We often believe this is an ailment associated only with old age, but that is not the case. The earlier it is detected and treated, the better the prognosis will be. Here is what you need to know.
Key Figures and Data
- 5,000 Soles: The average monthly budget for treatment using biological medications.
- 500 Soles: The average monthly cost when using classic synthetic drugs.
- 7 to 1: The rate of rheumatoid arthritis in mestizo populations (7 women for every 1 man).
- 1988: The year since which sex has been considered to play a very important role in this disease.
Early Signs and Diagnosis
Waking up in the morning feeling tired, accompanied by numbness and stiffness in one or more joints—even without swelling—are early signs of possible Rheumatoid Arthritis (RA).
It is difficult to accept this possibility, but statistics show that one in every one hundred people develops this autoimmune disease. Furthermore, it is three times more frequent in women.
Verónica Briceño’s Story: “In my case, it started with knee pain. At first, we thought it was a meniscus issue because I liked sports and doing ‘steps’; but later the discomfort became general, and pain appeared in my elbows, neck, and left wrist. It was 1996, I was 36 years old, and I was traveling to Spain to pursue a doctorate. It was a very aggressive rheumatoid arthritis, but once I started taking the medications, I improved; however, the pain persisted”.
Upon finishing her studies in Spain, she returned to Peru and sought specialized help.
Causes and Risk Factors
The exact cause of RA is unknown, but it is known that genetic factors (perhaps having relatives with this problem, like Verónica) and environmental factors converge in its development.
- Smoking: This is one of the environmental factors.
- Risk for Smokers: Smokers have a 50% higher risk of not responding favorably to the treatments used at the onset of rheumatoid arthritis.
For reasons that remain unclear, the immune system mistakenly attacks the healthy cells of the synovial membrane, the tissue that lines the joint. In response, the immune system releases chemicals that cause inflammation.
Medical Treatments
The goal of treatment is the remission of the disease. Therefore, it is important to stop the inflammatory process that damages and deforms the joints. While there is no cure, specific fast-acting drugs have been developed over the last 15 years to halt RA inflammation.
Types of Medication:
- Methotrexate: It has always been used in the treatment of RA, though now in higher doses. It is effective and economical.
- Disease-Modifying Drugs: Medications designed to slow the deterioration caused by persistent inflammation. These include synthetic and biological options. They are fast-acting but high in cost.
- Immunosuppressants: RA drugs have an immunosuppressive effect and can cause adverse side effects. Because of this, patients must undergo regular medical check-ups.
Important Considerations:
- Vaccines and Pregnancy: If you use RA drugs, avoid vaccines based on live organisms. Consult your doctor if you are pregnant.
- Infection-Free: Before prescribing biological medications, the doctor rules out the presence of infections such as tuberculosis and hepatitis B.
The Evaluation Process
- Clinical Evaluation: A rheumatologist performs a clinical evaluation to rule out joint inflammation.
- Tests: Blood tests are ordered to detect the presence of the rheumatoid factor, anti-cyclic citrullinated peptide (anti-CCP) antibodies, and C-reactive protein.
Disease Progression: If the inflammatory process is not stopped—the primary goal of drug treatment—the cartilage and surrounding bone of the joint will be damaged. This is not a disease exclusive to old age, as is often believed. The intensity and course of the disease vary by person:
- In 60% of patients, it is permanent.
- In 20%, it is undulating (with episodes of flares and remissions lasting months or years).
- In 20% of patients, remission is achieved after six months of treatment.
Surgery: An Extreme Alternative
Living with RA is not a sentence to be in constant pain. Surgery is an alternative when the joint has been damaged and is no longer functional.
- Implants: Joint implants, such as prosthetics, can be used.
- Small Joints: There are techniques for the small joints of the hand and wrist that preserve function.
- Outpatient Procedures: According to Dr. Alejandro Badía, a hand and upper extremity surgeon at the Badia Hand to Shoulder Center in Miami, many patients now have prosthetics for shoulders, elbows, wrists, the base of the thumb, and finger joints. All of these are outpatient interventions.
A Success Case: Verónica Briceño was operated on 10 years ago by Dr. Badía. In the past, the standard treatment for a wrist that didn’t respond to other therapies was total wrist fusion. Today, that can be avoided with mobility-preservation procedures, which allowed Verónica to return to running and practicing tae-bo.
Final Note: These techniques are not currently practiced in the country (Peru), but there is interest in opening a specialized center with advisory from Dr. Badía.
Sources: Rheumatologists Juan Angulo, Karina Espejo; Dr. Luis Vidal (President of the Peruvian Society of Rheumatology); Dr. Alejandro Badía (www.drbadia.com). Sunday, May 25, 2014.
