Rheumatoid arthritis (RA) is estimated to affect approximately 0.24 to 1 percent of the Indian population and is twice as common in women compared to men. It affects more than 180 million people in India; the prevalence is higher than many well-known diseases such as diabetes, AIDS, and cancer. Around 14% of the Indian population seeks a doctor's help every year for this joint disease.

In the series on rheumatoid arthritis, the team of Medicircle is speaking to many eminent rheumatologists so that there is awareness about all aspects of this disease amongst people.

Dr. Rachit Gulati, Senior Resident, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, has special interests in musculoskeletal Ultrasound, Interventional Physiatrist, Pain Management, and Rheumatology. He previously started and headed the department of PMR in Jalpaiguri Super-specialty Hospital.

Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, provides world-class; quality health services with ultra-modern techniques at affordable cost and is equipped with modern state-of-art equipment and infrastructure.

 Rheumatoid Arthritis more common in women

Dr. Gulati explains that “Rheumatoid Arthritis is a chronic multisystemic autoimmune inflammatory disease, which affects the younger population in their 20s and 30s, and is twice more common in women as compared to men. By the term autoimmune, it can be implied that the body's immune system or the self-defense system starts acting against one's joints and sometimes other body organs as well. In about 15 - 20% cases, the disease can be associated with problems in kidneys, eyes, skin, etc, which is much more problematic and the prognosis is worse too in those patients,” he says.

Mornings are more challenging for patients with RA

Dr. Gulati lists down the symptoms of RA,

• “Pain accompanied with swelling,
• Decreased range of motion,
• Palpable warmth - principally in joints of hands like the joints at the base, middle, and tip of the finger, wrists, elbows, shoulders, and knees as well.
• This pain is significantly associated with morning stiffness, or an early morning decrease in range of motion, which lasts for more than 60 to 90 minutes.

So very commonly patients say that they are unable to hold objects like a cup of tea,” he says.

Diet and rheumatoid arthritis

Dr. Gulati says, “There is no demonstrable link proving that a problematic diet would lead to rheumatoid arthritis or a certain type of diet would cure it. However, since rheumatoid arthritis is an inflammatory disease, there are certain kinds of food that help in fighting inflammation:

• Fish like salmon and tuna are rich in omega 3 fatty acids. So, they are very good when it comes to fighting inflammation
• Rheumatoid arthritis is very much linked to the depletion of calcium. In the Indian scenario depletion of calcium is faster because India is one of the world's capitals in osteoporosis. So, dairy foods like milk, butter, ghee, etc. help in improving the calcium in the body.
• Mediterranean diet which principally comprises of olive oils and grains is helpful
• Beans and nuts are good in fiber and should be consumed by patients of RA
• Food items rich in vitamin C and zinc also prove helpful," says Dr. Gulati

Stay away from:

• Tobacco
• Alcohol
• Red Meat
• Processed Food
• Food items high in calories,” he says.

Early suppression of inflammation may prevent joint damage

Dr. Gulati suggests that the visit to the doctor should be as soon as possible, “Studies have indicated that early suppression of inflammation may prevent joint damage. Delaying may cause a lot of deformities and disabilities. Doctors diagnose through clinical, radiological, or pathological tests. An early diagnosis can lead to much better results as the effects of rheumatoid arthritis can be reduced to such an extent that it does not create a problem functionally. Early diagnosis provides a window of opportunity to reverse it and get fully cured in rare cases. Spontaneous remission without treatment is even rarer. So, visiting the doctor as early as possible and getting into treatment is highly recommended to escape aggravation of the disease,” he says.

Pocket-friendly diagnosis and treatment options for RA

Dr. Gulati sheds light on the advanced diagnostic modalities of recent times:

• “Doppler, ultrasonography detects signs of rheumatoid arthritis very early. It is available even in the primary and community health centers now
• Disease activity measurements do not require complex calculations these days. They are available in form of apps on Android and iOS stores. So even a doctor who is sitting in a sub-center or a primary health center has the armamentarium to properly diagnose and manage rheumatoid arthritis
• Disease-modifying anti-rheumatic pocket-friendly drugs are commonly available now
• Medical Council of India or the National Medical commission nowadays has focused on producing more and more rheumatologists and experts who can treat patients with rheumatoid arthritis skillfully
• American College of Rheumatology and the European Union of the league against rheumatism has designed an arthritis classification criteria through which rheumatoid arthritis is getting detected very early nowadays. The multidisciplinary and multi-pronged approach is being adopted to treat rheumatoid arthritis,” he says.

(Edited by Amrita Priya)