Rheumatoid Arthritis Found in Transplanted Hands of 33-year-old Patient
Rheumatoid arthritis (RA) is a chronic condition that causes pain, swelling, and stiffness in the joints. The wrists and joints in the hands and feet are the most common body parts that are affected. Rheumatoid arthritis can be diagnosed at any age, although it is most common among individuals between the ages of 30 to 50. As of now, RA affects more than 3 million Americans.
The Discovery
Individuals have feared rheumatoid arthritis for some time now, as it is one of the most disabling types of arthritis. On a positive note, outlook has greatly improved as several new treatments are continuously being developed. Still, RA remains a severe condition with unpredictable outcomes. In a case report published on June 27th in the Annals of Internal Medicine, rheumatoid arthritis was diagnosed in a 33-year-old patient who underwent bilateral hand transplantation. The recipient received allogenic bilateral hand and forearm transplants. Neither the donor nor the recipient reported a personal or family history of rheumatoid arthritis.
One year following the transplantation, the recipient developed subacute bilateral hand pain and swelling; however, her shoulders, elbows, and knees were not affected. Blood tests were conducted and revealed negative results for rheumatoid factors, antinuclear antigen, and anti-cyclic citrullinated peptide antibodies.
Normal C-reactive protein levels are below 3.0mg/dL, yet the recipient’s level of C-reactive protein showed an increase up to 6.5mg/dL. Moreover, MRI and Ultrasonography tools were used to detect specific radiographic findings. Proximal interphalangeal, palpable bilateral synovitis in the metacarpophalangeal and wrist joints was confirmed, together with findings of synovitis and effusions, moderate tenosynovitis, and erosive alterations.
Despite undergoing immunosuppressive therapy with tacrolimus, prednisone, and methotrexate, the recipient developed swan-neck deformity. Brittany L. Adler, MD, from Johns Hopkins University School of Medicine in Baltimore, and her colleagues wrote that this is the first case of rheumatoid arthritis in a hand transplant recipient that they have witnessed. As to what the exact cause was that lead to the transplant rejection, remains unclear.
What was the Cause?
In general, the exact cause of rheumatoid arthritis remains unknown. There is evidence that suggests certain genes that run in families may make you more susceptible to autoimmune conditions. Basically, your immune system works by warding off foreign substances in your body, such as bacteria and viruses. In an autoimmune disease such as RA, for some unknown reason, the immune system attacks your healthy tissue, thus triggering inflammation. The inflammation is then sent to your joints, leading to joint pain and swelling. If the inflammation is persistent, it could lead to irreversible joint damage.
If you fear that you have rheumatoid arthritis, it is best to speak with a rheumatologist – a doctor who specializes in diagnosing and treating RA. He or she will ask you about your personal and family history, as well as any recent symptoms that you may have been experiencing. They will also examine each joint, as RA tends to affect joints in both the left and right sides of the body.
Moreover, blood tests will be performed to measure inflammation levels and look for antibodies linked to RA. Such antibodies include rheumatoid factor (RF), which is found in over 80% of individuals with RA. While there is no one test that can accurately confirm RA, there are several other diagnostic tests that can help to make a proper diagnosis. MRI, ultrasound scanning, and x-ray examinations may be useful in revealing joint space narrowing and joint damage, such as erosions.
As with the unpredictable outcome in the case involving the 33 year old transplant patient, RA can be rather deceiving because imaging tests may not always show joint damage. In fact, it could be an indication that the disease is in an early stage of development and hasn’t damaged the joints yet. If, however, your results indicate that the disease is progressing, it is best to view your options on receiving proper treatment based on your individual case.
Unfortunately, there is no cure for rheumatoid arthritis; however, there are appropriate treatment options that can help you to live a full life, with flare-ups taking place in between months or even years.
Such treatment options include the following:
- Long-use medication to relieve symptoms and slow progression of joint damage
- Physiotherapy and occupational therapy to help improve mobile function and performance in daily activities
- Surgery to relieve severe pain and correct any joint problems / deformities
The goal of any of the above treatments is to relieve any painful symptoms you may be experiencing and improve your mobility in taking on everyday tasks. Keep in mind that every individual is different and no single treatment works for every patient. You may have to change treatment once in your lifetime to determine what works best for you.
One of the most important aspects when it comes to rheumatoid arthritis is self-care. Taking a active and hands-on approach in your care can ensure that you maintain good health and an overall good quality of life. First and foremost, while there is no specific diet for RA, it is important to eat certain foods that are rich in antioxidants. Tomatoes, strawberries, oranges, green leafy vegetables, fatty fish, and nuts, are examples of such foods that can help control or even reduce inflammation.
Moreover, being physically active is a beneficial part of RA treatment. Most doctors recommend performing low-impact aerobic exercises that are designed to boost muscle strength and flexibility. This, in turn, will decrease the pressure you feel on your joints and improve your overall health. Find a physical therapist that can help you put together an exercise program tailored to your capabilities, taking into account your energy, pace, and any joint damage that you have. When RA is active and you experience flare-ups, it is best to rest. Rest helps to reduce severe tiredness and inflammation. When you feel a little better, you can perform gentle exercises; however, it is best not to overexert yourself.
Studies show that supplements and topical treatments can help alleviate symptoms of RA. Turmeric and omega-3 fish oil supplements can reduce pain and morning stiffness, while topical treatments, such as creams or patches, can be applied directly to the skin to sooth stiff joints and muscles. Generally, depending on your condition, it is best to speak with your doctor before using any supplements or treatments and discuss the possible side effects.
On the other hand, different types of treatment, such as heat and cold therapies, work best as natural therapies used to ease muscle pain, relieve joint stiffness, and reduce inflammation. On the topic of natural therapies, relaxation techniques are highly recommended when it comes to coping with RA.
Meditation, yoga, massage, visualization, acupuncture, and guided imagery are just a few examples of techniques that can help reduce arthritis pain and improve joint function. What’s more, research shows that such therapies can ease stress and anxiety, lowering your chances of developing depression.
It is true that rheumatoid arthritis is unpredictable. As in the case of the 33 year old transplant patient, there were no signs or symptoms to suggest susceptibility to RA. However, findings reveal that certain genes may make you more likely to develop an autoimmune condition such as RA. For this reason, if you are at high risk of developing RA or you experience any of its signs or symptoms, speak with a rheumatologist to receive an appropriate treatment plan. With the right treatment and proper self-care, symptoms can be controlled and kept functioning at normal levels.
Being diagnosed with a chronic condition is life-changing and it can be devastating. At times, you may even want to be left alone or you may feel depressed. However, having a support system of family, friends, co-workers, and loved ones to provide emotional support can help you to cope with RA. Remember, thanks to continuous advancement in technology, more and more improved treatments are being developed. Rheumatoid arthritis is far more treatable nowadays than it used to be.
References
https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis
http://www.nhs.uk/conditions/rheumatoid-arthritis/Pages/Introduction.aspx
http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/diagnosing.php
http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/self-care.php
