From this article you will learn about rheumatoid arthritis: what it is, causes, symptoms, treatment, diagnosis. Prognosis for recovery, whether the disease can be cured.
Article publication date: 06/13/2019
Article updated date: 01/18/2020
What is it, rheumatoid arthritis? This is the name of a systemic autoimmune disease that affects the joints and internal organs.
First manifestations of the disease:
- morning stiffness in the hands (feels can be compared to tight gloves);
- symmetrical inflammation of the joints of the arms and legs, for example the knees (70% of cases): that is, manifesting itself on both limbs at once.
The joints swell and their temperature rises. Due to the sharp, boring pain, it is difficult to move.
At first, the disease progresses in waves - exacerbations are replaced by fairly long periods of remission (stages of asymptomatic progression), but gradually it moves into an advanced stage: at this stage, constant inflammation of the tissues causes persistent deformation of the limbs (fingers bend to the sides, upwards, and take on an unusual shape).
Changes in fingers due to disease A person loses a lot of weight and loses muscle mass. He develops diseases of internal organs:
- Pericarditis is inflammation of the pericardium, the serous (outer) membrane surrounding the heart.
- Pleurisy is inflammation of the pleura, the membrane surrounding the lungs.
- Vasculitis is inflammation of the inner wall of blood vessels.
- Neuropathy is damage to nerve fibers.
- Ankylosis - joint tissues grow together and ossify.
Rheumatoid arthritis is diagnosed quite often:
- the prevalence of pathology in men is 4–13 people per 100,000 population;
- for women – 13–36 people out of 100,000 people.
The onset of the disease usually occurs between 35 and 45 years of age. However, it can appear at any other age.
This is one of the most difficult chronic diseases to treat. It is incurable and progresses throughout life. About 35–40% of patients lose their ability to work within the first 5 years.
If you have symptoms of the disease, contact a rheumatologist.
Data on rheumatoid arthritis. Click on photo to enlarge Causes of pathology
The causes of the disease are unknown. However, it is assumed that a special role in the fact that the protective forces of the immune system are directed towards the destruction of one’s own connective tissue is played by:
- heredity;
- the presence of an HLA antigen (a special chain of proteins, an antigen whose structure resembles the antigens of infectious pathogens);
- problems with immunity.
| Triggering factors can be | Factors that increase the risk of disease |
|---|---|
|
Hypothermia and overheating |
Gender (in men the disease is diagnosed 3–5 times less often) |
|
Previous infections |
|
|
Taking certain medications (cytostatics) |
|
|
Severe poisoning |
|
|
Disorders of the endocrine glands |
Types of rheumatoid arthritis
There are several forms of rheumatoid arthritis (RA for short):
Four stages
| Stage | Characteristic diagnostic signs |
|---|---|
|
Very early (lasts up to 6 months) |
The periarticular tissues become denser, and small foci of osteoporosis appear on the x-ray The patient's lymph nodes become enlarged, the temperature periodically rises, weakness and fatigue appear |
|
Early (from 6 months to 1 year) |
X-ray shows osteoporosis, decreased gaps between joints, single cysts in the bones (hollow formations) Joints become inflamed and painful (mostly small ones), subcutaneous nodules appear in the elbow area, which indicates the presence of damage to internal organs |
|
Expanded (after 1 year) |
X-rays show osteoporosis, cysts in bone tissue, joint erosions, a clearly visible decrease in the gaps between joints All symptoms are vivid, joints are deformed, extra-articular manifestations are added |
|
Late (after 2 years) |
What is late stage rheumatoid arthritis? Diagnostic signs – osteoporosis, erosions and growths along the edges of the joints (spikes), tissue ossification (ankylosis) The joints are noticeably deformed, their functions are impaired, the patient cannot care for himself In some severe cases, arthritis recedes into the background, and diseases of the internal organs come to the fore |
Stages of the disease. Click on photo to enlarge Characteristic symptoms
The first signs are inflammation and morning stiffness in the joints.
First of all, the small joints of the limbs are affected (the process is symmetrical). A person gets the feeling that he spent the night in a tight corset or put on tight gloves. After half an hour or an hour, this feeling passes, the patient “paces.”
The pain in the inflamed joints is so strong and intense that it can be compared to a toothache. It is impossible to touch the joints, any movements are greatly amplified discomfort, so the patient is forced to take the most comfortable positions.
Such symptoms of rheumatoid arthritis do not subside for a long time (weeks).
In the later stages of the disease, severe deformation of the joints occurs. It is difficult for a person to perform any actions (for example, it is difficult or impossible to hold a cup, spoon and other small objects in one’s hands and use them).
Several degrees of functional impairment (joints, limbs) in RA:
- Everything functions well, the person can perform professional duties and take care of himself.
- The functions are partially preserved, the patient can take care of himself, but is not able to perform professional duties.
- A person is capable of self-service; he is not capable of other activities.
- Loss of all functions, disability.
There are 2 large groups of signs of rheumatoid arthritis:
- Systemic symptoms - indicate problems with internal organs.
- Joint syndrome – indicates damage to the joints.
1. Extra-articular manifestations
Systemic symptoms of RA often accompany the seropositive form:
- The muscles noticeably decrease in volume, lose strength, become flabby (atrophy), and in some places become inflamed and painful (focal myositis).
- The skin becomes thinner and becomes dry. One of the characteristic signs is small subcutaneous nodules in the elbow area (0.5 to 2 cm in size), they are immobile, painless, and occur during an exacerbation. How to treat rheumatoid arthritis, or rather, it skin manifestations? There is no point in treating rheumatoid nodules; usually, with the onset of remission, they disappear on their own.
- Areas of dying cells appear under the nails, and the plates themselves crumble and become deformed.
- Signs of vasculitis are small pinpoint hemorrhages on the skin and internal bleeding.
- In 60%, the lymph nodes become inflamed, painful, and severely enlarged (lymphadenitis).
When the serous membranes of internal organs are damaged, pleurisy and pericarditis develop. In some forms of RA, the spleen is enlarged.
Patients may suffer from amyloidosis (metabolic disorder), renal failure, digestive disorders, neuritis (damage to the nerve trunks of peripheral nerves with sensory disturbances).
Patients with RA quickly lose weight and feel fatigued. They develop neuropsychic weakness (asthenia) and anemia. Lack of hemoglobin and red blood cells (anemia) is one of the indirect diagnostic symptoms rheumatoid arthritis (treatment is required).
Symptoms of rheumatoid arthritis. Click on photo to enlarge 2. Articular RA syndrome
Joint signs of rheumatoid arthritis:
- In 70% of cases, at the initial stage of the disease, damage to small joints occurs, less often - inflammation of large joints. Usually the joints are affected symmetrically.
- With each exacerbation, more and more joints are involved in the process.
- The disease develops gradually, first painful swelling and stiffness appear, and the temperature increases (up to 37.5 degrees).
- Sometimes the onset of the disease is sudden and very acute, inflammation of the joints occurs against the background of sudden temperature fluctuations, and is accompanied by damage to internal organs.
- A person experiences a boring pain (increasing to unbearable when trying to move), swelling appears, and the temperature in the joint area rises.
Unlike rheumatoid arthritis, which resembles RA in symptoms, articular symptoms persist for a long time. With rheumatism, they disappear without a trace within 2–4 weeks; treatment of rheumatoid arthritis requires time and effort.
The functions of the joints are limited (at first due to pain, then due to improper fusion and ossification of tissues). Over time, the muscles and ligaments around inflamed joint weaken.
This leads to the formation of:
- Dislocations and displacements.
- Contracture (fixation of a joint in a certain position due to improperly fused tissues).
- Hammer-shaped fingers.
- Deformities of limbs and joints.
Click on photo to enlarge In later stages, the tissues of the deformed joints grow together and ossify, making them completely immobile (ankylosis).
Possible complications of the disease
- Myocardial infarction – death of the heart muscle due to impaired blood supply;
- heart failure;
- narrowing of the aorta in the valve area, creating problems for blood flow from the left ventricle;
- renal failure - impaired kidney function;
- amyloidosis – a disorder of protein metabolism;
- polyserositis - inflammation of several serous membranes (surrounding the organ from the outside) of different internal organs;
- formation of bronchopleural fistulas (a direct channel between the bronchial tree and the pleural cavity).
Diagnostics
The patient is referred for consultation to a rheumatologist when:
- painful swelling of several joints (at least 3);
- their symmetrical defeat;
- complaints of morning stiffness that lasts for a long time (more than 6 weeks);
- subcutaneous nodules;
- changes on the radiograph (osteoporosis, erosions and cysts of the articular surfaces).
Diagnostic symptoms of rheumatoid arthritis on x-ray:
Click on photo to enlarge If it is necessary to clarify the diagnosis:
- An MRI is prescribed (the method allows you to determine the condition of the periarticular tissues).
- A puncture is performed (synovial fluid is extracted, in which specific cells (ragocytes), leukocytes can be found).
The viscosity of synovial fluid in RA decreases. Changes in the synovium (the membrane surrounding the joint) characteristic of rheumatoid arthritis are also found:
- proliferation of synovial villi;
- active division and growth of the layer of surface cells;
- grains of fibrin (protein);
- pockets of dead cells.
Laboratory diagnostics is a whole range of studies, of which the most informative are blood tests for:
- Rheumatoid factor (positive for seropositive, negative for seronegative arthritis). The presence of RF complicates the treatment of rheumatoid arthritis.
- C-reactive protein (CRP) (its increased value indicates the presence of inflammation).
- Antibody titer to citrullinated peptide (ACCP is increased in autoimmune diseases). ACCP is a specific protein that grows in the blood during rheumatoid arthritis (autoimmune joint disease).
- Leukocytes (low only in Felty syndrome, in other cases – above normal).
- Hemoglobin (reduced, as well as red blood cells).
- ESR (erythrocyte sedimentation rate) is increased.
- The number of T-lymphocytes (reduced).
In 75% of patients, rheumatoid factor appears a year after the onset of the disease.
Treatment methods
The disease is incurable. The struggle with it continues throughout my life. Symptoms and treatment are closely related.
The main goals of therapy, in addition to eliminating severe symptoms:
- achieve stable and long-term remission;
- inhibit the activity of autoimmune reactions;
- prevent or slow down the onset of complications of RA.
To do this, the patient is prescribed medications that quickly relieve the most severe symptoms RA:
- hormones (Dexamethasone, Prednisolone, Hydrocortisone);
- anti-inflammatory NSAIDs: Ibuprofen, Piroxicam, Diclofenac;
- basic drugs that need to be taken for years (with their help they inhibit the progress of the disease): cytostatics (Remicade, Cyclophosphamide, Methotrexate), gold drugs (Auranofin, Aurothiomalate)
Physiotherapy
Rheumatoid arthritis is treated not only with medications, but also with physiotherapeutic methods.
They help speed up tissue healing, maintain muscle tone, and maintain joint mobility.
What methods are effective:
- Phonophoresis and electrophoresis with medications (under the influence of an electric field or ultrasound, the permeability of the skin improves, and medicinal substances reach the affected area).
- Electrical muscle stimulation (muscle stimulation with electric current).
- Balneotherapy (mineral water baths).
- Mud therapy.
- Physical therapy exercises.
A mandatory stage is sanatorium-resort treatment.
Examples of exercise therapy for hands for rheumatoid arthritis Drug therapy
How to treat rheumatoid arthritis? To relieve severe symptoms, the patient is prescribed:
- Non-steroidal anti-inflammatory drugs - Ibuprofen, Ortofen, Indomethacin, Nimesulide.
- Hormonal anti-inflammatory drugs in injections into the joint - Hydrocortisone, Metipred.
Click on photo to enlarge The following are effective as basic medications for RA:
| Drug names | Spectrum of action |
|---|---|
|
Cytostatics, immunosuppressants (Methotrexate, Azathioprine) |
Affect division immune cells and the activity of the immune process, restraining it |
|
Anti-inflammatory, immunosuppressive, antimicrobial drugs (D-penicillamine, Sulfasalazine) |
Affect the activity of the immune process and reduce the severity of inflammatory processes |
|
Gold preparations (Krizanol) |
They have cytostatic properties; they are prescribed for severe disease, as well as for contraindications to taking Methotrexate |
|
Quinoline derivatives (Delagil) |
Reduce inflammation, influence the activity of immune processes |
Click on photo to enlarge Recently, the following has been used in the treatment of RA:
- New medications are biological agents that neutralize substances responsible for the development of autoimmune reactions (Infliximab).
- New techniques introduce stem cells into the joint, restoring damaged surfaces.
Conservative treatment of rheumatoid arthritis with medications is long-term. Some medications have been taken for years.
Surgical treatment (joint replacement) is performed for arthrosis.
Folk remedies for arthritis
Long-term use of herbal remedies according to folk recipes is quite effective and helps to curb the development of the disease.
Home Remedies Recipes:
- Infusion of laurel (Noble laurel). Grind a few bay leaves (so that you get 1 tablespoon of raw material), pour in 450 ml of boiling water, leave in a thermos overnight. In the morning, strain, drink 1/3 of a glass 3 times a day before meals (30 minutes). Continue treatment for rheumatoid arthritis for 14 days. After the same break, you can repeat it.
- Dandelion infusion. Wash and chop the dandelion roots. 1 tsp. Pour a glass of boiling water over the finished mixture, let it brew for 1 hour under the lid. When ready, divide into 4 parts, drink during the day 30 minutes before meals. Take the product for 6 to 12 months.
Before starting treatment with folk remedies, be sure to consult with your doctor.
On the left is an infusion of bay leaves, on the right is an infusion of dandelions. Click on photo to enlarge Prevention
Exacerbation of arthritis can be prevented by adhering to certain principles of a healthy diet.
