Rheumatoid arthritis: classification, diagnosis

Rheumatoid arthritis: differential diagnosis and diagnosis

Rheumatoid arthritis is a joint disease in which the joints become inflamed in the early stages, then the erosion of bone structures develops and in neglected form the inflammation spreads to other internal organs.

The main causes of rheumatoid arthritis are transferred infectious diseases, genetic predisposition, immune system failure. Most often, women of up to 55 years of age suffer from this form of arthritis.

As a result of a malfunction of the immune system, the body begins to perceive the cells of the articular tissues as hostile, actively produce leukocytes and destroy them. Define rheumatoid arthritis in the early stages and prescribe treatment is difficult, because often the symptoms are expressed very poorly.

Symptoms of rheumatoid arthritis in the early stages

It is desirable that the diagnosis of rheumatoid arthritis is carried out as early as possible, before the inflammatory process spreads to other organs. Treatment in this case almost always gives good results, it allows to stop inflammation and stop the development of the disease.

But the symptoms of rheumatoid arthritis at an early stage are very weak, the patient rarely appeals to the doctor, therefore the diagnosis of illness or disease rheumatoid arthritis is put and treatment begins when illness or disease is already turned around.

In time to determine arthritis and begin treatment in the early stages will help such characteristic symptoms:

• Formation of rheumatoid nodules under the skin;
• Detection of rheumatoid factor serum;
• Availability of ATSTSP;
• Increased level of neutrophils in the synovial fluid;
• Erosion of the articular surfaces of the bone;
• Osteoporosis around the bones of the affected joints.

But even if any of the symptoms listed are listed, this is not the reason to diagnose rheumatoid arthritis. Especially, if people of advanced age with presence of chronic diseases are surveyed.

Precise diagnosis is possible only after a complete examination and exclusion of other pathologies.

In 1987, the American College of Rheumatology identified the symptoms by which it would be possible with a large proportion the likelihood of diagnosing rheumatoid arthritis at an early stage - diagnostic criteria for rheumatoid arthritis arthritis.

The established diagnostic criteria for rheumatoid arthritis are as follows:

1. Morning stiffness - for an hour or more after awakening, the patient feels the stiffness of the joints, which sometimes prevents him from getting out of bed.
2. Disorders of proximal, wrist and metacarpophalangeal joints.
3. Formation of rheumatoid nodules - seals under the skin in the joints of the joints.
4. Erosion of wrist and carpal joints, revealed by means of roentgenography.
5. Edema of the periarticular areas, presence of effusion in the joint cavities.
6. Symmetrical defeat of paired joints.
7. Presence of a rheumatoid factor in the blood.

Not necessarily all of these symptoms should be clearly manifested, but if at least 4 of them are identified, doctors diagnose rheumatoid arthritis and begin treatment.

Diagnosis of rheumatoid arthritis in the laboratory

Rheumatoid arthritis does not belong to those joint diseases, which can easily be diagnosed simply by comparing external symptoms and visual inspection of the patient. Additional research is needed, as is further diagnosis of arthritis.

With rheumatoid arthritis for blood analysis, it is always possible to establish the presence of rheumatoid factor, an increase in ESR and anemia of varying severity. In other joint diseases, these indicators are usually normal or slightly increased.

What is the rheumatoid factor?

If there are at least smeared, single symptoms, according to which it would be possible to assume the development rheumatoid arthritis, the doctor will necessarily give a referral to the analysis that determines the rheumatoid factor in blood serum. The presence of the Russian Federation does not necessarily mean that a person is ill with arthritis.

In 5% of healthy people, serum is found in the RF. In this case, rheumatoid factor can manifest itself in other diseases. Rheumatoid arthritis is confirmed only in a third of patients who have a rheumatoid factor.

However, in combination with studies on ATSTSP and CRP, you can make a fairly good prognosis for the development of the disease and determine the treatment.

If the titers of all these indicators are significantly higher than normal, rheumatoid arthritis will be acute and severe, with numerous complications.

ACPC indicator

ACCPs are antibodies to the cyclic citrulline peptide. To date, the study on ATSPP is one of the most reliable ways to identify rheumatoid arthritis.

