Health

Sunday July 1, 2007

Don’t ignore that pain

By PAUL YEO



The first National Rheumatoid Arthritis Day (National RA Day) in Malaysia will be launched by the Arthritis Foundation Malaysia on July 7 (next Saturday). In conjunction with the event, we take a closer look at the disease.

Consultant rheumatologist Dr Chow Sook Khuan ... ‘To date, the goal of treatment in RA is to reduce joint inflammation and pain, maximise joint function, and prevent joint destruction and deformity.’
IT may start off as a slight stiffness or some tenderness and swelling in the joints, particularly in the mornings. However, many people ignore the pain and view it as a temporary irritation rather than a possible medical condition as it usually fades away after an hour or two, or after massaging and placing a warm cloth over the affected areas.

What they are unaware of is that these are early symptoms of rheumatoid arthritis.

Affecting approximately five in 1000 people in Malaysia, rheumatoid arthritis (RA) is an autoimmune disease in which joints, usually including those of the hands and feet, are symmetrically inflamed, resulting in swelling, pain, and often the eventual destruction of the joint’s interior.

While RA is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms. Typically, however, this medical condition is a progressive illness that has the potential to cause joint destruction and functional disability.

Researchers have worked for years to find the cause of the abnormal autoimmune response associated with RA, but there is no single cause which has been found.

Common theories point to a genetic predisposition and a triggering event. However, researchers are currently debating whether RA is one disease or several different diseases with common features.

Identifying RA

Rheumatoid arthritis may start suddenly, with many joints becoming inflamed at the same time.

Most often however, it starts subtly, gradually affecting the joints and may go unnoticed or ignored. The inflammation is usually symmetrical whereby if one side of the body is affected, the corresponding joint on the other side is also affected.

Typically, the small joints in the fingers, toes, hands, feet, wrists, elbows and ankles become inflamed first. The inflamed joints are most often painful and stiff, especially after awakening or after prolonged inactivity.

According to Dr Chow Sook Khuan, President of Arthritis Foundation Malaysia, the symptoms of RA fluctuate, depending on the degree of tissue inflammation.

“When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive or otherwise known as in remission,” Dr Chow explains.

“During remissions, symptoms of the disease disappear, and patients generally feel well. When the disease becomes active again, symptoms return. The return of disease activity and symptoms is called a flare. The course of rheumatoid arthritis varies from patient to patient, and periods of flares and remissions are typical,” added Dr Chow.

During a flare, individuals with RA may experience one or more of the following:

  • Fatigue

  • Loss of appetite

  • Flu-like symptoms, including low-grade fever

  • Muscle and joint aches and stiffness

  • Weakness

  • Pain associated with prolonged sitting

  • Depression

  • Weight loss

  • Anaemia

  • Cold and/or sweaty hands and feet

    It is also said that about 30% to 40% of RA patients have rheumatoid nodules, or lumps of tissue just under the skin, usually near in the fore arm.

    Seeking proper help

    It is common for individuals in the early stages of RA to ignore the flares and the symptoms that may appear along with it. However, like any other disease, early detection is vital to treat and prevent the progression of RA.

    “Most of my patients come and see me only when the pain is too much to bear or when they find it difficult to carry out their daily tasks. In some instances, their RA was in the advanced stage and had already caused significant damaged and deformity to their joints, which leaves them with limited mobility,” said Dr Chow.

    “It is very disconcerting as a doctor to have to see otherwise healthy individuals being a ‘victim’ to the effects of RA, especially when it can be prevented and managed with early diagnosis and treatment,” expressed Dr Chow.

    A normal joint.
    Cheah Ley Yan, principal of a pre-school who is in her late 40s, is one example of an RA patient who sought treatment only when the pain got unbearable. Her RA condition began with pain in the knee joints about five years back. However, she dismissed the pain thinking that it was caused by strain on the joints from gym workouts, and that with rest and less strenuous activity, it would go away.

    “The thought of having RA didn’t cross my mind at that time as I didn’t know that the pain associated with RA was persistent; that it comes and goes, but it in fact stays with you. When the condition first started, the pain was not excruciating and hence bearable. But as time went by, my condition worsened and I was in pain constantly,” said Cheah.

    “It was only when my condition reached the stage where I could hardly move and didn’t have much movement in all my joints – the feet, hands, neck – that I decided I had to do something,” added Cheah.

    Joint changes in rheumatoid arthritis.
    However, instead of seeking proper medical help, Cheah like many, sought alternative “treatment” or relief from acupunctures and different types of massages in the hope of alleviating her pain and improve her overall condition. Despite all that and being practically dependent on painkillers, all these “therapies” only provided temporary pain relief for Cheah.

    By the time Cheah sought help and treatment from a rheumatologist, a medical doctor who treats arthritis and other joint conditions, she had difficulty in dressing up and putting on her undergarments, climbing up the stairs and carrying things. She could not straighten her elbows and rotate her hands 360 degrees.

    Cheah’s rheumatologist informed her that RA had affected four main joint areas – both her hands, elbows and knees. Luckily for Cheah, there was no deformity in her joints. Now, with proper treatment, Cheah’s RA is well managed and under control.

    “As a patient whose RA condition is well controlled, I can continue to live my life just like any healthy, normal person. Having said that, I also need to be very conscious of certain limitations and pay extra attention in taking care of my joints. These are part of managing the condition,” said Cheah.

    Treatment

    “To date, the goal of treatment in RA is to reduce joint inflammation and pain, maximise joint function, and prevent joint destruction and deformity. Early medical intervention has been shown to be important in improving outcomes,” stressed Dr Chow.

    With promising advances in the treatment of RA over the past few years, doctors are able to treat the condition through various kinds of medications.

    Two common options in treating RA include Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Disease Modifying Anti-Rheumatic Drugs (DMARDs).

    Typically, NSAIDs are used to reduce pain and inflammation, whereas DMARDs (which are not anti-inflammatory agents) promote disease remission and prevent progressive joint destruction.

    But a more recent medication, biologics, has been seen to provide treatment breakthrough to both doctors and RA patients. It works to reduce inflammation as well as prevent the progression of joint deformities.

    According to Dr Chow, aggressive management can improve function, stop damage to joints as seen on x-rays, and prevent work disability. However, it is optimal treatment for the disease, which involves a combination of medications, rest, joint strengthening exercises, joint protection, and patient and family education, that is key to the management of RA.

    “Treatment is also most successful when there is close cooperation between the doctor, patient, and family members,” concluded Dr Chow.

    About National Rheumatoid Arthritis Day

    The first National Rheumatoid Arthritis Day (National RA Day) in Malaysia will be launched by Arthritis Foundation Malaysia on July 7, 200,7 at 3.00pm at Yuk Choi School in Taman Megah, Petaling Jaya, Selangor.

    A public forum on rheumatoid arthritis will also be held in conjunction with the launch to promote public understanding of the serious burden of the disease. This educational and awareness initiative is fully supported by Wyeth Malaysia.

    For more information or to confirm attendance for the event, please contact the AFM Secretariat at 03-5621 6177 or email a_fm@tm.net.my.

    About Arthritis Foundation Malaysia

    The Arthritis Foundation Malaysia (AFM) was set up in 1995 by a group of medical personnel, professionals and patients with the aim to improve the care of arthritis sufferers in this country.

    Assisting needy patients remains an important agenda of AFM, which led to the formation of the Arthritis Fund in March 2003. For more information about AFM, log on to http://www.afm.org.my or email a_fm@tm.net.my

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