A special diet for RA has not been developed, but switching to plant foods, boiled cereals (for example, rice) and vegetables helps reduce the number of exacerbations.
How to treat rheumatoid arthritis with diet? Some rheumatologists recommend eliminating allergenic foods from the diet (for example, tomatoes, eggplants), others recommend introducing more vitamins and animal protein into the diet.
Protein is essential for RA. It helps reduce muscle loss. However, preference should be given to lean meats and sea fish, as well as boiled or baked foods.
- be regularly seen by a doctor (examined and examined 1–2 times a year);
- reduce physical activity (except for exercise therapy) by choosing a walking cane, orthopedic braces, and comfortable shoes.
Various orthopedic knee braces Prognosis for the disease
Rheumatoid arthritis is not completely curable. The pathology often worsens and progresses rapidly, complicated by diseases of the internal organs.
The prognosis depends on the stage at which arthritis was diagnosed (early is easier to stop and avoid complications).
Factors that worsen the prognosis:
- extra-articular manifestations;
- drug resistance.
Treatment for rheumatoid arthritis continues throughout your life.
The pathology leads to disability in 35–40% of patients 5 years after the onset of the disease, which causes a reduction in life expectancy by 3–15 years.
The cause of death during the disease is often an infection that develops against the background of insufficient activity of the immune system (due to taking basic drugs), renal failure, amyloidosis (a disorder of protein metabolism with the deposition of protein complexes - amyloids) in the internal organs) or diseases of the cardiovascular system.
Primary sources of information, scientific materials on the topic
- Rheumatic diseases. Guide to Internal Medicine. Nasonov V. A., Bunchuk N. V., Medicine, 1997, p. 363–373.
- Handbook of Internal Medicine. Harrison T.R. Section “Clinical Immunology and Rheumatology”.
» What joints are affected by rheumatoid arthritis
Rheumatoid arthritis is a dangerous disease with a wide area of damage, including not only joints, but also the main systems of human life, which is why it is called systemic. Therefore, it is extremely important to recognize its earliest symptoms. The first signs of pathology are still reversible, but chronic pathology is much more difficult to treat, and it can lead to destruction of joints and other organs and an unfavorable prognosis. How to treat rheumatoid arthritis - this is what the pages of this article are devoted to.
I="">Causes of rheumatoid arthritis
According to classical medicine, the following possible causes of the disease are identified:
- Autoimmune processes, the mechanism of which is activated under the influence of genetic factors
- Infectious factors:
- These may be viruses of the following diseases:
- measles, mumps, acute viral infection
- hepatitis B
- herpes, Eppstein-Barr virus
- herpes zoster
- retroviral infection leading to malignant tumors in the lymphatic and circulatory systems
Stages of rheumatoid arthritis
The disease rarely manifests itself in all its multiple symptoms at once.
- In the first stage, local swelling and pain occur near the joint, and the temperature on the surface of the skin may also increase
- Within a month and a half, these symptoms are reversible and can be easily treated with anti-inflammatory drugs
The photo shows the stages of rheumatoid arthritis:
I-3="">Disease symptoms
There is something common, regardless of the cause of arthritis - this is the presence of specific antibodies in the blood, called rheumatoid factor.
To make a diagnosis, donating blood for a rheumatic test is the first prerequisite.
But rheumatoid factor itself does not mean the presence of arthritis, since it can be detected in some infectious diseases, chronic liver pathologies, and even in healthy people.
Rheumatoid arthritis, in addition to changes in blood tests, has its own clinical symptoms.
They can be divided into three groups:
General symptoms
- Fatigue, weakness and weakness
- Flu symptoms, including elevated temperature and aching joints
- Dryness of the mucous membranes of the eyes and mouth
- Depression and lack of appetite
- Cold sweating
Joint symptoms
- Pain at night and in the morning
- Formation of nodules on joints according to a symmetrical type:
- Initially, rheumatoid arthritis affects the small joints on both hands or feet, and then moves to larger ones.
- The following types of joints are primarily affected:
- second and third metacarpophalangeal
- proximal interphalangeal
- knee
- wrist
- elbow
- ankle
In the photo - rheumatoid arthritis of the foot:
I-6="">Extra-articular symptoms
Rheumatoid arthritis gives rise to a simply enormous number of various symptoms and syndromes. The forms of its clinical manifestation are varied. This inflammatory joint disease affects:
- On the cardiovascular and respiratory systems, causing:
- Pericarditis, atherosclerosis, vasculitis, cardiac and respiratory failure, pleurisy, pneumofibrosis
The photo shows the surface of the skin with a mesh pattern in rheumatoid arthritis:
I-7="">Types of rheumatoid arthritis
Rheumatoid arthritis in two thirds of cases is polyarthritis, that is, it affects many joints. Much less often, several or one joint is affected by the disease
Symptoms of the disease can be mixed or relate to a specific group of patients:
- If both joints and organs are affected, this disease is called articular-visceral.
- If the disease occurs before the age of 16 years, then such arthritis is called juvenile
- The combination of several signs at once is called a syndrome.
Syndromes in rheumatoid arthritis
- Still's syndrome:
- Juvenile rheumatoid arthritis of seronegative type with erymatous rash, increased leukocytes, ESR and enlarged lymph nodes
In the photo - Felty's syndrome:
I-9="">Diagnosis of the disease
Making an accurate diagnosis is difficult, since rheumatoid arthritis in its symptoms resembles many diseases:
- Rheumatism
- Gout
- Infectious arthritis (gonococcal, syphilitic, chlamydial)
- Reactive (Reiter's syndrome)
- Lyme disease (borreliosis)
Of fundamental importance for diagnosis are:
- Biochemical and general blood test:
- with calculation of erythrocyte sedimentation rate (ESR) and platelets
- determination of antibody titer to cyclic peptide ACRF (rheumatoid factor)
Diagnostics allows you to make a preliminary prognosis of the disease.
Adverse Signs
Unfavorable signs are considered:
- Steady involvement of new joints with each new attack
- Increase in ESR and antibody titers
- Non-responsiveness of the patient to basic medications
- Early and rapid destruction of joints, visible on x-ray
The photo shows an x-ray of the affected joint:
I-11="">Treatment of rheumatoid arthritis
If an injection is detected during diagnosis, then antibacterial treatment is prevailing.
I-12="">Selection of NSAIDs and GCS
If symptoms of articular manifestations predominate, select an appropriate non-steroidal anti-inflammatory drug (NSAID) or glucocorticosteroids (GCS)
- Of course, you can choose aspirin, diclofenac, and ibuprofen, which are COX-1 inhibitors (cyclooxykenase, which synthesizes prostaglandins, which are responsible for inflammation).
- But the duration of treatment for arthritis dictates the need to take drugs from this series that are less harmful to the gastrointestinal tract, which include COX-2 inhibitors:
- Movalis (meloxicam), nimesulide, celecoxib
Basic drugs
NSAIDs and corticosteroids can help with the early stages of rheumatoid arthritis. They also serve to relieve pain attacks. But for chronic arthritis, other, non-symptomatic remedies are needed.
Today, rheumatologists have somewhat changed the previous treatment regimen - moving from a gradual increase in doses of basic drugs to a sharp aggressive attack on the disease immediately after the diagnosis revealed rheumatoid arthritis. In some ways, this scheme is reminiscent of chemotherapy for oncology.
Such harsh treatment is justified when the consequences of the disease are worse than complications from medications.
The following drugs are used:
Sulfasalazine, penicillamine, leflunomide, aminoquinol, etc.
I-14="">Complex therapy
How to cure rheumatoid arthritis?
The treatment regimen is individual for each patient. After all, there is such a variety of symptoms:
- For example, the content of leukocytes or neutrophils in the blood can be either increased or decreased
- Both violent extra-articular manifestations in the form of fever, myotrophy, sweating, and their absence against the background of joint pain are possible
- Absence or presence of visceral symptoms
However, the main thread of treatment is:
- The use of NSAIDs and corticosteroids for exacerbation of pain and inflammation
- Taking basic medications:
- Methotrexate, sulfasalazine, D-penicillamine
Surgery
Surgical treatment of rheumatoid arthritis is used only if it is necessary to remove a completely destroyed joint or for its fusion.
Surgery becomes especially relevant for instability in the cervical spine that threatens the spinal cord.
The main surgical method is arthrodesis, that is, artificial ankylosis of the vertebrae.
Additional measures
In addition, to combat rheumatoid arthritis you need:
- Physiotherapy (electro- and phonophoresis)
- Physiotherapy
- Prevention of osteoporosis:
- taking calcium supplements with the regulation of this element in the body: in combination with vitamin D
- food containing dairy products (cheese, cottage cheese, sour cream) and nuts
The influence of pregnancy on the course of the disease
Of course, for a young woman such a terrible disease looks like a tragedy, because treatment with basic drugs can lead to infertility and is unsafe for the health of the woman herself. Nevertheless, the desire to have a child turns out to be stronger. How do rheumatoid arthritis and pregnancy get along together?
https://www.youtube.com/embed/3kIh75hBLxE?feature="oembed="">
Joints often affected by rheumatoid arthritis are the wrists, hands, legs, and ankles. The disease can affect the elbow, shoulder, hip, knee, neck and jaw joints.
It usually affects joints on both sides of the body at the same time, such as the joints of both hands. The joints most often affected are the joints of the hands and feet.
Extra-articular signs and symptoms also occur in rheumatoid arthritis. Unlike osteoarthritis, which affects only the bones and muscles, rheumatoid arthritis can affect the entire body, including organs such as the heart, blood vessels, lungs and eyes. Rheumatoid arthritis causes changes in many joints at once, whereas osteoarthritis usually causes changes in only one or a few joints, even though several joints may be affected at once.
Small bumps called rheumatoid nodules form under the skin of the elbows, hands, knees, toes and back of the head. These nodules, usually painless, range in size from a pea to a walnut.
“Which joints are affected by rheumatoid arthritis” and other articles from the Arthritis section
Rheumatoid arthritis is a chronic systemic connective tissue disease that primarily affects the joints. This is one of the most serious diseases, affecting approximately 1% of the world's population.
Signs
Rheumatoid arthritis primarily affects small joints. Typically, the disease begins with inflammation of the metacarpophalangeal joints (located at the base of the finger) of the index and middle fingers and inflammation of the wrist joints. Moreover, this inflammation is symmetrical, that is, it develops on both hands at once. Joints swell and hurt. Moreover, the pain intensifies at night, in the morning, and until about noon the person suffers from unbearable pain. Patients themselves often compare this pain to toothache. However, by warming up or simply after any vigorous activity, the pain usually decreases. This is the difference between rheumatoid arthritis and arthrosis, in which pain intensifies due to physical activity. In the middle of the day the pain subsides and by evening it is almost unnoticeable.
Almost simultaneously with the damage to the joints of the hands, the joints of the feet also become inflamed. The joints at the base of the fingers are predominantly affected.
Pain and swelling may last for several months.
After some time, from several weeks to several months, larger joints become inflamed - ankle, knee, elbow, shoulder. However, in older people aged 65-70 years, the disease can begin with damage to large joints and only then inflammation of small ones occurs.
Another characteristic symptom of rheumatoid arthritis is morning stiffness. It can manifest itself as a feeling of a stiff body, and a feeling of tight gloves on your hands. Some patients feel as if their body is in a corset in the morning. In mild forms of the disease, this stiffness lasts about two hours after waking up, with severe forms stiffness may last throughout the first half of the day.
Joint deformity, which develops in the later stages of the disease, greatly affects the quality of life. It happens that the hands are fixed in an unnatural position and deviate outward. This is an ulnar deformity and develops 1-5 years after the onset of the disease. And it happens that the mobility of the wrist joints decreases. In this case, patients have to make great efforts to straighten or bend the hand at the wrist. Later, the mobility of other compounds also decreases.
Knee joints can not only become deformed. Quite often, fluid accumulates in the joint cavity. This is called a Baker's cyst. This cyst stretches the joint capsule, and in severe cases even ruptures it. Then the liquid pours into the soft tissues of the lower leg. In this case, swelling of the lower leg develops, and sharp pain appears in the leg.
It happens that not only the joints are affected, but also the spine. Moreover, it mainly suffers cervical region. In this case, patients complain of neck pain.
In severe cases, the cricoid-arytenoid joint may be affected. Then the sufferer’s voice becomes rougher, shortness of breath and dysphagia appear. When this joint is damaged, the patient increasingly develops bronchitis.
With rheumatoid arthritis, patients complain of constant weakness, loss of appetite, weight loss up to cachexia (extreme exhaustion), and poor sleep. The temperature rises to low-grade levels, this condition is accompanied by chills. However, in some cases the temperature may rise to 39°C. Rheumatoid nodules often form on the skin - dense, rounded formations the size of a pea. Most often they are located below the elbows, on the hands, and on the feet. There are usually not many nodules. They may disappear and reappear, or they may remain in place for many years. There is no harm to health from them, however, they spoil the patient’s appearance. However, in some cases, rheumatoid nodules may be localized in the lungs (Kaplan syndrome).
Rheumatoid nodules are an extra-articular manifestation of rheumatism, it can occur not only on the skin. May be affected the cardiovascular system, in this case, vasculitis, pericarditis, and early atherosclerosis develop. The kidneys may be affected, in which case amyloidosis and, rarely, nephritis develop. There may be unpleasant complications from the blood - anemia, thrombocytosis, neutropenia. When the eyes are affected, keratoconjunctivitis, episcleritis or scleritis develops. The muscles and nervous system may also be affected.
Description
Rheumatoid arthritis – quite serious illness, which in a few years turns an able-bodied person into a helpless disabled person. This disease continues for many years. Some suffer from it all their lives.