Of the one hundred patients who had these antibodies detected, the diagnosis of rheumatoid arthritis was indeed confirmed.

For diagnosis, the number of ACPs correlating with the main indicators of the disease is determined. It:

• activity of RA;
• increased ESR;
• CRP;
• DAS28;
• Number of affected joints.

ESR is deciphered as the rate of erythrocyte sedimentation. This indicator can determine the level of inflammation in the body. In a healthy person, the rate of entry of erythrocytes into a test tube is low. If the inflammatory process develops, it rises.

CRP is a test for C-reactive protein. This indicator also speaks of inflammation, but is considered more reliable than the previous one.

It helps to identify not only the presence of inflammation and its level.

By measuring the level of CRP, you can determine how effective the treatment is and adjust it if necessary. The SRB is measured using a special scale DAS28.

Clinical blood test

Severe anemia, low hemoglobin levels, but high platelet counts - all these are indirect symptoms of rheumatoid arthritis.

Leukocytes do not increase, a slight increase in their number is noted only in Felty's syndrome. Eosinophilia and an increase in ESR, a normal blood test also shows.

Blood chemistry

The level of ceruloplasmin and active proteins is the two most important indicators that attention is paid to.

If the level is raised, this means that the disease is acute and dynamic, treatment should be as accurate and effective as possible.

Changes in synovial fluid

Synovial fluid in rheumatoid arthritis should be studied continuously, all changes in its composition are fixed and help to differentiate rheumatoid arthritis. In a healthy joint, the fluid resembles a thick, clear, jelly-like mass.

In RA, the synovial fluid becomes cloudy, its viscosity decreases, the analysis reveals a high protein content and a low glucose content.

Among the leukocytes, a large number of neutrophils are found, while the leukocytes themselves play a big role in determining the diagnosis.

X-ray of the joints

With the help of this method, it is almost impossible to detect the symptoms of rheumatoid arthritis at an early stage. X-rays can show swelling in the joint area or the presence of effusion in the joint cavity. But these signs are visible and with a visual examination, the X-ray for their detection is not necessary.

To detect lesions of joints in the early stages, it is more appropriate to use magnetic resonance imaging and other modern methods of computer diagnostics.

Further, the X-ray is also not particularly effective as a diagnostic method. You can only compare the condition of the joints and determine the symmetry of the lesions. But the X-ray image will not say anything about the nature of the illness.

Such a survey helps to establish, correctly chosen treatment, how effective it is, how to continue it.

Several different x-ray techniques are used, along which it is possible to establish:

1. Degree of narrowing of the joint space;
2. Number of erosions;
3. Deformation of bone tissue;
4. Degree of destruction of joints and fusion of their elements;
5. Thinning of the cartilaginous layer;
6. Probability of formation of cystic tumors.

Treatment is assigned only after comparing the results of all analyzes.

A source: http://sustav.info/bolezni/arthritis/revmatoidnyj-artrit-diagnostika.html

Rheumatoid arthritis: classification, diagnosis

Among all connective tissue diseases, the most common problems for mankind are articular manifestations of rheumatic diseases.

The first thing that is necessary for the effective treatment of any disease is a clear and universal classification of the pathological condition at a particular point in time in a particular patient.

Key Concepts

The correct diagnosis is 80% successful treatment. If his wording is clear to any doctor, then the likelihood of adequate therapy is increased by an order of magnitude.

According to the generally accepted opinion among physicians, clinical classification should perform practical functions. In the definition of the Spanish rheumatological society, it must solve such problems:

1. To promote an adequate and correct choice of treatment tactics.
2. Assist the practitioner in his routine daily work.
3. Be useful for statistical data processing.

At first glance, there are not many requirements. However, the specificity of rheumatoid arthritis requires a more detailed approach for almost every point.

Мкб 10

The International Classification of Diseases 10 revision (Mkb 10) has not become a universal tool. Its shortcomings are as follows:

1. It is unsuitable for indexing individual clinical cases.
2. It does not allow to assess the current state of the patient.
3. Does not make it possible to make a medical forecast.

