Rheumatologist Lists Swollen, Stiff Joints as Early Signs of Rheumatic Arthritis

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  • As Pfizer Sensitises Patients on the Condition

Prof. Olufemi Adelowo

A Professor of Medicine and Consultant Rheumatologist, Olufemi Adelowo, has raised the importance of patients’ awareness on rheumatic arthritis (RA), saying it will enhance their early presentation for treatment, as there are no preventive measures for the disease.

Adelowo, who works at the Lagos State University College of Medicine (LASUCOM) Ikeja, Lagos, highlighted the early symptoms of RA as painful and swollen joints, especially the joints of the fingers, wrist, elbows, shoulders, knees and the peripheral joints.

Rheumatoid arthritis is a disabling disease that affects the joints with pain, swelling, and stiffness. It is an autoimmune condition, which implies that the immune system attacks healthy cells in the body by error.

The World Health Organisation, WHO, has estimated rheumatic and musculoskeletal diseases to be the second largest causes of disability worldwide, as measured by years lived with disability. The burden of these diseases is projected to be higher in low-income and middle-income countries owing to limited access to clinical services and treatments.

This explains the motive behind patients’ awareness campaign on the condition embarked upon by multinational biopharmaceuticals like Pfizer, as they seek to enlighten patients on the debilitating effects of the disease and the importance of early presentation for better outcomes.

In one of its recent advocacies, displayed on its official website, Pfizer remarked that RA is a focus of its inflammation and immunology therapeutic area, declaring its willingness to partner with thousands of study sites and tens of thousands of trial participants around the world.

The rheumatologist, in an exclusive interview with Pharmanewsonline,  mentioned other presenting features of RA such as stiffness in the joints, fever, weight loss, excessive fatigue, general unwell and anaemia. He advised patients to seek medical attention immediately they observe any of these symptoms. He however noted that the disease does not affect the joint of the spine.

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“Basically, the presentation is that of arthritis, that is, you have painful and swollen joints, especially the joints of the fingers, the wrist, elbows, shoulders, knees and it also affects the peripheral joints. It does not dwell on the joint of the spine.

“Another presenting feature is stiffness in the joint, especially when people wake up in the morning and they are as stiff as wood and finds it difficult to stretch. They may also run a fever, lose weight, and go through constitutional symptoms like excessive fatigue. They generally feel unwell, and they may also come in with anaemia. Those are the common features at the onset and that’s what to look out for”, he explained.

Additionally, he said RA can also affect so many other structures of the body like the lungs, heart, blood, liver and so on, but there is no established cause of the disease.

With the prevalence rate of the disease in Nigeria pegged around 40 per cent, studies suggest that the cause of the condition is not far fetched from environmental infections and human genes.

Affirming this, Adelowo said “We do not know what the cause is, but we think it is an interaction with the environment and something within the body itself. That is, the gene.

“That is why we talk of the shared episode in the gene, particularly manifesting in people who smoke. There have been some bacteria and viruses in the environment that could have been the cause but honestly, we do not know what triggers off the rheumatoid arthritis in the first instance, but we know there is an interaction between something within the environment like some germs and the genes in the body”.

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Corroborating the rheumatologist’s view, Dr Ugochukwu Nzeako, a trauma surgeon, at the National Orthopaedic Hospital, Igbobi, identified hereditary as a major cause of RA, stating that once it’s in the gene of parents, there is every possibility that members of the family may come down with the disease.

He said previous studies conducted on the disabling disease have shown that it occurs more in women than men. While risk increases with age, it’s however occurs at any age, as prevalence spans across all age groups.

Differentiating between RA and osteoarthritis, the professor of medicines said while RA affects all age groups, osteoarthritis affects only the elderlies. He further acknowledged the existence of other forms of arthritis, which according to him are more than 100 types, with different types of painful episodes.

 

Arthritis
Fingers of a patient suffering from rheumatoid arthritis.

“When we say someone has arthritis, we are not saying much but arthritis is a manifestation of many conditions. As a matter of facts there are more than 100 types of arthritis. The osteoarthritis mentioned earlier, has been known to affect the older people while other arthritis cuts across all age group from the young to the very old”, he said.

Contrary to the propagation of some school of thoughts, that balance diet and physical exercise can help prevent this condition, the rheumatologist categorically stated  that there are no preventive measures, because it is an autoimmune condition. The sure way out is early detection, and effective management.

According to him: “There are no preventive measures as such because there are no diet that you can take or not take, there no medicines you can take or not take to prevent arthritis because it is something that comes by interactions within your gene and the environment. Nobody can predict who is going to have it and who would not.

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“It is known to be managed by  specialists called rheumatologist for a start and they know the type of drugs to administer, as they have been trained to manage this condition. They are trained to undergo some investigations, like evidence of inflammation. There are blood tests that should be carried out to detect the evidence of inflammation in the body and one of them is Erythrocyte sedimentation rate (ESR) and the other one is C-reactive protein (CRP).

“We also do the liver function test because primarily, the drugs we use to manage rheumatoid arthritis affects liver. Due to the involvement of many joints, we do not ask for x-rays of all the joints. What is going on in the other joints will reflect in the x-ray of the hands and the feet”, he disclosed.

The rheumatologist asserted that there is no known cure for RA presently, thus the adoption of supportive and palliative approaches in its management with aim to slow down disease progression, alleviate symptoms and reduce functional limitations, is crucial for patients best outcomes.

Medical Director, Pfizer East and West Africa, speaking during a virtual rheumatology awareness media roundtable, organised by Pfizer in the course of the year, noted that RA remains one of the most common rheumatic and musculoskeletal disease (RMDs) in the region.

He expressed optimism in Pfizer’s advocacy on the disease, which aims to continue raising awareness around treatments options on the condition.

“We want to work closely with the healthcare community to ensure early diagnosis, increased patient access and medication adherence”, he said.

 

 

 

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