It is known that rheumatoid arthritis is an autoimmune disease. For some reason, a large number of immune complexes are formed in the body, which circulate in the blood and enter the joints, causing inflammation, which later leads to destruction. In addition, these immune complexes can attack other organs and tissues, leading to extra-articular manifestations of rheumatoid arthritis. Rheumatoid nodules are formed by an accumulation of immune cells and lymphocytes around a small area of dead tissue, but it is not known what attracted these cells there and what came first - tissue necrosis or accumulation of immune cells. And what contributes to the activation of lymphocytes is unknown. There are hypotheses that viruses, bacteria, allergies, injuries, heredity and many other factors are to blame for the development of this disease. The onset of the disease after severe stress is also possible.
There are many forms of rheumatoid arthritis:
- acute polyarthritis , in which the joints of the hands and feet are predominantly affected, rheumatoid factor (autoantibodies to class G immunoglobulins) is often detected in the blood;
- acute monoarthritis , in which large joints are affected;
- symmetrical polyarthritis , which is characterized by a gradual increase in pain and stiffness in the small joints of the arms and legs;
- monoarthritis of the knees or shoulder joints , in which the knee or elbow joints are first affected, and then the small joints of the feet or hands are affected quite quickly;
- polyarthritis - a disease that mainly affects young people, which, in addition to joint pain, is characterized by fever, enlargement of the liver and spleen;
- palindromic rheumatism – multiple recurrent attacks of acute symmetrical polyarthritis of the hands, lasting several hours or days and ending full recovery;
- generalized myalgia It begins with stiffness, depression, carpal tunnel syndrome, muscle pain, and joint damage comes later.
There are also special clinical forms rheumatoid arthritis:
- Adult Still's disease, which is characterized by recurrent fever, arthritis, and skin rash;
- Felty's syndrome, which is characterized by an enlarged liver and spleen, joint damage, hyperpigmentation of the skin of the legs, lung lesions, Sjögren's syndrome and frequent infectious complications.
With rheumatoid arthritis, osteoporosis develops. And depending on the condition of the bones, there are 4 stages of this disease:
- Stage I, initial, which is characterized only by periarticular osteoporosis;
- Stage II, in which the joint space narrows, but osteoporosis affects the bones only around the joint;
- Stage III, which is characterized by all the signs of the second stage and bone erosion;
- Stage IV combines signs of the third and ankylosis (complete immobility of the joint, resulting from any changes in it) of the bones.
You can find out what stage of the disease a patient has using an x-ray examination.
Rheumatism usually occurs in waves, with exacerbations and remissions. In less than 10% of cases with this disease there is spontaneous long-term remission . In 15% of cases there is intermittent flow , in which spontaneous or treatment-induced remissions alternate with exacerbations, during which previously unaffected joints are seized. In approximately 60% of cases, the course of the disease progressive . At the same time, new joints are constantly involved in the pathological process, and extra-articular manifestations are also characteristic of this course. In the remaining cases, the course of the disease rapidly progressive . This course is characterized by rapid development of the disease with severe extra-articular manifestations.
Diagnostics
The diagnosis is made by a rheumatologist. However, you may need to consult a neurologist and ophthalmologist. Usually the therapist refers the patient to a rheumatologist if he has characteristic symptoms lasts more than 6 weeks, more than three joints are inflamed, or morning stiffness lasts more than 30 minutes.
To make a correct diagnosis, it is necessary to do a general and biochemical blood test, and conduct a study of rheumatoid factors in the blood. The following studies are also prescribed:
Treatment
To treat rheumatoid arthritis, drugs that suppress the immune system are used. If the drug does not have an effect within three months, it is changed. This basic therapy. Also used hormonal drugs to relieve inflammation in the form of ointments, creams and tablets. Non-steroidal anti-inflammatory drugs can also be used to relieve inflammation.
Prevention of osteoporosis is also of great importance. For this purpose, special drugs and a diet with high content calcium.
The immune system can also be stimulated by physical methods:
- plasmaphoresis, in which plasma with a large amount of rheumatoid factors is removed and donor plasma is administered to the patient;
- lymphocytophoresis, in which lymphocytes and monocytes are removed from the blood using a centrifuge, which reduces blood reactivity and the degree of inflammation;
- irradiation of lymphoid tissue, in which the lymph nodes, spleen, and thymus are sequentially irradiated;
- drainage of the thoracic lymphatic duct, in which the lymph is centrifuged, the cellular sediment is separated, and the liquid part of the lymph is returned back to the lymphatic duct.
Physiotherapy is widely used to treat rheumatoid arthritis. At an early stage, laser therapy is indicated; however, a course of more than 15 procedures is not recommended. Also on early stages shown ultraviolet irradiation and electrophoresis with dimethyl sulfoxide. Cryotherapy is often used to reduce pain.
At later stages, phonophoresis with hydrocortisone, pulsed currents and magnetic therapy are used.
Physical therapy is indicated to restore joint function.
Prevention
Prevention of rheumatoid arthritis is divided into primary and secondary. Primary prevention is measures aimed at preventing the disease. It lies in timely treatment infectious diseases, as well as the rehabilitation of foci of infection, for example, carious teeth. It is important to strengthen the body, toughen up, play sports and lead an active lifestyle, and, if necessary, take vitamins.
Secondary prevention involves preventing exacerbations and complications in those suffering from rheumatoid arthritis. It includes physical therapy, timely reception of necessary medicines. It is also important to follow a diet. It is necessary to limit the consumption of fats, sugar, salt, eat more vegetables and fruits, dairy products, and cereals.
The whole truth about: rheumatoid arthritis of the joints and other interesting information about treatment.
Rheumatoid arthritis is a systemic disease of unknown etiology with widespread damage to connective tissue, mainly in the joints, with erosive changes in them, with a chronic, often relapsing and progressive course. The trigger can be an infection, a cold, or an injury.
The pathological process leads to complete destruction of articular tissues, gross deformations and the development of ankylosis, which leads to loss of joint function and disability.
In severe cases, internal organs (heart, kidneys, lungs, blood vessels, muscles, etc.) can also be affected, which significantly worsens the prognosis for rheumatoid arthritis. We will discuss the symptoms, diagnosis and treatment methods in detail in this article.
The prevalence of rheumatoid arthritis among the adult population of various climatic zones averages 0.6 - 1.3%. The annual incidence over the past decade has remained at 0.02%.
An increase in rheumatoid arthritis with age has been noted; women are more often affected than men. Among people under 35 years of age, the prevalence of the disease is 0.38%, in people aged 55 years and older - 1.4%. High frequency The disease was detected in first-degree relatives of patients (3.5%), especially in females (5.1%).
What is it: causes of occurrence
Why does rheumatoid arthritis occur and what is it? Rheumatoid arthritis is an autoimmune disease, that is, a disease that occurs when the normal functioning of the immune system is disrupted. As with most autoimmune pathologies, the exact cause of the disease has not been identified.
It is believed that the provoking factors for the occurrence of the disease are:
- Genetic predisposition - close relatives of patients with rheumatoid arthritis develop this disease much more often.
- Infections - arthritis often occurs after measles, herpes infection, hepatitis B, mumps.
- Unfavorable external and internal environment- hypothermia, exposure to toxic products, including occupational hazards, stress, as well as pregnancy, breastfeeding, menopause.
Under the influence of these factors, cells of the immune system begin to attack the cells of the joint lining, which causes inflammation in them. This process causes the joints to become swollen, warm, and painful to the touch. Cells of the immune system also cause damage blood vessels, which explains the so-called extra-articular symptoms of rheumatoid arthritis.
Juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (Still's disease) is an inflammatory disease of the joints, it is characterized by a progressive course with a fairly rapid involvement of internal organs in the process. This disease occurs in 5-15 people per 100,000 children.
The disease occurs in children under 16 years of age and can last for many years. The appearance of the disease can be the result of various influences - viral and bacterial influences, cooling, medications, increased sensitivity to some factors external environment and many others.
First signs
Rheumatoid arthritis can begin acutely and subacutely, with the latter type of onset observed in most cases.
The first signs of RA:
- chronic fatigue;
- constant muscle weakness;
- weight loss;
- the appearance of muscle pain for no apparent reason;
- sudden and causeless jumps in temperature to a subfebrile level (37-38ºС);
- increased sweating.
As a rule, such manifestations of the disease remain unattended, and then articular syndrome and extra-articular manifestations of the disease develop.
Symptoms of rheumatoid arthritis: joint damage
In the case of rheumatoid arthritis, when studying the patient’s complaints Special attention refers to the following symptoms:
- Pain in the joints, their nature (aching, gnawing), intensity (strong, moderate, weak), duration (periodic, constant), connection with movement;
- Morning stiffness in the joints, its duration;
- Appearance of joints (swelling, redness, deformation);
- Persistent limitation of joint mobility.
A patient with rheumatoid arthritis may also have other symptoms:
- Hyperemia of the skin over the inflamed joints;
- Atrophy of adjacent muscles;
- With subluxations in the proximal interphalangeal joints, the hand has the appearance of a “swan neck”, with subluxations in the metacarpophalangeal joints - “walrus flippers”.
Upon palpation you can detect: an increase in skin temperature over the surface of the joints; soreness of the affected joints; “lateral compression” symptom; muscle atrophy and skin thickening; subcutaneous formations in the joint area, most often the elbow, so-called rheumatoid nodules; Patellar balloting symptom to determine the presence of fluid in the knee joint.
Depending on clinical and laboratory data, there are 3 degrees of exacerbation of RA:
- Low (joint pain is assessed by the patient as no more than 3 points on a 10-point scale, morning stiffness lasts 30-60 minutes, ESR 15-30 mm/hour, CRP - 2 plus);
- Moderate (pain – 4-6 points, stiffness in joints up to 12 hours after sleep, ESR – 30-45 mm/hour, CRP – 3 plus);
- High (pain – 6-10 points, stiffness observed throughout the day, ESR – more than 45 mm/hour, CRP – 4 plus).
In RA, peripheral joints are primarily affected, but we must not forget that this is a systemic disease, and any organs and tissues where connective tissue is present can be involved in the pathological process.
Extra-articular symptoms in rheumatoid arthritis
The development of extra-articular (systemic) manifestations is more typical for the seropositive form of rheumatoid arthritis with a severe long-term course.
- Muscle damage is manifested by atrophy, decreased muscle strength and tone, and focal myositis.
- Skin damage is manifested by dryness, thinning of the skin, subcutaneous hemorrhages and small focal necrosis.
- Impaired blood supply to the nail plates leads to their fragility, striations and degeneration.
- The presence of rheumatoid nodules - subcutaneously located connective tissue nodules with a diameter of 0.5-2 cm. They are characterized by a round shape, dense consistency, mobility, painlessness, less often - immobility due to adhesion to the aponeurosis.
The presence of rheumatoid vasculitis, which occurs in 10-20% of cases.
The most severe course of rheumatoid arthritis is characterized by forms that occur with lymphadenopathy, damage to the gastrointestinal tract (enetritis, colitis, amyloidosis of the rectal mucosa), nervous system (neuropathy, polyneuritis, functional autonomic disorders), involvement of the respiratory system (pleurisy, diffuse fibrosis, pneumonitis, fibrosing alveolitis , bronchiolitis), kidneys (glomerulonephritis, amyloidosis), eyes.
From the outside great vessels and hearts with rheumatoid arthritis, endocarditis, pericarditis, myocarditis, arteritis may occur coronary vessels, granulomatous aortitis.
Complications
- pathologies of the cardiovascular system;
- nervous system dysfunction;
- blood diseases;
- defeats respiratory system;
- kidney diseases;
- damage to the joints and musculoskeletal system;
- skin lesions;
- eye diseases;
- gastrointestinal dysfunction;
- mental disorders;
- other pathologies.
How to distinguish RA from other diseases?
Unlike rheumatism, with rheumatoid arthritis the inflammation is persistent - pain and swelling of the joints can last for years. This type of arthritis differs from arthrosis in that the pain does not increase with load, but, on the contrary, decreases after active movements.
Diagnostics
American Rheumatological Association Diagnostic Criteria for Rheumatoid Arthritis (1987). Having at least 4 of the following signs may indicate the presence of a disease:
- morning stiffness for more than 1 hour;
- arthritis of 3 or more joints;
- arthritis of the joints of the hands;
- symmetrical arthritis;
- rheumatoid nodules;
- positive rheumatoid factor;
- radiographic changes.
A blood test shows the presence of inflammation in the body: the appearance of special inflammatory proteins - seromucoid, fibrinogen, C-reactive protein, as well as rheumatoid factor.
Making a diagnosis of rheumatoid arthritis is possible only by assessing the totality of symptoms, radiological signs and results laboratory diagnostics. If the result is positive, treatment is prescribed.
Treatment of rheumatoid arthritis
In the case of an accurate diagnosis of rheumatoid arthritis, systemic treatment involves the use of certain groups of drugs:
- non-steroidal anti-inflammatory substances;
- basic drugs;
- hormonal substances (glucocorticoids);
- biological agents.
On modern stage development of medicine, the following goals are set in the treatment of rheumatoid arthritis:
- reduction and, if possible, elimination of symptoms of the disease,
- prevention of destruction of joint tissue, disruption of its functions, development of deformations and adhesions (ankylosis),
- achieving stable and long-term improvement in the condition of patients,
- increase in lifespan,
- improving quality of life indicators.
Treatment consists of a complex of methods of drug therapy, physiotherapy, therapeutic nutrition, surgical treatment, sanatorium treatment and subsequent rehabilitation.
Nonsteroidal anti-inflammatory drugs
This group of drugs is not included in the basic therapy of rheumatoid arthritis, since it does not affect the destructive process in the joints. However, drugs from this group are prescribed to reduce pain syndrome and eliminate stiffness
in the joints.