It provides data that is suitable for statistical processing, but is of little use for the treatment of a particular patient. Its creators openly acknowledge that Mkb 10 is designed to assess the health of the nation and is unsuitable for use by rheumatologists.

Statistical data is very important for large-scale studies and forecasts.

The search for a universal mechanism

Therefore, for a long time, attempts were made to find a compromise solution that both tasks: it included statistics and gave doctors all the necessary information about a particular patient.

It was not easy to solve the problem. On the practical side, the clinical classification of rheumatoid arthritis should contribute to:

1. Forming a clear understanding of the illness of the attending physician in accordance with the achievements of modern medicine.
2. Correct and complete formulation of the diagnosis.
3. The choice of adequate therapy at the current stage of arthritis.

To be suitable for statistical processing, the classification should allow:

1. Compare individual indicators for different treatment facilities (between different countries - too).
2. To register different forms of the disease.

If we simply take and combine the necessary formulations, the diagnosis of rheumatoid arthritis becomes bloated and unsuitable for clinical practice.

The process of improving the classification of rheumatoid arthritis continues even now.

Current state of affairs

At different times, different versions of the working classification of rheumatoid arthritis (RA) were used. In the first, from 1959, there were 5 sections. Then the number of partitions was reduced to 4.

But science does not stand still. Particularly noticeable progress in diagnostic methods. Thanks to this, doctors have the opportunity to establish a diagnosis at a fairly early stage. Accordingly, the effect of therapy is more pronounced.

In modern domestic medicine, the classification includes 8 sections. Each of them characterizes one or another side of the RA.

To use it began from September 30, 2007.

Practical use

The approach used looks rather slender and versatile: for Mkb 10 there is the first section, for the practicing doctor - all together.

The category of mandatory studies included the detection of rheumatoid factor (RF), first introduced assay for antibodies to the main PA damaging factor: cyclic citrulled peptide (ACPI).

A positive innovation was the use of a special index DAS28. It is calculated by several parameters:

1. Number of joints with painful sensations.
2. The number of swollen joints from pre-selected 28.
3. Erythrocyte sedimentation rate.
4. General state of human health.

The indicator DAS28 is obtained as a result of complex mathematical calculations and is subject to evaluation only by specialists.

Section "Basic diagnosis"

Its peculiarity is that in the formulation of the diagnosis there can be at once two criteria from this section.

For example, if a rheumatoid factor is not found in the blood, but there are a number of other signs that make it possible to suspect RA.

Then the beginning of the diagnosis will be: "Probable seronegative rheumatoid arthritis M06.9".

The concept of a probable RA has been introduced recently. The goal is to establish the diagnosis as early as possible, without waiting for the generally accepted 6 months duration of the disease. Such an opportunity allows doctors to save their health much longer.

The term "rheumatoid factor" means antibodies that reliably damage the body's own tissues (let's not forget that RA is an autoimmune disease). Special methods are used for their detection.

• ELISA is an enzyme immunoassay.
• Immunonephilometric (based on light scattering) method.
• Latex test.

The detection of rheumatoid factor allows us to confidently talk about the rheumatic nature of the joint pathology.

If it is not detected, but the risk of the occurrence of RA is recognized as high (genetic predisposition, risk factors and a similar clinical picture), then they say about the likely rheumatoid arthritis. And begin appropriate treatment.

Section "Clinical stage"

The practical value of this data is quite high. On how far the disease has progressed, the goals to be achieved in the course of treatment are set. So:

1. The expected result of treatment for the first stage is the achievement of complete remission.
2. When the clinical stage has already been developed (more than 12 months, pathological changes are expressed quite strongly), the primary task of rheumatologists is to reduce the activity of the disease. Remission is seen as a welcome outcome.
3. In the late phase, the preservation of an acceptable quality of life comes to the forefront. At this stage, it is also important to combat complications. Surgery may be indicated.

The clinical picture, which is noted in an individual patient at a particular point in time, must necessarily be included in the formulation of the diagnosis.

Section "Activity of the disease"

A very important part of the diagnosis in the treatment plan. At high indexes of DAS28, more intensive and aggressive treatment is required, for example, cytostatics. Moderate indicators allow the use of sparing schemes. A low index, less than, indicates a remission.

