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Rheumatology is a branch practical medicine, in which specialists study and treat rheumatological diseases. Their specific share in the total morbidity is gradually increasing, which requires the development effective ways diagnosis and treatment. This is also necessary to prevent early disability of patients and to improve the quality of life of the sick.

General characteristics of rheumatology

Rheumatology studies degenerative, inflammatory and dystrophic joint diseases. They are also complemented by systemic vasculitis, the so-called collagenoses. The objectives are to optimize their diagnosis and carefully study predisposing factors. In case of successful implementation of the main rheumatological tasks, the possibility of stopping the pathology in the early stages of detection is practically guaranteed.

And yet, what diseases does a rheumatologist treat? A doctor with this specialization treats diseases of the joints and blood vessels of the body and heart diseases of rheumatological etiology. Patients who are prone to these types of diseases can be isolated from the population in advance. Effective prevention will ensure that the disease does not develop. However, this is still only a promising task that requires study.

Classification of rheumatological diseases

Rheumatic diseases are systemic or local lesions of connective tissue associated with degeneration, inflammation or dystrophy. A rheumatologist who treats these pathologies must have a competent understanding of the types and characteristics of lesions in a particular pathology. Therefore, all diseases must be classified.

In accordance with the characteristics of the lesion, systemic diseases, diseases of the joints of the axial skeleton, pathologies of the joints of the accessory skeleton, heart lesions, systemic vasculitis, and autoimmune skin lesions are distinguished. Systemic diseases tend to affect all connective tissue, while local diseases are limited to certain localizations.

List of rheumatological diseases

When wondering what a rheumatologist treats in adults, many people assume there are only a few clinical diagnoses. In reality, the whole complexity of rheumatology is that there are quite a lot of diagnoses. At the same time, symptomatically and clinically various diseases may proceed similarly. Often the treatments also have similarities. IN general view Rheumatological diseases are represented by the following list:

• acute rheumatic fever;
• Bekhterev's disease;
• rheumatoid arthritis;
• gouty arthritis;
• scleroderma;
• juvenile (youthful) arthritis;
• osteoporosis;
• osteoarthritis;
• systemic lupus erythematosus;
• bursitis;
• rheumatic acquired heart defects;
• diseases combined into the group of vasculitis.

These diseases that a rheumatologist treats in adults have many similarities. The most obvious is connective tissue damage. At the same time, in the group of vasculitis there are even more diseases that are difficult to diagnose and treat. Moreover, the complexity of rheumatology is that these diseases are similar to many others that are treated by other specialists. Therefore, this industry is distinguished by the need to identify clear criteria for differential diagnosis.

Diseases from the vasculitis group

Vasculitis is one of those pathologies that is treated by a rheumatologist. The disease is very diverse. Vasculitis is different clinical manifestations, location of the lesion, features of the course, specific immunological or histochemical markers. It is very important that many of them can be treated quite successfully with correct, timely diagnosis. The group of vasculitis is represented by the following diseases:

• Takayasu arteritis;
• temporal arteritis;
• periarteritis nodosa;
• Kawasaki disease;
• Wegener's disease;
• Churg-Strauss vasculitis;
• microscopic polyangiitis;
• Henoch-Schönlein hemorrhagic vasculitis;
• cryoglobulinemic vasculitis;
• anti-GMB disease;
• urticarial vasculitis (hypocomplementary);
• Behçet's disease;
• primary angiitis of the central nervous system;
• Cogan's syndrome;
• cutaneous arteritis;
• isolated aortitis;
• leukocytclastic cutaneous angiitis;
• sarcoidosis vasculitis;
• lupus vasculitis;
• rheumatoid vasculitis.

In addition to the above primary vasculitis, there are also specific secondary ones. In particular: cryoglobulinemic vasculitis associated with hepatitis C, vasculitis with hepatitis B, with syphilis, drug-induced immunocomplex and paraneoplastic vasculitis. These diseases occur only in the presence of primary pathology. For example, paraneoplastic syndrome develops in response to growth malignant tumor and represents a systemic reaction of the body to a neoplasm.

Rheumatological heart diseases

A cardiologist-rheumatologist who treats heart diseases of a rheumatic nature, deals with acquired cardiac pathologies. Among them, the most common is valve stenosis or valve insufficiency (isolated and combined) due to damage by streptococci. These diseases are due to a fairly developed medical service and thanks to extensive antibiotic therapy, they develop less frequently than before. However, they are still severe and lead to disabling valve damage.

Diagnosis of diseases such as acute rheumatic fever and chronic rheumatic heart disease, as well as their treatment and rehabilitation of patients are the responsibility of a rheumatologist-cardiologist. At the same time, often in multidisciplinary medical centers there are no such specialists. Therefore, these diseases are dealt with by a rheumatologist, who also deals with other rheumatic diseases, including diffuse and systemic lesions of connective tissue and vascular pathologies.

Rheumatic joint lesions

Joints and bones are derivatives of connective tissue. Therefore, their defeat is also examined by a rheumatologist. What does this specialist treat? He is engaged in the diagnosis and treatment of primary and secondary osteoarthritis, osteoporosis, arthritis and other joint lesions, excluding traumatic ones. There is another specialty in the same industry - orthopedist. He works to restore skeletal functions lost due to the disease.

Rheumatologists most often deal with osteoarthritis. These diseases develop in old age, and in old age they greatly reduce a person’s motor activity. Rheumatoid arthritis is much less common. This disease most often manifests in at a young age and continues to get worse in old age. Often, rheumatoid arthritis has some systemic manifestations that can significantly worsen the prognosis for the patient.

Also, a rheumatologist who treats the above diseases is engaged in the diagnosis, treatment and rehabilitation of patients with ankylosing spondylitis, psoriatic and gouty arthritis, juvenile joint damage, with reactive arthritis. The importance of treating these pathologies is very high, because without suppression of pathological processes, ankylosis soon develops. The result of this is a complete cessation of joint mobility.

Pediatric rheumatology

Among all the rheumatology specialties, there is one more - pediatric rheumatologist. What this specialist treats should be understood in more detail. So, a pediatric rheumatologist is engaged in identifying and diagnosing rheumatic diseases that are specific only to children, or those that develop in childhood. There are very few of them, and they are often discussed in the general course of rheumatology.

It is noteworthy that childhood rheumatic diseases are chronic pathologies requiring lifelong therapy. They proceed aggressively and reach the highest stage of activity quite quickly. Among them, the most common pathologies are the following: reactive arthropathy, juvenile rheumatoid arthritis, ankylosing spondylitis, polyarthritis nodosa, dermatopolymyositis, scleroderma.

According to statistics from the Ministry of Health of the Russian Federation, the number of cases rheumatic diseases, first identified in children, is steadily increasing. It's probably just that health care has become more accessible, and diagnostics more specific. Therefore, cases that were previously ignored are now being successfully treated, even if they require lifelong therapy. Diseases treated by a rheumatologist and orthopedist should be studied in more detail, which will make it possible to develop measures effective prevention and treatment.

