Rheumatoid arthritis is a chronic autoimmune disease that causes joint stiffness, pain, and inflammation. It affects around 1% of the population and is three times more common in women. Symptoms include pain and swelling in joints that is worse in the morning. The disease progresses over time and can lead to joint damage and deformity if not treated properly. Prognosis varies between individuals but sustained disease activity over a year generally leads to worse outcomes.

1. RHEUMATOID ARTHRITIS
Dr. Ramkumar
© Punarnava Ayurveda
May 2008
* This Article is a Free Download. Any tampering with or misuse of a part or whole of
information produced herein will not be entertained. The contents of this article can be accessed,
printed and downloaded in an unaltered form with copyright acknowledged for a non-commercial
use and not for a direct commercial use.
Punarnava Ayurveda 1
Authentic Ayurveda for Universal Well Being
www.punarnava-ayurveda.com

2. Rheumatoid Arthritis
Rheumatoid Arthritis (RA) is a chronic multi-system disease of unknown
cause. Rheumatoid arthritis is an autoimmune disorder that causes stiffness
and pain in the joints. Although there are a variety of systemic
manifestations, the characteristic feature of RA is persistent inflammatory
synovitis, usually involving peripheral joints. The potential of the synovial
inflammation to cause cartilage destruction and bone erosions and
subsequently joint deformities is the hallmark of the disease.
The prevalence of definite RA is approximately in 1 percent of the
population; women are affected approximately three times more often than
men. The prevalence increases with age and sex differences diminish in the
older age group. RA is seen throughout the world and affects all races. The
onset is most frequent during the fourth and fifth decade of life with 80
per cent of all patients developing the disease between the age of 35 and
50.
Characteristically RA is a chronic polyarthritis. In approximately two-thirds
of the patients, it begins with fatigue, anorexia, generalized weakness, and
vague musculoskeletal symptoms until the appearance of synovitis becomes
apparent. This prodrome may persist for weeks or months and defy
diagnosis.
Signs and symptoms – Pain, swelling and tenderness may initially be poorly
localized to the joints. Pain in affected joints, aggravated by movement, is
the most common manifestation of established RA. Morning stiffness of
greater than 1-hour duration is an almost invariable feature of inflammatory
arthritis. The majority of patients will experience constitutional symptoms
like weakness, easy fatigability, anorexia and weight loss.
The American Rheumatism Association has developed criteria for the
diagnosis of RA. The presence of seven of these criteria establishes the
diagnosis of classic RA, whereas five criteria indicate definite RA, and
three, probable RA.
Punarnava Ayurveda 2
Authentic Ayurveda for Universal Well Being
www.punarnava-ayurveda.com

3. The criteria are:
1. Morning stiffness
2. Pain on motion or tenderness in at least one joint
3. Swelling in at least one joint
4. Swelling of at least one other joint
5. Symmetric joint swelling
6. Subcutaneous nodules
7. Radiologic changes typical of RA
8. Demonstration of Rheumatoid factor in serum
9. Poor mucin precipitate from synovial fluid
10. Characteristic histologic changes in synovium
11. Characteristic histologic changes in nodules.
(Criteria 1-5 must be continuous for at least 6 weeks. Criteria 2-6 must be
observed by a physician)
Clinical course and prognosis – The course of RA is quite variable and
difficult to predict in an individual patient. Five years after the onset of RA,
evidence of disease activity may be found in as few as one-third of all
patients. Remissions of disease activity are most likely to occur during the
first year. Although sustained disease activity of more than 1 year’s duration
portends a poor outcome, the rate of progression of joint abnormalities is
not constant; the greatest progression takes place during the first 6 years
of disease and at a much slower rate thereafter. The median life expectancy
of persons with RA is shortened by 3 to 7 years. Of the 2.5 fold increase in
mortality rate, RA itself is a contributing feature in 15-25 percent. Drug
therapy may also play a role in the increased mortality rate seen in these
individuals.
**
Punarnava Ayurveda 3
Authentic Ayurveda for Universal Well Being
www.punarnava-ayurveda.com