Dr. Abhrajit Ray

1) What is arthritis?

Arthritis literally means inflammation of a joint. This is due to inflammation of the joint lining called synovium, which results in joint swelling and causes pain and stiffness as the main symptoms.

2) How do you know whether you have Arthritis?

Patients with Arthritis may experience the following symptoms: pain and swelling of one or more joints, feel stiffness in the joints - more in the morning, redness and warmth of the affected joints and these symptoms can be recurrent or persistent.

3) Is it seen only in elderly people?

No, this is a common misconception. Arthritis can affect any age group- even children. However, osteoarthritis which is a disease of the cartilage of the joint (also referred to as 'wear and tear' arthritis), affects older people.

4) Is arthritis more common in women?

Yes, arthritis generally is more common in women than men. Rheumatoid arthritis is 3 times more common in women.

5) Any special diet for Arthritis?

No special diet is required for arthritis patients except Gout where a diet low in animal protein and limiting alcohol intake can be helpful in the overall treatment.

6) Will exercise help my joints?

Exercise is important to maintain the flexibility, range of movement at the joint and to strengthen the muscles. However, exercise will not reduce joint inflammation and usually should be started, only after effective control of inflammation with proper therapy.

7) What is the difference between a Rheumatologist and an Orthopedic Surgeon?

Rheumatologists are Physicians and Orthopaedic surgeons are surgeons; therefore all medically related joint disorders are dealt by a Rheumatologist. When the joints are badly damaged or when there are fractures, then you need to consult an orthopedic surgeon

8) What are the commonly used drugs in the treatment of arthritis?

The drugs/medicines used for the treatment of arthritis and related disorders can be classified under the following categories:
a) Non-steroidal anti-inflammatory agents (NSAIDs) : These drugs, as the name implies, are anti-inflammatory and are not steroids. They are commonly referred to as 'pain-killers'. However, they work by reducing inflammation and in addition also have pain relieving (analgesic) properties. They do not have any specific disease modifying or controlling actions, but can be useful for symptomatic benefit. Some NSDAIDs are: Ibuprofen, Diclofenac, Naproxen etc. There is a group of NSAIDs called Cox-II inhibitors that are considered to be easier on the stomach and they include: Etoricoxib and Celecoxib. b) Analgesics: These include : Paracetamol and Tramadol and are 'pure' pain relievers. c) Disease-Modifying Drugs (DMARDs) : These are medicines that have a specific disease modifying/controlling effect and are also referred to as immuno-suppressants. These include: Chloroquine, Methotrexate, Sulfasalazine, Azathiaprine, Cyclophosphamide etc. d) Miscellaneous: There are a number of other medicines that may be used, such as Colchicine, Allopurinol or Febuxostat, used for Gout.

9) How can a Rheumatologist help you?

A Rheumatologist helps by:
a) Evaluating a patient with joint complaints and making a correct diagnosis;
b) Planning the correct treatment for the patient;
c) Monitoring the patient periodically as indicated, to recognise and complications and/or side effects as early as possible;
d) In preventing joint damage and improving quality of life of the patient.

10) What causes rheumatic diseases?

Rheumatic diseases are generally believed to be caused by a combination of genetic and environmental factors. In other words, you may be born with a susceptibility to a disease, but it may take something in your environment to get the disease started. Some of these factors have been identified. For example, in osteoarthritis, inherited cartilage weakness or excessive stress on the joint from repeated injury may play a role. In rheumatoid arthritis, juvenile idiopathic arthritis, and lupus, patients may have a variation in a gene that codes for an enzyme called protein tyrosine phosphatase nonreceptor 22 (PTPN22). Certain viruses may trigger disease in genetically susceptible people. For example, scientists have found a connection between Epstein-Barr virus and lupus. There are likely many genes and combinations of genes that predispose people to rheumatic diseases, and many different environmental factors that trigger them. Gender is another factor in some rheumatic diseases. Lupus, rheumatoid arthritis, scleroderma, and fibromyalgia are more common among women. This indicates that hormones or other male-female differences may play a role in the development of these ¬conditions.

11) Who is affected by rheumatic diseases?

Approximately 4-6 out of 10 consultations with a family physician are for a musculo[skeletal complaint. Rheumatic diseases are a more frequent cause of activity limitation than heart disease, cancer, or diabetes. Rheumatic diseases affect people of all races and ages. Some rheumatic conditions are more common among certain populations. For example:
Rheumatoid arthritis occurs two to three times more often in women than in men.
Scleroderma is more common in women than in men.
Nine out of 10 people who have lupus are women.
Nine out of 10 people who have fibromyalgia are women.
Gout is more common in men than in women. After menopause, the incidence of gout for women begins to rise.
Systemic lupus erythematosus is more common in women than in men, and it occurs more often in African Americans and Hispanics than in Caucasians.