Systemic collagenoses

Systemic collagenoses are another group of diseases that rheumatologists deal with. These pathologies, unlike articular lesions, develop quickly, but do not lead to disability so quickly. However, the polymorphism of their manifestations forces them to be studied even more actively, since during their development they affect many organs. Vessels, skin, all connective tissue, heart valves and myocardium, kidneys and joints are somehow affected by systemic vasculitis.

Dangerous collagenoses

The most studied, but no less dangerous collagenoses are: systemic lupus erythematosus and scleroderma. A rheumatologist who treats these diseases must be well versed in diagnostic criteria. It is also important to determine clinical course diseases, which will allow prescribing adequate therapy. The goal of treatment is to prevent complications of the disease and eliminate the current severity of the condition.

Despite the presence of modern cytostatics, glucocorticoids and non-steroidal anti-inflammatory drugs, these diseases are difficult to treat. Dermatomyositis is also a problem. These diseases, which are treated by a rheumatologist in children and adults, are accompanied by a host of systemic reactions. Therefore, therapy must be started as quickly as possible.

Vasculitis in rheumatology

Any rheumatologist who treats vasculitis perfectly understands the main features of their course. However, every specialist is convinced that much is still unknown to medicine about these pathologies. In particular, the causes of diseases remain poorly understood. Only general patterns were found. Sometimes they are not enough to differentiate one vasculitis from another. Moreover, a number of diseases in this category develop together with other diseases. Therefore, this branch of medicine is really important. We hope that after reading the article it will become clear to the reader who a rheumatologist is, who he is and what he treats.

RHEUMATIC DISEASES

Rheumatic diseases(systemic connective tissue diseases) are a group of diseases characterized by damage to the connective tissue due to a violation of the body's immune homeostasis (connective tissue diseases with immune disorders). This group of diseases was first identified by P. Klemperer in 1941 based on the study of rheumatism and systemic lupus erythematosus and called collagen diseases, since the main changes were represented by fibrinoid changes in collagen fibers; in subsequent studies it was shown that in this group of diseases all connective tissue with paraplastic substance and cellular elements, vessels and nerve fibers. Since 1964, as a result of the study of this group of diseases, immunomorphology methods have become widely used. It has been found that these diseases are characterized by immune inflammation, developing in connection with the

improved homeostasis. Great credit in the development of this problem belongs to academicians A.I. Nesterov, E.M. Tareev A.I. Strukov, who were awarded the Lenin Prize. ■ Currently, the group of rheumatic diseases includes rheumatism, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, systemic scleroderma, periarteritis nodosa, and dematomyositis.

The International Classification of Rheumatic Diseases, without proper justification, significantly expands this group of diseases, in the Literature in Lately The term “diffuse connective tissue diseases (DCTD)” is quite often used, which includes systemic lupus erythematosus, systemic scleroderma, and dermatomyositis.

Rheumatic diseases have a number of common symptoms:

- the presence of chronic focal infection; - pronounced disturbances of immunological homeostasis; - generalized vasculitis; - chronic undulating course; - systemic progressive disorganization of the connective tissue

The presence of chronic focal infection. Group A B-hemolytic streptococcus is known to cause rheumatism. Diplostreptococcus and mycoplasma are considered as the cause rheumatoid arthritis. Measles, rubella, mumps, reoviruses, parainfluenza, Epstein-Barr HRS viruses can cause various rheumatic diseases: systemic lupus erythematosus, systemic

dark scleroderma, rheumatoid arthritis, dermatomyositis

Bekhterev's disease. Great role in studying the significance of viruses

for rheumatic diseases belongs to Acad. RAMN V. A. Na

For diseases to occur, conditions for infection to be resolved are necessary. Such conditions are: hereditary

predisposition (presence, for example, of certain histocompatibility antigens), hereditary weakness of lysosomal membranes (infection, ultraviolet irradiation provoking

cause the occurrence of systemic lupus erythematosus, rheumatoid arthritis), hereditary abnormality of collagen in connective tissue fibers (occurs in rheumatoid arthritis),

similarity of microorganism antigens with human tissue antigens

century B-hemolytic streptococcus group A has cross_

but reacting antigens with cardiac myocyte antigens are one

from the mechanisms of rheumatism, theory of A. Kaplan, 1951). Severe disturbance of immunological homeostasis. These

disorders are represented by hypersensitivity reactions. In all rheumatic diseases, reactions are pronounced

immediate hypersensitivity. It is characteristic that heterologous antigens (B-hemolytic streptococcus, viruses) form a toxic immune complex with antibodies, which is determined in rheumatism and systemic lupus erythematosus. Autologous antigens form the same immune complexes with autoantibodies, damaging various tissues and vascular walls in rheumatoid arthritis, systemic lupus erythematosus, systemic scleroderma, dermatomyositis, ankylosing spondylitis, and possibly periarteritis nodosa. It follows from this that the processes of autoimmunization in rheumatic diseases are the leading link in pathogenesis.

A delayed-type hypersensitivity reaction is often represented by cellular cytolysis, which can be focal (formation of granulomas) or diffuse. This type of hypersensitivity reaction is especially characteristic of systemic scleroderma, rheumatoid arthritis, dermatomyositis, and is possible with rheumatism, systemic lupus erythematosus.

Generalized vasculitis. An immediate hypersensitivity reaction occurs in the microvasculature (capillary, venule, arteriole). As a result, destruction (fibrinoid necrosis), plasmorrhagia, thrombosis, proliferation of the endothelium and perithelium occur. Morphologically, destructive-proliferative thrombovasculitis is identified, which can be endo-, meso-, peri- and panvasculitis. A delayed-type hypersensitivity reaction is represented in this case by a proliferative component. Generalized vasculitis is characteristic of all rheumatic diseases. Destructive vasculitis is more common in systemic lupus erythematosus, rheumatism, exacerbation of rheumatoid arthritis; proliferative ones are more typical for systemic scleroderma, ankylosing spondylitis, dermatomyositis. The consequence of generalized vasculitis is plasmorrhagia, the release of immune complexes into the tissue, the appearance of macrophage-type cells and T-lymphocytes in it.

Systemic progressive disorganization of connective tissue. It consists of 4 phases: - mucoid swelling;

Fibrinoid changes (manifestation of an immediate hypersensitivity reaction);

Inflammatory cellular reactions (expression of immediate and delayed hypersensitivity reactions); - sclerosis.

The listed changes are characteristic of all rheumatic diseases. The depth of disorganization of connective tissue and the predominant nature of damage to one or another organ determine the characteristics of the clinical manifestations and morphology of rheumatic diseases (another group sign of rheumatic diseases).

Chronic and undulating course(alternating exacerbations and remissions). Very typical for rheumatic diseases.

Visceral lesions. These lesions determine the “face” of a particular rheumatic disease. Thus, with rheumatism, it is mainly the heart that suffers; for rheumatoid arthritis - joints; with systemic scleroderma - various areas of localization of the skin, kidneys; with ankylosing spondylitis - spinal joints; with systemic lupus erythematosus - kidneys, heart and other organs; with dermatomyositis - muscles, skin; with periarteritis nodosa - blood vessels, kidneys. However, multi-organ damage is characteristic of all rheumatic diseases.

