In Portugal, RA affects women four times more than men and as such we must be aware of joint complaints, particularly if they do not have an identifiable cause or if they last for weeks or months. Characteristic, RA affects multiple joints, namely the small joints of the hands and feet, but can involve many other joints. As a systemic rheumatic disease, it can involve, in addition to the musculoskeletal system, other organs such as the lung, the heart, the eyes, etc.
In RA, the pain is inflammatory, which means that it is more in the morning or at the end of the night, improving throughout the day, associated with a feeling of stiffness or “rust” of the joints that are loose or difficult mobilization in the morning extending this stiffness for more than 30 minutes. Many times this stiffness lasts for hours leading many patients to get up some time before they are able to function better when they arrive at work.
Like many rheumatic diseases, rheumatoid arthritis has the ability to abruptly interfere with all areas of life, limited the ability to work with others and the family. The limitation in several joints and inflammation and the variability of both the joints and the intensity of pain or a decrease in the strength and function of the joints implies both with small tasks and with the ability to walk or move.
But this is a disease of Rheumatology of Rheumatologists and of hope, because in the last years the capacity that exists to give patients back their capacity for life has been the greatest transformation that we can do. An early diagnosis, a follow-up by the specialist in Rheumatology and a joint plan and the adapted medications can return to a patient if not all or at least almost all of his life. And it is about life that we talk about, the ability to take care of yourself and your children, to be able to go to work and be available for that, to be able to sleep and rest or to walk without pain or to be able to do what all of us do again we want to do.
Early diagnosis requires the patient to understand that pain that involves one or more joints that does not have an apparent cause and that lasts from days to weeks should be investigated. Even more if you have swollen joints (with edema, heat and redness) if you reach several joints you should always seek help from the family doctor or a Rheumatologist
Then it should be in the connection between the Rheumatologist and in the strength of that relationship that a strategy to reach the diagnosis initially and later in a therapeutic plan that will include exercise, diet, stop smoking but also several therapeutic weapons that we have today to make available to patients. Unlike 10 or 15 years ago today, we have many options for achieving ambitious goals of achieving remission or low disease activity. Biological or biotechnological medications or the latest JAK inhibitors can, if simpler medications fail, make an extraordinary difference in life even in the most severe cases of Rheumatoid arthritis. This means that we have a clinical picture that, although chronic, and therefore for life, can restore life to the patient as fully as possible with the least possible impact of the disease.
For that, we have to fight for a good connection between the patient, the family doctor of Rheumatology. This articulation is fundamental in the results obtained and in the evolution of patients throughout their lives with the disease. We cannot have a “pig in a poke” and patients should demand access to the rheumatologist for serious and disabling rheumatic diseases and not be sent to hospital consultations by non-specialists in Rheumatology who are certainly not the best specialists in Rheumatology and therefore, without the specific training to be able to follow seriously ill patients with rheumatic pathology. The NHS has treated rheumatic patients and Rheumatology as not being essential and although there is the capacity and specialists for this, more than half of the NHS hospitals do not have, almost all of them, the specialty of Rheumatology. This is due to a lack of planning, a lack of strategic vision, but also because socially rheumatic diseases are considered diseases of old people, which clearly are not, and that pain and limitation is acceptable.
Nothing more false than that rheumatic diseases have an important social impact with more than 1000 million euros annually in sick leave and early retirements, but for the patient we must never resign ourselves to being unhappy and in pain without really knowing if there is a cause, but also solution for our pains and disabilities. The future of each of the patients with rheumatoid arthritis depends on several variables, but fundamentally in the early diagnosis and in a follow-up by Rheumatology. Nowadays, only very difficult cases of rheumatoid arthritis, which fortunately are increasingly rare, will not be able to have a life, albeit with limitations and with the disease, which is getting closer to normal.
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