If DAS28 is very high or does not decrease for a long time against the background of treatment, the patient should be considered as a candidate for special therapeutic techniques (cytokines, pulse therapy).

The importance of this index is also high for the pharmaco-economic evaluation. Simply put, it helps determine the economic feasibility of a particular treatment regimen.

Section "System manifestations"

The effect that rheumatoid arthritis on the body is not limited to joints. When he is often observed pathological changes from other organs, which also require medical intervention.

Sometimes, by the degree of development or, conversely, the extinction of these extra-articular phenomena, one can judge the activity of the underlying disease.

It is impossible to overlook systemic manifestations, as they can significantly complicate the patient's condition and worsen the prognosis.

Section "Instrumental characteristics"

Modern medicine has at least three available ways to look at the condition of the joints: radiography, ultrasound, magnetic resonance tomogram.

Each of these methods has its own special properties and they can not replace each other. With their help you can evaluate:

• Condition of the joint bag (swelling, wrinkling).
• Sections of bones adjacent to articular surfaces (osteoporosis).
• Presence or absence of subluxations in the advanced stage of the disease.
• Degree of atrophy of interosseous (vermiform) muscles.
• Whether there are erosions on articulate surfaces (erosive arthritis it is simple to find out on MRT).

The last point is very important for the forecast and development of treatment tactics.

The appearance of erosion indicates a progression of the disease. If this occurs against the background of treatment, it is required to change the therapy scheme to more aggressive.

Section "Additional immunological indicators"

The possibility of detecting ATSTSP for diagnostic importance is comparable to the detection of rheumatoid factor. This indicator gives an opportunity to evaluate the effectiveness of therapy (the level of antibodies is reduced). Allows for reliable early diagnosis of RA.

Section "Functional classes"

For health care is of practical value in terms of examination of disability. Based on these indicators, the issue of recognizing a sick person as an invalid, the appointment of social assistance is being decided.

Section "Complications"

Manifestations of some complications can be very serious. For example, a subluxation of the joint between the first and second cervical vertebra leads to instability of the entire cervical spine.

Secondary amyloidosis, osteonecrosis and other pathological conditions caused by RA are able to surpass it in terms of the degree of influence on human health.

Complications of rheumatoid arthritis require attention, treatment and are necessarily included in the diagnosis.

Use in practice

Now the doctor has the opportunity to formulate a diagnosis that will be multifaceted to characterize the patient for any rheumatologist. Even if the patient does not go to the place of the main treatment.

It's simple: the data are listed in order starting from the first section. In the case where there is no data, they are omitted. If any research was not conducted, a question mark is put.

Let us consider in detail what words mean in the formulation of the diagnosis. To do this, we again use the table representation:

Rheumatoid arthritis seronegative

The clinical stage is very early

A source: http://1lustiness.ru/zhenskie-bolezni/kategoriya/74368-revmatoidnyj-artrit-klassifikatsiya-formuliroa-diagnoza

Classification of rheumatoid arthritis

Rheumatoid arthritis is a disease of an autoimmune nature, in which lesions of bone joints occur.

The essence of the autoimmune process is that the body begins to perceive its own cells as strangers and attack them.

At the beginning of the disease, lesions and deformations of the small and medium joints occur. At the advanced stage of the process, arthritis can affect other systems and organs (respiratory, circulatory system).

The disease can begin at any age, more often in 40-45 years. However, there is also juvenile rheumatoid arthritis, which affects children under the age of 14 years.

Causes of the disease

Among the variety of etiological factors that can cause rheumatoid arthritis are the following:

1. Heredity. There is a proven link between the presence of a specific gene (DRB1) and the occurrence of rheumatoid arthritis.
2. Postponed infections. These include viral (rubella, herpes, Epstein-Barr, hepatitis, influenza), bacterial infections (sore throats, tonsillitis).
3. Frequent and prolonged hypothermia.
4. Hormonal disorders in the body.
5. Super-strong physical activity (weightlifting, work associated with hard work, lead to a narrowing of the joint gap and deformations of the joints).
6. Postponed strong emotional shock (death of close people, divorce, etc.)
7. Injuries, injuries, fractures.
8. Harmful habits (smoking, alcohol abuse, drug addiction)
9. The environmental factor (living in industrial zones, as well as cities with poor environmental conditions)

How is rheumatoid arthritis classified?

