There are established procedures and guidelines that would enable diagnose the presence of Rheumatoid arthritis accurately without making mistakes and without having to apply the wrong management.
The disease can be properly diagnosed through the following procedures and investigations:
1. History: History taking and physical examination will give the doctor a clue as to the actual cause or predisposing factors to the disease condition.
2. Synovial fluid examination: This shows a remarkable abnormality. The colour is turbid (cloudy); it has low viscosity and clots on standing. It also contains many cells.
3. Rheumatoid factor: Blood sample reveals the presence of high molecular weight protein known as the Rheumatoid factor (RF). This is diagnostic.
4. X-ray: X-ray of the joint will show abnormality of the affected joint. It will reveal eroded cartilage and osteoporosis of the affected joint.
5. Erythrocyte Sedimentation Rate: This will be abnormally high. The normal value using the Wintrobe method is 0-6.5mm/hr (for men) and 0-15mm/hr (for women).
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Management
Rheumatoid arthritis is incurable but can be managed to give relief to the patient and minimize the damage to the joints. The treatment is to help make the patient more comfortable, prevent or correct deformities and maintain or restore the function of the affected joints.
Drugs
1. Analgesics (Anti-inflammatory drugs)
2. Anti-malarial
3. Corticosteroids
1. Anti-inflammatory drugs: This group of drugs otherwise known as the 'Non-Steroidal Anti-inflammatory Drugs (NSAID) have three basic properties- Analgesic, Anti-inflammatory and Anti-pyretic. Aspirin is the drug of choice. Other drugs in this group include Indomethacin (Indocid), Phenylbutazone (Butazolidin), Tanderil (Oxyphenylbutazone), Ibuprofen, Diclofenac, Naproxen, Celecoxib, etc.
These drugs should be used under strict medical supervision because of their ability to cause gastric ulceration and bleeding. They should also not be taken on an empty stomach.
2. Anti-malarial drugs: Anti-malarial drugs like Chloroquine and Quinacrine also provide a great relief against the inflammation of the joints.
3. Corticosteroids: Corticosteroids such as Prednisolone, Betamethasone, Dexamethasone and Hydrocortisone are also useful in the control of pain, and stiffness as well as improve physical and mental well-being. Corticosteroids should strictly be prescribed by medical personnel.
Other treatment measures include:
a. Application of heat: Wet heat in the form of hot baths helps to improve blood supply to the joint and control spasm thereby relieving pain. Dry heat (Infrared bulbs or hot water bag) can also be applied over the joint to provide relief.
b. Splinting: Braces, bivalve casts or splints can be applied over the joint to relieve pain and spasm. The splints also help prevent dislocations and deformity. They also promote rest of the joint and correct deformity.
Rest: Patient should have enough rest if seriously ill. Patient should be rested on a bed that is flat and firm with a bed board under the mattress. A bed cradle should be put in place to keep the bed clothes off the joint.
Exercise: Patient should be advised to exercise joints mildly several times daily. Patient should also be told to avoid over-exercising himself up to point of pain and fatigue. Patient should maintain a balance between rest and activity.
Pain relief: Sedatives and tranquillizers can be given in addition to drugs already discussed above and patient taught to recognize the side effects of the drugs.
Nutrition/elimination: Fluid intake should be increased if it is not contraindicated. Balanced diet should be given in frequent small amounts. Constipation can be prevented by the use of stool softeners or by increasing food rich in fibres.
Physical care: Pressure areas should be taken care of regularly to prevent pressure sore. Joints should be observed for redness, swelling, heat, deformity and limitation of movement and patient should be assisted with physical care e.g. bathing if pain is severe.
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