Scheme39. Pathogenesis of rheumatic diseases

Pathogenesis of rheumatic diseases. Caused by emerging immunopathological reactions in organs and tissues (Scheme 39). The focus of chronic infection causes tension and distortion of the body's immune response, resulting in autoimmunization, the formation of toxic immune complexes and immunocompetent cells, damaging the microcirculatory bed of certain organs or tissues. As a result, systemic progressive disorganization of connective tissue develops, which is the main morphological manifestation of rheumatic diseases.

RHEUMATISM

Rheumatism (Sokolsky-Buyo disease) is an infectious-allergic disease with predominant damage to the heart and blood vessels, an undulating course, periods of exacerbation and subsidence.

Ethnology. The causative agent is (i-hemolytic streptococcus of group A, which causes sensitization of the body (repeated tonsillitis). Genetic factors and age are of great importance in the occurrence of the disease.

Pathogenesis. With rheumatism, a complex immunological response occurs to the presence of the pathogen in the sensitized organism. It should be noted that streptococcus has cross-reacting antigens with cardiac myocyte antigens, therefore the antibodies produced in the body are directed not only against streptococcal antigens, but also against cardiac myocytes. The process of autoimmunization occurs. Some streptococcal enzymes destroy the connective tissue surrounding myocytes, resulting in the formation of antibodies directed against the connective tissue of the heart. Immune complexes and effector cells that appear in the blood damage the microcirculatory bed, enter the surrounding connective tissue, subjecting it to fibrinoid changes, up to necrosis . As a result of tissue necrosis, tissue thrombokinase is released, which triggers the blood coagulation system, and fibroblast proliferation factor is activated through platelets. On the other hand, necrosis causes the development of a macrophage cellular reaction (the nature of the reaction is determined by the characteristics of the antigen). Macrophages, in addition to carrying out phagocytosis, produce a number of membrane-attack factors: interleukin-1, which activates T-lymphocytes and promotes the chemotaxis of neutrophil leukocytes; platelet proliferation factor, which determines an increase in the number of platelets at the site of injury and enhances blood clotting processes; fact-

fibroblast proliferation tor, which promotes the proliferation and maturation of fibroblasts. As a result of necrosis, tumor necrosis factor (TNF) is formed, which deepens the processes of tissue necrosis, damages the capillary endothelium and thus promotes the formation of microthrombi in the affected area, causes the proliferation of B-lymphocytes responsible for the formation of circulating antibodies. Proliferation of fibroblasts ultimately leads to sclerosis at the site of injury. All the described changes are realized morphologically in the form of a combination of immediate or delayed hypersensitivity reactions. In rheumatism, systemic disorganization of connective tissue (valve, stroma, parietal endocardium and epicardium) consists of 4 phases:

Mucoid swelling (reversible process);

Fibrinoid changes (irreversible process);

Cellular inflammatory response; - sclerosis.

Mucoid swelling and fibrinoid changes up to necrosis are an expression of the HNT reaction. The cellular inflammatory response reflects delayed-type hypersensitivity. As a result of the cellular reaction, a granuloma is formed, in the center of which fibrinoid necrosis is located, around which macrophage-type cells with large hyperchromic nuclei are located in a fan-shape. A granuloma consisting of such large macrophages is called blooming. Subsequently, the cells begin to stretch, and a large number of fibroblasts are formed. This type of granuloma is called fading granuloma. Ultimately, fibroblasts replace macrophages and form a large number of collagen fibers. This granuloma is called cicatricial granuloma. All described changes in granuloma are accompanied by the presence of lymphocytes and plasma cells in the surrounding tissue.

The morphogenesis of rheumatic granuloma was described in detail by L. Ashoff (1904) and later by V.T. Talalaev (1921), therefore this granuloma is also called Ashoff-Talalaev granuloma.

Granuloma is located in the connective tissue of the valves, parietal endocardium, myocardium, epicardium, and vascular adventitia.

In rheumatism, a nonspecific cellular reaction is also observed, which is focal or diffuse in nature. This reaction is represented by lymphohistiocytic infiltrates in the stroma of various organs. In addition, with rheumatism, common vasculitis occurs, which are considered as nonspecific reaction. Vasculitis occurs in various organs and tissues.

Clinical and morphological forms. Depending on the predominant damage to a particular organ, 4 forms of rheumatism are distinguished: cardiovascular, polyarthritic, nodose and cerebral.

Cardiovascular form. This form is the most common and occurs in both adults and children. The main manifestations of the disease concern the heart and blood vessels. Inflammatory and dystrophic changes develop in the connective tissue of all layers of the heart.

Endocarditis is the main manifestation of this form of rheumatism. According to localization, valvular, chordal, and parietal endocarditis are distinguished. The most pronounced changes usually develop in the leaflets of the left atrioventricular (mitral) and aortic valves. Damage to the leaflets of the right atrioventricular (tricuspid) valve is rare and is combined with damage to the mitral or aortic valves.

There are 4 types of rheumatic valvular endocarditis: diffuse (or valvulitis), acute verrucous, fibroplastic, recurrent warty.

Diffuse endocarditis(V.T. Talalaev’s valvulitis) is characterized by mucoid swelling, edema of the connective tissue base of the valve, and congestion of the capillaries. The endothelium is not affected, there are no thrombotic lesions. With treatment, the process is reversible, the structure of the valves is completely restored.

Acute warty endocarditis accompanied not only by mucoid swelling, but also by fibrinoid necrosis of connective tissue and valve endothelium. The edges of the valves are especially affected. As a result of the destruction of the endothelium, conditions are created for the formation of blood clots, which are located along the edge of the valve and are represented mainly by fibrin (white blood clot). Thrombotic deposits on valves are called warts.

Fibroplastic endocarditis develops as a consequence of the two previous forms of endocarditis and is characterized by the predominance of the processes of sclerosis and scarring.

Recurrent verrucous endocarditis manifested by processes of disorganization of connective tissue in sclerotic valves. An obligatory component of this endocarditis is necrosis of the endothelium and the formation of warts (thrombotic deposits of various sizes) on the valves.

As a result of endocarditis, sclerosis, hyalinosis of the valves develop, and heart disease is formed.

Heart disease in rheumatism is represented by either stenosis or valve insufficiency. Most common

a combination of these types of defects. The most often affected are the mitral (75%) and aortic (up to 25%) valves. A combination of mitral and aortic heart defects is often observed. As a result of dystrophic changes, necrosis and sclerosis, the valves thicken, become deformed, grow together, and lime is deposited in them. Sclerosis and petrification of the annulus fibrosus are always observed. The valve chords are thickened, shortened and sclerotic. The valve leaflets are pulled up to the papillary muscles. The opening of the valves is usually sharply narrowed, looking like a fish mouth (funnel-type heart defect). If valve insufficiency predominates, a “diaphragm” type defect occurs, which is always accompanied by pronounced working hypertrophy of the left ventricle of the heart. The prolonged existence of a heart defect in a patient ultimately leads to the development of acute or chronic cardiovascular failure, which causes the death of patients.

Myocarditis is one of the common manifestations of rheumatism. There are 3 forms of myocarditis: nodular (granulomatous), diffuse interstitial (interstitial) exudative, focal interstitial (interstitial) exudative.