Classifications of rheumatoid arthritis are diverse in origin and manifestation of the disease. Most subspecies of rheumatoid arthritis are included in the final formulation of the diagnosis, which affects the prognosis and treatment of the disease. Consider the main ones:

Classification of rheumatoid arthritis depending on laboratory parameters of blood (rheumatoid factor):

1. Seronegative is the absence of rheumatoid factor in the blood or synovial fluid (20%). Manifestations in the form of polyarthritis or Still's syndrome in adults.
2. Seropositive - the presence of rheumatoid factor in the blood and / or synovial fluid (80%). Manifestations in the form of multiple arthritis, lesions of the lungs and heart.

Depending on the process activity:

1)The stage of exacerbation, in turn, is divided into 3 degrees:

• Low - weak pain, morning stiffness 20-30 min, ESR indicators - from 15 to 30 mm / h, CRP - ++
• Medium - moderate pain, morning stiffness up to 10 hours, ESR - 30-40 mm / h, CRP - +++
• High - pain acute, causing suffering, morning stiffness persists all day, ESR - more than 40 mm / h, CRP - ++++

2)The stage of remission, in which there is no pain and other signs of the disease (CRP, ESR).

Depending on the radiographic pattern, the stages are:

• periarticular osteoporosis is mild
• narrowing of the joint space and single holes in the bone tissue (usuras)
• the bone tissue is "eaten" by usuras
• ankylosis, bony growths, deformed joints.

Depending on the physical activity of the patient:

1. The first degree - despite the development of the disease, the functionality of the joints is preserved, the habitual way of life
2. The second degree - the limitation in some actions, the decrease in working capacity, the patient needs help from time to time.
3. The third degree is a complete limitation of movements, loss of efficiency.

Depending on the prevalence of the lesion:

• Monoarthritis - localization of inflammation in one joint
• Oligoarthritis - no more than 2 joints are involved in inflammation
• Polyarthritis - more than 2 joints are affected.

Depending on the dynamics of rheumatoid arthritis:

1. Rapid option: the increase in symptoms and radiographic signs: erosion, deformation, for a short period of time (up to a year).
2. Slowly developing option: there are many years without causing gross functional changes in the joints.

Symptoms of rheumatoid arthritis

The main articular symptoms of rheumatoid arthritis are:

• Constant aching pain, which subsides after the onset of active movements and is wavy in character.
• The disease begins with small compositions of the lower and upper extremities (metacarpophalangeal, radiocarpal).
• The symmetrical nature of the lesion of the articulations (two arms, two legs)
• Signs of inflammation in the joints (increased local temperature, reddish skin color, sharp pain, swelling).
• Over time, the joint deforms and its function is disrupted. And in the late stages of immobilization.
• In the later stages, the involvement of larger (knees, shoulders, pelvis)
• Changing weather, atmospheric pressure can affect the symptoms of the disease.

Extra-articular symptoms of rheumatoid arthritis

Out-of-articular symptoms include:

• Deterioration of general condition (apathy, subfebrile condition, increased fatigue).
• Muscles (decrease in strength and tone, local myositis, later - atrophy).
• Skin and its appendages (hemorrhagic manifestations, fragility and deformation of the nail plate, round dense painless nodules, thinning of the skin).
• Gastrointestinal tract (colitis, decreased appetite, increased flatulence).
• Nervous system (various polyneuropathies).
• Respiratory system (pleurisy, alveolitis, fibrosis, pneumonitis).
• Kidneys (glomerulonephritis, later - amyloidosis)
• The organs of vision (conjunctivitis, uveitis, etc.)
• Cardiovascular system (lesions of the myocardium, pericardium, and also coronary vessels)

The formulation and diagnosis of rheumatoid arthritis is based on the following criteria: patient complaints, specialist examination, laboratory tests and objective instrumental indicators.