Most often used:
- diclofenac;
- ibuprofen;
- nimesil;
- movalis;
- indomethacin;
Prescribed during periods of exacerbation of pain and severe stiffness. Prescribed with caution to patients with gastritis.
Basic drugs
In combination with hormones, they help reduce the activity of rheumatoid arthritis. The most common drugs for treatment currently are:
- gold preparations;
- methotrexate;
- leflunomide;
- penicillamine;
- sulfasalazine.
There are also reserve drugs: cyclophosphamide, azathioprine, cyclosporine - they are used when the main drugs do not give the desired effect.
Biological agents
Monoclonal antibodies to certain cytokines neutralize tumor necrosis factor, which in the case of rheumatoid arthritis provokes damage to its own tissues.
There are also studies suggesting the use of lymphocyte differentiation regulators as a treatment for rheumatoid arthritis. This will avoid damage to the synovial membranes by T-lymphocytes, which are incorrectly “directed” to the joints by the immune system.
Glucocorticoids
These are hormonal drugs:
- prednisolone;
- dexamethasone;
- methylprednisolone;
- triamcinolol;
They are prescribed both in the presence of systemic manifestations of the disease and in their absence. Today, in the treatment of rheumatoid arthritis, treatment is practiced with both small and large doses of hormones (pulse therapy). Corticosteroids are excellent for pain relief.
Methotrexate for rheumatoid arthritis
According to reviews, methotrexate for rheumatoid arthritis is actively prescribed in Russia and European countries. This is a drug that inhibits cells of the immune system, prevents the occurrence of inflammatory processes in the joints and aggravates the course of the disease. Now it is used very widely.
The drug has several side effects, so it is used under the close supervision of the attending physician; during the course of treatment, the patient must regularly undergo blood tests. Despite this, methotrexate for rheumatoid arthritis is the most appropriate solution, in some cases it is simply irreplaceable.
The price of the drug varies depending on the form of release in the range from 200 to 1000 rubles.
Physiotherapy
Only after it is removed acute form illness, blood tests and temperature return to normal - massage and other physical therapy methods can be used for rheumatoid arthritis. The fact is that physiotherapy has a stimulating effect and can enhance inflammatory process.
These methods improve blood supply to the joints, increase their mobility, and reduce deformation. Phonophoresis, diathermy, UHF, ozokerite and paraffin, infrared irradiation, therapeutic mud, and balneotherapy at resorts are used. We will not dwell on these methods in detail.
Operation
Surgery can improve the health situation in the relatively early stages of the disease if one large joint (knee or wrist) is persistently inflamed. This surgery (synovectomy) removes the synovial lining of the joint, resulting in long-term relief of symptoms.
Joint replacement surgery is performed for patients with more severe joint damage. The most successful operations are on the hips and knees.
Surgical intervention has the following goals:
- relieve pain
- correct deformities
- improve the functional condition of joints.
Rheumatoid arthritis is primarily medical problem. That's why surgery is prescribed to those who are under the supervision of an experienced rheumatologist or physician.
Nutrition
The rules of the diet are as follows:
- including enough fruits and vegetables;
- reducing the load on the kidneys, liver and stomach;
- exclusion of foods that cause allergies;
- replacing meat with dairy and plant products;
- consumption of foods high in calcium;
- avoidance of foods that cause excess weight.
Rheumatoid arthritis treatment with folk remedies
Treatment with folk remedies involves the use medicinal plants, which have analgesic and anti-inflammatory properties.
- To relieve pain from rheumatoid arthritis, take equal amounts of elderberry flowers, parsley root, stinging nettle leaf and willow bark. Grind everything, and then brew 1 tablespoon of the mixture with 1 glass of boiling water, then boil for 5-7 minutes over low heat, then cool and strain. Take two glasses of decoction, morning and evening.
- The flowers collected during the flowering of the chestnut tree are filled with high-quality vodka (you need to take one part of vodka for two parts of flowers). The mixture is infused for two weeks in a dark place, filtered and after that the tincture is ready for use. You need to take the tincture 5 drops three times a day an hour before meals.
- 50 grams dissolve in one hundred grams of alcohol camphor oil and add 50 grams of mustard powder. Separately, beat the whites of two eggs and add them to the mixture. The resulting ointment is rubbed into the affected joint and relieves pain symptoms well.
- Burdock will help relieve joint pain. It can be used in the form of tinctures. Grind the leaves of the plant in a meat grinder and pour in vodka (500 ml of vodka for 500 g of leaves). Shake the mixture and put it in the refrigerator. At night, apply gauze soaked generously in this solution to the sore spot. The pain goes away after several compresses. Treatment of rheumatoid arthritis with folk remedies can also be done by wrapping whole burdock leaves at night.
At home, you can make compresses, rub in homemade ointments, and prepare decoctions. It is important to follow the correct eating style, which helps restore metabolism in the body.
Prevention
Prevention of the disease and its exacerbations is aimed, first of all, at eliminating risk factors (stress, smoking, toxins), normalizing body weight and maintaining a balanced diet.
Compliance with these rules will help avoid disability and prevent the rapid progression of RA.
Forecast
Rheumatoid arthritis shortens life expectancy by an average of 3 to 12 years. A 2005 study by the Mayo Clinic found that the risk of heart disease is twice as high in those with rheumatoid arthritis, regardless of other risk factors such as diabetes, alcoholism, high cholesterol and obesity.
The mechanism by which the risk of heart disease increases is unknown; the presence of chronic inflammation is considered a significant factor. It is possible that the use of new biological drugs can increase life expectancy and reduce risks for the cardiovascular system, as well as slow down the development of atherosclerosis.
Limited studies demonstrate a reduction in the risk of cardiovascular disease, while an increase in total cholesterol levels is observed while the atherogenic index remains unchanged.
Joint diseases today are one of the most common health problems among people over 50 years of age. Rheumatoid arthritis knee joint, the symptoms and treatment of which are known to doctors, is an autoimmune pathology that affects even children, unlike other joint disorders. When the disease occurs, the body's immune system begins to perceive joint cells as pathological and fights against them, which is why inflammation occurs. The knee joints are affected in most cases symmetrically.
Provoking factors
Rheumatoid arthritis occurs in people due to disruption of the immune system.
The following factors can give impetus to the development of pathology:
- severe allergic reaction – especially common in children;
- serious metabolic disorders;
- severe infectious diseases;
- traumatic lesions of the joints, in which there was severe inflammation;
- severe form of psoriasis;
- severe purulent processes in the body;
- systemic autoimmune diseases.
Whatever causes the pathology, it has chronic course, and all therapy is aimed only at eliminating symptoms and reducing the rate of disease progression. According to statistics, pathology occurs more often in women than in men, and first appears at a young age. The disease is especially severe in women and leads to serious complications.
Symptoms of rheumatoid arthritis in women and men
Rheumatoid arthritis in women has more intense symptoms than in men. It is quite difficult to confuse pathology with the symptoms of another disease, and therefore a doctor, even before conducting tests, can make a preliminary diagnosis quite easily. The disease tends to symmetrically affect the joints, and therefore, after the knee joint on one side begins to deteriorate, pathology develops in the second knee. Impairments can also develop in both knees at the same time.
Main signs of pathology:
- in the morning there is stiffness in the sore joint, which completely disappears after 2-3 hours of activity;
- knee pain after intense physical activity. With severe destruction of articular tissues, pain of pronounced intensity appears in the second half of the night and, reaching a peak in the morning, persists until lunch. By evening the pain disappears;
- severe weakness in the diseased joint - disrupts its normal functioning and prevents full movement;
- swelling of the lymph nodes - first located as close to the knee as possible, and then regional;
- an increase in temperature to insignificant levels at the time of exacerbation of the disease and its complete normalization during periods of remission;
- deterioration in sleep quality due to pain;
- change in taste preferences.
As the disease progresses, the symptoms intensify, and during exacerbations the patient’s condition seriously deteriorates. Gradually, other joints, as well as the cardiovascular system, are involved in the pathological process. This process is especially rapid if there is no therapy.
In advanced forms of the disease, all manifestations of pathology are divided into local and general.
Direction of treatment
Therapy for the disease is aimed at four main goals, without which it is impossible to relieve the exacerbation and begin maintenance treatment.
- Relieving inflammation. Until the condition is advanced, non-steroidal drugs are used. If they are ineffective, then hormonal agents may be required to relieve inflammation.
- Reducing the load on the joint. For this purpose, knee pads are used, which additionally fix the knee, preventing deformation of the joint due to pathological changes.
- Relieving swelling and restoring mobility of the sore joint. In addition to medications and physiotherapy, physical therapy is used for this.
- Restoration of damaged tissues and reduction of the activity of the pathologically altered immune system.
If even one of the stages of treatment is missed, restore normal condition patient is impossible.
How is rheumatoid arthritis of the knee treated?
Treatment of the disease is complex. It is carried out continuously in order to maintain a satisfactory condition of the knee joint and prevent the progression of pathology.
Therapy includes the following elements:
IT IS IMPORTANT TO KNOW! JOINT PAIN, recommended by doctors!* >>
- wearing a special splint or other orthopedic devices that support the joint;
- physical therapy classes, the complex of which is selected individually;
- the use of physiotherapeutic procedures, including medicinal baths;
- regular massage courses;
- taking medications.
What kind of therapeutic measures will be carried out is determined by the attending physician, depending on how severe the joint damage is.
Modern medicines
When treating the disease, 4 types of medications are prescribed:
- non-steroidal anti-inflammatory drugs;
- painkillers;
- chondroprotectors - prescribe medications latest generation, which place minimal stress on the stomach and are most effective against diseased joints;
- glucocorticosteroid drugs.
If the inflammation is accompanied by bacterial damage to the joints, a course of treatment with antibiotics is carried out.
In severe cases they resort to surgical intervention. The decision on how therapy will be carried out is made by the doctor depending on the degree of damage. Each case is individual, and therefore each patient is treated according to a special scheme.
The main drugs that are used to treat pathology are given in the table.
IT IS IMPORTANT TO KNOW! The only way TREATMENT OF ARTHROSIS AND ARTHRITIS, recommended by doctors!* >>
Specific medications will be prescribed by the doctor depending on the general condition of the patient and whether there are other chronic diseases. Immunosuppressants can also be used - medications to reduce the activity of the immune system, which helps reduce the intensity of the attack of leukocytes on joint cells. Such drugs are used extremely carefully so as not to cause a severe decline in immunity, which poses a serious threat to the body as a whole.
Massage during treatment
Massage for rheumatoid arthritis is necessary in order to improve blood circulation and tissue nutrition. The procedure also helps normalize lymph flow and relieve swelling. Initially, a massage course is carried out by a specialist after the acute inflammation has been relieved. Next, the patient is recommended to carry out regular self-massage using ointments and creams for the joints. It should be done in a circular motion, starting from the lateral surfaces of the knee, then under it, and then along the outer part of the knee.
The leg should be in a horizontal position during the procedure to avoid stagnation of blood and lymph. You should massage every day before bed, and if possible, in the morning. This treatment is contraindicated if there are open wounds in the knee area, the cartilage is seriously deformed, and the disease is in a state of exacerbation. Massage for rheumatoid arthritis gives results only if carried out in courses.
Exercises to treat rheumatoid arthritis of the knee
Therapeutic exercise helps prevent joint deformation and the development of short term serious deterioration in their mobility. A properly selected set of exercises prevents exacerbations of the disease. In addition to therapeutic exercises, swimming is useful, which has a beneficial effect on all metabolic processes in the body.
Gymnastics for rheumatoid arthritis of the knee joint is carried out strictly according to medical indications. To prevent deterioration of the condition, patients are prohibited from introducing new exercises at their own discretion without the consent of the doctor. Also, exercise therapy cannot be performed if there are disturbances in the functioning of the cardiovascular system. Row chronic pathologies internal organs is also a contraindication to therapeutic exercises.
IT IS IMPORTANT TO KNOW! The only way to get rid of JOINT PAIN, recommended by doctors!* >>
When performing exercise therapy, you should adhere to a number of rules.
- The load is increased gradually. At first, the exercises are carried out with minimal impact, which gradually increases.
- There should be no acute pain when performing exercises.
- Unpleasant sensations in the sore knee after gymnastics can last no more than 15 minutes. If they last longer, this indicates excessive load during exercise or incorrectly selected exercises. You must immediately inform your doctor about this situation.
- If you have rheumatoid arthritis, exercise should be done at the same time every day. You can skip gymnastics classes only for medical reasons, and for women - on the days of menstruation and premenstrual syndrome.
During the period of remission of the disease, the load during gymnastics for rheumatoid arthritis should be maximum.
Traditional methods of treatment
Folk remedies can be used in parallel with the main treatment to relieve symptoms. Such drugs cannot be used as the main therapy for rheumatoid damage to the knee joint. They will not give the desired result and will not stop the development of the disease, but at the same time they will blur the symptoms for some period, which is why timely and correct treatment will be delayed. As a result, rheumatoid arthritis will continue to develop, and the cardiovascular system will be involved in the pathological process.
The following recipes are considered the best folk remedies.
- Raw potato compress to relieve pain. This remedy helps with exacerbation of the disease, for a number of patients completely replacing analgesics. For procedure 2, large potatoes are washed from the soil and grated. Next, placing it in a colander, immerse the mass in boiling water for 3 seconds and then, allowing it to drain a little, spread it on gauze folded 4 times. The potatoes are covered with a layer of gauze and applied to the knee. The top is covered with polyethylene and insulated with a woolen scarf. This compress should be applied throughout the night for at least 7 days in a row.
