Rheumatoid Arthritis and how it’s confused with Gout
Rheumatoid Arthritis and how it’s confused with Gout
Rheumatoid arthritis and gout both are types of arthritis , somehow shows similar symptoms and have resemblance because both diseases results in inflammation of peripheral joints, which may cause confused diagnosis and patient recognition sometimes but causes and treatments are entirely different.
Rheumatoid Arthritis
Rheumatoid arthritis is an immmune mediated inflammatory disease (IMID), that not only affect joints but wide variety of systems includes skin, lungs, heart, eyes and blood vessels .
Sign And Symptoms
Normal flares after waking up in morning
Pain, swelling and stiffness in several joints
More likely affect fingers, knuckles wrist and toes
Changes in appearance and mobility of affected joints.
Lumps under skin
Weight loss
Fever and weakness
Cold temperature make it even worse
Causes
This autoimmune disorder occurs, when body’s own immune system mistakenly attacks healthy tissues of body mostly joints.
Your defense system release antibodies to lining of joints and these antibodies attack there, which cause lining cells (synovial cells) to divide and lead to inflammation. In this process, chemicals are also released which may damage near bones, cartilage, tendons and ligaments.
It can affect any joint lined by synovial membrane.
Risk factors
GENETICS AND OTHER TRIGGERS :-It was assume that may be Rheumatoid Arthritis is a hereditary disease but actually it isn’t. Although, it runs in some families which may due to environmental factors, genetic factors or combination of both. Even when genetically suspectible individual experience the external triggers (e.g smoking, infection or trauma) that trigger an autoimmune reaction and cause this immune disorder.
Other factors includes :-
AGE :- It can occur at any age but more likely older ages between 30–50.
GENDER :- American Research studies have shown about 1.5 million American develop RA out of which women have approximately three times more ratio than men.Hence, symptoms hits hard and more severe in women.
OBESITY :- 329 review studies finds that obesity can progress severity in symptoms https://onlinelibrary.wiley.com/doi/abs/10.1111/ijcp.13045 research outcomes find RA patients have ( BMI≥30.0Kg/m2)
DIET :- High calorie food provoke inflammation whearas, Mediterranean diet may help to reduce RA associated symptoms.
Diagnosis
Early diagnosis within 6-months of symptoms onset can help to begin treatment for slow disease progession and for reduced damage. RA can primarily diagnosis by examing symptoms , performing physical examnation, conducing lab tests, Doing X-rays
Rheumatoid factor (RF) and other blood tests
Rheumatoid factors are immune system’s protein that may attack healthy tissues in body.
Rheumatoid factor test calculate rheumatoid factor (RF) in blood. High RF indicate autoimmune disease such rheumatoid arthritis .Although, it can be detected in healthy individual and the case may be that autoimmune disease patient have normal RF level.
OTHER BLOOD TESTS ARE :-
· Anti-nuclear antibody (ANA)
· Anti-cyclic citrullinated peptide (anti-CCP) antibodies
· C-reactive protein (CRP)
· Erythrocyte sedimentation rate (ESR, or sed rate)
Like RF, these blood test also used in diagnosis of rheumatoid arthritis.
Treatment
The aim of rheumatoid treatment now is towards achieving lowest possible level of disease activity, remission, reducing joint damage and to improve physical function and quality of life.
The various pharmacological strategies are there for treatment plan.
NSAIDs (non-steroidal anti-inflammatory drugs)
Corticosteroids
DMARDS ( Disease modifying antirheumatic drugs )
NSAIDS
These agents reduce acute inflammation by reducing pain and enhance function. ASPIRIN the oldest drug of non-steroidal class but now been replaced by other NSAIDs because of narrow window, high GI-toxicity rate and daily doses disruption.Other NSAIDs includes over the counter drugs like ibprufen and naproxen and prescribed drugs including Etodolac, Meloxicam, sulindac, declofenac, indomethacin etc.
COX-2 inhibitors, one of known class of NSAIDs includes agents like celecoxib are effective anti-inflammatory designed to reduce gastrointestinal risk of NSAIDs but has possible concern of cardiovascular risks.
Corticosteroids
These are agents having both anti-inflammatory and immunoregulatory activities, are predominantly used for symptomatic relief of acute pain and inflammation.
Corticosteroids contribute by modulating gene expression as binds to glucocorticoid receptors, which specifically lead to up-regulation of anti-inflammatory and down-regulation of pro-inflammatory genes. On this regard, this inhibit inflammatory effect of circulating monocytes and eosinophills.
Prednisone and methylprednisolone are commonly used, although having undesirable side effects like immunosuppression, steroid-induced diabetes, osteoporosis, muscule weakness, thin skin, easy bruising, hypertension, edema and hypokalemia.
DMARDs
Disease modifying antirheumtic drugs (DMARDs) are likely to slow the progession of rheumatoid arthritis which lead to fewer symptoms and less damage over time. They inhibit T-cells and B-cells suppress body’s immune and inflammatory responses.
Unlike other medications, only DMARDs have two disease course and improve radiographic results, either conventional DMARDs (e.g, Methoxenate, leflunomide, Hydrochloroquine and sulfasalazine) or Biologic DMARDs (Etanercep, Adalimumab, inflinimab, abatacept, Ritunimab, Golimumab, Tocilizumab).
The common side effects of DMARDs are rashes, temporary hair loss, abnormal liver function tests, nausea, diarrhea, weight loss, abdominal pain and neuropathy.
Other Agents
These includes :- Tumor Necrosis Factor Inhibitors
T-cells costimulatory blocking Agents
B-cell Depleting Agents
Interleukin-1 (IL-1) Receptor Antagonist Therapy
Immunonodulatory and Cytotoxic Agents
Surgical approaches to treat Rheumatoid arthritis
Usually RA patient don’t have surgery, but those who have already damaged joints goes for this option to get relief from joint pain and to improve everyday functioning.
The common applicable surgeries are:
Joint Replacement (arthroplasty)
Joint fusion (arthrodesis)
Removal of inflamed synovial tissue (synovectomy)
On what basis it’s confused with GOUT ?
Similar symptoms like lumps under skin, pain and swelling in the joints are one of the reason that gout may confuse with rheumatoid arthritis. As in both cases, lumps under skin appears although causes of these appearances differs.
In RA, inflammation around joint can lead to bumps or nodules under skin. Whearas, In gout sodium urate crystals accumulate under skin and resulting lumps look alike to RA nodules or lumps.
Gout in it’s later stages, may look alike a lot like RA as causing pain and inflammation in multiple joints but again causes and treatments are different.
Gout is an inflammatory disease that occurs, when excess uric acid circulating in the bloodstrems deposited as sodium urate crystal in many joints. Whearas, rheumatoid arthritis is an autoimmune disorder as mentioned above.
EVENTUALLY, certain questions have been raised like :-
Does rheumatoid arthritis risk factor for gout ?
Against to opinion,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891477/ RESEARCH proposed that even at lower rate but gout does occur in an individual with RA. In future, risk factors of gout such as obesity, hypertension and chronic kindney disease may enhance incidence of gout in RA patients.
Can Rheumatoid Arthritis leads to high uric acid ?
Study by the new ARTHRITIS CARE AND RESEARCH, shown that 17% of patient blood has increased level of uric acid. This indicates the risk for cardiovascular disease, Renal dysfunction, ultimately Gout
That’s all about rheumatoid arthritis and it’s relativeness with gout, which common audience must know for prevention and cure of ownself and lovedones.
Do you and your relatives or friends have these diseases ?
Do you know one who had simultaneously developed both rheumatoid arthritis and gout ?
