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In the first case, I had pain in my fingers and knees for 1 year, and it usually got worse after using the affected area. When I woke up in the morning, I had a 30-minute fist clenching symptom, and there was no swelling or tenderness in my knee, but my fingers were thick and mildly tender.
In the second case, the pain in the fingers and knees had been getting worse when he was immobile, and he had difficulty washing dishes or picking bottle caps. When I woke up in the morning, my hands and knees felt stiff and could not bend well, and these symptoms did not go into remission until the afternoon. It was also accompanied by edema and tenderness. Which of the two cases is a rheumatoid arthritis patient?
What are the symptoms of rheumatoid arthritis and how is it diagnosed?
Of the previous two cases, the first is typical of a patient with degenerative arthritis and the second is a patient with rheumatoid arthritis. The Greek word for rheumatismus means "to flow." In other words, rheumatic disease is a disease caused by bad fluid flow, and it is an autoimmune chronic inflammatory disease.
Rheumatoid arthritis is characterized by morning stiffness lasting more than one hour, problems in three or more areas, and bilateral symmetry. In particular, rheumatoid arthritis is diagnosed if these symptoms persist for at least six weeks. In addition, there is a probabilistic feature that rheumatoid positive factors are found in the blood test, but it should be noted that 70~80% of rheumatoid arthritis patients are positive, and about 5% can come out even in normal groups. The main symptoms experienced by patients with rheumatoid arthritis are pain, swelling, stiffness, deformity, and dysfunction, all of which reduce the patient's quality of life.
As we have seen in the previous two cases, degenerative arthritis and rheumatoid arthritis are different diseases, but they have similar patterns and need to be accurately diagnosed. The reason for this is that there are many differences in the treatment used, the course of the disease, the presence of complications, and the quality of life depending on the outcome of the two arthritis diagnoses. For a more accurate test, rheumatoid arthritis may be diagnosed with an anti-CCP test with high sensitivity and specificity.
How have rheumatoid arthritis been treated?
The treatment guideline for rheumatoid arthritis is 'to diagnose accurately, early, and aggressively treat it'. As a result, symptoms and signs are minimized to induce a state of 'remission' in which deformity and loss of function are prevented, and treatment is aimed at a complete cure.
Treatment for rheumatoid arthritis has been done with aspirin, steroids, antirheumatic drugs, and biologic therapies, from past to new. Aspirin, which was invented from willow bark, has been used to treat the disease, and since the invention of steroids in the 1950s, it has been effective as a treatment with dramatic effects, such as allowing patients to stand and walk in a day, but the risk of side effects and complications when used in the long term has become known. Since then, anti-rheumatic drugs such as methotrexate have been synthesized, and biologics have recently been developed through clinical trials and are widely used.
It can be a problem when choosing the right treatment among many treatments, and the answer is to use a drug that has a good therapeutic effect and has fewer side effects. This is because rheumatoid arthritis is a chronic disease, and the progression of the disease affects the quality of life and longevity, so that if the treatment is effective, it is possible to live a normal life.
What are the treatments for rheumatoid arthritis?
First, non-steroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs are what we often call 'anti-inflammatories' and are used to reduce pain and reduce inflammation. The analgesic effect appears within 24 hours, while the anti-inflammatory effect appears after about 7 days. Use should be avoided when kidney and liver function is compromised, when dehydrated, and in the elderly. However, these nonsteroidal anti-inflammatory drugs do not play a significant role as a fundamental treatment.
Second, steroid anti-inflammatory drugs
Steroid anti-inflammatories have the advantage of being very quick and powerful in their therapeutic effects, so they should be used early and in small doses. It has a strong anti-inflammatory effect within 24 days after taking it, and long-term use should be avoided due to the risk of various side effects.
Third, antirheumatic drugs
Synthetic antirheumatic drugs, such as methotrexate, sulfasalazine, leflunomide, and antimalarials, are used to induce remission or slow the progression of rheumatoid arthritis. It is more effective to use 2~3 of these drugs together than to use one of them alone.
Fourth, biologics
The background of the emergence of biologics developed for disease-targeted therapy is different from the above three cases. In order to understand the cause and pattern of the disease, we looked inside the joints and found that various cells and inflammatory substances were intertwined, so we developed a drug that can control the inflammatory substances and cells. Injectable drugs include TNF-a inhibitors and IL-6 inhibitors, which kill inflammatory substances, and B-cell inhibitors that regulate cells, and recently oral drugs such as JAK inhibitors, which are superficial rheumatic drugs (DMARDs). The fact that it can reduce the side effects of other drugs by prescribing biologics is a great advantage, so it is currently widely used in Korea.
Why should rheumatoid arthritis be treated?
If inflammation in the affected joint is not effectively controlled, it can lead to a gradual restriction of movement over time, resulting in a fixed joint deformity. Untreated rheumatoid arthritis can cause irreversible joint damage within two years, and if treatment is not resolved with medication, surgery may be necessary.
In addition, if major organs such as the lungs, heart, and kidneys are involved in addition to the joints, it is a fatal disease that can affect lifespan, so it requires prompt treatment. In addition, when there is inflammation such as rheumatoid arthritis, it is better to reduce or minimize exercise, so you should follow the medication guide, get enough rest, and exercise only at a mild intensity.
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