Rheumatoid – ‘Arthritis or disease?’
While doing some research in history of rheumatoid arthritis long before I became a rheumatologist, I came across an article where this disease was described in early 1800 by a french medical student. However study of historical paintings would suggest that RA could have been present as early as the 15th century, when artists started to paint the human body accurately rather than figuratively. My curiosity of finding evidence of rheumatoid arthritis in historical paintings helped rekindle my interest in art. Out of the all great artists from history, Pierre-Auguste Renoir is one of my favorite painters. He was one of the world’s most celebrated impressionist painters, but very few people know that he suffered from debilitating rheumatoid arthritis most of his life. Although the deformities he suffered because of the rheumatoid arthritis were disabling, Renoir never stopped painting nor decreased the quality of his work.
What is Rheumatoid arthritis (RA)?
Rheumatoid arthritis is an autoimmune disease. It is caused by your body’s own immune system attacking your body. It is a chronic inflammatory disease. It primarily affects your joints but it is a systemic disease and can affect any organ of your body. Approximately 1 in every 100 people has rheumatoid arthritis. Women are about three times more likely than men to develop rheumatoid arthritis.
What causes Rheumatoid arthritis?
It is well established that genetic and environmental factors can affect the development of various autoimmune diseases. However specific cause of developing RA is unknown. Among these factors, cigarette smoking not only significantly increases the risk of developing RA but also response to certain therapy is poorer in heavy smokers. In early research scientists also found some connections between viral infection, microbes and lifestyle changes as a consequences of the industrial revolution. However the most interesting hypothesis I came across was about a link between sugar, periodontal disease, and RA. In history importation of sugar from the West Indies to Europe resulted in epidemic of periodontal disease which was linked to the appearance of RA. We now know from recent researches that bacteria named Porphyromonas gingivalis, found in oral cavity is associated with peridontitis, which produces peptidyl arginine deiminase, which citrullinates proteins leading to inflammation and consequent RA.
What are the symptoms of RA?
In the early stages, rheumatoid arthritis typically affects small joints, especially the joints of your hands and feet. It may also begin in a single, large joint, such as the knee or shoulder, or it may come and go and move from one joint to another. The joint symptoms of rheumatoid arthritis usually begin gradually and include pain, stiffness, redness, warmth to the touch, and joint swelling. The joint stiffness is most bothersome in the morning and after sitting still for a period of time. The stiffness can persist for more than one hour. Although joint problems are the most commonly known issues in rheumatoid arthritis, the condition can be associated with a variety of other problems such as inflammation of lung causing shortness of breath, nerve compression causing numbness/tingling, increased risk of cardiovascular diseases and strokes. And that is why it is not just an arthritis but a systemic disease.
How to diagnose RA?
Your rheumatologist can diagnose RA based on many factors, including the characteristic signs and symptoms, the results of laboratory tests, and the results of x-rays. Not all the factors are present in early RA and in some cases, it may be necessary to monitor the condition over time before a diagnosis of rheumatoid arthritis can be made with certainty.
How do you treat RA?
There are many different drugs available to treat RA. Your rheumatologist can decide what medication is best suited for you depending on severity of your disease and other medical conditions. Treatment with drugs, especially when initiated early in the course of disease, is effective in reducing symptoms and joint damage, thus improving the quality of life in a majority of patients. In a minority, the disease may remit completely, although remission is rare without continuing drug treatment. In about 10 to 20 percent of people, rheumatoid arthritis may be resistant to available treatments, although the increasing number of drugs available makes it possible to use combination therapies to improve outcomes.
You can also visit arthritis foundation website for more tools and resources.
Despite his arthritis, Pierre-Auguste Renoir was able to maintain an incredible level of precision and efficiency with his painting. More importantly, he remained positive and did not let his condition affect his passion for painting or take away from the beauty that he saw in the world around him. Renoir applied a wide variety of coping mechanisms and came up with different ways to continue painting despite his limitations from RA. Renoir’s long battle with rheumatoid arthritis serves as an inspiration to people with RA.
“The pain passes, but the beauty remains.” – Pierre-Auguste Renoir