. Managing Rheumatoid Arthritis effectively often requires a comprehensive approach that includes both medical treatment and exercise.

First-Line Management: NSAIDs and Corticosteroids

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment for RA, aiming to relieve pain and decrease inflammation. NSAIDs such as acetylsalicylate (Aspirin), naproxen (Naprosyn), ibuprofen (Advil and Motrin), and etodolac (Lodine) can provide fast-acting relief and are a key component of RA medications for pain management.

Corticosteroids, such as prednisone, offer a more potent anti-inflammatory effect than NSAIDs but carry a higher risk of side effects. For this reason, they are typically indicated for short periods and at low doses during RA exacerbations or flares.

Opioid Analgesics

While opioid analgesics like codeine, dextropropoxyphene, and tramadol may provide short-term relief for RA pain, their potential adverse effects often outweigh the benefits. As a result, other analgesics are usually considered as initial treatment options.

Second-Line Management: Disease-Modifying Antirheumatic Drugs

Disease-modifying antirheumatic drugs (DMARDs), including conventional DMARDs like methotrexate (MTX), hydroxychloroquine (Plaquenil), and sulfasalazine (Azulfidine), serve as the second line of treatment. They aim to promote remission by slowing or stopping the progression of joint destruction and deformity, and can reduce the risk of developing lymphoma associated with RA.

Newer Medications

Recent advancements in RA treatment have introduced newer medications such as Leflunomide, an oral medication, and biologic agents like etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), and certolizumab pegol (Cimzia), which are part of biologic therapy including anti-TNF therapy (drugs that help stop inflammation).

Surgical Interventions

Surgical intervention, including Rheumatoid Arthritis surgery and joint fusion, is considered a last resort for RA treatment. Indications for surgery include intractable joint pain or functional decline due to joint destruction after all nonsurgical approaches have failed. The goal of surgical management is to relieve pain for the patient and restore the function of the joints.

Other Therapies

Patients with RA may benefit from a variety of non-pharmacological interventions alongside their prescribed treatments. These interventions can help manage symptoms and improve quality of life.

  • Occupational Therapy and Assistive Devices: Guidance from occupational therapists and the use of assistive devices can make daily activities easier and less painful.
  • Physical Therapy: Regular sessions can help maintain joint mobility and strengthen the muscles around the joints, which in turn can provide support and reduce stress on the joints.
  • Exercise: A tailored exercise program can help in maintaining flexibility, improving endurance, and strengthening the muscles that support the joints.
  • Dietary Supplements:
    • Fish Oil and Omega-3 Fatty Acids: These supplements have been shown to have anti-inflammatory effects, which can be beneficial for RA patients.
    • Cumin: This spice is also known for its anti-inflammatory properties and can be included in the diet to help manage symptoms.

Medical Cannabis

In recent years, the therapeutic potential of medical cannabis has been a topic of significant interest within the medical community, especially when it comes to managing chronic pain conditions such as RA. The active compounds in medical cannabis, primarily THC and CBD, have been recognised for their anti-inflammatory properties, which can play a crucial role in alleviating the discomfort and pain associated with RA. Here’s a closer look at how medical cannabis fits into the broader spectrum of treatment options for chronic pain:

Anti-inflammatory Properties of Medical Cannabis

  • THC and CBD: These are the two main active compounds found in cannabis. THC is known for its psychoactive effects, while CBD is non-psychoactive and has been widely studied for its therapeutic benefits.
  • Pain Relief: By interacting with the body’s endocannabinoid system, these compounds can help reduce inflammation and thereby decrease pain sensation. This is particularly beneficial for individuals suffering from chronic conditions like RA, where inflammation is a key contributor to pain.

Tripterygium Wilfordii Hook. F as a Treatment Option

In addition to these modern treatments, Tripterygium Wilfordii Hook. F, known as Thunder God Vine, is recognised for its anti-inflammatory and immunosuppressive properties. Derived from a traditional Chinese medicinal herb, it has shown potential in reducing symptoms and joint damage in RA. However, its use requires careful management due to potent effects and possible side effects, underlining the importance of professional guidance in its administration.

Navigating Rheumatoid Arthritis: A Path to Symptom Management and Quality of Life

Despite the absence of a permanent cure, efforts are concentrated on symptom management and halting disease progression. A comprehensive treatment approach is essential, incorporating pharmaceuticals to regulate chemical imbalances, rehabilitative therapies for maintaining joint functionality, lifestyle adjustments including diet and exercise, and possibly surgical interventions for severe cases.

RA is distinct from other arthritis forms like osteoarthritis, with unique clinical manifestations and diagnostic tests emphasising the need for prompt, precise diagnosis. The treatment spectrum for RA is wide, ranging from NSAIDs and corticosteroids to DMARDs and advanced therapies like biologic agents and neurostimulation. Additionally, non-pharmacological measures such as physical and occupational therapy, customised exercise programs, and dietary supplements play a crucial role in symptom management. Addressing RA’s complexities requires an integrated treatment strategy that merges medical, physical, and lifestyle measures, aiming to enhance the lives of those afflicted by this challenging condition.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Latest News

Obesity rates in Australia
IBS (irritable bowel syndrome) vs ulcerative collitis vs Crohn's disease (ir ritable bowel disease)
Understanding cachexia
Irritable bowel syndrome symptoms & treatments

Suggested Reading

Obesity rates in Australia
IBS (irritable bowel syndrome) vs ulcerative collitis vs Crohn's disease (ir ritable bowel disease)