12) Will be I able to have a family if I have Rheumatoid Arthritis?

Rheumatoid Arthritis should not affect your ability to get pregnant or have a healthy baby. Your rheumatologist will work with you to change your treatment plan if you want to conceive a baby, as some DMARDs, including methotrexate, can cause severe birth defects. Both women and men with Rheumatoid Arthritis should use birth control to prevent pregnancy while taking methotrexate or other drugs that could cause birth defects. These drugs should also be avoided while a woman is pregnant or breastfeeding. Women who have Rheumatoid Arthritis often experience a reduction in their symptoms while they are pregnant.

13) What are the long-term effects of Rheumatoid Arthritis? Will my joints be deformed?

Rheumatoid Arthritis can have serious long-term effects if you do not seek a diagnosis early and start treatment to control your inflammation. Joints can become painful and stiff, and they can break down and become almost impossible to use. Rheumatoid Arthritis can affect internal organs as well, causing inflammation of the eyes, heart, lungs or skin. However, early diagnosis and treatment can help control your inflammation and prevent joint damage. Many people with Rheumatoid Arthritis today can avoid joint deformity or even the need to replace severely damaged joints. The best way to avoid joint damage and control your Rheumatoid Arthritis is to seek diagnosis and treatment with a rheumatologist as soon as possible. You can also stay fit with regular, joint-friendly exercises, manage your weight, eat a healthy diet and avoid smoking.

14) Is medicine the only way to help relieve symptoms of rheumatic diseases?

We recommend several treatment options for relieving the symptoms of rheumatic diseases. If medication is available for your condition, we will prescribe it in addition to recommending lifestyle changes. A healthy diet, regular exercise, weight loss, limiting alcohol and stopping smoking are all important actions you can take in successfully relieving symptoms. Depending on your condition, we may also recommend physical and occupational therapies.

15) I think I may have RA, what is my next step?

If you think your symptoms may be RA, then schedule an appointment with your primary care physician or GP to discuss them. They can refer you to see a rheumatologist for a comprehensive evaluation. If your symptoms have started between the last four weeks to six months, then your provider may consider sending you to our Early Arthritis Clinic.

16) Do I need to stop my medicines if I am having an operation?

If you need to have an operation, it is likely that you will need to stop your rheumatology medication a few weeks before the surgery. You will be able to re-start your medication a few weeks after the operation so long as the wound is fully healed and you are well. This is because there may be an increased risk of infection if you are taking some rheumatology medications such as methotrexate or biologic therapies. You should ask your surgeon or contact the Rheumatology Department if you require further information on this. Some doctors or dentists may advise additional antibiotic medicines for certain surgical or dental procedures if you are taking certain rheumatology medication such as methotrexate or biologic therapies.

17) Do arthritis symptoms go away during pregnancy?

Many women who have arthritis find that their symptoms lessen when they are pregnant. However, once the pregnancy is over, the arthritis returns. Usually, pregnant women with ankylosing spondylitis feel no difference in their condition when pregnant whilst women with osteoarthritis of the knee and hip may find their arthritis gets slightly worse when pregnant.

18) How long do I have to stop taking my arthritis medication before I start a family?

Women and men taking stronger medication for their arthritis such as methotrexate or other disease modifying anti-rheumatic drugs (DMARDs) will have to consult their doctor or consultant about the best course of action.
The amount of time taken for a drug to leave the body can be very variable. However, it is recommended that if taking drugs such as Methotrexate then you should leave at least 3 months after stopping this medication before considering pregnancy.

19) Are complementary and alternative therapies helpful for people with arthritis?

Complementary medicine uses therapies that work alongside conventional medicine. Alternative medicine includes treatments not currently considered part of evidence-based Western Medicine.
Some herbal medicines are not recommended for people with arthritis and some may interfere with your Rheumatology medications. You should not start any new complementary or alternative therapies without first discussing with your Rheumatologist or Rheumatology Specialist Nurse.

20) Does the weather affect my arthritis?

The links between arthritis and the weather are inconclusive. There is no overwhelming evidence to support this and information has been anecdotal and subjective. Many people with arthritis say that their joints ache before a storm, and, according to experts, this is due to a drop in pressure and a rise in the humidity causing pain and stiffness in the joints. However, a change in the weather will not cause arthritis, but can worsen the symptoms.