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Early Signs Of Rheumatoid Arthritis


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Around 690,000 people in the UK suffer from rheumatoid arthritis with its joint pain, fatigue and stiffness. At present there is no cure for this painful and life-changing illness, but early arthritis diagnosis can make an enormous difference to the pain and progression of the disease.

Patients and doctors should act quickly to get the right help. The following patient story highlights a situation when rheumatoid arthritis patient, Jean, did not get the early diagnosis or help she needed at the right time:

Jean says: “As a sailor I used to race boats quite competitively and I was racing during the summer of 2006 when I noticed a growing amount of pain in my hands and feet. Shortly after this time I was in charge of a barbeque at a friend’s 40th birthday party when I found turning the food on the barbecue almost impossible. At the time I thought ‘what on Earth is this’ and dismissed it. When I look back now I realise that those times when my hands were seizing up or becoming very stiff were the first symptoms of rheumatoid arthritis.

It took me a while to go to the doctor as at first I just put it down being overactive, doing too much sport and not getting enough rest. I believed the symptoms I had would simply go away. When I eventually did approach my GP, the correct diagnosis still took quite some time. It took three separate visits to the doctor before someone realised that there was something seriously wrong and I was able to then be referred to a specialist.

At first my GP believed I had RSI (Repetitive Strain Injury) from the amount of typing involved in my job working in the City. It was only when I started having problems with my feet that I actually started to put two and two together. I then went back to my GP and actually suggested that these two things might be connected. At this point, my GP believed the problems with my hands and my feet were not connected and gave me a list of exercises to do.

Mornings can be an absolute nightmare if you have rheumatoid arthritis. One of the major issues that I had at that time was actually getting down the stairs. I used to have to come down the stairs on my bottom because I was unable to put one foot down in front of the other and I could not grip a banister either because my hands were so painful and tight. It was a very difficult time in my life.

I did end up in tears with the GP and really start to beg somebody to take this seriously, and gratefully at that time I actually saw another GP who said ‘I think there is something serious going on here’ and sent me for a referral. From then on things started to move at quite a pace and even on my first appointment the Rheumatologist suggested that it might be rheumatoid arthritis.

Now that I have the diagnosis, I take quite a combination of drugs. I take a daily dose of steroids. I also take methotrexate every week, and then I inject one of the new biologics once every couple of weeks. They are expensive but they really work for me and the good thing is that there is a lot of research going on at the moment about these new treatments.

I have a long term condition that I am still getting used to. It is part of me but it is not all of me.

Early diagnosis can make a real difference in the treatment of Rheumatoid Arthritis, so insist on a referral to a specialist, take a family member or a friend with you if you think it will help. It can make a real difference to the quality of the rest of your life.”

Dr. Graham Davenport from the Royal College of General Practitioners said: “It is tragic to hear Jean's story but unfortunately it is not that uncommon. I feel very sorry that Jean has suffered for so long because of a delay in diagnosis.”

Signs of RA

RA affects the joints of the hands by causing swelling and tenderness of the joint capsule, but it can also cause little cavities in the ends of the bones aligning the joints called erosions. These erosions can lead to significant damage and destruction of the joint, and in time disability.

The symptoms of rheumatoid arthritis include:
• joint pain and swelling
• stiffness
• tiredness (fatigue), depression, irritability
• anaemia
• flu-like symptoms, feeling hot or generally ill, and sweating

Other rare rheumatism symptoms are:
• weight loss
• eye inflammation
• rheumatoid nodules (local swelling or lump under the skin, usually firm)
• inflammation of other body parts, such as lungs and blood vessels and the membrane around your heart

Few GPs receive adequate training in spotting the earliest signs of RA. In fact few GPs have any training at all in rheumatology doing their hospital training. Most GPs are not aware of modern research which shows the benefit of the newer drugs including immuno-supressives and biologic treatments. These drugs can stop the erosions developing and crucially they can enable patients to return to work as quickly as possible and carry on with their normal activities. Unfortunately, there is no specific diagnostic test for RA which is why diagnosis will continue to be difficult.

The most important thing is that an individual displaying the early symptoms of RA gets a rapid referral to the specialist from their GP. The individual will then be seen by a specialist within a matter of weeks.

The patients themselves also have some responsibility. People often delay seeing their general practitioner because they feel nothing can be done for their arthritis, but this is not the case for rheumatoid arthritis. It is important in situations where a patient is not offered a referral that they request a second opinion.

Here is method for remembering the first signs of rheumatoid arthritis:

The S factor –
• If you have stiffness, or the joints in your hands are swollen and painful in the morning for 30 minutes of more
• If you have persistent swelling in one or more joints, and if you squeeze the joints you have tenderness or pain

If a person has any of these S's then they could have early rheumatoid arthritis. It is essential that they see their doctor as soon as possible. With early treatment for rheumatoid arthritis, people can return to a normal life.

This video was produced in collaboration with the National RA Society. Please visit them on NRAS.org.uk or call their helpline: 0800 298 7650 for Rheumatoid Arthritis support and information.

 

10033 Published October 2011

 

Review scheduled for October 2013

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