When the first manifestations of rheumatoid arthritis appear: aching joint pain, morning stiffness, inflammation of the joints, it is necessary to consult a specialist. Do not take any medication and do not go through the physiotherapy yourself.

Modern methods of treating rheumatoid arthritis

1) Drug therapy

This method helps to remove signs of inflammation, as well as slow the progression of the disease.

There are following directions in treatment:

1. Basic therapy (Methotrexate, Sulfasalazine, Arava and their various combinations). These drugs can suppress autoimmune processes in tissues, improve the prognosis of the disease.
2. Hormonal corticosteroids (prednisolone, hydrocortisone, dexamethasone, metipred).
3. Anti-inflammatory nonsteroidal agents (ibuprofen, ketotifen, meloxicam).
4. Multivitamin complexes, muscle relaxants to improve the general condition of the patient.

2) Local treatment of rheumatoid arthritis

1. Intra-articular administration of drugs (corticosteroids: prednisolone, hydrocortisone, diprospan, Kenalog). This method helps to quickly reduce inflammation and pain.
2. Creams and ointments (Butadion, Indomethacin, Fastum-gel, Voltaren, etc.) also help reduce signs of inflammation.

3) Physiotherapy treatment(laser therapy, cryotherapy, infrared irradiation, applications with paraffin, therapeutic mud, etc.) is used only during remission and under the supervision of a specialist.

4) Therapeutic physical training(fitness, yoga, pilates, swimming, respiratory gymnastics) should be conducted during remission and under the supervision of the physician of the physical training center with the selection of an individual program.

5) Diet.Proper and moderate nutrition plays an important role in the treatment of rheumatoid arthritis. Patients should be excluded from the following products: pork, citrus, fatty dairy products.

In the diet should add fish and seafood, vegetables and fruits, eggs, buckwheat and pearl barley. It is recommended to take food 5-6 times a day in small portions in fresh, cooked or stewed. It is desirable to reduce consumption of fried, fast food, salt and sugar.

It is also necessary to refrain from smoking and drinking alcohol.

Detailed information, as well as how to go painlessly to diet food and stuff, you can get in this material.

Operative treatment

Surgical intervention is performed with frequent uncontrolled exacerbations, long-term ineffective therapy, as well as pronounced changes in connections with loss of physiological functions. The following types of manipulation are distinguished:

• Arthroscopy is the method by which the necessary medications are introduced (painkillers, anti-inflammatory drugs drugs) directly into the joint, and also the products of tissue decay (cartilaginous fragments, outgrowths, pathological liquid)
• Endoprosthetics - an operation in the course of which the affected bone connection of the hypoallergenic artificial joint is replaced. This procedure is carried out with irreversible destruction of the joints.

Drug therapy in combination with curative gymnastics, healthy lifestyle, physiotherapy and correct nutrition can give not only a positive result in treatment, but also prolong the remission time for a long time disease.

Conclusion

Rheumatoid arthritis is a serious and dangerous disease that brings pain and suffering to patients. Despite the fact that there are no specific preventive measures for the disease, doctors recommend adhering to the rules that will help reduce the risk of the disease:

• Strengthening of immunity and timely treatment of chronic foci (sore throats, tonsillitis).
• Do not allow prolonged and frequent hypothermia.
• To lead a healthy lifestyle, to give up smoking and alcohol abuse.
• To prevent viral diseases during the epidemic season.
• At the first signs of the disease, immediately consult a therapist or rheumatologist.
• Moderately engage in sports, do not overstrain muscles and joints.

A source: http://lechsustavov.ru/artrit/klassifikaciya-revmatoidnogo-artrita.html

Rheumatoid arthritis: definition and diagnosis

Definition

Rheumatoid arthritis is an autoimmune disease characterized by the development of destructive changes in joints with impaired function and inflammatory phenomena from the internal organs.

Causes

The exact causes of this pathology are not established. A great role belongs to heredity. In close relatives the probability of the disease is 1.5 times higher.

Some scientists believe that rheumatoid arthritis is manifested due to the effect of infectious agents, which are mycoplasmas, Epstein-Barr virus and group B streptococci.

Smokers are at risk.