- Compresses with 9% vinegar. This measure helps relieve pain and reduce swelling of the joint. For treatment, dissolve a tablespoon of vinegar in 2 cups of boiling water and, after soaking a cloth in the solution, apply it to the sore spot. Next, the knee is wrapped according to all the rules of a compress. You can leave this vinegar lotion for 6-8 hours.
- Burdock leaves. This remedy helps relieve swelling and reduce pain. If you don’t have burdock on hand, you can use coltsfoot or cabbage leaves for the same purpose. For treatment, the leaves are slightly crushed in the hands or pierced in several places with a pin. After this, they are applied to the knee and secured with a bandage. Next, the leg is wrapped in woolen cloth. The leaves attached to the knee must be changed once every 6 hours.
- Honey compresses. This remedy helps fight inflammation. For treatment before going to bed, you need to lubricate sore knee honey in a thin layer. Afterwards, the knee must be wrapped in cling film and insulated. Treatment is carried out for at least 15 consecutive days.
If rheumatoid arthritis occurs, the patient must undergo a course of complete therapy, which includes various techniques, including exercise therapy. In the future, continuous maintenance therapy is required. Without it, it is impossible to prevent the further development of pathology in a short time. Even with treatment, the disease will gradually develop and ultimately lead to disability. Knees suffer quite often from autoimmune joint diseases, and therefore supportive therapy is well developed.
Rheumatoid arthritis is an autoimmune disease that affects connective tissue and includes systemic complications. The joints are primarily affected - the disease is characterized by symmetrical polyarthritis of small joints. Extra-articular symptoms include damage to the muscles, heart, lungs, liver, gastrointestinal tract, etc. Rheumatoid arthritis is severe and causes disability in 70% of patients.
Causes and conditions of the disease
The exact causes of the development of rheumatoid arthritis have not been established. Modern scientists are inclined to two main hypotheses for the development of the disease:
- Genetic predisposition– if rheumatoid arthritis was diagnosed in parents, then the likelihood of its occurrence in children increases. The rule of genetic predisposition is clearly expressed in monozygotic twins. Recent research has identified certain histocompatibility antigens that code for malfunctions in the body's immune responses. In patients with rheumatoid arthritis, these antigens are present and can be inherited.
- Viral pathogen– according to clinicians, the vast majority of patients have high titers of antibodies to the Epstein-Barr virus in their blood. It is important to note the similarity between certain fragments of the virus and a portion of the histocompatibility antigen chain. It is also assumed that the disease can be caused by herpes viruses, rubella, papilloma B19, etc.
- Bacterial agents– Recent studies have shown that the entry of bacteria into the body is accompanied by an immune response to the so-called “stress proteins” synthesized by microbes. It is assumed that these components are capable of triggering a complex pathogenetic mechanism leading to the formation of rheumatoid factor.
- Trigger components of the disease– these are the conditions that contribute to the launch of a pathological reaction. In healthy people, triggers do not cause disease, but if a person is predisposed, they trigger pathogenesis. These include:
- frequent hypothermia;
- smoking and alcohol;
- joint injuries;
- hormonal changes;
- stress;
- harmful ecology.
According to statistics, the disease develops:
- more often in women than in men;
- over the age of 45;
- at frequent illnesses respiratory system, arthritis, developmental anomalies of the musculoskeletal system;
- with a family history;
- in the presence of the above antigens.
Occurrence and course of the disease
The pathogenesis of rheumatoid arthritis is a very complex autoimmune process. In our article we will only look at key points, allowing the average reader to understand the mechanism of development of pathology. The disease is based on a pathological immune response that attacks healthy connective tissue cells, mistakenly recognizing them as foreign. This autoimmune process occurs in several stages:
- Synoviocytes located in the connective tissue produce a large amount of inflammatory substances (cytokines) and activate special cells of the immune system - T-helper type 1.
- Helper T cells secrete interferon gamma, which activates another immune cell - macrophages and monocytes. The latter also produce specialized inflammatory substances:
- tumor necrosis factor – promotes the release of the liquid part of the blood into the area of inflammation, forming edema and inflammation.
- IL-1 contributes to the development of osteoporosis in the joint area and an increase in body temperature.
- IL-6 - activates liver cells, which produce large amounts of C-reactive protein, and also promote the transformation of B lymphocytes into plasma cells.
- IL-8 – increases the concentration of neutrophils in the joint fluid.
- Plasma cells produce modified immunoglobulins M and G, which attack the connective tissue, and when interacting with unchanged immunoglobulins G, they damage the microvasculature of the joint.
- The release of endothelial growth factor leads to additional formation of capillaries in the connective tissue, as well as specialized tissue called pannus. This tissue has signs of a tumor and can grow in the joint cavity, causing its deformation.
Classification of rheumatoid arthritis
To formulate the correct diagnosis, the doctor must know the classification of the disease. Clinicians use the International Classification of Diseases, 10th revision (ICD-10), which is more convenient for correctly formulating a diagnosis. For a patient, such a classification is too complicated, so we will analyze the types of rheumatoid arthritis according to the following criteria:
- For joint syndrome:
- monoarthritis– one joint is involved;
- oligoarthritis– inflammation of two joints;
- polyarthritis– involvement of 3 or more joints.
- By radiographic stages:
- first– thickening of cartilage and articular capsule walls, small areas of osteoporosis;
- second– formation of erosion foci on cartilage, narrowing of the joint space, development of a large zone of osteoporosis;
- third– deformation and periodic dislocations in the affected joints;
- fourth– complete disappearance of the joint space, there may be signs of bone fusion.
- According to the clinical picture:
- low activity– morning stiffness in the joints for up to 30 minutes, slight pain during the day, moderate swelling of the joints, erythrocyte sedimentation rate (ESR) up to 30 mm/hour, test for C-reactive protein (CRP) +;
- average activity– stiffness in the first half of the day, moderate pain (possible without exercise), severe swelling over the affected area. ESR up to 40 mm/hour, CRP ++, increased levels of inflammatory blood enzymes;
- high activity– stiffness in the joints continues all day, complications include damage to internal organs, ESR more than 40 mm/hour CRP +++, a pronounced predominance of inflammatory enzymes.
- According to the progression of the disease:
- very early stage– pathology develops within six months;
- early stage– the clinical picture of rheumatoid arthritis is characterized by the duration of symptoms from 6 to 12 months;
- advanced stage– the disease lasts for more than 12 months without significant destruction of the joints;
- late stage– pathological processes last more than 2 years with severe deformation of the joints.
- By limiting physical activity:
- first degree– maintaining efficiency and normal lifestyle;
- second degree– periodic loss from the usual way of life;
- third degree– inability to carry out work activities.
- fourth degree– lack of ability to self-care, disability.
- According to laboratory tests for rheumatoid factor:
- seropositive– based on test results, rheumatoid factor is detected;
- seronegative– rheumatoid factor is absent.
It is important to mention several options from ICD-10:
- Youthful (juvenile)– is a chronic rheumatoid arthritis that occurs in children with predominantly joint damage.
- Rheumatoid bursitis- inflammation of the joint capsules. The shoulder joints are predominantly affected.
- Felty's syndrome– a complication in which the clinical picture is accompanied by an enlarged spleen and a decrease in granulocytes in the blood.
Symptoms of rheumatoid arthritis
The course and development of the disease is expressed by articular and extra-articular manifestations. The articular lesion develops primarily and represents inflammatory polyarthritis. Extra-articular signs, or complications of the underlying disease, are involved in the pathology later and are characterized by multiple lesions (skin, muscles, internal organs, fundus, lymph nodes).
What joints are affected by rheumatoid arthritis?
Arthritis is characterized by damage to the same type of joints on the right and left sides - for example, arthritis of the knee joints on the right and left. It is important to note that small-caliber joints are predominantly affected.
The onset of the disease is usually preceded by:
- sudden changes in climate - spring or autumn;
- suffered from acute respiratory viral infections, pneumonia, etc.;
- stress or psycho-emotional stress;
- injuries;
- hormonal changes in the body - puberty, pregnancy or menopause.
When a doctor questions a patient, a so-called prodromal period or a period of precursors is often revealed, appearing several weeks before the onset of the disease. This period corresponds to:
- general weakness, prostration;
- periodic lack of appetite, weight loss;
- slight rises in temperature and sweating;
- slight joint pain and morning stiffness.
Pain in the joints occurs due to the concentration of inflammatory substances in the connective tissue.
The onset of development is usually subacute or latent, in which the symptoms are mild, and the disease progresses gradually - complaints of pain in the joints do not appear immediately. Gradually, the pain increases, forcing the person to consult a doctor. Sometimes the disease begins acutely, accompanied by severe joint pain, morning stiffness, and fever.
Above the affected joint you can find:
- swelling and redness;
- pain reaction when touched;
- increase in local temperature.
Stiffness also occurs in the joint. Later, mobility decreases, which ultimately leads to a complete lack of mobility with subsequent deformation of the joint. The most common targets for rheumatoid attack are the joints of the hands and feet, elbows, knees and shoulders. Less commonly involved in pathology are the hip, sacroiliac and ankle. The exception joints for rheumatoid arthritis are the distal interphalangeal joint (located just above the nail plate), the proximal interphalangeal joint of the little finger, and the metacarpophalangeal joint. thumb(located at its base).
Rheumatoid lesions of the hand joints
The goals of rheumatoid lesions are:
- metacarpophalangeal joints 2 to 5 are the joints near the base of the fingers;
- proximal interphalangeal joints from 1 to 4 fingers;
- all the wrist joints and the carpometacarpal joints are a series of small joints in the area of the palm itself.
As a rule, the small joints listed above are affected first. Soreness leads to the fact that the patient is unable to clench his hand into a fist, and his fingers become very swollen. After a few months, the intermetacarpal muscles begin to atrophy, which leads to retraction of the skin on the palm and back of the hand. Deformations and subluxations of the metacarpophalangeal joints occur, as a result of which the fingers bend with a deviation towards the little finger. The little finger itself bends less than the other fingers. Clinicians call this deformity “major's fin.” Then a curvature of the fingers occurs according to the “swan neck” principle - the proximal interphalangeal joints of the fingers are bent, and the distal joints are excessively extended.
Sometimes deformities occur with flexion of the metacarpophalangeal and extension of the lower interphalangeal joints (button loop). All of these changes greatly impair the functions of the hand.
Ultimately, pathological changes in the hand can lead to:
- to shortening of the fingers, fusion of the phalanges with each other and complete loss of mobility;
- tenosyviitis - inflammation of the finger flexor tendons, as well as their synovial canals.
The result of tenosyviitis is swelling of the finger and severe pain. When the branches of the median nerve that pass near the affected joints are compressed, loss of sensation from fingers 1 to 3 is possible. With prolonged compression, the pain can spread to the entire forearm to the elbow.
Damage to other joints of the upper limb
Later, the disease attacks the wrist, elbow and shoulder joints.
Deformation of the listed joints in rheumatoid arthritis manifests itself after the development of inflammation and is irreversible.
- Wrist rheumatoid arthritis leads to pain, swelling of the affected area, and limited flexion and abduction of the hand. Wrist arthritis is often complicated by synovitis and median nerve neuralgia.
- The elbow joint is formed by the articulations of three bones - the ulna and radius forearms, as well as humerus. Therefore, arthritis can involve all three joints that form the compound elbow joint. Local arthritis is accompanied by severe pain during flexion and extension; contracture may develop in an intermediate position. With severe inflammation, it is impossible to carry out rotational movements (supination and pronation).
- Arthritis of the shoulder joint is characterized by the spread of inflammation to the tendon bursae, collarbone, and muscle frame. Swelling, pain and limited movement gradually develop.
- Inflammation can spread to the axillary lymph nodes. Due to the fact that the shoulder joint has only one ligament and is strengthened due to muscle tone, myalgia, turning into atrophy, leads to habitual subluxation of the shoulder.
Damage to the joints of the foot
After the hand, the second target for rheumatoid arthritis is the foot. Most often, inflammation develops in the metatarsal-phalangeal joints of the 2-4 fingers and is accompanied by pain when walking, standing on tiptoes, and jumping. Visually, swelling of the dorsum of the foot, hammertoe deformity, subluxation of the listed joints, and hallux valgus are noted.
Later, arthritis is accompanied by inflammation of the synovial bursae and synovitis, leading to compression of the plantar nerves. Traumatic effects on the nerves lead to loss of sensation in the foot, pain that can rise up to the knee joint.
Other arthritis of the lower extremity
- Rheumatoid arthritis of the knee is characterized by pain and swelling in the knees. The pain intensifies with flexion movements, during squats, and when climbing stairs. Often when severe swelling There is a discharge of fluid when the anterolateral area of the knee is touched. Severe pain can lead to the development of contracture in the semiflexion position, as well as protrusion of the joint capsule in the posterior sections (Baker's cyst). Long-term arthralgia of the knee joint forms atrophy of the anterior group of thigh muscles.
Damage to the temporomandibular joint
The temporomandibular joint is a combined joint - its functionality is accompanied by synchronous movements in both capsules. Arthritis is always accompanied by only bilateral pain. Morning stiffness causes particular discomfort to the patient - difficulty opening the mouth and pain during chewing makes eating much more difficult. This leads to weight loss and nervousness. At severe course Neighboring anatomical structures may be involved in the inflammatory process:
- chewing and temporal muscles;
- adjacent cellular spaces;
- parotid salivary gland;
- branches of the trigeminal and facial nerves.
Damage to the joints of the spinal column
Vertebral joints are extremely rarely involved in the clinical picture of rheumatoid arthritis. Arthritis usually develops at the junction of the head with the first cervical vertebrae (atlanto-occipital joint), and at the junction of the first and second cervical vertebrae (median and lateral atlanto-axial joints). Clinically, inflammation manifests itself as pain in the upper neck, characterized by the inability to painlessly turn the head to the side.
