Rheumatoid Arthritis And Women: Debunking Myths
Rheumatoid arthritis affects 0.5-1% of general population worldwide. Women are affected more commonly than men (female to male ratio varies from 3:1 to 9:1).
Exercise is an important part of management of RA.
- In general, autoimmune diseases are more commonly seen in women
- Multiple factors play a role in the causation of RA
- Birth control pills can make symptoms of RA worse
Rheumatoid arthritis is the most common chronic inflammatory arthritis involving small joints of hands and feet predominantly but large also get involved. It affects 0.5-1% of general population worldwide. Women are affected more commonly than men (female to male ratio varies from 3:1 to 9:1). "In general, autoimmune diseases are more commonly seen in women. This higher prevalence is partly attributed to the X chromosome, which has many genes relating to immune system. Women have two X chromosomes, which bless them with robust immune system that provides defense against infections, but make them vulnerable for autoimmune diseases like RA. Also, female sex hormones (oestrogen) play a role in development of autoimmune diseases, which is manifested by the fact that RA starts shortly after puberty, and often changes profile during pregnancy", according to by Dr. Uma Kumar, Professor of Rheumatology at AIIMS.
However, exact cause of RA is still not known. Multiple factors play a role in the causation of RA. In genetically susceptible individuals hormones (estrogen, prolactin), obesity and environmental factors like air pollution, cigarette smoking, infections (bacteria or viruses), insecticides and, occupational exposure to mineral oil and silica play a role in the development of arthritis. RA is also triggered by stress and unhealthy eating. The disease expression, in terms of rate of progression and severity, is also modified by various exogenous factors like smoking and infection. RA is not hereditary but studies have revealed that the risk of being diagnosed with RA increases by three times if someone has a first-degree relative with disease.
Let us have a look at a few myths debunked by Dr. Uma Kumar Professor, Head Department of Rheumatology at AIIMS:
Myth: Birth control pills can make symptoms of RA worse.
Reality: Birth control pills do NOT worsen the symptoms of RA but they may modify the disease severity.
Myth: Women with RA have more trouble in conceiving.
Fact: RA does not decrease the fertility.
Myth: Women on oral contraceptive pills cannot take RA medications.
Reality: Yes, patient can continue both simultaneously.
Myth: RA mostly affects the elderly women.
Reality: No, RA is the disease of young women. Incidence of RA increases from 25 to 55 years of age, after which it plateaus until the age 75 and then decreases.
Myth: Obese women are more likely to get RA.
Reality: Yes, obesity increases the production of inflammatory cytokines and oxidative free radicals, which contribute to development of RA in presence of other risk factors.
Myth: RA is no different from osteoarthritis in women.
Reality: RA and osteoarthritis are two entirely different diseases. RA is an autoimmune inflammatory arthritis affecting women of reproductive age group while osteoarthritis is a non-inflammatory degenerative joint disease usually occurring after 40 years of age. They differ in epidemiology, causes, mechanism, clinical presentation, management and course of disease.
Myth: Women with RA shouldn't exercise, as it can be dangerous to the inflamed joints.
Reality: Only aggressive, intense and high impact exercises to be avoided during active joint disease i.e. when joints are inflamed. Exercise is an important part of management of RA.
Myth: RA cannot be treated.
Reality: RA is a treatable condition. In current times, many therapeutic agents known as disease modifying antirheumatic drugs (DMARDs) with proven efficacy and acceptable safety are available in India. 60-70% patients respond to oral conventional synthetic DMARDs. After conventional synthetic DMARDs, we need to try targeted synthetic DMARDs as the next course of treatment. Those patients who do not respond to even targeted synthetic DMARDs are then moved to biologics. Those who have refractory RA, require biologic agents which are expensive drugs. Early diagnosis, aggressive treatment to control inflammation as fast as possible and continued physical activity is the 'Mantra' to treat RA. Also, it is possible for RA patient to lead a pain free, disability free normal life but on drugs.
Myth: Women with RA do not face the risk of any other disease.
Reality: RA patients are at increased risk of developing cardiovascular events (myocardial infarction, angina, arrhythmia), hypertension, stroke, COPD, depression and solid malignancies.
Myth: RA cannot be prevented.
Reality: There are a few potentially modifiable risk factors, which can be altered resulting in reduced incidence of RA like stopping smoking, reduction of extra weight, healthy eating habits (avoid foods high in sugar salt and fat) better air quality and regular exercise.
Obesity increases the production of inflammatory cytokines and oxidative free radicals, which contribute to development of RA in presence of other risk factors."
Dr. Uma KumarProfessor & Head, Department of Rheumatology, All India Institute of Medical Sciences
Myth: You cannot effectively treat RA symptoms.
Reality: RA is a treatable medical condition just like diabetes mellitus, hypertension etc. Majority of patients need to take drugs throughout their life under the supervision of a 'Rheumatologist' preferably, or a Physician.
Myth: RA is like any other arthritis form and can be improved through lifestyle and other changes.
Reality: RA is an autoimmune inflammatory polyarthritis which requires treatment with disease modifying antoirheumatic drugs like Methotrexate, Sulphasalazine, leflunomide etc. Lifestyle modification also plays a supportive role in preventing or retarding joint damage.
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