Q: What are the causes of rheumatoid arthritis? I have been suffering from it for more than 3 years. I am 28 years old. My lab results are: X-ray both knee joints-normal; E.S.R.-17 mm; Haemoglobin-10.8 g/dl; RBC Count-3.2 mill/cumm; PCV-34%; Platelet Count-1,94,000/cumm; RA Factor- 2.9 iu/mL [N; <20]; C-reactive protein-2.4 mg/L. What precautions should I take?

A:Before I discuss the cause of rheumatoid arthritis (RA) I wish to clarify as to when the diagnosis of RA is made in a given person. RA can be diagnosed if there are persistent visible swellings associated with pain on the use of joints in the fingers, knuckle joints and the wrist joints (often associated with visible swellings in the elbow, knee and ankle joints), very painful feet due to involvement of joints in the feet making it very difficult to walk, especially on getting up from the bed. The symptoms are worse in the night and early morning and are associated with severe stiffness in the joints on getting up from the bed. The stiffness starts to improve slowly as one starts to gently move the joints or do some early morning exercises. There is usually associated fatigue and weight loss with high ESR, high platelets, low haemoglobin and high alkaline phosphates. These symptoms & signs and abnormal investigative findings must be persistent (not transient) for at least 6 weeks then one can be diagnosed as suffering from rheumatoid arthritis. If you are in doubt about your diagnosis you must be seen by a rheumatologist (not by an orthopaedic surgeon). Making a diagnosis is important, as now there are wonderful new medicines that control the disease rapidly and completely. As you have not given any description of your symptoms, it is not possible to give any diagnosis in your case. The investigations are normal, which is possible only when the disease has been fully controlled by the newer drugs. The cause of RA is genetic where shared epitope genes are inherited that, when interacted with some unknown environmental factors (could be some virus) lead to a self perpetuating chronic auto immune inflammatory reaction in the lining tissue (synovia) of the joints. This can be easily controlled by the newer drugs given in right doses over a period of time.