KUALA LUMPUR, Jan 28 – Many people mistakenly assume that joint pain is simply a natural part of ageing, often overlooking rheumatoid arthritis (RA) as a potential cause.
RA is a chronic autoimmune disease that can affect individuals at any age, not just older adults.
In fact, in 2019, the World Health Organization (WHO) estimated that over 18 million people worldwide live with RA, underscoring its global prevalence.
Dr Cheah Chee Ken, consultant rheumatologist at Sunway Medical Centre, aims to raise awareness about RA in Malaysia and dispel misconceptions surrounding this misunderstood condition.
An Overview Of Rheumatoid Arthritis (RA)
In Malaysia, RA is a prevalent condition, with studies indicating that it affects five in every 1,000 people nationwide.
However, Dr Cheah shares, “Only 20 per cent of the general population seek help from primary care providers when they experience chronic musculoskeletal diseases, and just 50 per cent of RA patients pursue treatment one year after symptoms onset.”
Despite this, awareness of RA remains limited, and many cases go undiagnosed or misdiagnosed.
RA is commonly described as an autoimmune inflammatory condition where the body’s immune system attacks the joints.
“Individuals with a genetic predisposition or those who experience physical trauma, such as car accidents, may be more susceptible to abnormal immune activity, leading to inflammation in the joint lining, known as the synovium.
“This inflammation triggers symptoms ranging from joint pain, swelling and morning stiffness,” said Dr Cheah.
Contributing Factors To Rheumatoid Arthritis
Given the potential triggers of RA are still being researched, certain factors are known to increase the risk. Dr Cheah points out that women are two to three times more likely than men to develop the condition.
In addition to gender and family history considerations, the contributing factors for RA can be classified into two categories:
- Direct factors are directly linked to conditions like epigenetic, hormonal, reproductive, neuroendocrine, and more.
- Environmental or lifestyle-related factors such as smoking, exposure to secondhand smoke, airborne or infectious agents, poor oral hygiene habits, chronic periodontitis, gum infection and many more.
“RA can occur in individuals at any age, but it most commonly develops between ages 30 and 50. Notably, smokers and individuals with obesity have a higher risk of developing RA and tend to respond less effectively to treatment,” added Dr Cheah.
Physical And Emotional Toll On Patients And Their Loved Ones
Living with RA requires lifelong management, as there is currently no cure for the condition.
“Managing RA may include medications, physical therapy, and sometimes surgeries to replace knees or hips.
“These treatments can lead to significant medical expenses, placing financial strain on families, especially if the patient or caregiver must reduce their working hours or stop altogether,” noted Dr Cheah.
Additionally, the unpredictability of RA, including sudden flare-ups and the potential for long-term disability, can also take a psychological toll.
“Patients and their families often face mental health challenges like anxiety or depression and need emotional support, as well as education to better understand and manage RA,” said Dr Cheah.
There are also support groups, such as Arthritis Foundation Malaysia (AFM), which offer a vital network where individuals can share experiences, practical advice, and encouragement, helping them cope with the condition’s physical and emotional toll.”
Dispelling Myths And Misconceptions
RA is often surrounded by myths that can delay diagnosis and treatment. Dr Cheah points out one common misconception.
“A common misconception is that exposure to cold weather, environments or water can worsen RA. However, there is no direct evidence to support this belief.”
Dr Cheah also discusses the tendency of some patients to turn to alternative medicine.
“Some patients may turn to alternative medicine, fearing that conventional treatments may cause side effects or toxicities.
“As a result, they avoid seeking proper medical advice in the early stages, potentially worsening their condition,” according to Dr Cheah.
“It’s also important to understand that while RA can be effectively managed long-term, and some patients may even achieve drug-free remission if treated within the critical window period of three to six months after symptom onset, there is currently no definitive cure for the disease,” he added.
If not managed properly, RA can cause irreversible complications, affecting the joints and other parts of the body, such as the lungs, heart, eyes, and even the spine, leading to mobility issues.
Diagnosis And Treatment Strategies
Unlike other conditions, diagnosing RA is particularly challenging due to the lack of a specific test, making the process more complex.
The early signs and symptoms of RA often resemble those of other diseases, which can lead to delays and difficulties in making an accurate diagnosis.
“Given these complexities, we will develop a combination of approaches which start with a detailed patient history that includes the onset of symptoms, disease progression, and any RA-related symptoms, followed by a physical examination to detect the hallmarks of the condition like joint tenderness, swelling, bulkiness, or restricted movements.
“In addition, a musculoskeletal ultrasound will be performed to identify inflammation, joint damage, the condition of the synovial lining, and the presence of joint effusion.”
“In the early stages of RA, patients typically receive anti-inflammatory medications, which can be non-steroidal painkillers or steroidal treatments, to suppress inflammation quickly.
“To modify the progression of RA, disease-modifying antirheumatic drugs (DMARDs) are essential, which can be classified as conventional synthetic DMARDs or biologic DMARDs.
“Patients diagnosed early often respond better to conventional synthetic DMARDs, whereas adjustments may be needed for those who does not respond well to treatment, which can include advanced therapies like biologic DMARDs and oral small molecules.
“These advanced therapies target specific inflammatory molecules involved in RA activity, offering improved efficacy and fewer side effects compared to traditional treatments,” said Dr Cheah.