Classification

Rheumatoid arthritis is classified according to a number of symptoms. All these indicators are included in the formulation of the final diagnosis of rheumatoid arthritis.

1. Diagnosis: seronegative, seropositive, probable rheumatoid arthritis, special clinical forms (Felty syndrome and Still's disease).
2. Stage: very early, early, unfolded, late.
3. Activity: remission, low, medium, high.
4. Extra-articular manifestations: subcutaneous nodules, eye lesions, Sjogren's syndrome, polyneuropathy, pericarditis and pleurisy, polyneuropathy.
5. By the presence of erosion: erosive, non-erosive.
6. According to the X-ray examination: I, II, III, IV.
7. According to the immunological examination: anti-PTC (+), anti-CPR (-).
8. Functional class: I (quality of life does not suffer), II (slightly suffers), III (much suffering), IV (difficulties in self-service).
9. Complications: osteoporosis, secondary amyloidosis, osteonecrosis, secondary arthrosis, tunnel syndromes, subluxation in the atlanto-axial joint, atherosclerosis.

Symptoms

Rheumatoid arthritis in its clinical picture has articular and extraarticular symptoms.

Joint manifestations

Joint lesions can be reversible (synovitis) and irreversible (erosion, ankylosis). This distribution determines the severity of the process and the choice of treatment tactics.

The symptom of synovitis is morning stiffness, which is observed for at least one hour.

A characteristic sign of this disease is a persistent inflammation of the metacarpophalangeal and proximal interphalangeal joints on both sides. The brush function is violated early.

It is difficult for a patient to squeeze his hand into a fist, to hold objects and so on. Also there is an atrophy of the interosseous muscles and it seems that the hand has lost weight. As the process progresses, the atrophy extends to the shoulder girdle.

If patients do not follow treatment recommendations, subluxations, contractures and ankylosis are formed. This leads to characteristic deformations. The "fin of the walrus" and "the neck of the swan" are forming. In this case, the diagnosis of rheumatoid arthritis is obvious.

Approximately one third of patients undergo inflammatory process of metatarsophalangeal joints of II-IV fingers. This will manifest pain when walking and eventually deform the foot.

Less commonly involved in the pathological process of the knee, ankle, hip and temporomandibular joint.

Extra-articular manifestations

The following diseases are very diverse.

1. Diseases of the pleura (pleurisy, pleural fibrosis).
2. Pathology of the respiratory tract and lungs (bronchiectasis, diffuse panbronchiolitis, follicular bronchiolitis, amyloidosis).
3. Cardiovascular pathology (vasculitis, pericarditis, myocarditis).
4. Renal lesions (glomerulonephritis)
5. Diseases of the eyes (uveitis, episleritis).

Diagnostics

Usually, the diagnosis of rheumatoid arthritis is difficult. It is based on complaints of the patient, the objective picture during the examination, the results of laboratory and instrumental research.

Patients complain of pain, morning stiffness, low-grade fever, fatigue.

When conducting a doctor's examination, signs of inflammation (hyperemia, swelling, hyperthermia over the joint area). With palpation, soreness is noted.

In the late stages of rheumatoid arthritis leads to deformations due to contractures and subluxations.

Laboratory examination

Numerous changes can be noted in the results of laboratory and instrumental data.

In the general analysis of blood there is a decrease in hemoglobin, significantly accelerated ESR, increased the number of leukocytes and platelets. This indicates a severe course of the disease. The leukocyte formula is characterized by neutropenia, which often indicates the Felty syndrome.

In the biochemical analysis of blood protein is reduced, increased creatinine, glucose, transaminase, dyslipidemia is noted. The most common reason for such changes is the use of medications that treat rheumatoid arthritis. Also, these abnormalities may indicate the severity of the inflammatory process.

Rheumatoid factor (RF) in the analysis is found in 90% of patients with this pathology. In the early stages, only 50% of patients are found.

But as the titers of this indicator increase, one can judge the severity of the process, the development of complications from the internal organs, the progression of the disease.