Extra-articular manifestations of rheumatoid arthritis (complications)
These lesions occur during a long course of the disease, mainly in seropositive patients. Clinicians attribute these pathologies to complications of rheumatoid arthritis, since they develop with a systemic effect on the body.
IT IS IMPORTANT TO KNOW! The only way TREATMENT OF ARTHROSIS AND ARTHRITIS, recommended by doctors!* >>
Muscle damage
Myopathy in rheumatoid arthritis begins with damage to three muscle groups of the hand:
- eminence of the thumb;
- elevation of the little finger;
- intermediate muscles.
Later, the myopathy rises and affects the posterior group of muscles of the forearm. In the lower extremity, the disease attacks the anterior muscles of the thigh and gluteal region. Myopathy is characterized by pain during muscle contraction, which aggravates movement processes.
Skin changes
With a long course of rheumatoid arthritis, the skin dries out and becomes thinner, and numerous hemorrhages appear on the skin throughout the body. The nail plates become more brittle, with transverse striations. Small areas of soft tissue death are noted under or near the nails.
Rheumatoid nodules
These are small dense formations located under the skin. They are usually mobile and painless, loosely connected to the surrounding tissues. They are usually located on the dorsum of the elbow joint, the extensor side of the forearm and the back of the head. Sometimes found in the myocardium, heart valves, between the membranes of the brain or spinal cord, in lung tissue. They usually form during periods of exacerbation, and during remission they can disappear completely or significantly decrease. There is such a serious complication as rheumatoid nodulosis - the presence of nodules scattered throughout the body with multiple swelling of the joints, the presence of cysts and an elevated level of rheumatoid factor in the blood.
Lymph node involvement
This complication is detected during an exacerbation and is characterized by an increase in a number of lymph nodes, usually near the affected joints:
- with arthritis of the joints of the upper limb, there is an increase in the elbow, axillary and cervical nodes;
- temporomandibular arthritis is accompanied by enlargement of the submandibular and cervical lymph nodes;
- arthritis of the joints of the lower limb leads to temporary hypertrophy of the inguinal lymph nodes.
Lymphadenopathy is often accompanied by an enlarged spleen.
Damage to the stomach, intestines and liver
- Damage to the stomach is characterized by suppression of the synthesis of gastric juice, the formation of numerous erosions and ulcers. The result of such complications is dull nagging pain in the epigastrium, the formation of plaque on the mucous membrane of the tongue, and decreased appetite.
- Rheumatoid arthritis can be complicated by inflammation of the small and large intestines – enteritis and colitis. Damage to the intestines leads to acute and chronic pain, bloating, stool disorders, nausea and vomiting.
- Sometimes the liver becomes enlarged and its boundaries expand.
Pulmonary complications
Damage to the lungs in rheumatoid arthritis usually occurs in parallel with damage to their membrane, the pleura. Damage to the pleura is characterized by inflammatory changes - pleurisy.
Pleurisy can be dry or exudative. In the first case, friction of dry, inflamed pleura during breathing causes the patient severe discomfort. Exudative pleurisy is characterized by the effusion of liquid blood into the pleural cavity, followed by compression of the lung, which leads to shortness of breath and a feeling of heaviness on the affected side. Lung damage is manifested by the development of pneumonitis and fibrosing alveolitis. Characteristic feature complications of the lungs and pleura are the weak effectiveness of antibiotics and the rapid effect of the use of anti-inflammatory drugs.
Cardiac complications
Heart damage in rheumatoid arthritis manifests itself in the following diseases:
- Inflammation of the muscle membrane - myocarditis.
- Defeat outer shell in the form of pericarditis.
- Formation of acquired malformations of the heart due to damage to the inner lining of the heart - endocarditis.
- Damage to the pericardial vessels - the aorta (aortitis) and coronary arteries (coronary arteritis).
Inflammatory changes in the heart and blood vessels are manifested by complaints of shortness of breath and chest pain. A more accurate diagnosis is made by a cardiologist after undergoing an appropriate examination.
Kidney complications
Kidney damage in rheumatoid arthritis involves the glomerular apparatus in the inflammatory process, resulting in the development of rheumatoid glomerulonephritis and renal amyloidosis. As a result of renal complications, anemia may develop in rheumatoid arthritis, which forms when the disease becomes chronic.
Damage to the organ of vision
Eye damage in rheumatoid arthritis is very rare and is manifested by inflammation of the outer layer of the eyeball - the sclera. Inflammatory changes are characterized by severe pain, dilation of capillaries, and sometimes the formation of small rheumatoid nodules. With combined pathologies, the development of dry conjunctivitis is possible, in which the closure of the eyelid is accompanied by severe pain.
Complications from the nervous system
Damage to the nervous system is characterized by the following symptoms:
- Frequent headaches and dizziness indicate impaired blood supply to the brain and encephalopathy.
- A reaction to changes in temperature, increased sweating and changes in diuresis indicate damage to the autonomic nervous system.
- Weakness in the affected limbs and difficulty moving speak in favor of ischemic neuropathy.
- Stitching pain in the limbs and parasthesia occur when the corresponding nerves are pinched and with neuralgia.
Other complications
If rheumatoid arthritis develops over a long period of time, combined complications may occur, such as inflammation of the pleura and pericardium, multiple hemorrhages in the internal organs.
Establishing diagnosis
Articular lesions occur in later stages of the disease. Since the articular syndrome does not manifest itself at the onset of the disease, diagnosing rheumatoid arthritis in the early stages is very difficult.
IT IS IMPORTANT TO KNOW! The only way to get rid of JOINT PAIN, recommended by doctors!* >>
There are certain criteria for diagnosing rheumatoid arthritis:
- morning stiffness in joints for at least an hour;
- arthritis of three or more joints;
- damage to the joints of the hand;
- symmetrical involvement of joints in the clinical picture;
- presence of rheumatoid nodules;
- presence of rheumatoid factor;
- joint x-ray picture.
The diagnosis of rheumatoid arthritis is positive when four of the above symptoms are detected. It is important to note that the first four symptoms should persist for one to two months. Indisputable evidence of rheumatoid arthritis is synchronous small polyarthritis. To identify the criteria described above, as well as additional diagnostic parameters, laboratory and instrumental research methods are used.
Laboratory methods
- General blood test - with high activity of the process, anemia may develop (a drop in hemoglobin, leukocytes). An increase in ESR in rheumatoid arthritis is an indirect sign of the development of the disease.
- A biochemical blood test is informative for determining the degree of inflammation activity and identifying complications. First of all, attention is paid to an increase in C-reactive protein, fibrinogen, seromucoid, sialic acids, haptoglobin, globulins and a decrease in albumin levels.
- Immunological blood test is one of the informative methods. Rheumatoid arthritis is supported by the presence of rheumatoid factor and cryoglobulins. Antikeratin antibodies, LE cells, and circulating immune complexes are often found in the blood.
Instrumental research methods
Instrumental diagnosis involves the use of methods that allow visual identification of arthritis. The most common methods include: X-ray examination, magnetic resonance imaging, examination of synovial fluid followed by biopsy.
X-ray examination
This type of study is the most informative because it allows us to identify inflammation and deformation in the joints. The main radiographic signs of rheumatoid arthritis:
- diffuse or focal osteoporosis;
- reduction of joint space;
- the appearance of erosions on the articular surfaces.
X-ray stages of rheumatoid arthritis are determined by the doctor depending on the listed criteria.
Magnetic resonance imaging (MRI)
MRI for rheumatoid arthritis is an alternative to x-ray examination. MRI is based on the use of magnetic waves. If at x-ray examination While bone structures are displayed in detail, MRI provides excellent visualization of soft tissues.
Synovial fluid examination and biopsy
Synovial fluid - produced by cells of the joint capsule to reduce friction during movement. Thanks to synovial fluid, the coefficient of friction in joints is 0.01. Articular fluid reflects all pathological changes in the joint, so taking it for analysis significantly complements the diagnostic criteria. A biopsy of the joint capsule with the presence of fibrin and inflammatory elements will leave the diagnosis of rheumatoid arthritis beyond any doubt.
Main characteristics of synovial fluid
Differential diagnosis
Differential diagnosis is a thorough analysis of examination results in order to filter out inappropriate diagnoses with similar symptoms. Differential diagnosis of rheumatoid arthritis is carried out with reactive arthritis and osteoarthritis.
- Reactive arthritis– this is damage to the joints after suffering diseases of infectious etiology.
- Osteoarthritis– a set of diseases of various etiologies with damage to the joints with subsequent deformation.
The main differences between these three types diseases are given in the table below.
Differential differences between rheumatoid arthritis, reactive arthritis and osteoarthritis:
| Age | any | 20-40 years | over 40 years old |
| Pain symptom | strong | strong | average |
| Morning stiffness | strong | average | can not be |
| Symmetry of the lesion | present | absent | absent |
| Arthritis | permanent | during periods of exacerbation | weak or absent |
| Joint damage | minor polyarthritis | large on the lower limb | any |
| Course of the disease | progresses | amenable to therapy | progresses slowly |
| Muscle atrophy | present | absent | absent |
| Link to infection | absent | present | absent |
| ESR | greatly increased | increased | does not change |
| Rheumatoid factor | positive | negative | negative |
| Antigen HLA B27 | negative | positive | negative |
Treatment
Treatment of rheumatoid arthritis is a complex process that requires a responsible approach from both the attending physician and the patient. According to modern research, it is impossible to cure the disease; therapy is aimed only at alleviating symptoms and slowing down the progression of joint damage. Treatment includes drug therapy and physical therapy. Prevention of the disease includes physical therapy and spa treatment. As a supplement, treatment with folk remedies is possible, but only under the supervision of the attending physician.
Drug therapy
Drug therapy includes symptomatic treatment - necessary to relieve pain and basic therapy - the purpose of which is to maintain the integrity of the musculoskeletal system and prevent complications.
Relieving pain and inflammation in joints
The drugs of choice are non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal painkillers - glucocorticoids. Symptomatic therapy significantly alleviates the patient’s suffering, but does not cure the underlying disease; when it is discontinued, the symptoms gradually recur.
NSAIDs for rheumatoid arthritis are prescribed in the following sequence:
- selective NSAIDs– have a minimum of side effects and last a long time. These drugs can be taken for a long time - from several months to several years. The most popular drugs from this group are: Meloxicam, Movalis, Celebrex, Nimesil, Nise, Nimid, Revmoxib.
- non-selective NSAIDs– are appointed when the selective group is ineffective. These drugs have a quick effect, but have significant side effects - especially from the gastrointestinal tract. As their effectiveness and toxic effects increase, they are divided into the first and second stages. The first step drugs are Diclofenac, Ibuprofen, Ketoprofen. The second stage is represented by Indomethacin, Ketorolac and Piroxicam. Symptomatic therapy
Attention! If there is no positive effect for a maximum of a week, you must contact your doctor to change the drug.
Glucocorticoids for rheumatoid arthritis they have a strong analgesic effect. They are hormonal drugs, so their overdose can cause the following side effects:
IT IS IMPORTANT TO KNOW! The only way TREATMENT OF ARTHROSIS AND ARTHRITIS, recommended by doctors!* >>
- hormonal imbalances;
- hyperfunction of the adrenal cortex;
- pancreatitis, diabetes mellitus;
- decreased immunity, frequent ARVI;
- thrombosis and bleeding;
- the appearance of edema;
- gastrointestinal disorders;
- other disorders: itching of the mucous membranes of the respiratory tract, diseases of the sensory organs.
The drugs of choice are: medrol, diprospan, prednisolone, methylprednisolone, triamcinolol, dexamethasone, betamethasone.
Basic therapy
Basic therapy for rheumatoid arthritis includes groups of long-acting drugs that significantly slow down destructive changes in connective tissue.
Cytostatics– these drugs are used primarily in oncology, but are the best means of basic therapy for rheumatoid arthritis. The mechanism of their action is aimed at inhibiting the growth of pannus and slowing down destruction in the joints.
The most popular cytostatics:
- Methotrexate;
- Arawa;
- Remicade.
Biological drugs– their effect is aimed at binding tumor necrosis factor, which plays a key role in the pathogenesis of rheumatoid arthritis. An important point is that these drugs are prescribed separately from each other due to the high likelihood of severe side effects.
Drugs of choice include:
- Anakinra;
- Actemra;
- Rituximab;
- Etanercept;
- Humira;
- Orence.
Chondroprotectors- prescribed for the purpose of restoring cartilage tissue and increasing its resistance to autoimmune attacks of rheumatoid arthritis.
These include:
- Teraflex;
- Artra;
- Alflutop;
- Hyaluron.
Other basic therapy drugs are various groups of drugs that are aimed at strengthening the immune system:
- Sulfasalazine;
- Bicilin-3;
- Penicillamine;
- Cycloferon;
- Delagil.
Physiotherapy
Physiotherapy is a set of methods based on the therapeutic effects of natural and artificially created factors on the human body. The most popular physical therapy methods for rheumatoid arthritis are massage, electrophoresis, acupuncture and cryotherapy.
Massage
Massage for rheumatoid arthritis is used only during periods of remission, during which pain significantly decreases, swelling subsides, and the general health patient. The massage is performed by a specialist on the affected joints and surrounding soft tissues.
Beneficial properties of massage:
- improves blood circulation and tissue trophism;
- promotes the absorption of exudate into the circulatory system and reduces swelling;
- prevents local atrophic changes in muscles;
- prevents the deposition of calcium salts in joints;
- normalizes movements in the joint, reduces stiffness in the morning;
- prevents joint deformation.
