Rheumatoid arthritis is commonly associated with old age. How common is the condition in the young people?

Rheumatoid arthritis is a chronic persistent inflammatory polyarthritis mainly involving the small joints of hands and feet, although large joints such as knee and hip joints can also be affected. It usually affects young women of reproductive age, ie, 20-40 yrs. Elderly individuals can also be affected. Male to female ratio is 1: 5.

What causes rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease. Exact cause is still not known. But it is known that something in the body goes awry. Our own immune system which targets the nonself substances such as bacteria and viruses, recognizes them and fights with them to eliminate them from the body. In Rheumatoid arthritis our immunity starts recognising the joint tissue called synovium, a lining of joint cavity, starts manufacturing the antibodies against this tissue. These antibodies, recognised in the blood test as Rheumatoid factors and anti CCP antibodies, start attacking this tissue and cause inflammation manifesting itself as joint swelling and then it is called arthritis.

The youngest patient who came to me seeking treatment…

Although inflammatory arthritis commonly occurs in children also, but then this is called Juvenile inflammatory arthritis, which may or may not progress to rheumatoid arthritis in aduldhood. I have seen such type of arthritis even in 02 yrs old. But the term Rheumatoid arthritis is a term to be used when it occurs in individuals of > 16 yrs of age. In that sense I have seen a patient even 17 yrs old developing rheumatoid arthritis.

What’s the common treatment protocol?

In case of Rheumatoid arthritis, once diagnosed by a rheumatologist based on established diagnostic criteria, in addition to nonsteroidal anti inflammatory drugs, immunomodulators are to be used as early as possible to control the autoimmune inflammation if joint deformities are not desired. To begin with, we start methotrexate and hydroxychloroquine in combination. Various other immunomodulators used are sulfasalazine, D-Penicillamine, Leflunomide. Sometimes help is also taken from steroids, cytotoxic drugs with sole aim of controlling autoimmune related inflammation. Latest drugs with the same aim are biologics such as anti TNF agents ( infliximab, etanercept) and other anticytokine and B cell and T cell therapies. Management of RA is like management of diabetes mellitus, in which we control blood sugar level to save the target organs, in the same way we control level of inflammation in RA to save the joints from ongoing damage.

What are the current advances made in the treatment?

Current advances as enumerated above, are targeted therapies to target various inflammation causing molecules (cytokines) such as anti TNF, IL6, IL1 etc, and to target cells involved in the perpetuation of inflammation, such as Rituximab against B cell, and Abatacept against T cell. A lot more are being researched and yet to enter the market.

What dietary restrictions a patient should adhere to?

Dietary restrictions: No dietary restriction has proved to substantially reduce the inflammation of RA and stop the ongoing joint damage. However, patients are adviced so many drugs which are likely to cause gastric inflammation, therefore, it’s better to reduce the intake of spicy food. As being overweight is detrimental to the health of joints, patients are adviced to reduce weight by cutting down their calorie intake. (S)he is also adviced to have a balanced diet containing lots of fruits and salads which are full of antioxidants. It will be better to expose the skin to the sun for at least 1/2 hr at appropriate time of the day so that the required Vitamin D can be made by the skin. If that is not possible, Vitamin D fortified foods or Vitamin D supplements are to be added in the diet. New research is showing that Vitamin D defficiency may initiate and perpetuate auto immune diseases.