Q: My 28 years old husband is suffering from swelling in feet for the last few days. It causes a lot of pain. During morning, he experiences stiffness and pain in elbows as well. My husband’s uric acid is 6.8 mg/dl and his ESR is 45 mm. The doctor diagnosed it as a symptom of rheumatoid arthritis. Is my husband suffering from rheumatoid arthritis? Is it curable?

A:The diagnosis for rheumatoid arthritis is based on well-defined criteria. Your husband's symptoms of swelling in the leg and pain in the elbows with an ESR of 45 mm and some morning stiffness cannot be straight away classified as rheumatoid arthritis, though it may turn out to be so after investigations. The currently accepted criteria were described by the American College of Rheumatologists in 1987. They recommend that at lest four from a list of seven symptoms/signs/investigations are required to classify patients as having rheumatoid arthritis. These include:

1. Morning stiffness lasting more than one hour.
2. Arthritis of three or more joint areas but at lest three joint areas observed by a physician and occurring simultaneously.
3. Arthritis of hand joints.
4. Symmetric arthritis – that is involvement of same joint areas on both sides of the body.
5. Rheumatoid nodules – these are small nodules occurring on the skin around bony prominences especially around elbow.
6. Positive rheumatoid factor
7. Typical radiological changes.

(Adapted from Harrison’s principles of internal medicine, 2008)

In your case, some clarifications are required before your husband can be labelled and put on treatment for rheumatoid arthritis. Your husband therefore needs to show a Rheumatologist who can analyse his symptoms and physical signs. These days the disease responds well to drugs that are known as disease modifying drugs. The specific drugs given for rheumatoid arthritis are toxic, need regular monitoring, and are given for long term and therefore treatment with these is initiated only when the diagnosis is confirmed. In some patients the disease has a natural history but there is no way of predicting this.