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As the name says, inflammatory arthritis (IA) refers to swelling in the joints and subsequent degeneration, commonly due to an immune reaction or infection. IA usually affects several joints simultaneously making it challenging for individuals to go about their daily activities comfortably. IA includes rheumatoid, reactive, psoriatic, gouty arthritis, among others. It is important to note that this form of arthritis can affect children as well, in a condition known as juvenile idiopathic or juvenile rheumatoid arthritis. In this article, Dr. Pradeep Mahajan, Regenerative Medicine Researcher, StemRx Bioscience Solutions Pvt. Ltd., Navi Mumbai, will help you understand more about inflammatory arthritis and its implications in the ongoing COVID-19 pandemic.
The word 'autoimmune' means that the immune system of our body considers its own cells as foreign bodies and attacks them. In autoimmune arthritis, the immune system mistakenly attacks the tissues of the joints (cartilage, ligaments, bone), resulting in inflammation and subsequent joint degeneration. What triggers an autoimmune condition is not clearly understood; however, genetic and environmental factors, as well as lifestyle (in certain cases) play a role.
The symptoms of this form of arthritis are typically stiffness in the affected joint commonly during morning hours and in cold conditions, pain, swelling, occasionally redness and a warm feeling in the affected area, and restricted movements. While the symptoms may occasionally overlap with sports injuries, non-autoimmune arthritis/degenerative joint disease (such as osteoarthritis), etc., autoimmune arthritis may also be associated with certain systemic symptoms (fever, accompanying systemic/organ inflammation, etc.). Moreover, age of onset is usually an indicator of autoimmune arthritis. Generally, degenerative forms of arthritis occur in older individuals, whereas autoimmune forms can occur as early as in adolescence or early-adulthood.
Due to the early age of onset, it is important to diagnose these conditions promptly in order to initiate treatment and prevent excessive joint damage and disability. There are diagnostic tests, such as RA factor for rheumatoid arthritis, blood uric acid level for gouty arthritis, etc.; however, awareness about the condition and clinical presentation is important to even consider the investigations.
Conventional treatment is predominantly based on symptoms. Medications may be prescribed to reduce the inflammation and in cases to target the dysfunctional immune responses. However, pharmacological management does not provide long-term relief. Physiotherapy rehabilitation is equally important to maintain the function of the affected joints.
Among the newer treatments, cell-based therapy has shown promise in the treatment of inflammatory as well as autoimmune conditions. Patients with autoimmune inflammatory arthritis can benefit from the anti-inflammatory and immunomodulatory properties of mesenchymal cells in the body. As this therapy targets the underlying cause, the results are more definitive and can be maintained for a long period. The cells are sourced from the patients' own body; therefore, there are no external agents used and the treatment is safe for patients of all age groups.
For a while now, COVID-19 has wreaked havoc in our lives. The pandemic has proven even more challenging for patients with systemic illnesses, and those with inflammatory arthritis have been advised to take added precautions. There are two reasons for this. First, patients with IA, especially the autoimmune forms, tend to be on immunosuppressive treatment regimens. Therefore, their risk of acquiring a rapidly spreading infection like COVID-19 is higher. Second, patients with autoimmune IA have an inherently disturbed immune mechanism. Considering their improper immune system responses, it is advisable to follow stringent precautions to avoid acquiring COVID-19 as well.
Please note though that there is no direct evidence that having IA increases the risk of COVID-19 or its complications (with the exception of those on immunosuppressive drugs). The purpose to safeguard such individuals is only to prevent additional disease burden on them. Healthcare providers/Treating physicians should be consulted to chart out a treatment plan, including the medications to be taken and at-home rehabilitation to ensure that prolonged periods of inactivity considering restricted outdoor movement and lockdowns do not end up worsening their overall health condition.
In case a patient with IA acquires COVID-19, it is advisable that the treating doctor consult with the patients' healthcare provider to modify or change any medications during the treatment of COVID-19. The priority should be to treat the COVID-19 infection and minimize the extent of damage. Following recovery, intensive rehabilitation may be initiated to maintain systemic and joint function. As for vaccination of such individuals against COVID-19, the Health Ministry has recommended that patients under prolonged corticosteroid/immunosuppressant medications take the vaccination. The healthcare provider can advise the vaccination based on the current health status of the patient, by modifying the ongoing treatment plan if required.
At the end of the day, prevention is better than cure nonetheless, instead of fearing the pandemic, patients with IA (and other systemic illnesses as well) should aim at maintaining a healthy lifestyle and continue their medications and exercises to gain an upper hand over COVID-19 and their arthritis itself!
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