Nodular myocarditis characterized by the formation of granulomas in the perivascular connective tissue of various parts of the heart. Granulomas are in different phases of development: “blooming”, “fading”, “scarring”. In myocytes, protein or fatty degeneration is noted to varying degrees of severity. Nodular myocarditis ends with diffuse small focal cardiosclerosis.

Diffuse interstitial exudative myocarditis described by M.A. Skvortsov. It occurs predominantly in children and is characterized by diffuse infiltration of the stroma with lymphocytes, histiocytes, neutrophilic and eosinophilic leukocytes. The vessels are full of blood, stromal edema is pronounced. The myocardium loses its tone, becomes flabby, the cavities of the heart expand, therefore the clinical manifestation of this myocarditis is always severe cardiovascular failure. As a result, diffuse cardiosclerosis develops in the myocardium.

Focal interstitial exudative myocarditis has the same morphological manifestations as diffuse, only the process is focal in nature. Clinically, it usually occurs latently. The result is focal cardiosclerosis.

Pericarditis in rheumatism can be serous, fibrinous and serous-fibrinous. It should be noted that rheumatism is characterized by polyserositis. Pericarditis ends with the formation of adhesions in the pericardial cavity. Sometimes complete obliteration of the pericardial cavity and even calcification of fibrinous deposits (armored heart) are possible.

When there is a combination of damage to all layers of the heart during rheumatism, they speak of pancarditis; if the endocardium and pericardium are affected, then they speak of oreumatic carditis.

Rheumatic vasculitis, especially of the microvasculature, is very typical. Fibrinoid necrosis, thrombosis, and proliferation of endothelial and adventitial cells develop in arteries and arterioles. The permeability of the vessel walls is increased. Diapedetic hemorrhages and sometimes larger hemorrhages are possible. As a result of rheumatic vasculitis, arteriosclerosis occurs.

Gender and the arthritic form of rheumatism. Occurs in 10-15% of patients. Mainly small and large joints are affected. Serofibrinous inflammation develops in the joint cavity. The synovial membrane is full-blooded, vasculitis, proliferation of synoviocytes are pronounced, the connective tissue undergoes mucoid swelling, and exudate (usually serous) forms in the joint cavity. Articular cartilage is not involved in the process, so joint deformation is usually not observed with rheumatism. Changes in other organs and tissues are usually mild, although there is some degree of damage to the heart and blood vessels.

Nodose (nodular) form of rheumatism. Occurs in children. It is characterized by the phenomena of disorganization of connective tissue in the periarticular area and along the tendons. In the affected areas, large foci of fibrinoid necrosis are found, surrounded by a cellular reaction (lymphocytes, macrophages, histiocytes). The so-called erythema nodosum develops. If the flow is favorable, small scars will form at the site of these nodes. In other organs in such patients, characteristic changes are also found, but there are no clear clinical symptoms.

Cerebral form of rheumatism. Caused by the development of rheumatic vasculitis. Occurs in children and is called minor chorea. In addition to rheumatic vasculitis, especially at the level of microcirculation, dystrophic and necrobiotic changes in brain tissue and minor hemorrhages are found. Damage to other organs and tissues is poorly represented, although it is always detected during a targeted examination.

It should be noted that with all forms of rheumatism there is an interest immune system, in which hyperplasia of lymphoid tissue and plasma cell transformation are detected.

Complications rheumatism is most often associated with the development of thromboembolic syndrome caused by warty endocarditis. With heart disease, cardiovascular

flock failure, which is associated with myocardial decompensation. Sometimes various complications can be caused by adhesions in the cavities of the pericardium, pleura, and abdominal cavity.

SYSTEMIC LUPUS ERYTHEMATOSUS

Systemic lupus erythematosus (Libman-Sachs disease) - systemic disease with severe autoimmunization, having acute or chronic course and characterized by predominant damage to the skin, blood vessels and kidneys.

Systemic lupus erythematosus (SLE) occurs in 1 in 2,500 healthy people. Young women (90%) aged 20-30 years are affected, but the disease also occurs in children and elderly women.

Etiology. The cause of SLE is unknown. At the same time, a lot of data has accumulated that indicate a deep breakdown of the immunocompetent system under the influence of a viral infection (presence of virus-like inclusions in the endothelium, lymphocytes and platelets; persistence of a viral infection in the body, determined using antiviral antibodies; frequent presence of measles and parainfluenza viruses in the body , rubella, etc. A contributing factor in the development of SLE is a hereditary factor. It is known that in patients with SLE the antigens HLA-DR2, HLA-DR3 are most often detected, the disease develops in identical twins, patients and their relatives have reduced function of the immunocompetent system. Nonspecific provoking factors the development of SLE are a number of medications (hydrazine, D-penicillamine), vaccination for various infections, ultraviolet irradiation, pregnancy, etc.

Pathogenesis. It has been proven that in patients with SLE there is a sharp decrease in the function of the immunocompetent system, leading to a distortion of its function and the formation of multiple organ autoantibodies. The main issue concerns the processes of regulation of immunological tolerance due to a decrease in T-cell control - Autoantibodies and effector cells are formed to the components of the cell nucleus (DNA, RNA, histones, various nucleoproteins, etc., there are more than 30 components in total). Toxic immune complexes and effector cells circulating in the blood affect the microcirculatory bed, in which predominantly immediate hypersensitivity reactions occur, and multiple organ damage to the body occurs.

Pathological anatomy. The morphological nature of changes in SLE is very diverse. Fibrinoid changes predominate in the walls of microvasculature vessels

nuclear pathology, manifested by vacuolization of nuclei, karyo-rhexis, formation of so-called hematoxylin bodies; characterized by interstitial inflammation, vasculitis (microcirculatory bed), polyserositis. A typical phenomenon for SLE is lupus cells (phagocytosis of the cell nucleus by neutrophilic leukocytes and macrophages) and antinuclear, or lupus, factor (antinuclear antibodies). All these changes are combined in various relationships in each specific observation, determining the characteristic clinical and morphological picture of the disease.

The skin, kidneys and blood vessels are most severely affected in SLE.

A red “butterfly” is noted on the skin of the face, which is morphologically represented by proliferative-destructive vasculitis in the dermis, swelling of the papillary layer, and focal perivascular lymphohistiocytic infiltration. Immunohistochemically, deposits of immune complexes are detected in the walls of blood vessels and on the basement membrane of the epithelium. All these changes are regarded as subacute dermatitis.

Lupus glomerulonephritis occurs in the kidneys. Characteristic signs of SLE in this case are “wire loops”, foci of fibrinoid necrosis, hematoxylin bodies, hyaline thrombi. Morphologically, the following types of glomerulonephritis are distinguished: mesangial (mesangioproliferative, mesangiocapillary), focal proliferative, diffuse proliferative, membranous nephropathy. As a result of glomerulonephritis, shrinkage of the kidneys may occur. Currently, kidney damage is the leading cause of death in patients with SLE.

Vessels of different sizes undergo significant changes, especially the vessels of the microvasculature - arteriolitis, capillaritis, and venulitis occur. In large vessels, due to changes in vasa vasorum, elastofibrosis and elastolysis develop. Vasculitis causes secondary changes in organs in the form of degeneration of parenchymal elements and foci of necrosis.

