Rheumatoid Arthritis

What is Rheumatoid Arthritis?

Rheumatoid arthritis is an autoimmune disease that causes damage to the joint linings throughout
the body. It is a chronic inflammatory disorder that can also affect the skin, eyes, lungs, heart, blood,
or nerves.

The disease is marked by periods of severe symptoms and signs known as flares or exacerbations,
along with periods of remission where there are no symptoms.

Due to the difficulty in diagnosing the disease, there are multiple steps to be followed. First, the
patient’s joints will be physically examined. The doctor will look for swelling and redness and
determine the function and range of motion of the joint. They will also check for warmth and
tenderness and test the reflexes and muscle strength. Multiple blood tests such as the rheumatoid
factor (RF) test, anticitrullinated protein antibody test (anti-CCP), antinuclear antibody test,
erythrocyte sedimentation rate, and the c-reactive protein test. These tests help determine the
condition of the body’s antibody production, which can be indicative of rheumatoid arthritis. The
rheumatoid factor test looks for a protein called rheumatoid factor, of which levels are associated
with autoimmune diseases like rheumatoid arthritis. The erythrocyte sedimentation rate helps
determine the degree of inflammation but does not determine the cause of the inflammation.

The symptoms of rheumatoid arthritis include:

 Tenderness and pain of joints

 Swollen joints
 Stiffness in the joints
 Deterioration of joint function

Rheumatoid arthritis usually starts in the hands, but also occurs in the extremities and also in the
hips, jaws, knees, and shoulders. The symptoms are usually symmetrical, which means that they
show up in the same joints on both sides of the body. The symptoms can also go beyond the joints
and can include:

 Fatigue
 Muscle aches
 Poor appetite
 Malaise
 Depression
 Rheumatoid nodules (bumps under the skin)
 Inflammation of the lining around the lungs
 Heart pericarditis or myocarditis
 Pulmonary fibrosis

Biopsychosocial Model

The biological cause of rheumatoid arthritis is when the immune system attacks the synovium- the
lining of the membranes around the joints. This inflammation thickens the synovium, eventually
destroying the cartilage and bone within the joint. The tendons and ligaments that hold the joint
together weaken and stretch. Gradually, the joint loses its shape and alignment. Doctors suspect
that a genetic component most likely causes the disease. However, it is more likely to just make
someone more susceptible to environmental factors such as infections that may trigger the disease.
The psychological model of health and illness when linked with rheumatoid arthritis, shows links
between mental health and chronic pain illnesses. Chronic pain illnesses are difficult to live with and
can adversely affect mental health, leading to periods of depression. This has also been suggested to
have adverse effect on the pain. The insomnia caused by the disease’s chronic pain, causes severe
issues with mood. The inability to participate in activities due to the pain is also a huge contributing
factor to depression in chronic pain patients. Being in constant pain also causes chronic fatigue,
which cannot be relieved by simply resting. Chronic pain patients are also susceptible to developing
substance use disorders due to medication for the pain.

The social factor of the disease includes isolation from peers and social circle, which can lead to
depression. The pain of the disease is hugely inhibitory, leading to an inability to perform many
activities which can harm social life.

Treatments

There is no cure for rheumatoid arthritis but treatments can help manage the pain and help alleviate
symptoms. Treatments can help manage the pain and control the inflammatory response which can
in many cases cause a remission. Decreasing the inflammation can also help to prevent further joint
and organ damage. Treatments may include:

 Medications- Medications generally are either immunosuppressants or anti-inflammatories.

Occasionally, steroids are prescribed during flares in order to temporarily calm the joint.
 Alternative or home remedies- Changes to lifestyle such as aids can help improve the quality
of life and functioning during flares.
 Dietary changes- Supplementing a healthy lifestyle with nutritional supplements such as
omega-3 fatty acids in fish oil and borage seed oil are shown to help reduce inflammation.
 Exercise
 Physiotherapy can aid the patients in retaining mobility in the joints.
 In extreme cases, doctors might suggest surgery to remove the inflamed lining of joints,
repair the stressed tendons, fusion of joints which cannot be replaced, or total joint
replacement.

Fibromyalgia

What is Fibromyalgia?

Fibromyalgia is a chronic pain disorder characterized by musculoskeletal pain along with fatigue,
sleep, memory, and mood issues. It is believed that fibromyalgia amplifies painful sensations by
affecting the way the nervous system processes painful and nonpainful. Symptoms often begin after
an event such as physical trauma, surgery, infection, or significant psychological stress.

The primary symptoms of fibromyalgia include:

 Muscle pain, twitching, or tightness

 Low pain threshold
 Draining fatigue
 Trouble concentrating and remembering (known as fibro fog)
 Insomnia or nonrestorative sleep
 Anxiety
 Depression
  Headaches
 Bladder problems
 Irritable bowel syndrome
 Heart palpitations

There is no test to detect fibromyalgia. Health care professionals will first rule out various other
diseases such as underactive thyroid, different types of arthritis, and lupus. They will also conduct
various blood tests to check hormone levels and signs of inflammations, and X-rays. When those are
all ruled out, a two-part scoring system is used to measure how widespread the pain has been and
how much the symptoms affect daily life.

Biopsychosocial Model

The biological factor which causes fibromyalgia is unclear. It is hypothesized that the disorder is a
problem with central pain processing in the brain, where there may be an increased sensitivity or
perception of pain to a given trigger. Risk factors include traumatic events, repetitive injuries,
autoimmune disease, CNS problems, and genetic components.

The psychological factors show links between mental health and chronic pain illnesses. Chronic pain
illnesses are difficult to live with and can adversely affect mental health, leading to periods of
depression. This has also been suggested to have adverse effect on the pain. The insomnia caused by
the disease’s chronic pain, causes severe issues with mood. The inability to participate in activities
due to the pain is also a huge contributing factor to depression in chronic pain patients. Being in
constant pain also causes chronic fatigue, which cannot be relieved by simply resting. Chronic pain
patients are also susceptible to developing substance use disorders due to medication for the pain.

The social factor of the disease includes isolation from peers and social circle, which can lead to
depression. The pain of the disease is hugely inhibitory, leading to an inability to perform many
activities which can harm social life.

Treatments

There is no cure for fibromyalgia but treatments can alleviate symptoms. Each patient experiences a
different set of symptoms; hence an individualized treatment is required. This may include:

 Exercise program
 Acupuncture
 Psychotherapy
 Behavior modification therapy
 Chiropractic care
 Massage
 Physical therapy
 Low-dose anti-depressants
 Pain relievers
 Dietary measures- Patients who incorporate high energy foods with low sugar, non-gluten,
non-additive, more seeds and nuts, have shown fewer pain symptoms.