Rheumatoid arthritis affects more than just your joints! Risk factors, complications and drug treatments can be understood at once
Women and genetic factors account for the majority? Risk factors for rheumatoid arthritis
Rheumatoid arthritis (RA) is an autoimmune disease that causes joint pain and swelling. Dr. Cai Yunzhen from the Department of Rheumatology and Allergy at Linkou Chang Gung Memorial Hospital said that the prevalence rate of rheumatoid arthritis in Taiwan is about 1-2%, and the number of patients is roughly estimated to be 100,000-200,000. It mostly occurs between the ages of 30-50, and the male-to-female ratio is about 1 : 3. In recent years, due to the advancement of diagnostic tools and health awareness, the number of patients has continued to increase, and rheumatic immune diseases account for the majority.
Dr. Cai Yunzhen pointed out that the exact cause of rheumatoid arthritis is currently unknown. Genetic factors and risk factors are the main causes of rheumatoid arthritis. Studies have pointed out that about 40%-60% of the risk factors for rheumatoid arthritis are genetic factors. Those whose parents or siblings suffer from rheumatoid arthritis have a risk of developing rheumatoid arthritis that is 3-5 times higher than that of the average person. In terms of environmental factors, obesity, smoking, hormones, and environmental pollution may all induce rheumatoid arthritis.
Not only joint deformation affects the whole body! Complications of Rheumatoid Arthritis
Dr. Cai Yunzhen explained that the course of rheumatoid arthritis progresses rapidly, and about 80-85% of patients experience joint damage in the first 2 years of the disease. Rheumatoid arthritis can usually be divided into four stages: in the first stage, the inflammatory reaction causes soft tissue edema and the joints begin to swell; in the second stage, joint deformation, bending, and crooked fingers begin to appear; in the third stage, deformed joints It will compress the nerves and cause neuralgia; in the fourth stage, the condition worsens to the point where the joint tissue is completely eroded and almost fused, which may lead to permanent joint damage and deformity.
Rheumatoid arthritis is a systemic chronic inflammatory disease. In addition to invading joints, it may also cause extra-articular symptoms, such as stroke, eye disease, cardiovascular disease (thrombosis), lung disease, cutaneous vasculitis, carpal tunnel syndrome, osteoporosis, Joint damage. In addition, 50-75% of patients with rheumatoid arthritis have sleep disorders, and poor sleep quality will affect disease activity, depression and even disability, leading to a vicious cycle that worsens the condition.
According to a survey by the Association of Friends of Rheumatoid Arthritis of the Taiwan, in the past year, more than 60% (68.9) of people seeking medical treatment due to rheumatoid arthritis went to ophthalmology departments, more than 50% of orthopedics patients (53.4%), and gastrointestinal, hepatobiliary and gastrointestinal departments. As high as more than 40% (44.7%).
Is there any chance steroid drugs could be zeroed in? Treatment goals for rheumatoid arthritis
Dr. Lu Junji, from the Department of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, said that treat-to-target (T2T) treatment for rheumatoid arthritis aims at early improvement and long-term maintenance of low disease activity. According to the 2022 treatment guidelines of the European League of Rheumatology (EULAR), the treatment goals for rheumatoid arthritis are:
Improve disease activity by at least 50% within three months of treatment;
Achieve disease activity within 6 months of treatment. Remission or “low disease activity”.
Since rheumatoid arthritis is a systemic inflammatory reaction that may affect other organs in the body, treatment will be divided into joint and non-joint drugs, and depending on the situation, the patient will be helped to reduce dependence on steroids as much as possible, and even reach " Zero on steroids". However, in the real world, patients’ compliance with treatment is easily affected by drug payment, treatment myths, lifestyle, or lack of improvement of their condition.
The use of rheumatoid arthritis drugs is mainly divided into three categories. The first category is emergency treatment and improving symptoms, mainly non-steroidal anti-inflammatory drugs and steroids; the second category is regulating immune response, using disease-modifying anti-rheumatic drugs (DMARDs), mainly immunomodulators; the third category is targeted therapy, mainly biological agents and small molecule oral drugs. In recent years, the international medication order for rheumatoid arthritis has gradually shifted to early use of targeted therapy to reduce the risk of joint deformation.
Dr. Lu Junji said that most of the targeted treatments for early-stage rheumatoid arthritis are injections, and patients tend to have the misconception that injections are more effective than oral drugs. In fact, both biological agents and small molecule oral drugs are used in targeted treatments. The effect is equivalent, but rheumatoid arthritis requires a multi-pronged approach. Some targeted drugs must be combined with traditional oral disease-modifying anti-rheumatic drugs (DMARDs). It is not that injections and medicines can only be chosen one or the other. Discussing appropriate treatments with your doctor as early as possible can also reduce the possibility of complications from other joint symptoms in the future, resulting in more medications.
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