Making sense of rheumatoid arthritis

by | November 28, 2019

Find out what RA is and what physical activities that are recommended for those with RA.


After years of full-time work, the Merdeka Generation is looking towards retirement, or have just begun their retirement. In this new chapter of life, many retirees pick up sports such as golf or badminton to fill their newfound leisure time. Unfortunately, these hopes and plans can get derailed very quickly, as they start to encounter new sets of problems; going up and down stairs takes more effort, their hands start to hurt after one session of badminton, and their joints are constantly aching.

Sometimes, these minor aches and pains are simply part and parcel of ageing, but other times, they may be a symptom of a more serious issue. Rheumatoid arthritis (RA) is one of the more common types of arthritis, affecting around 45,000 people in Singapore. RA is an autoimmune disorder in which the immune system mistakenly attacks healthy tissues in the joints, causing inflammation that can lead to joint deformities if left untreated.

Early diagnosis of RA is key to ensuring that quality of life is not severely impacted. With the proper knowledge and care, RA can be managed, and retirees will still be able to enjoy their golden years. With the new Merdeka Generation CHAS scheme launched recently, the silver generation that might be struggling with RA can now opt to see a general practitioner to help manage the condition without burning a hole in their retirement savings. While high impact sports like tennis may be out of the question, there are still many other ways for individuals with RA to lead a healthy and active lifestyle.

Ageless Online finds out more from Dr Lim Chien Wei, a family physician at Healthway Medical Clinic (Fajar), about RA and what physical activities that are recommended for those with RA:


What are some of the symptoms of rheumatoid arthritis that are often overlooked, and why? 

Minor joint aches, fatigue and low-grade fever can actually be early symptoms of RA. It can also be accompanied by a loss of appetite. These flu-like symptoms are often dismissed as a passing cold, or simply feeling “under the weather”, but they can actually be an indication of RA, especially when they appear in conjunction with joint-specific symptoms, such as pain, stiffness or tenderness in the joints.

In the elderly, it can overlap with age-related joint diseases like osteoarthritis, polymyalgia rheumatica, reactive arthritis, etc. It is more likely to be RA if the joint swelling and pain are symmetrical, i.e. occurring on similar joints on both sides of the body, and if morning stiffness lasts more than one hour for more than six weeks.


What is the difference between rheumatoid arthritis and osteoarthritis?

There are many differences between RA and osteoarthritis (OA), with the main difference being the cause (etiology) of the condition.

Osteoarthritis is the most common chronic form of arthritis; it is a degenerative joint disorder caused by the wear and tear of the cartilage that arises from the end of the bones in the joints. The development of OA can be attributed to genetic factors, being overweight, previous joint injuries like fractures and even overuse injuries. The onset of osteoarthritis is slow, and it can take years before the symptoms start appearing. Symptoms are usually localised and generally get worse after prolonged use and get better with rest. X-rays are used to diagnose OA and blood tests are usually not helpful in making a diagnosis.

On the other hand, RA is an autoimmune disorder. What this means is that the body mistakenly perceives healthy tissues around the joint as a threat, allowing its own immune cells to attack it. This leads to inflammation around the joints, making the joints feel swollen, stiff and painful. The onset of RA is relatively quick and can develop within weeks or months, affecting both sides of the body. RA also affects other parts of the body like the eyes, lungs, skin, heart and blood vessels. Additionally, RA also makes an individual more fatigued than usual and affects the general well-being of the individual. Symptoms are usually worse in the mornings and after inactivity. Blood tests are essential in making a diagnosis in RA.


Which groups of people are at risk of developing rheumatoid arthritis? 

Onset of RA can occur at any age, but it is usually seen in young women aged 25 to 45. However, recent studies have shown that RA is becoming more common among adults in their 60s. Women are also more likely to develop RA, with the condition affecting three times as many women as men. Individuals who have family members with RA also have an increased risk of developing RA themselves.

It has been found that smoking increases the risk of developing RA, particularly if the individual has a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity. People – especially women aged 55 and younger – who are overweight or obese have a slightly higher risk of developing RA as well.


How does having rheumatoid arthritis affect quality of life? 

RA is a chronic condition with symptoms like joint stiffness, joint swelling and joint tenderness. The inflammation around the joints caused by RA can lead to limited flexibility and loss of strength, making everyday tasks difficult. Even simple chores such as cooking and cleaning can become extremely painful and challenging, and individuals with RA may need a lot of help with things that they used to be able to do on their own.

They may experience physical weakness and exhaustion, along with trouble sleeping. All of these symptoms can greatly impact the individual’s overall well-being. To make matters worse, being dependent on others for simple tasks and the general helplessness caused by the condition may also lead to mood disorders such as depression.


What happens when rheumatoid arthritis is left untreated? 

