Not all arthritis are the same. Learn more about rheumatoid arthritis, osteoarthritis, lupus, and gout
The Philippine Rheumatology Association (PRA) aims to reach out to the public and advocate on the awareness of arthritis conditions that can affect an individual.
These conditions are rheumatoid arthritis, osteoarthritis, lupus, and gout. PRA vows to connect more to the lay so they know if they have the signs and symptoms of these conditions and prevent it from having further risks in their health.
Rheumatoid arthritis (RA) is a chronic inflammatory joint disorder that usually affects women aged 40 – 60 years old, although it may begin at any age. It is characterized by joint pain, swelling and warmth associated with morning stiffness that lasts for more than 30 minutes and fatigue.
Frequently involved joints are the small joints of the hands and feet; however, larger joints such as shoulders, wrists and knees may be affected as well. The 2010 American College of Rheumatology (ACR)/European League Against Rheumatism(EULAR) Classification Criteria is used to diagnose RA.
Categories included in the criteria are the number and the type of joints involved, blood tests – acute phase reactants (ESR and CRP) and serologies (rheumatoid factor and anti-cyclic citrullinated peptide)and duration of symptoms.
The goal of therapy is to control inflammation and prevent deformities and complications associated with uncontrolled arthritis. The first line of treatment is the conventional disease modifying drugs or DMARDs with methotrexate being the most commonly used. It can be given with or without low dose steroids and as needed analgesics.
If there is no improvement after consecutive dosage increases, biologics or targeted synthetic DMARDs are indicated. These are more specific and targeted drugs that may be given orally, subcutaneously or intravenously. Regular visit with rheumatologist is recommended to monitor the disease activity, adjust drug dosages and to determine the adverse effects of medications.
Osteoarthritis (OA) is a type of arthritis where there is a gradual loss of cartilage from the joints, particularly the weightbearing ones. It often affects the knees, hands, hips and spine and rarely, the elbows, wrists and ankles.
It is mostly seen in elderly patients, earning the name “rayuma ng tumatanda” (arthritis in the elderly), but can occur earlier than usual in joints previously damaged by trauma or repeated inflammation. Other risk factors are gender, obesity, occupation and sports injuries.
It is a chronic condition with low-level pain initially that tends to worsen over time. The clinical manifestations include pain, stiffness, swelling, crackling or grating sensation, bony outgrowths, and restriction of movement.
There is no blood test specific for OA but certain tests like ESR, uric acid, or rheumatoid factor may help rule out other causes of joint pain such as gout or rheumatoid arthritis. An x-ray of the involved joint may be requested, which can reveal subchondral sclerosis, narrowing of joint space, and bone spur formation. X-ray also helps exclude other causes of pain and can assist in the decision making for possible surgical intervention.
Treatment begins with non-drug interventions including patient education, weight loss regimens, exercise, use of footwear with insole support, and use of canes or walkers. There is no dietary restriction for OA unlike in gout. Drug treatment include analgesics, symptomatic slow acting drugs for OA and occasionally, joint aspiration and injection (steroid or visco-supplementation) if there is swelling or effusion.
Selena Gomez, a popular 25 year old singer, shocked her 130 million Instragram followers last year by posting a photo of herself after kidney transplant. She has systemic lupus erythematosus (SLE) or lupus.
SLE is lifelong illness wherein the body’s immune system, which is supposed to protect it from infection and disease, turns on itself and attacks the body’s organs. It is seen more in young women, but can also affect men, the elderly, and even children.
The more common signs or symptoms of SLE include unexplained fatigue; painful joints and muscles; fever without a known cause; rash, especially across the cheeks and bridge of nose; excessive hair loss; frequent mouth ulcers; swollen legs or face; kidney problems; shortness of breath. One, some, or all of these may occur in people with SLE.
If you have any of the above symptoms, you are encouraged to consult a doctor, preferably a rheumatologist (a specialist of lupus and other arthritis). Blood and urine tests will be requested, and the results will be interpreted along with the person’s signs and symptoms. There is no known cure for SLE, however, it can be managed and controlled. With proper treatment, people with SLE have an excellent chance to live healthy and normal lives.
Gout is the most common inflammatory arthritis, affecting up to 10 percent of adults worldwide. In the Philippines, prevalence is placed at 1.6 percent of the population. It frequently affects adult men and postmenopausal women.
Typically, gout patients experience “attacks” of sudden and intense swelling and pain in one or more joints of the lower limbs such as the base of the big toe, ankles and knees, lasting for a few days, followed by symptom-free periods.
Gout is commonly associated with hypertension, diabetes, obesity, high cholesterol, and kidney disease.
Gout is caused by a high level of uric acid in the body, which causes uric acid crystals to form and deposit in the joints and other organs such as the kidneys. A high uric acid can be caused by certain diseases such as kidney disease, blood and bone disorders, and cancer, and by consuming too much purine-rich foods and drinks such as red meat, internal organs, seafood, beer and sugary drinks.
The management of gout requires long-term treatment with uric acid-lowering drugs to keep the blood uric acid at 6mg/dL or lower, and drugs that prevent/address inflammation.
Maintaining a normal weight, regular exercise, eating a healthy/balanced diet, hydrating with water, and regular follow-up with your doctor are important to keep gout under control.