In the heart of some patients with SLE, abacterial warty endocarditis is observed (Liebman-Sachs endocarditis), a characteristic feature of which is the presence of hematoxylin bodies in the foci of necrosis.

In the immunocompetent system (bone marrow, lymph nodes, spleen) phenomena of plasmatization and hyperplasia of lymphoid tissue are detected; the spleen is characterized by the development of periarterial “onion-shaped” sclerosis.

Complications in SLE are caused mainly by lupus nephritis - the development of renal failure. Sometimes in connection with

zi s intensive treatment corticosteroids and cytostatic drugs can cause purulent and septic processes, “steroid” tuberculosis.

RHEUMATOID ARTHRITIS

Rheumatoid arthritis(infectious polyarthritis) is a chronic disease, the basis of which is the progressive disorganization of the connective tissue of the membranes and cartilage of the joints, leading to their deformation.

Mostly women (70%) and children (5-7%) suffer from rheumatoid arthritis; this disease is rare in men.

Etiology and pathogenesis. The cause of rheumatoid arthritis (RA) is unknown. It is assumed that the source of the disease is B-hemolytic streptococcus, diplostreptococcus, mycoplasma, Epstein-Barr virus. Persistent infection leads to damage to the synovial membrane, exposure of collagen fiber antigens, on which humoral and cellular reactions develop. The condition that determines the implementation of infection is the presence of antigens HLA-B27, B8, HLA-DR4,3. It is known that in carriers of these histocompatibility genes the risk of the disease increases tenfold.

The humoral immune reaction is represented by the formation of autoantibodies belonging to the IgM class, possibly IgG, IgA, IgD, directed towards one’s own IgG. These autoantibodies are called rheumatoid factor. It is produced in synoviocytes, cells of joint infiltrates, and is found in synovial fluid and blood in the form of a circulating immune complex. The attachment of complement components C3 or C5 to such an immune complex determines its damaging effect on the synovium and the microvasculature, as well as the chemotaxis of neutrophil leukocytes. These same complexes interact with macrophages and monocytes, activating their synthesis of interleukin-1, prostaglandin E, fibroblast and platelet proliferation factor, which promote the formation of collagenase by synoviocytes, the processes of necrosis and sclerosis. The immune complex, circulating in the blood and fixating in the microvasculature, causes generalized vasculitis in organs and tissues.

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Arthritis due to brucellosisArthrogryposis

Rheumatoid diseases

Rheumatoid arthritis

Synonym: Felty syndrome.

The disease usually occurs in adolescence. In most patients, the development of polyarthritis was preceded by tonsillitis, odontogenic infection and others. chronic infections(otitis, sinusitis). This gave grounds to classify the disease as a manifestation of chroniosepsis. Currently, Felty's syndrome is considered as a peculiar manifestation of collagenosis. The disease is rare.

Symptoms. These patients have a moderate enlargement of the lymph nodes. The course is usually chronic and progressive. The initial stage is characterized mainly by damage to the joints. From the blood side there is moderate leukemia and neutropenia. Anemia and thrombopenia are absent. In the 2nd stage, spleno-articular syndrome with symptoms of leukopenia are clearly expressed. In the 3rd stage general state is sharply disrupted. There is severe weakness, lethargy, adynamia, and cachexia develops. The skin is dry, with yellowish-brown pigmentation on exposed parts of the body. There is severe deformation of the joints with subluxations of the phalanges of the fingers and toes. Osteoporosis and muscle atrophy develop. The movement of patients is extremely difficult. Hematological data are characterized by severe hypochromic anemia, moderate thrombopenia, severe leukopenia with neutropenia, reaching the degree of agranulocytosis, relative lympho- and monocytosis. During this period, there are frequent exacerbations of polyarthritis with high fever, sometimes chills and sweat.

Sokolsky's disease - Bouillaud

Synonyms: acute articular rheumatism, rheumatic disease, rheumatic polyarthritis, Buyo's disease.

Symptoms . Acute illness infectious etiology, characterized by predominant damage to the cardiovascular system (endocarditis, myocarditis). Less commonly (45% of patients) in clinical picture changes in the joints predominate, which are manifested by high temperature, severe pain, swelling, hyperemia skin in the joint area, the presence of serous effusion. Due to severe pain patients place their limbs in a flexed position; flexion contractures often develop, but the affected joints do not ankylose. After the attack is eliminated, the function of the joint is usually restored. More often than others, the knee, ankle, wrist and elbow joints are affected. The disease is paroxysmal in nature, with one or another joints being involved in the process (“flying rheumatism”),

X-ray When examining the affected joints, osteoporosis of the epiphyses is revealed, which is of a neuro-reflex nature and depends on the intensity and duration pathological process.

Treatment rheumatoid arthritis and Sokolsky's disease conservative (medication, physiotherapy). IN severe cases- stabilizing (arthrodesis) or mobilizing (arthroplasty, osteotomy) operations.

Forecast favorable in the treatment of early forms of articular rheumatism.

Still's disease

Synonyms: rheumatoid arthritis in children, atrophic arthritis, chronic rheumatoid arthritis. The etiology is not specified. There is a theory about the infectious origin of the disease and about a genetically determined predisposition. The disease occurs in the first years of life.

Symptoms. The disease is characterized by para-articular changes in tissues with subsequent destruction of the articular surfaces, swelling, limited mobility, and subsequent ankylosis of the joints, enlargement of the lymph nodes, especially in armpits and in the area of ​​the elbow joints. Secondary anemia and light brown skin pigmentation often accompany this pathology.

X-ray Deformation of the joints, “blurred” contours, and sometimes bone growths are revealed.

Treatment V initial stages conservative, recently preference is given to early synovectomies; in later stages, stabilizing operations and arthroplasty.

Forecast not always favorable.

Humeroscapular periarthritis

Inflammatory process in the soft tissues surrounding the shoulder joint. The disease is based on trauma or rheumatic infection, colds. In the pathogenesis of periarticular changes, the neurotrophic component plays an important role.

Symptoms: pain in shoulder joint, muscle atrophy, sometimes sensory disturbances; the disease is chronic.

X-ray At the onset of the disease, no changes in the joint are detected. Over time, osteoporosis appears, sometimes areas of calcification. The size of the shadow can be from a pea to a large bean. Its contours are clear. Foci of calcification may be multiple. In elderly patients, arthrosis changes in the shoulder joint are often detected.

Treatment: in the acute period, rest (immobilization of the limb), novocaine blockades, radiotherapy; in case of chronicity - thermal procedures, including mud therapy, UHF therapy, exercise therapy, massage; at chronic forms - surgery; removal of lime deposits.

Forecast favorable.

Epicondylitis and styloiditis

Diseases similar to those described above with the same ethnological component (trauma, hypothermia).

Symptoms: pain in the area of ​​the internal or lateral condyle of the humerus (epicondylitis) or in the area of ​​the styloid process radius(styloiditis), swelling, limitation of function.

X-ray, except for osteoporosis, no changes are detected during a long course; There are also no areas of calcification.

Treatment conservative, as with periarthritis of other localizations.

Forecast favorable.

