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    Rheumatoid Arthritis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Rheumatoid Arthritis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Rheumatoid Arthritis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Ebook197 pages2 hours

    Rheumatoid Arthritis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

    By Kenneth Kee

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    About this ebook

    Rheumatoid arthritis is a medical disorder that is the most common autoimmune form of arthritis.
    Autoimmune diseases are illnesses that happen when the body tissues are wrongly attacked by its own immune system which consists of cells and antibodies whose purpose is normally to seek and destroy invaders of the body, especially infections.
    Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disorder featured by an inflammation of the synovial joints resulting in joint and periarticular tissue damage, as well as a wide range of extra-articular features.
    Joint inflammation creates typical changes:
    1. Heat and sometimes redness,
    2. Swelling,
    3. Pain,
    4. Stiffness (especially in the early morning or after inactivity),
    5. Progressive joint destruction and
    6. Loss of joint function.
    RA is a systemic disease with other manifestations of the disorder:
    1. Eyes: secondary Sjogren's syndrome, scleritis and episcleritis.
    2. Skin: leg ulcers especially in Felty's syndrome (association of rheumatoid factor positive rheumatoid arthritis, neutropenia and splenomegaly).
    3. Rashes, nail fold infarcts.
    4. Rheumatoid nodules: these are common, and may occur in the eyes, may be subcutaneous, and may be in the lung, heart and occasionally the vocal cords.
    5. Neurological: peripheral nerve entrapment, Atlanto-axial subluxation, polyneuropathy, mononeuritis multiplex.
    6. Respiratory system: pleural affliction, pulmonary fibrosis, obliterative bronchiolitis, Caplan's syndrome.
    7. Cardiovascular system: pericardial affliction, valvulitis and myocardial fibrosis, immune complex vasculitis.
    Two lab tests that often help in the diagnosis are:
    1. Rheumatoid factor
    2. Anti-CCP antibody
    X-rays may show soft tissue swelling, peri-articular osteopenia, loss of joint space, erosions and deformity.
    There is no known curative treatment for rheumatoid arthritis.
    1. Symptom modifying aids to relieve the symptoms but do not alter the natural history of the conditions.
    These medicines are Non-steroidal Anti-inflammatory Drugs (NSAIDS) like diclofenac, iboprufen.
    2. Disease modifying drugs such as:
    a. Steroids
    b. Methotrexate,
    c. Sulphasalazine,
    d. Redaura,
    e. Hydroxychloroquine
    They have been shown to slow down the damage caused by Rheumatoid Arthritis.

    TABLE OF CONTENT
    Introduction
    Chapter 1 Rheumatoid Arthritis
    Chapter 2 Causes
    Chapter 3 Symptoms
    Chapter 4 Diagnosis
    Chapter 5 Treatment
    Chapter 6 Prognosis
    Chapter 7 Gout
    Chapter 8 Osteoarthritis
    Epilogue

    There was a young woman in the 1970s who had just graduated from Nanyang University who developed this severe condition and swollen joint pains.
    After x-rays and blood tests it was confirmed that she had Rheumatoid arthritis.
    She was referred to Tan Tock Seng Hospital for treatment.
    She was given steroids and painkillers.
    Sometimes the pain was so bad that she had to call me for house calls to give her injections to relieve her pain.
    It was depressing to see her becoming worse by the year with deformities of her wrists and ankles.
    Finally she had to be admitted to hospital for a new anti-cancer medicine which did relieve her pain.
    Unfortunately the deformities could not be remedied.
    It was sad to see a young woman ready for work becomes a recluse with deformities unable to work or help herself.

    LanguageEnglish
    PublisherKenneth Kee
    Release dateNov 10, 2016
    ISBN9781370569687
    Rheumatoid Arthritis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions
    Author

    Kenneth Kee

    Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

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      Book preview

      Rheumatoid Arthritis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions - Kenneth Kee

      Rheumatoid Arthritis,

      A

      Simple

      Guide

      To

      The Condition,

      Diagnosis,

      Treatment

      And

      Related Conditions

      By

      Dr Kenneth Kee

      M.B.,B.S. (Singapore)

      Ph.D (Healthcare Administration)

      Copyright Kenneth Kee 2016 Smashwords Edition

      Published by Kenneth Kee at Smashwords.com

      Dedication

      This book is dedicated

      To my wife Dorothy

      And my children

      Carolyn, Grace

      And Kelvin

      This book describes the Rheumatoid Arthritis, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

      (What You Need to Treat Rheumatoid Arthritis)

      This eBook is licensed for the personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

      If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

      Thank you for respecting the hard work of this author.

      Introduction

      I have been writing medical articles for my blog http://kennethkee.blogspot.com (A Simple Guide to Medical Condition) for the benefit of my patients since 2007.

      My purpose in writing these simple guides was for the health education of my patients.

      Health Education was also my dissertation for my Ph.D (Healthcare Administration).

      I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.com.

      This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Conditions into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

      From which many free articles from the blog was taken and put together into 700 amazon kindle books and some into Smashwords.com eBooks.

      Some people have complained that the simple guides are too simple.

      For their information they are made simple in order to educate the patients.

      The later books go into more details of medical conditions.

      The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

      Since 2013, I have tried to improve my spelling and writing.

      As I tried to bring you the latest information about a condition or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

      Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

      I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

      I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

      I apologize if these repetitions are irritating to some readers.

      Chapter 1

      Rheumatoid arthritis:

      Rheumatoid Arthritis

      Rheumatoid arthritis is an even more severe condition than osteoarthritis.

