Rheumatoid Arthritis (RA) is the most common form of chronic inflammatory joint disease. In its typical form RA is a symmetrical, destructive and deforming polyarthritis affecting small and large synovial joints, with associated systemic disturbance, a variety of extra-articular features and the presence of circulating antiglobulin antibodies (rheumatoid factors). Characteristically, the course of the disease is prolonged with exacerbations and remissions.
Subcutaneous nodules are seen in 5% to 10% of cases in India compared to 25% in Western counterparts. These nodules vary in size and are seen over the pressure points like the olecranon process, scapula, sacrum and the occiput.
Rheumatoid arthritis functional grading:
Grade I :
- No handicap.
- Can carry on all daily activities.
Grade II :
- Moderate restriction of activities but independent.
- Marked restriction of activities mostly limited to self care.
- Needs assistance.
- Bed or chair bound.
- Incapacitated and dependent.
RA is diagnosed according to the following criteria:
- Morning stiffness more than 1 hour.
- Arthritis of three or more joints.
- Arthritis of hand joints.
- Symmetrical arthritis.
- Rheumatoid nodules.
- Positive Rheumatoid factor.
- Radiological changes.
Laboratory investigations may help either to establish a clinical diagnosis or to assess the prognosis and the possible course of the disease. But the diagnosis of RA is essentially clinical.
ESR is useful for assessment of disease activity. It is elevated in RA and comes down when the disease undergoes remission.
The most important immunological investigation is detection of rheumatoid factor,. A cut-off value of 80 IU/ml with latex agglutination test and a differential agglutination titre (DAT) of 16 are more specific.
C-reactive protein (CRP) is a useful marker of acute phase response and its measurement is valuable in the management. High levels of CRP at the onset of disease correlate with poor prognosis.
Synovial fluid analysis is a valuable indicator of the inflammatory status. The leucocyte count is usually in the range of 5,000 to 20,000 cells per mm3 with neutrophilic predominance. Counts over 50,000 cells per mm3 indicate possible superadded infection. Protein concentration ranges from 2.5 g/dL to 3.5 g/dL. The glucose content is low compared to simultaneously estimated blood glucolose levels.
Plain radiograph (X-ray) of the joint in the early stages shows soft tissue swelling around the affected joint and later juxtaarticular osteoporosis. Erosions are seen as the disease progresses. In later stages there is destruction of the cartilage, resulting in joint space narrowing, cyst formation, subluxation of the joints and deformities (Table 17.13) (Fig. 17.7). These changes are especially seen over the PIP joints, MCP joints, MTP joints, wrists, knees and hip joints
Anaemia is the commonest occurrence in RA
RA can also affect other systems of the body than the joints. It can manifest into the following illnesses
- Weight loss
- Susceptibility to infection
- Digital arteritis
- Pyoderma gangrenosum
- Mononeuritis Multiplex
- Visceral arteritis
- Conduction defects
- Coronary vasculitis
Eye related disorders:
- Keratoconjunctivitis sicca.
- Pleural effusions
- Fibrosing alveolitis
- Caplan’s syndrome
- Muscle wasting
- Cervical cord compression
- Compression neuropathies
- Peripheral neuropathy
- Mononeuritis multiplex
- Felty’s syndrome.
Treatment @ Homeocare International (HCI):
We at Homeocare International study each Arthritis patient in detail clinically and homeopathically and prescribe advanced constitutional medicines according to their individual genetic constitution.
Constitutional approach, an excellent method of selecting proper homoeopathic medication for a variety of health issues ranging from common cold to a large variety of incurable cases, especially all chronic diseases, in brief-“Homoeopathic approach is holistic as well as individualistic; holistic in the sense that the medicine is selected for the patients as a whole, but not for individual diseased organs/parts; individualistic from the view point that each individual patient is considered different from others, although all are suffering from the same disease.