Heel bone spurs

The disease is a hook-shaped or spine-shaped growth on the heel bone at the site of attachment of the long plantar ligament, less often at the site of attachment of the Achilles tendon. Sometimes the presence of a “spur” is asymptomatic. In 20% of patients, the spurs are bilateral.

Some consider it as an option for the formation of the skeleton, others - as a pathological “growth” due to chronic injury, flat feet, rheumatism and other inflammatory processes.

Symptoms: burning pain, like a feeling of a nail in the heel. The pain intensifies when standing. Pain occurs due to the appearance of periostitis and inflammation of the underlying mucous membrane. Often, a heel spur is combined with hyperkeratosis of the plantar surface of the foot.

X-ray The “spur” (exostosis) contains all the elements of the calcaneus with the medulla and cortical layer.

Treatment conservative (thermal procedures, rest, novocaine injections), for persistent pain and ineffectiveness of conservative treatment is indicated surgical removal"spurs".

Ankylosing spondylitis

Synonyms: Bekhterev's disease.

Ankylosing spondylitis affects 0.08-2.6% of the population (V.M. Chepoy, 1976), mainly young people (15-30 years old). Among disabled people with joint diseases, 16% are patients with ankylosing spondylitis. The basis of the disease is primary chronic damage to the synovial membrane of the intervertebral, costovertebral and sacroiliac joints. Fibrinoid deposits appear, sometimes necrosis of articular cartilage and rejection of necrotic particles into the lumen of the joint. The discs develop degenerative changes, synchondrosis, ossification of the articular capsule and ankylosis of the joints occur. The ligaments become sclerotic and ossify.

Hereditary factors play a large role in the occurrence of this pathology.

Symptoms. Gradually increasing restriction of movements in the spinal column with their complete loss, forced posture, kyphosis, flattened lordosis. The process involves joints, where mobility is also lost. General weakness, weight loss, irritability, drowsiness are signs of this pathology. The disease progresses slowly, progresses over years, pain appears in the bones, especially during physical activity, the pain is radiating, especially at night. The temperature is low-grade, ESR is increased. The gait is stiff. Patients become unable to work. Breathing excursion chest almost completely stops. Severe atrophy of the back muscles appears. Along with damage to the spine and joints with ankylosing spondylitis, the pathological process may involve; nervous and muscular system, lungs, gastrointestinal tract, organs of vision, etc.

X-ray Typical changes are found: ankylosis of intervertebral joints, ossification of discs, calcification of ligaments; the spinal column resembles a bamboo cane; sometimes destruction of the vertebral bodies is visible.

Joint damage is characterized by narrowing of the joint spaces, subchondral changes, and ankylosis, mainly bilateral.

Treatment presents great difficulties for patients; usually limited to conservative therapy, including drug treatment, exercise therapy, physiotherapy.

Forecast adverse.

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Arthritis due to brucellosisArthrogryposis

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.

Statistics

Prevalence of rheumatoid arthritis among the adult population of different climatic and geographical 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%, and among people aged 55 years and older – 1.4%. A high incidence of 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. Like 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:

1. Genetic predisposition– close relatives of patients with rheumatoid arthritis develop this disease much more often.
2. Infections – arthritis often occurs after a history of herpetic infection, hepatitis B, mumps.
3. Adverse factors of the external and internal environment– hypothermia, exposure to toxic products, including occupational hazards, stress, as well as pregnancy, breastfeeding, .

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 to blood vessels, which explains the so-called extra-articular symptoms of rheumatoid arthritis.

Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis (Still's disease) is inflammatory disease 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 environmental factors 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:

1. Pain in the joints, their nature (aching, gnawing), intensity (strong, moderate, weak), duration (periodic, constant), connection with movement;
2. Morning stiffness in the joints, its duration;
3. Appearance of joints (swelling, redness, deformation);
4. Persistent limitation of joint mobility.

A patient with rheumatoid arthritis may also have other symptoms:

1. Hyperemia of the skin over the inflamed joints;
2. Atrophy of adjacent muscles;
3. 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:

1. 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);
2. Moderate (pain – 4-6 points, stiffness in joints up to 12 hours after sleep, ESR – 30-45 mm/hour, CRP – 3 plus);
3. High (pain – 6-10 points, stiffness observed throughout the day, ESR – more than 45 mm/hour, CRP – 4 pluses).

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.

1. Muscle damage manifested by atrophy, decreased muscle strength and tone, focal myositis.
2. Skin damage is manifested by dryness, thinning of the skin, subcutaneous hemorrhages and small focal necrosis.
3. Impaired blood supply to the nail plates leads to their fragility, striations and degeneration.
4. 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, amyloidosis of the rectal mucosa), the nervous system (neuropathy, polyneuritis, functional autonomic disorders), involvement of the respiratory system (, 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;
• damage to the 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.

Indicates the presence of inflammation in the body: the appearance of special inflammatory proteins - seromucoid, C-reactive protein, and rheumatoid factor.

Making a diagnosis of rheumatoid arthritis is only possible by assessing the totality of symptoms, radiological signs and results laboratory diagnostics. At positive result treatment is prescribed.

Treatment of rheumatoid arthritis

When accurate diagnosis rheumatoid arthritis, systemic treatment involves the use of certain groups of drugs:

• 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 drug therapy, physiotherapy, therapeutic nutrition, surgical treatment, sanatorium treatment and subsequent rehabilitation.

Nonsteroidal anti-inflammatory drugs

This group of drugs is not included in basic therapy 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:

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;
• 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:

• 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, and 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 are used, healing mud, balneotherapy at resorts. We will not dwell on these methods in detail.

Operation

Surgery can correct a health situation in the relatively early stages of the disease if one large joint(knee or wrist) is constantly 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 functional state joints.

Rheumatoid arthritis is primarily a medical problem. Therefore, surgery is reserved for those who are under the supervision of an experienced rheumatologist or doctor.

Nutrition

The rules of the diet are as follows:

• inclusion sufficient quantity 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;
• eating foods with increased content 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.

1. To relieve pain in rheumatoid arthritis, you should take equally 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.
2. Flowers collected during chestnut flowering 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.
3. Dissolves in one hundred grams of alcohol 50 grams of 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.
4. 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 risk reduction cardiovascular diseases, while an increase in total cholesterol levels is observed while the atherogenic index remains unchanged.

Rheumatoid diseases are among the most common. They were known in ancient times, however, previously it was believed that these ailments develop as a result of improper circulation of fluid in the body.

There are many diseases that have similar symptoms, which is why if the symptoms that will be described below occur, you should definitely contact a rheumatologist for diagnosis and treatment.

Features of rheumatic diseases

Systemic connective tissue disorders are commonly called rheumatoid diseases. They are characterized by extensive damage to connective tissue and blood vessels, which is associated with a disorder of the immune system.

Damage to connective tissue manifests itself in the form of systemic degenerative processes. All rheumatoid diseases have certain clinical and morphological features, which depend on the localization in certain organs and tissues. The course of illnesses is chronic and undulating.

The degenerative process affects bones, cartilage, joints, ligaments, tendons and muscles. Rheumatoid diseases are characterized by painful sensations, decreased motor activity of the limbs, and limited functioning of one or more affected areas. In particular, there are signs of swelling, inflammation, a feeling of heat, and redness.