Electrophoresis
This is a technique based on the use of drugs and the combined effects of galvanization. Electrophoresis for rheumatoid arthritis has a strong analgesic effect, as it is used in combination with glucocorticoids. The advantage of the method compared to conventional medication is that side effects are minimized and effectiveness is significantly prolonged.
Acupuncture and cryotherapy
Acupuncture is a physiotherapeutic procedure based on the reflex action of needles on certain areas located nearby major nerves. Cryotherapy is based on the effect of cold air on the affected area, about -180 degrees Celsius. Acupuncture and cryotherapy for rheumatoid arthritis are considered distracting procedures and are used as an addition to the main methods to relieve pain symptoms.
Traditional medicine and rheumatoid arthritis
Salt baths, tinctures and decoctions based on leaves and medicinal herbs are used as traditional methods of treatment. For salt baths for rheumatoid arthritis, sea or table salt, magnesium sulfate, and potassium bromide are used. Taking salt baths helps normalize blood circulation, improves local metabolism, and reduces swelling of surrounding tissues.
Also often used for treatment:
- Bay leaf for rheumatoid arthritis – 1 teaspoon of leaf powder is brewed with boiling water and boiled for 10 minutes. Take 3 times a day, a third of a glass before meals.
- Mumiyo for rheumatoid arthritis is used together with honey - stir 50 g of mumiyo and 100 g of honey and take 1 teaspoon 30 minutes before breakfast.
- Gelatin, ginger and tomatoes also have beneficial properties for rheumatoid arthritis. The presence of these products in the diet has a general strengthening effect on the body and on cartilage tissue in particular.
Prevention
Prevention of rheumatoid arthritis is divided into primary and secondary. Primary prevention involves preventing the onset of disease in healthy person, and the secondary one is aimed at preventing the development of relapses and complications in people suffering from rheumatoid arthritis.
Primary prevention includes:
- diagnosis and treatment of infectious diseases;
- identification chronic infection in organism;
- strengthening the immune system and maintaining a healthy lifestyle.
Secondary prevention implies:
- strict adherence to doctor’s recommendations for taking medications, attending physiotherapeutic procedures and following a diet;
- spa treatment during periods of remission;
- constant exercise therapy.
Video materials
What is rheumatoid arthritis? It is a disease that causes inflammation and pain in the joints, leading to disruption of their normal mobility. As the disease develops, the synovial membrane that lines the joint capsule is destroyed, then the process moves to the intra-articular tissues, resulting in ankylosis (complete immobility of the joint). On initial stages pathology, the symptoms of rheumatoid arthritis may resemble polyarthritis, but in its etiology the disease differs from other diseases of the skeletal system that have similar symptoms. The fact that this is an independent disease is confirmed by the presence of a separate code for rheumatoid arthritis according to ICD 10. Rheumatoid arthritis of the joints affects both children and adults, but is four times more common in women than in men. There were no significant differences in the symptoms and course of the disease by gender - in both cases the disease develops in the same way, and the same can be said about the methods of treatment.
What does rheumatoid arthritis look like?
Causes and signs of rheumatoid arthritis
Rheumatoid arthritis is a chronic articular pathology that causes erosive and destructive processes in the connective and intra-articular tissues of the bone apparatus, which is irreversible. According to ICD 10 (the tenth version of the International Classification of Diseases), the following types of pathology are distinguished:
- M05 is a seropositive form in which rheumatoid factor is present in the patient’s blood. The development of the disease occurs gradually;
- M06 is a seronegative type, occurring in approximately 20% of cases, when the presence of rheumatoid factor is not observed, and the disease develops quite quickly;
- M08 – so-called juvenile or juvenile rheumatoid arthritis.
Rheumatoid arthritis of the joints is diagnosed in approximately two percent of the population of European countries, including Russia. Most often, the disease affects the small joints of the fingers and toes, and the large ones - the wrist, elbow, shoulder, ankle and knee. Defeat hip joints and spine in rheumatoid arthritis occurs much less frequently - this usually characterizes last stage diseases.
The main cause of rheumatoid arthritis is a malfunction of the immune system. The body fights its own cells as if they were foreign. Therefore, chronic rheumatoid arthritis belongs to a group of autoimmune diseases in which the immune system destroys tissue instead of protecting it. In this case, joints are no exception.
The impetus for the development of rheumatoid arthritis can be:
- Allergic reaction;
- Past infectious disease - rubella, herpes, various types of hepatitis and other pathologies;
- Surgical intervention.
Also risk factors are heavy physical work and severe hypothermia. The immune system is forced to sharply intensify its activity, and as a result of hard work, the immune system ceases to distinguish its own from someone else’s.
Causes of rheumatoid arthritis
The immune status decreases and begins to fail in old age, which is caused by natural reasons. This can also be one of the causes of rheumatoid arthritis. Therefore, rheumatoid arthritis in adults, or rather, elderly people, appears much more often than in children and youth. It is important to distinguish rheumatoid arthritis from other joint diseases as early as possible, since the main danger of rheumatoid arthritis in the absence of timely treatment is the development severe complications and damage to internal organs (heart and kidneys). Experts include the first symptoms of rheumatoid arthritis, which allow one to suspect the development of this particular pathology:
- The development of the pathological process usually begins with small joints on the toes. The pain intensifies when pressing on the fingertips. Subsequently, inflammation spreads to large joints. One of the characteristic signs of pathology is the symmetry of the lesion, i.e. paired joints hurt at the same time: both knees or both ankles;
- In the morning hours, there is severe stiffness in movements: before getting out of bed, it takes considerable time to develop the joints;
- Patient complaints about pain symptoms, the severity of which depends on the stage of rheumatoid arthritis and the individual characteristics of the patient’s body - the threshold of sensitivity to pain is different for all people. The nature of the pain is aching, attacks are of moderate strength, but of significant duration, and exhaust the patient with their constancy. The pain reaches its peak at night and morning time. In the afternoon it may subside until it disappears completely, but returns in the evening;
- An itchy rash appears on the surface of the skin in the area of diseased joints, rolling nodules form under the skin - round painless compactions from 2-3 mm to 2-3 cm in diameter, which can disappear and reappear;
- Periodically, a feverish state and a relatively slight increase in body temperature occurs, not due to any external reasons;
Symptoms of rheumatoid arthritis
All these symptoms can be attributed to systemic manifestations of rheumatoid arthritis. Also, the early stage of rheumatoid arthritis is characterized by signs of general intoxication of the body: weight loss, weakness, lethargy, sweating, muscle pain, which is why patients often confuse the disease with pathologies of an infectious nature.
Having discovered one or more signs of rheumatoid arthritis, a person needs to consult a specialist as soon as possible and undergo a detailed examination. The sooner a patient begins systematic treatment of rheumatoid arthritis of the joints, the higher his chances of achieving, if not recovery (as already mentioned, degenerative processes are irreversible), then long-term stable remission, allowing him to avoid the development of complications and lead a normal lifestyle.
Diagnosis and classification
A complete diagnosis of rheumatoid arthritis is possible only with the use of the complex diagnostic techniques. An external examination and questioning of the patient, studying the medical history (previous diseases) of the patient himself and his immediate family helps the doctor make a primary diagnosis of rheumatoid arthritis, since the disease is often hereditary, affecting members of the same family.
To clarify the diagnosis, the following studies are carried out:
- General and biochemical blood tests;
- X-ray.
Blood tests for rheumatoid arthritis show a decrease in hemoglobin levels, a decrease in the number of red blood cells and platelets, and an increase in the erythrocyte sedimentation rate (ESR). The concentration of so-called C-reactive protein and gammaglobulin in the blood increases. All these signs indicate the presence of an inflammatory process in the body.
Methods for diagnosing rheumatoid arthritis
The fact that it was caused by rheumatoid arthritis of the joints is clearly confirmed by the presence of rheumatoid factor in the blood, which is a special substance that promotes the destruction of joint tissue. It is produced by the body in response to a request from the immune system, which mistakenly perceives joint cells as foreign. The degree of concentration of this substance indicates the stage of development of the disease: the deeper the pathological processes, the higher the level of this indicator.
But with a seronegative type of rheumatoid arthritis, rheumatoid factor may be absent in the blood. Therefore, the decisive word in establishing a diagnosis belongs to fluoroscopy, which gives the doctor the opportunity to obtain a visual representation of the processes occurring in the affected joints. The classification of rheumatoid arthritis by stage is also based on X-ray data.
The first stage of rheumatoid arthritis can be diagnosed by:
- Bone thinning;
- Thickening and compaction of soft tissues;
- Signs of periarticular osteoporosis;
- Cysts that appear on the image as clearing of bone tissue.
A characteristic feature of the first stage is the degree of activity of rheumatoid arthritis. The disease can progress slowly, starting in adolescence or even childhood (so-called juvenile rheumatoid arthritis), but develop to its full extent only in adulthood. But another option is also possible, in which the disease takes off rapidly immediately after its occurrence.
In the second stage, bone erosion begins to develop. At first it is localized near the cartilaginous layer, gradually capturing deeper layers. Deformation of the cartilage itself is not visible at this stage, but changes in soft tissues and the initial stage of atrophy of the muscles attached to the affected parts of the bone apparatus are observed, which can be attributed to extra-articular manifestations of rheumatoid arthritis. Swelling appears in the area of the synovial bursa, the joints swell, and patients complain of pain and aches.
The progression of bone erosion signals the approach of the third stage, at which the deformation of the joint becomes clearly visible on the image, the synovial tissues become denser, which leads to limited mobility. Muscle atrophy progresses. Accelerated calcification begins - the deposition of salts on the surface of the joint. Calcifications have different densities in different areas of the bone.
The fourth, or advanced stage of rheumatoid arthritis is characterized by severe osteoporosis. Articular syndrome in rheumatoid arthritis in the fourth stage leads to narrowing/fusion of interarticular spaces, bone deformation, multiple erosions and cysts. In this form, the curvature of the bones is clearly visible not only on an x-ray, but also on a regular photo of rheumatoid arthritis.
Attention!
Spontaneous remission of rheumatoid arthritis without the use of medications is possible. But the vast majority of patients do not have to seriously count on self-healing - the disease requires persistent systematic treatment.
Therapeutic techniques for rheumatoid arthritis
When starting treatment for rheumatoid arthritis of the joints, modern medicine For this purpose, it involves the use of drugs from the so-called basic group, which act on the main causes of the disease.
Traditional therapy
Basic therapy includes drugs of five groups:
- Gold salts;
- Immunosuppressants;
- Antimalarial;
- Sulfonamides;
- D-penicillamine.
Traditional therapy for rheumatoid arthritis
Aurotherapy (gold therapy) is most effective for acute rheumatoid arthritis. If used at an early stage, they can significantly slow down the development of the disease, therefore they are often used in the treatment of children and adolescents. Gold salts also have a positive effect on related ailments: they suppress the development of fungal microflora and Helicobacter - the culprits in the development of gastritis and stomach ulcers. They can be used in the treatment of patients with cancer.
A complication of aurotherapy is golden dermatitis - skin rashes in the form of spots and blisters, the appearance of which is accompanied by severe itching. In most cases, they disappear quickly after stopping the drug, but sometimes they do not go away for months. Therefore, when taking gold preparations, you need to carefully monitor the condition of the body.
Immunosuppressants, or cytostatics, reduce the level of immune response, helping to reduce its destructive power in the fight against one’s own body. Many patients are afraid of the word “immunosuppressant”, fearing to be left without any immune defense, as happens in oncology. But the doses of drugs for rheumatoid arthritis are incomparable with those used in anticancer therapy, and therefore cannot lead to a similar effect.
Antimalarials were actively used in the treatment of rheumatoid arthritis in the middle of the last century, when most modern medicine was not available pharmacological drugs against this disease. Now they are used much less frequently, and only for indolent forms, when there is no need for intensive care.
Sulfonamides do not act as quickly as immunosuppressants, which occupy first place in the “hit parade” of antirheumatoid drugs. They are favored by good tolerability, minimal side effects and low price.
D-penicillamine causes unwanted side effects in half of cases of seropositive rheumatoid arthritis and up to one third of cases of seronegative rheumatoid arthritis. But if the doctor has no choice. he uses this drug as a last resort for rheumatoid arthritis when nothing else has worked.
Folk remedies
Many patients, along with pharmacological treatments, use folk remedies to treat rheumatoid arthritis. Herbal healers recommend the following recipes:
Wraps for sore joints fresh leaves burdock, coltsfoot or cabbage alleviate joint pain and reduce inflammation;
Liquid ointment, which can be prepared from raw yolk, has the same properties. chicken egg(preferably homemade), adding to it a teaspoon of turpentine and apple cider vinegar and mixing thoroughly. Lubricate your joints with it better evening before going to bed;
Another recipe for a healing balm includes two glasses of freshly squeezed black radish juice, half a glass of vodka and half a glass of honey (add the ingredients one at a time, mixing thoroughly). Add a tablespoon of table salt to the resulting mixture and stir until completely dissolved. The product must be stored in the refrigerator, poured in small portions as needed and heated in a water bath. After rubbing the balm into the joints, they must be covered warmly.
Folk remedies are used as a complement to traditional drug therapy, but do not replace it. They can be applied to the surface of the skin only if there are no microtraumas on it - abrasions, abrasions, scratches.
Traditional methods treatment of rheumatoid arthritis
Experts divide prevention of rheumatoid arthritis into:
- Primary – helping to prevent the development of the disease;
- Secondary – helping to avoid its exacerbations.
Primary prevention involves minimizing the threat of infectious colds, timely sanitation of foci of chronic inflammation and infection (caries, sinusitis, etc.), strengthening the immune system, hardening, healthy image life, good nutrition. rejection of bad habits. To prevent exacerbations, you should also avoid infectious diseases, limit physical activity, avoid hypothermia, follow a diet, reducing the consumption of foods such as pasta and white bread, sweets, coffee.