Joint damage leading to deformity is one of the consequences of untreated RA. RA causes the body’s immune system to attack healthy joint lining (synovium), causing cartilage and bone damage. Over time, if left untreated, this damage can become permanent, with joints that are weakened causing a further loss of function and increasing the likelihood of becoming disabled.

Anaemia is another consequence of RA, as the inflammation of the joints causes a decrease in the formation of red blood cells in the bone marrow. Symptoms of anaemia include constant fatigue, pale skin, cold extremities, shortness of breath, and even chest pains.

Carpal tunnel syndrome is also a common complication of RA. Inflammation in the wrist joints can cause nerve compression, resulting in the loss of feeling or having the sensation of pins and needles in the fingers. There may also be pain along the wrist and arm, as well as weakness. If left untreated, grip strength may weaken.

Long-term or prolonged damage to the bones can also cause individuals with RA to develop osteoporosis, another chronic condition in which the bones become brittle and break easily.

Individuals with RA also have an increased risk of coronary heart disease, as inflammation caused by RA can lead to the narrowing of the blood vessels caused by build-up of plaque in the arteries. This is one of the more serious consequences of untreated RA, as cardiovascular disease is the cause of death of about 30 to 50 percent of people with RA.

Untreated RA can also cause inflammation and scarring of the lung tissues, which can lead to chronic cough, fatigue, and progressive shortness of breath.


What are the treatments available for rheumatoid arthritis? 

The goals of RA treatment are to stop inflammation (putting the disease in remission), relieve symptoms, prevent joint and organ damage, and improve physical function and overall well-being while reducing long-term complications. This can be achieved with a combination of medication, and physical and occupational therapy.

Doctors will prescribe medication based on patients’ individual requirements, but common medication for RA include nonsteroidal anti-inflammatory drugs (NSAIDS) to combat the inflammation and reduce pain, as well as disease-modifying antirheumatic drugs (DMARDS) with biologics that work to modify the course of the disease by targeting specific steps of the inflammatory process, thus preventing the disease from further attacking the joint tissues.

But while medication can control the symptoms of RA, it is important for physical and occupational therapy to be carried out to help RA patients cope with the condition and adapt to their daily living. RA is a lifelong condition that requires ongoing treatment and monitoring, and the cost of constant visits to the doctor can add up. Some may be hesitant to seek medical help for this reason, but with the new Merdeka Generation Package under the Community Health Assist Scheme, doctor’s visits for chronic conditions are subsidised up to S$340 per year, ensuring that the silver generation will be able to receive the help they need to manage chronic conditions such as RA, without burning a hole in their retirement savings.


How can patients with rheumatoid arthritis participate in sports safely? 

When starting a new sport, it is crucial to start small and go slow; even 10 minutes of stretching a day will go a long way for someone who has not exercised in a long time. Only after the body has adjusted to the new physical activity should the level of activity be increased incrementally. It is also important to pay attention to your body. The severity of RA symptoms can vary day to day, and any physical activity should be adapted according to the individual’s fitness level and what they can handle at that point in time. While it is important to stay active, it is equally important to know when to give your body a break.

Choosing the right sports is another important factor to consider. Low-impact activities that are easier on the joints, such as swimming, walking, cycling or even line-dancing, are a good start. These activities have a lower risk of injury, and are less likely to aggravate RA symptoms as they do not put too much pressure on the joints. Warm-up and cool-down stretches should also always be done before and after exercising.

It is normal to experience some pain and minor swelling after starting a new exercise programme, but they will ease once the body adjusts to the exercise. However, it is always best to consult a healthcare professional when in doubt. The doctor will be able to assess their patient’s condition better and provide information on attainable fitness goals, what the recommended level of activity is, as well as give advice on minimising the risks of injury.


What are some other activities recommended for patients with rheumatoid arthritis?

Low-impact activities that do not put too much stress on the joints are recommended for individuals with RA. Such activities include swimming and water aerobics as the buoyancy of the water will help to support one’s weight and reduce the pressure on the joints. Riding a stationary bike can also improve cardiovascular fitness and is a safe way to get the joints moving. This helps to reduce joint stiffness, increase the joint’s range of motion, improve leg strength, as well as build endurance.

In addition to aerobic activity, muscle-strengthening exercises like using resistance bands or light weights are recommended, as they help to build up muscles and increase strength for better joint support.

The bone damage caused by RA increases the risk of injuries being sustained in falls, so balance exercises are recommended to reduce the risk of injuries sustained by falls. Tai chi and yoga are great ways to work on balance, along with improving flexibility and coordination.

Doing such exercises in a class setting is a good way to keep active and to socialise, and the class setting also helps to ensure that the exercise is being carried out safely. As individuals with RA are more susceptible to depression, having an active social life is one way to maintain good mental health.




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