Major rheumatoid diseases

There are many different rheumatoid joint diseases, among which the following should be highlighted:

• ankylosing spondylitis;
• gout;
• fibromyalgia;
• arthritis;
• lupus;
• osteoarthritis;
• polymyalgia;
• scleroderma.

Ankylosing spondylitis is characterized by damage to the spine. This disease occurs in young people and invades the tendons of the shoulders, hips, and knees, causing intense pain and limited mobility.

Many people suffer from gout. This disease is characterized by the formation of urea microcrystals in the joints. The lesion mainly affects the big toes, causing severe attacks pain and tumor formation. Gout is most common in women.

Some forms of arthritis occur due to bacterial and viral infections entering the body. The disease develops when bitten by an infected tick, which subsequently provokes inflammation, joint stiffness and pain. Idiopathic juvenile arthritis occurs mainly in childhood, causing swelling, pain, and also leading to limited joint mobility. In some cases, it may be accompanied by a rash and fever.

Psoriatic arthritis develops in people suffering from various skin diseases. It affects the joints and can also appear on the nails. Rheumatoid arthritis is a joint disease that is characterized by the destruction of synovial tissue, causing pain, swelling and other disorders. Unlike all other types of rheumatoid diseases, arthritis develops symmetrically. It is most common in women.

Among the rheumatoid autoimmune diseases, lupus should be highlighted. Pathological cells destroy tendons. This disease mainly occurs in women.

Affects mainly the arteries, causing headaches, inflammation, quick loss weight, fever. A person suffers from stiffness in the joints, pain in the lower back, neck, hips, and aches. Unpleasant symptoms appear as a result of damage to muscles, joints, tendons, and ligaments.

Rheumatoid joint diseases differ somewhat in their symptoms, however, there are general rules. As soon as the disease has been diagnosed, treatment must begin immediately to avoid the development of dangerous complications.

Rheumatism

Among systemic rheumatoid diseases, rheumatism should be highlighted. It is characterized by significant damage to joints, cartilage or organs. The disease usually occurs in childhood or adolescence, although many are not aware of its existence. The main cause of rheumatism is predominantly streptococcal infection of the respiratory system, which leads to the development of acute tonsillitis and pharyngitis. In the absence of timely complex treatment the disease progresses to the chronic stage.

The main signs of the disease appear a certain time after a previous respiratory disease. Inflammation increases gradually, while in some joints the pain goes away, while in others it appears almost immediately. The inflammatory process may be unstable. It continues for 10-14 days, then subsides a little and resumes again.

The greatest danger of this systemic rheumatoid disease is that, in addition to the joints, the heart is also affected. The main goal of treatment is to eliminate the streptococcal infection, which provokes the onset of the disease and complications. For prevention, it is imperative to carry out health-improving measures.

Rheumatoid arthritis refers to joint diseases that are characterized by progressive damage to the joints, which leads to their deformation and loss of mobility. The knee joints are most often affected, leading to disability.

Rheumatoid arthritis is autoimmune disease, which often affects middle-aged and elderly people. During its course, certain antibodies are formed in the human body, the work of which is directed against one’s own joints. The occurrence of the disease is due to genetic predisposition, infections and many other reasons. During the course of inflammation, a fairly dense granulation connective tissue is formed, which begins to grow and leads to gradual destruction cartilage tissue. As a result, the usual mobility of the joints decreases. In more advanced stages, the disease can lead to complete loss mobility.

Rheumatoid arthritis refers to diseases that are accompanied by deformation of the limbs, which leads to partial or complete loss of existing musculoskeletal function. Patients lose their ability to work and become disabled. Doctors distinguish several stages of rheumatoid arthritis, which have their own characteristics. It is very important to promptly diagnose and treat to prevent dangerous complications.

The first stage of the pathology is characterized by synovitis, that is, effusion into the joint cavity, which can occur in various forms. At the second stage, characteristic changes occur in the joints, thickening of the synovial membrane, as well as the proliferation of connective tissue.

During the third stage, fusion of the articular parts with each other is observed, which makes movement in the affected area impossible. The onset of the disease is characterized by the occurrence of swelling of the fingers, which is combined with inflammation and swelling. Along with swelling of the joints, damage to the foot occurs, which manifests itself in the form of painful sensations under the balls of the toes. As the pathology develops, it gradually affects an increasing number of tissues, causing swelling and pain in the elbows, ankles, and shoulders.

During the course of rheumatoid arthritis, the symptoms of the disease do not appear immediately: at the initial stage, the patient does not even suspect the presence of the disease. Then gradually signs such as:

• stiffness of movement in the morning;
• periodic painful sensations;
• fever;
• education

In addition, the lesion can affect almost all organs - the coverage depends on the degree of activity of the pathology. However, this happens very rarely. It flows quite hard and causes a lot of unpleasant symptoms rheumatoid arthritis. Treatment of the disease must be comprehensive. It includes:

• anti-inflammatory drugs;
• glucocorticoids;
• biological agents;
• basic strengthening agents.

Anti-inflammatory drugs help to very quickly stop an acute attack and achieve a stable remission. In acute cases of the disease, the course of therapy is supplemented with high dosages of glucocorticoids. Biological agents help prevent necrosis, which can cause damage to the body's own tissues. In the course of rheumatoid arthritis, the prognosis of the disease largely depends on the severity of the pathological process, as well as the characteristics of treatment. In severe and advanced cases, the disease can lead to disability.

Rheumatoid polyarthritis

The disease rheumatoid polyarthritis is an inflammation of one or several joints. Distinguish certain types this pathological process. The disease refers to a severe systemic disorder of connective tissue, which can lead to partial loss of the patient's ability to work or even disability.

Basically, the disease develops in people aged 30-35 years and women often suffer from this pathology. It is a rheumatoid autoimmune disease that mainly destroys small joints.

The main cause of its occurrence is considered to be a disruption of the immune system. As a result, the immune system begins to perceive the cartilage of the joint and its structures as foreign. For this reason, inflammation begins. Often the pathology can be caused by a hereditary factor. Immunity disorders are promoted by external and internal reasons. These include the following:

• hypothermia of the body;
• exposure to pathogenic agents;
• stress;
• allergens and toxins;
• injury.

Polyarthritis is a very serious disease that is difficult to treat. Among its main features it is necessary to highlight the following:

• stiffness in the joint area in the morning;
• painful sensations when touched;
• inflammation of more than three joints.

In later stages, numbness of the limbs, increased temperature, burning in the affected area, and changes in the shape of the joints are observed. The pathological process can also affect other organs, in particular the heart, lungs, and kidneys. If such symptoms occur, you should immediately consult a doctor for diagnosis and treatment.

Therapy must be comprehensive and long-lasting. It is aimed at reducing pain in the patient. Anti-inflammatory drugs are prescribed to eliminate inflammation. Basic medications are of great importance. Despite the fact that their action is slow, medications have a beneficial effect on the mechanism of the disease and slow down the process of joint destruction.