It is important to carefully follow the instructions of doctors regarding sleep, work and rest, and also not to violate the schedule of taking the medications they prescribe. Under such conditions, the chances of long-term remission, allowing the patient to maintain working capacity and normal lifestyle, are quite high.
Rheumatoid arthritis primarily affects small joints. Typically, the disease begins with inflammation of the metacarpophalangeal joints (located at the base of the finger) of the index and middle fingers and inflammation of the wrist joints. Moreover, this inflammation is symmetrical, that is, it develops on both hands at once. Joints swell and hurt. Moreover, the pain intensifies at night, in the morning, and until about noon the person suffers from unbearable pain. Patients themselves often compare this pain to toothache. However, by warming up or simply after any vigorous activity, the pain usually decreases. This is the difference between rheumatoid arthritis and arthrosis, in which pain intensifies due to physical activity. In the middle of the day the pain subsides and by evening it is almost unnoticeable.
Almost simultaneously with the damage to the joints of the hands, the joints of the feet also become inflamed. The joints at the base of the fingers are predominantly affected.
Pain and swelling may last for several months.
After some time, from several weeks to several months, larger joints become inflamed - ankle, knee, elbow, shoulder. However, in older people aged 65-70 years, the disease can begin with damage to large joints and only then inflammation of small ones occurs.
Another characteristic symptom of rheumatoid arthritis is morning stiffness. It can manifest itself as a feeling of a stiff body, and a feeling of tight gloves on your hands. Some patients feel as if their body is in a corset in the morning. In mild forms of the disease, this stiffness lasts about two hours after waking up; in severe forms, the stiffness can last throughout the first half of the day.
Joint deformity, which develops in the later stages of the disease, greatly affects the quality of life. It happens that the hands are fixed in an unnatural position and deviate outward. This is an ulnar deformity and develops 1-5 years after the onset of the disease. And it happens that the mobility of the wrist joints decreases. In this case, patients have to make great efforts to straighten or bend the hand at the wrist. Later, the mobility of other compounds also decreases.
Knee joints can not only become deformed. Quite often, fluid accumulates in the joint cavity. This is called a Baker's cyst. This cyst stretches the joint capsule, and in severe cases even ruptures it. Then the liquid pours into the soft tissues of the lower leg. In this case, swelling of the lower leg develops, and sharp pain appears in the leg.
It happens that not only the joints are affected, but also the spine. Moreover, the cervical spine is predominantly affected. In this case, patients complain of neck pain.
In severe cases, the cricoid-arytenoid joint may be affected. Then the sufferer’s voice becomes rougher, shortness of breath and dysphagia appear. When this joint is damaged, the patient increasingly develops bronchitis.
With rheumatoid arthritis, patients complain of constant weakness, loss of appetite, weight loss up to cachexia (extreme exhaustion), and poor sleep. The temperature rises to low-grade levels, this condition is accompanied by chills. However, in some cases the temperature may rise to 39°C. Rheumatoid nodules often form on the skin - dense, rounded formations the size of a pea. Most often they are located below the elbows, on the hands, and on the feet. There are usually not many nodules. They may disappear and reappear, or they may remain in place for many years. There is no harm to health from them, however, they spoil the patient’s appearance. However, in some cases, rheumatoid nodules may be localized in the lungs (Kaplan syndrome).
Rheumatoid nodules are an extra-articular manifestation of rheumatism, it can occur not only on the skin. The cardiovascular system may be affected, in which case vasculitis, pericarditis, and early atherosclerosis develop. The kidneys may be affected, in which case amyloidosis and, rarely, nephritis develop. There may be unpleasant complications from the blood - anemia, thrombocytosis, neutropenia. When the eyes are affected, keratoconjunctivitis, episcleritis or scleritis develops. The muscles and nervous system may also be affected.
Description
Rheumatoid arthritis is a rather serious disease, which in a few years turns an able-bodied person into a helpless disabled person. This disease continues for many years. Some suffer from it all their lives.
It is known that rheumatoid arthritis is an autoimmune disease. For some reason, a large number of immune complexes are formed in the body, which circulate in the blood and enter the joints, causing inflammation, which later leads to destruction. In addition, these immune complexes can attack other organs and tissues, leading to extra-articular manifestations of rheumatoid arthritis. Rheumatoid nodules are formed by an accumulation of immune cells, lymphocytes, around a small area of dead tissue, but it is not known what attracted these cells there, and what came first - tissue necrosis or accumulation of immune cells. And what contributes to the activation of lymphocytes is unknown. There are hypotheses that viruses, bacteria, allergies, injuries, heredity and many other factors are to blame for the development of this disease. The onset of the disease after severe stress is also possible.
There are many forms of rheumatoid arthritis:
- acute polyarthritis , in which the joints of the hands and feet are predominantly affected, rheumatoid factor (autoantibodies to class G immunoglobulins) is often detected in the blood;
- acute monoarthritis , in which large joints are affected;
- symmetrical polyarthritis , which is characterized by a gradual increase in pain and stiffness in the small joints of the arms and legs;
- monoarthritis of the knee or shoulder joints , in which the knee or elbow joints are first affected, and then the small joints of the feet or hands are affected quite quickly;
- polyarthritis - a disease that mainly affects young people, which, in addition to joint pain, is characterized by fever, enlargement of the liver and spleen;
- palindromic rheumatism - multiple recurrent attacks of acute symmetrical polyarthritis of the hands, lasting several hours or days and ending with complete recovery;
- generalized myalgia begins with stiffness, depression, carpal tunnel syndrome, muscle pain, and joint damage comes later.
There are also special clinical forms of rheumatoid arthritis:
- Adult Still's disease, which is characterized by recurrent fever, arthritis, and skin rash;
- Felty's syndrome, which is characterized by an enlarged liver and spleen, joint damage, hyperpigmentation of the skin of the legs, lung lesions, Sjögren's syndrome and frequent infectious complications.
With rheumatoid arthritis, osteoporosis develops. And depending on the condition of the bones, there are 4 stages of this disease:
- Stage I, initial, which is characterized only by periarticular osteoporosis;
- Stage II, in which the joint space narrows, but osteoporosis affects the bones only around the joint;
- Stage III, which is characterized by all the signs of the second stage and bone erosion;
- Stage IV combines signs of the third and ankylosis (complete immobility of the joint, resulting from any changes in it) of the bones.
You can find out what stage of the disease a patient has using an x-ray examination.
Rheumatism usually occurs in waves, with exacerbations and remissions. In less than 10% of cases with this disease there is spontaneous long-term remission . In 15% of cases there is intermittent flow , in which spontaneous or treatment-induced remissions alternate with exacerbations, during which previously unaffected joints are seized. In approximately 60% of cases, the course of the disease progressive . At the same time, new joints are constantly involved in the pathological process, and extra-articular manifestations are also characteristic of this course. In the remaining cases, the course of the disease rapidly progressive . This course is characterized by rapid development of the disease with severe extra-articular manifestations.
Diagnostics
The diagnosis is made by a rheumatologist. However, you may need to consult a neurologist and ophthalmologist. Typically, a physician will refer a patient to a rheumatologist if the characteristic symptoms last more than 6 weeks, more than three joints are inflamed, or morning stiffness lasts more than 30 minutes.
To make a correct diagnosis, it is necessary to do a general and biochemical blood test, and conduct a study of rheumatoid factors in the blood. The following studies are also prescribed:
- radiography of the hand, foot, lungs;
- densitometry of the spine and femur.
Treatment
To treat rheumatoid arthritis, drugs that suppress the immune system are used. If the drug does not have an effect within three months, it is changed. This is basic therapy. Hormonal drugs are also used to relieve inflammation in the form of ointments, creams and tablets. Non-steroidal anti-inflammatory drugs can also be used to relieve inflammation.
Prevention of osteoporosis is also of great importance. For this purpose, special medications and a diet high in calcium are used.
The immune system can also be stimulated by physical methods:
- plasmaphoresis, in which plasma with a large amount of rheumatoid factors is removed and donor plasma is administered to the patient;
- lymphocytophoresis, in which lymphocytes and monocytes are removed from the blood using a centrifuge, which reduces blood reactivity and the degree of inflammation;
- irradiation of lymphoid tissue, in which the lymph nodes, spleen, and thymus are sequentially irradiated;
- drainage of the thoracic lymphatic duct, in which the lymph is centrifuged, the cellular sediment is separated, and the liquid part of the lymph is returned back to the lymphatic duct.
Physiotherapy is widely used to treat rheumatoid arthritis. At an early stage, laser therapy is indicated; however, a course of more than 15 procedures is not recommended. Ultraviolet irradiation and electrophoresis with dimethyl sulfoxide are also indicated in the early stages. Cryotherapy is often used to reduce pain.
At later stages, phonophoresis with hydrocortisone, pulsed currents and magnetic therapy are used.
Physical therapy is indicated to restore joint function.
Prevention
Prevention of rheumatoid arthritis is divided into primary and secondary. Primary prevention is measures aimed at preventing disease. It consists of timely treatment of infectious diseases, as well as sanitation of foci of infection, for example, carious teeth. It is important to strengthen the body, toughen up, play sports and lead an active lifestyle, and, if necessary, take vitamins.
Secondary prevention involves preventing exacerbations and complications in those suffering from rheumatoid arthritis. It includes physical therapy and timely administration of necessary medications. It is also important to follow a diet. It is necessary to limit the consumption of fats, sugar, salt, eat more vegetables and fruits, dairy products, and cereals.
Today, rheumatoid arthritis is considered an autoimmune disease that primarily affects the small joints of the hands. Over time, this pathology leads to deformation of bone tissue and dysfunction of the hand.
According to statistics, the pathology occurs in 0.8% of the population, and it is diagnosed much more often in women. There has also been an increase in the number of cases in age category after 50 years.
What are the causes of this disease?
The exact causes of rheumatoid arthritis have not yet been established. A role in the development of the pathology of certain infections is assumed: mycoplasma, Epstein-Barr virus, cytomegalovirus, rubella virus. Infection causes chronic damage to synovium joint Subsequently, this leads to the formation of new antigens on it inner surface, so-called autoimmune inflammation develops.
The next stage in the development of the disease is direct damage to the joints themselves with characteristic signs
What is the clinical picture of rheumatoid arthritis?
The onset of the disease, as a rule, does not have specific symptoms. For several months the patient may experience general weakness, increased fatigue, low-grade fever, pain in small and large joints. Very rarely, in 10% of cases, there is a rapid onset of the disease with high fever and enlarged lymph nodes.
The next stage in the development of the disease is direct damage to the joints themselves with characteristic signs:
1. Pain that gets worse with movement
2. Swelling and tenderness of the tissues around the joint
3. Stiffness in the joints, especially in the morning, for at least an hour
4. Local boost temperature, especially for large joints
What joints are affected by rheumatoid arthritis?
Mainly, localization is noted on the hands. Moreover, the lesion is always selective; the proximal interphalangeal and metacarpophalangeal joints are much more often involved. But the inflammatory process in the distal interphalangeal joints is observed much less frequently.
In addition, other joints may be affected in parallel. upper limbs: wrist, elbow. On the lower extremities these are most often the knee, ankle, and metatarsal joints.
The next stage in the development of rheumatoid arthritis is the appearance of deformities in the affected areas of the limbs. On the hands, they deviate to the radial side, and the fingers to the ulnar side, the so-called Z-shaped deformity. Characterized by limited mobility of the thumb, which prevents the patient from grasping small objects.
Many patients also experience extra-articular manifestations of the disease. These include: damage to the heart, lungs, pleura, development of muscle atrophy, rheumatoid nodules. Rheumatoid nodules are small, painless lumps located around the affected joint and do not cause concern to the main patient.
Methods for diagnosing the disease
Today, the diagnostic method is an initial examination of the patient and identification of characteristic clinical signs of the disease. The following additional studies have found application:
1. X-ray of joints
2. MRI of the hands
3. Detection of increased titers of rheumatoid factor during biochemical studies
4. Antibodies to cyclic citrullinated peptide, it is the most specific indicator of rheumatoid arthritis.
Treatment of rheumatoid arthritis
The first group of drugs used to treat rheumatoid arthritis are nonsteroidal anti-inflammatory drugs (NSAIDs). They quickly eliminate inflammation in the joints, relieve pain, but, unfortunately, do not stop progressive diseases.
The second group is glucocorticoid hormones. They are used in small doses, fractionally. A positive aspect of their use is that they slow down the progression of the disease, in particular the formation of bone destruction. There are also methods for their intra-articular administration.
Drugs that affect the immune stages of inflammation in the joints are also used. These include immunosuppressants, cytostatics, gold preparations, sulfasalazine and others. They need to be taken for a long time, many of them have a number of serious side effects.
Treatment of rheumatoid arthritis is aimed at minimizing symptoms: reducing inflammation and pain, restoring joint function, and preventing destruction and deformation. When choosing how to treat a disease, a rheumatologist focuses on the degree of activity of the process, the location of the affected areas, the general state of health and the age of the patient. Treatment of rheumatic disease should prevent complications from the heart, eyes, blood vessels, and skin, so it is important to consult a doctor in time.
Of the recently proposed treatment methods, extracorporeal hemocorrection techniques are used. These are technologies for cryomodification of autoplasma and incubation of cell mass with immunomodulators. Their essence is to take blood from the patient and extract autoimmune complexes from it. The treated blood plasma is then returned to the patient.
In each specific case of rheumatoid arthritis, a whole complex of therapeutic measures. It depends on the severity of the disease, stage of development, and the presence of concomitant lesions of internal organs. Only a specialist rheumatologist will be able to correctly prescribe a treatment regimen that will reduce the manifestations of the disease and its progression.
Loading...