      It is an auto-immune disease where the body’s own cells attack the joints.

      There was a young woman in the 1970s who had just graduated from Nanyang University who developed this severe condition and swollen joint pains.

      After x-rays and blood tests it was confirmed that she had Rheumatoid arthritis.

      She was referred to Tan Tock Seng Hospital for treatment.

      She was given steroids and painkillers.

      Sometimes the pain was so bad that she had to call me for house calls to give her injections to relieve her pain.

      It was depressing to see her becoming worse by the year with deformities of her wrists and ankles.

      Finally she had to be admitted to hospital for a new anti-cancer medicine which did relieve her pain.

      Unfortunately the deformities could not be remedied.

      It was sad to see a young woman ready for work becomes a recluse with deformities unable to work or help herself.

      Another patient who is a young Indian girl of 20 years of age was told to have her methretraxate injection once a month at my clinic.

      She faithfully came for the injections for 2 years with improvement of her symptoms.

      She had not seen me for the past 10 years.

      What is Rheumatoid Arthritis?

      Rheumatoid arthritis is a medical disorder that is the most common autoimmune form of arthritis.

      Autoimmune diseases are illnesses that happen when the body tissues are wrongly attacked by its own immune system which consists of cells and antibodies whose purpose is normally to seek and destroy invaders of the body, especially infections.

      Patients with autoimmune disorders have antibodies in their blood that attack their own body cells

      Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disorder featured by an inflammation of the synovial joints resulting in joint and periarticular tissue damage, as well as a wide range of extra-articular features

      RA is linked with significant morbidity, such as pain and disability.

      The suppression of inflammation in the early stages of the disease can lead to increased improvements in long-term outcomes.

      The improvements in the use of existing disease-modifying drugs, the formation of new drugs and the better application of a range of treatment methods such as non-pharmacological treatments are important in decreasing morbidity and mortality from RA.

      About one third of people with RA remain negative for RA factor.

      Even though there is knowledge of the role of circulating auto-antibodies in the production of 'seropositive' RA, the pathogenesis of seronegative RA is not well understood.

      The evidence indicates that RA 'serotypes' show distinct disorder groups that diverge with respect to genetic architecture, cellular pathology and even treatment responsiveness.

      Risk factors

      RA occurs from an interaction between genetic inheritance and environmental factors, such as:

      1. High birth weight,

      2. Smoking,

      3. Silica exposure,

      4. Alcohol abstention,

      5. Obesity,

      6. Diabetes mellitus,

      7. Rheumatoid factor, and

      8. Anti-citrullinated protein antibody

      Smoking is an important danger factor.

      HLA DR4 and DR1 are linked, especially in severe disease.

      There is possible infectious cause even though no organism has been found.

      The onset is more frequent in winter.

      Incidence

      One study found the population minimum incidence of RA to be 1.16% in women and 0.44% in men.

      The incidence of the disorder is low, with around 1.5 men and 3.6 women forming RA per 10,000 people per year.

      The overall incidence of RA is two to four times greater in women than in men.

      The peak age of incidence for both genders is the 40s but people of all ages can form the disease

      It is an autoimmune disease.

      This suggests the body's immune system wrongly attacks healthy tissue.

      RA can occur at any age, but is more frequent in middle age.

      Women get RA more often than men.

      Genes, infection, and hormone changes may be linked to the disease.

      Smoking may also be linked to RA.

      It is much less frequent than osteoarthritis which is a chronic disorder that happens in many people due to wear and tear on the joints as they age.

      What are the symptoms of Rheumatoid Arthritis?

      The doctor must recognize early symptoms and refer early.

      The presentation can differ greatly.

      Constitutional symptoms (e.g., profound fatigue, influenza-like symptoms, fever, sweats and weight loss) are frequent.

      Most of the time, RA involves joints on both sides of the body equally.

      The disorder often begins slowly.

      Early symptoms may be minor joint pain, stiffness, and fatigue.

      Joint symptoms may be:

      1. Morning stiffness, lasting more than 1 hour, is common.

      2. Joints may feel warm, tender, and stiff when not used for an hour.

      3. Joint pain is often felt on the same joint on both sides of the body.

      4. After a period of time, joints may lose their range of motion and may be deformed.

      Joint inflammation creates typical changes:

      1. Heat and sometimes redness,

      2. Swelling,

      3. Pain,

      4. Stiffness (especially in the early morning or after inactivity),

      5. Progressive joint destruction and

      6. Loss of joint function.

      Pain, swelling, muscle wasting and damage to joints lead to progressive deformity, disability and handicap.

      Tendon sheaths have synovial linings and inflammation of these can lead to tendon rupture.

      Wrists, fingers, knees, feet, and ankles are the most frequently affected.

      Signs of arthritis are:

      1. Symmetrical, distal, small joint arthritis affecting

      a. The proximal interphalangeal

      b. Metacarpophalangeal,

      c. Wrist,

      d. Metatarsophalangeal,

      e. Ankle,

      f. Knee and

      g. Cervical spine joints.

      2. Shoulders, elbows and hips are less frequently affected.

      3. Hand deformities, such as:

      a. Ulnar deviation,

      b. Swan neck and

      c. Boutonnière's deformity of the fingers,

      d. Z deformities of thumbs and

      e. Piano key deformity of the wrist.

      4. Muscle wasting and tendon rupture.

      5. Cervical complications (instability of the cervical spine).

      6. Occasionally, may present atypically as a monoarthritis, sudden-onset or systemic illness with minimal joint problems at first (especially in men).

      This is known as 'palindromic RA'.

      RA is a systemic disease with

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