What causes RA ?
Unfortunately we do not know the exact cause of RA. But we do have some insights into the disease mechanisms. Firstly there is genetic susceptibility. By that do not get an idea that RA is an inherited disorder. However, the disease shows increased familial tendency. It is not enough to be susceptible; an outside factor needs to trigger the disease process. It is felt that this could be a bacterium or a virus. No organism has so far been clearly implicated. You will naturally wonder whether we should check family members for genetic susceptibility and take preventive measures ? This is not advised as not practical; we do not know enough. One thing is clear. RA is neither an inherited disorder, nor a contagious disease.

Does the chronicity mean that the infection persists ?
The answer is no and therefore antibiotics play no role in the treatment of RA. What happens is somewhat like this - the triggering agent somehow changes body’s tissues or mimics body tissues in such a way that the body perceives self tissues as a foreign agent and attacks the tissues in an effort to eliminate the agent. This is obviously not possible. This explains the chronicity or incurable nature of RA.

How quickly are the joints damaged ?
RA is an aggressive disease. Joint damage begins very early, say by 3 – 6 months, and most patients will show evidence of joint damage by 2 – 3 years.

When and how should RA be treated ?
Like TB and cancer, the treatment should be started as soon as possible. Ideally by 3 – 6 months of disease onset. It is not enough to treat with so called pain killers like aspirin or brufen only. It is equally important to start medicines that control the disease. Commonly used drugs are chloroquine, sulfasalazine and methotrexate. Newer drugs like leflunomide, infliximab and etanercept are for patients who do not respond. Steroids are generally to be avoided, but in certain situations their benefits outweigh the side-effects. Judiciously used, steroids can be very useful.


Apart from drugs what else should be done ?
A judicious mixture of rest to joints and appropriate exercises are extremely important. These modalities prevent joint deformities, maintain normal joint motion and preserve muscle strength. Every patient of RA must do exercises.
Good nutritious diet is essential. There are no specific diets prescribed for RA.
Surgery is needed for advanced joint disease or for local complications. Synovectomy is useful early in the disease process. Advanced cases need joint replacement.

What is the outcome ?
Untreated uncontrolled RA is a crippling life long disease. It also shortens longevity. With proper treatment there is hope of avoiding these.

Message ?
IT IS TIME YOU TAKE ARTHRITIS SERIOUSLY.
(This is a general information page. More specific details will be available in future).