By Dr. Aruna Caldera, Consultant Rheumatologist MBBS, MD, MRCP (UK), MRCP (Rheumatology)
The word arthritis comes from ancient Greek. “Arthron” means joints; “itis” means inflammation; so, arthritis means inflammation of joints. Arthritis is one of the commonest disease categories which effect man. Some forms of arthritis may not even require any form of specific treatment, whereas some may even kill you.
Among long-term arthritis conditions, the most serious is rheumatoid arthritis. This disease occurs due to genetic variations that cause the immune system to malfunction and produce antibodies against the joints, leading to joint damage. We call this process, auto immunity; in simple words, your immune system which is supposed to protect you, starts to work against you.
If proper treatment is not started on time, the progression of the disease will be extremely difficult. Without proper treatment, it can make life miserable and may even lead to premature death.
Rheumatoid arthritis is a chronic, systemic inflammatory disease. Joint involvement is only one part of it. In simple terms arthritis is not limited to the joints. This is why relying only on ointments or topical treatments can lead to extra-articular (other organ) damage some of which could be catastrophic and lead to premature death.
If untreated, inflammation damages the joints—causing deformities, cartilage loss, and involvement of more joints over time. Complications usually appear after 10–15 years. Those who don’t understand, or refuse to believe this, often rely on short-term fixes and, unfortunately, will suffer later.
Eventually, joint deformities can become so severe that a person may not be able to walk without aid, button clothes, dress themselves, go to the toilet independently, open a bottle, or even open a door.
There are several types of rheumatoid arthritis:
Classical rheumatoid arthritis:
Affects small joints (fingers, wrists) and large joints (elbows, ankles, knees). Symptoms include morning stiffness, joint pain, swelling, weak grip, and fatigue.
Palindromic rheumatism
: Sudden joint pain (and swelling) that disappears within hours or days. Many of these patients may later develop classical rheumatoid arthritis. However, treatment can reduce this risk of progression to classical type. Medication may be needed even when symptoms are absent.
Monoarticular rheumatoid arthritis:
Affects a single joint. It is often mistaken for other conditions like gouty arthritis or osteoarthritis. Without proper treatment, it can destroy the joint and later progress to classical rheumatoid arthritis. Commonly affects larger joints, like knees, ankles, hips, and shoulders.
Polymyalgic onset (proximal) rheumatoid arthritis:
Seen in older individuals and even could be missed by clinicians. Patients usually complain of stiffness in both shoulders rather than joint pain or swelling.
Most patients experience morning stiffness (difficulty moving joints after waking) and joint “gelling” (stiffness after rest). Stiffness can last from minutes to hours and is caused by inflammatory substances accumulating in joints during sleep and rest.
Other symptoms may include whole-body pain, fatigue, weight loss, mild fever, depression, fibromyalgia (generalised wide spread pains)
Rheumatoid arthritis affects the whole body. The effects on other organ systems are identified as” extraarticular manifestations”. Most organs can get involved in poorly controlled disease. Some of the common manifestations include,
Skin vasculitis rashes and skin nodules
Lung disease (interstitial lung disease)
Heart disease (ischemic heart disease)
Osteoporosis
Eye problems which can even cause blindness (uveitis, scleritis)
Nerve disorders (polyneuropathy, mononeuritis)
Dry mouth (Sjogren’s syndrome)
About 40% of patients may develop such complications. The only way to reduce them is timely treatment.
In addition to joint swelling, the whole hand may swell like wearing a boxing glove. Swelling in the wrist can compress the median nerve, causing carpal tunnel syndrome (numbness in fingers). Surgery should not be rushed—arthritis must be treated first.
The disease can even affect the upper spine (neck joints). Neck pain along with other joint pain should not be ignored. In simple terms, rheumatoid arthritis can affect almost any joint except most parts of the spine.
No blood test is required to suspect or even diagnose rheumatoid arthritis. In some patients the rheumatoid factor antibody test will never be positive (seronegative rheumatoid arthritis). Waiting for lab confirmation before starting treatment is an unwarranted delay.
Some tests may show abnormalities:
Rheumatoid factor antibodies, Anti-CCP antibodies, ANA may be positive
ESR and CRP may be elevated
Haemoglobin may be low (anaemia of chronic disease)
Platelets may be high
Blood tests are more useful for monitoring treatment and medication safety rather than initial diagnosis. One important fact we must realise is the titre of the antibody test positivity has no correlation to disease activity and we cannot use the antibody titres to evaluate the response to treatment.
There are treatments that can even bring the disease into remission in no time at all. However, patients who delay treatment, take insufficient doses of medicines, stop medication early, follow inconsistent treatment, or rely on unscientific treatment methods are unlikely to achieve this.
Proper treatment involves starting with stronger medications and gradually reducing it as the disease improves. Simply controlling symptoms, without addressing the disease progression, is not enough; that is why using pain killers and prednisolone only cannot prevent extraarticular manifestations.
The first goal is on-drug remission. After that, patients should continue medication for more than 12 months without symptoms before gradually tapering. Stopping/tapering medications too early often causes relapse, which is a major reason why many patients fail to recover. Some patients may relapse even after stopping medication, but modern treatments allow long-term control without harm and sustained, drug-free remission in other patients. Most novel therapies are available in Sri Lanka as well.
The medications used are called DMARDs (Disease-Modifying Anti-Rheumatic Drugs). These do not just control symptoms—they change the course of the disease. Most patients respond to conventional DMARDs, but if not, biologic or targeted synthetic DMARDs should be started early—not after joint damage occurs. These treatments are available in Sri Lanka. Without consulting rheumatologist, patients may not receive these advanced forms of novel treatments.
Having rheumatoid arthritis is like being trapped in a room with a venomous snake. As long as you stay alert, you can avoid harm—but if you ignore it, it will strike. The disease must be treated at any cost. The choice is yours. With proper treatment initiated early, you can live a normal life. Ignoring the disease will not make it go away. Misinformation by people who aren’t aware of the severity of the disease and medications used often causes patients to avoid ideal treatment, leading to worse outcomes.
There is no point worrying after diagnosis; see a specialist early and seek treatment. You can live a normal life. Even pregnant or breastfeeding mothers can be treated safely without harming the baby. The precious time you waste starting a DMARD will definitely impact the final outcome.