Sokolsky disease

Among rare diseases According to the type of rheumatoid, Sokolsky's disease should be distinguished. It is characterized by the fact that it mainly affects the cardiovascular system, in particular, causing myocarditis and endocarditis. In some cases, patients experience changes in the joint area, which manifest themselves in the form of increased temperature, swelling, severe pain, and swelling in the area of ​​the affected joints. Due to severe pain, a person tries to bend his limbs.

After the attack is eliminated, the functions of the joint are almost completely restored. The ankle, elbow, and knee joints are most often affected. The disease is mainly of an increasing, paroxysmal nature, and the pathology affects a variety of areas.

Treatment of this disease is mainly conservative and involves the use of medications and conducting a course of physiotherapy. In especially severe cases, patients are prescribed surgery. When treated in the initial stages, the prognosis is favorable.

Ankylosing spondylitis

This disease mainly affects young people. It develops as a result of primary chronic damage to the synovial membrane of the costovertebral, intervertebral, and sacroiliac joints. As a result, fibroid deposits are formed, and sometimes necrosis of articular cartilage and gradual rejection of pathological particles into the lumen of the joint are observed.

Degenerative changes begin to develop in the discs, ossification of the articular capsule is observed, synchondrosis and ligaments begin to deform and ossify. Hereditary factors play a very important role in the development of this pathological process.

Symptoms are characterized by gradually increasing limitation of movements in the area spinal column with their complete loss. The pathology gradually affects various joints, and their elasticity is inevitably lost. Among the main signs of this disease are the following:

• irritability;
• sudden weight loss;
• severe weakness;
• drowsiness.

The disease progresses very slowly and progresses over several years. As a result, pain in the bones appears, especially with increased physical activity. The temperature remains within normal limits, the gait is constrained and an increase in ESR is observed. Patients become unable to work. After a certain time, pathology can affect a wide variety of tissues and organs. Joint damage is characterized by significant narrowing of the joint spaces, ankylosis, and many other disorders.

Treatment is quite complex and is usually limited to conservative therapy, which includes the use of medications, physiotherapy and exercise therapy. The prognosis for the course of the disease is unfavorable.

Heel bone spurs

The disease is characterized by the formation of a spiky or hook-shaped growth on the heel bone at the site of attachment of the plantar ligament. In some cases, its course is practically asymptomatic. It is noted that in 20% of patients the spurs are bilateral.

Some doctors consider such a formation as a formation of the skeleton, while others consider it a pathological growth formed in the presence of chronic injury, rheumatism, flat feet and other inflammatory processes.

The main symptoms include a burning pain that resembles the feeling of a nail in the heel. When standing, the pain increases significantly. Pain occurs with the formation of periostitis and inflammation of the underlying mucous membrane. In some cases, a heel spur is combined with hyperkeratosis. X-rays can reveal elements of the heel bone.

Treatment is carried out conservatively. In particular, the patient is indicated for thermal procedures and Novocaine injections. If there is persistent pain and ineffectiveness conservative therapy Surgical removal of the tumor is indicated.

Humeroscapular periarthritis

Humeral-scapular periarthritis is characterized by the fact that the inflammatory process occurs in the soft tissues that surround the shoulder joint. The development of the disease is based on trauma, colds, and rheumatic infections. Neurotrophic damage occupies a very important place in the pathogenesis.

Among the main signs of the progression of disorders are pain in the shoulder joint, impaired sensitivity, and muscle atrophy. Basically, the disease has a chronic course. At the very beginning of its development, practically no changes in the joint area are detected. After some time, osteoporosis begins to develop. Elderly people often experience arthrosis changes in the shoulder joint.

In the acute period, complete rest is indicated, which is why immobilization of the limb is required. Treatment requires novocaine blockades and radiotherapy. In case of chronic disease, thermal procedures are prescribed, physiotherapy, massage, UHF therapy. In particularly advanced cases, surgical treatment and removal of existing lime deposits are required. The prognosis is quite favorable.

Epicondylitis and styloiditis

These diseases occur as a result of hypothermia or injury. Among the main signs of the disease, it is necessary to highlight the presence of pain in the area of ​​the humerus, limited mobility, and swelling.

When performing an x-ray, no special changes are observed, in addition to signs of osteoporosis. Treatment is predominantly conservative, as with other types of rheumatoid diseases. The prognosis with proper treatment is favorable.

Still's disease

Mostly occurs in children. The provoking factor has not yet been fully established. There is a version that the disease develops as a result of penetration into the body pathogenic microbes, and also due to the presence of a genetic predisposition.

The pathological process is mainly observed in the first years of a child’s life and is characterized by changes in tissues with subsequent deformation of articular surfaces, limited mobility, swelling, and enlarged lymph nodes, especially in the armpits and elbow joints. This disease can occur with the addition of anemia, and pigmentation of the skin is also observed.

When carrying out diagnostics, X-rays can show deformation of the joints, some blurring of contours, and sometimes bone growths. At the initial stages of the disease, treatment is carried out conservatively. However, recently doctors have given preference to early synovectomies. For more late stage Stabilizing operations and arthroplasty are prescribed. The prognosis for the course of the disease is not always favorable.

Causes

It is very important to know in which diseases rheumatoid factor plays a key role, as well as for what reasons such disorders occur. The etiology of these diseases has not yet been sufficiently studied. Highest value attributed to viruses and infections, genetic factors, as well as the influence of a number of physical aspects, in particular, such as hypothermia and injury. Also, in some cases, diseases develop due to intolerance to certain medications.

Among the main factors that increase the risk of developing rheumatoid diseases, the following should be highlighted:

• smoking;
• excess weight;
• aging;
• some professions associated with joint overload.

Rheumatic diseases can occur at any age, regardless of gender, however, it is often women who suffer from such diseases.

Main symptoms

The symptoms of rheumatoid diseases, regardless of the provoking factor, are practically no different. Among the main signs are the following:

• constant joint pain;
• pain in the joint area upon palpation;
• temperature increase;
• severe swelling and inflammation in the affected area;
• stiffness and redness of the skin;
• lack of energy, increased fatigue, weakness, poor health;
• limited range of motion or joint flexibility.

If all these signs occur, you should definitely consult a doctor for complex diagnostics and treatment prescriptions.

Diagnosis of rheumatoid diseases is based on medical history, examination, and results instrumental studies And laboratory tests. Often it is not possible to make a correct diagnosis immediately, so a comprehensive examination is required. Some patients may need several visits to the doctor before an accurate diagnosis can be made and appropriate treatment can be prescribed.

Treatment of rheumatoid diseases is selected purely individually in each specific case, it all depends on the characteristics of the pathology. There is no specific treatment or treatment that is optimal for all patients.

During therapy, anti-inflammatory drugs are often used, which have a more pronounced effect than drugs that reduce the main symptoms. New modern biological drugs are considered the most effective.

Taking medications is a traditional form of treatment for rheumatoid diseases. However, there are also many other techniques, in particular, the introduction of medicine into the joint cavity or soft fabrics, chiropractic, acupuncture, alternative medicine. In some particularly severe cases, surgery is prescribed.

Treatment must be comprehensive and timely, since rheumatoid diseases can reduce life expectancy and lead to disability. Regular monitoring for the presence of concomitant diseases is recommended.