A more specific marker for the diagnosis of this disease is the level of anti-CPP antibodies. Due to this survey it is possible to identify rheumatoid arthritis in early stages, as well as to conduct differential diagnosis with other diseases similar in clinical manifestations.

As an immunological study, a HLA-DR4 marker is determined. This is an indicator of severe current and its detection indicates an unfavorable prognosis.

Instrumental examination

These methods of examination reveal changes in joints, damage to internal organs, complications.

Radiography of the hands and feet is performed to establish the stage of the disease and the degree of destruction. To reveal subluxation of the atlanto-occipital joint, X-rays of the cervical spine are performed.

The diagnosis is based on the Stenbroke classification.

With grade I, osteoporosis is detected, with II, osteoporosis + single erosions + narrowing periarticular cracks, with III all the same signs are noted, but erosions are multiple, with IV observed ankylosis.

A more reliable study is MRI, but it can not give an accurate assessment of early changes in the joint, since similar changes are found in normal. The benefits of MRI are evident in the diagnosis of complications, for example, osteonecrosis.

To identify complications, Echo-CG, fibrogastroduodenoscopy, and chest X-ray are performed.

The final diagnosis

The diagnosis of rheumatoid arthritis is performed according to WHO criteria. These criteria are as follows.

1. Morning stiffness at least 1 hour in the morning.
2. Symptoms of inflammation of three or more articular regions.
3. Inflammation of the joints of the hands.
4. Symmetry of defeat.
5. Presence of subcutaneous nodules.
6. Positive result of a blood test in the Russian Federation.
7. Typical radiographic changes.

The diagnosis of rheumatoid arthritis is made if at least four of the seven criteria are identified.The first four should be present for four weeks or more.

Differential diagnostics

The range of diseases with which it is necessary to differentiate this disease is extensive.

With a detailed clinical picture, the diagnosis of rheumatoid arthritis does not cause difficulties. In the case of the debut of the disease, there may be diagnostic errors.

To avoid them, you should use the differential diagnostic algorithm presented below.

Osteoarthritis. Characteristic is the destruction of the articular cartilage of interphalangeal, knee, ankle, hip, metatarsophalangeal joints. Radiographs show a narrowing of the joint gap and osteophytes. There are no laboratory disorders.

Inflammatory phenomena are expressed in an insignificant degree - there is no swelling, hyperthermia, distal interphalangeal joints are involved in the process. There is no morning stiffness.

Pain syndrome is associated with physical exertion and intensifies toward evening.

Systemic lupus erythematosus. Symmetrical defeat of the hands, knees. Inflammatory phenomena are not pronounced. The joints are not deformed. The titles of the Russian Federation are determined in rare cases. There are no erosions on the retgenograms.

Gout. The first attack begins with a lesion of the big toe with marked inflammation. In a chronic course, feet and hands are symmetrically affected. In the synovial fluid, urate crystals are found, large joints are often affected.

Articular syndrome with psoriasis. Monoarthritis, asymmetric oligoarthritis, symmetrical polyarthritis. Distal interphalangeal joints are often affected, spindle-like swelling of the fingers is characteristic. On the skin and nails, there are changes characteristic of psoriasis.

Lyme disease. The causative agent is Borreliaburgdorferi. First there is a migrating erythema and cardiac pathology, and later intermittent oligoarthritis and polyneuropathy. The debut of the disease is associated with a tick bite. The diagnosis is confirmed by a serological response to borelliosis.

Articular syndrome on the background of a viral infection. Patients complain of morning stiffness, symmetrical lesion of wrist joints and brushes. The onset of the disease is associated with an acute viral infection. This inflammation has the property of spontaneously passing through 4-6 weeks.

Prevention

You can not influence the hereditary factor. But you can lead a healthy lifestyle, in time to treat acute respiratory infections, to sanitize constantly the foci of chronic infection. In this case, rheumatoid arthritis will make itself felt.

Forecast

Thanks to the achievements of modern diagnostics, such a serious pathology is possible to reveal early stages. This makes it possible to prescribe an effective treatment, which in the majority of patients retains ability to work and allows reaching 50% of clinical remission.

A source: http://bolit-sustav.ru/bolezni/artrit/sovremennaya-diagnostika-bolezni/