Rheumatoid arthritis: diagnosis and treatment

Rheumatoid arthritis - symptoms, treatment, diagnosis and prevention in children and adults

Very severe chronic ailment - rheumatoid arthritis - symptoms, treatment, diagnosis of which is closely related to the stage at which the patient noticed signs of rheumatic joint changes and submitted the necessary tests blood. This dangerous disease can manifest itself in many ways, so many patients can not understand how to determine rheumatoid arthritis, why it is so painful to move, and no conventional means of joint pain help.

What is rheumatoid arthritis?

Although the first signs of RA were diagnosed in the XIX century, the causes that cause this unexpected serious illness have not yet been fully studied.

Rheumatoid arthritis is a serious and dangerous disease of an autoimmune nature, in which suddenly your own lymphocytes in a person's blood are taken for "Enemies" their healthy cells of the connective tissue of the joints, as a result of which the interarticulate fluid becomes small, the joints become inflamed, swollen and unbearably hurt.

According to codes adopted by WHO, the classification of rheumatoid arthritis includes many of its varieties. It:

• seropositive and seronegative RA, denoted in the classifier as * МО5 and -МО6.0;
• Felty's syndrome, which is accompanied by a pathology of the spleen. Indicated as -MM5.0;
• rheumatoid inflammation of synovial bags (bursitis), referred to as -MO6.2;
• other rheumatoid arthritis with refined and unspecified pathogenesis (-MM5.8, * MO6, -MO6.8, -MO6.9);
• Still's disease observed in adults (-MO6.1);
• juvenile or youthful RA (* МО8.0);
• rheumatoid nodule (-MO6.3).

Stages of

In patients with RA, the disease can begin differently, but all pass through the three main stages of rheumatoid arthritis at the onset of the disease:

• First, the tissues and muscles surrounding the joint begin to swell. This causes severe pain, an increase in temperature around the area of ​​the affected joint, it swells.
• Further, the lymphocytes begin to multiply in a geometric progression around the diseased joint, destroying harmful cells from their point of view. This causes a pathology, when the fluid in the shell of the joint becomes very small, the friction of the joint bones against each other increases, a serious aggravation of pain begins.
• If no therapeutic measures are taken at the second stage, the lymphocytes produce enzymes that damage the bones. This leads to the so-called "walrus fin" - a strong and terrible deformation of the fingers on the arms and legs of a person, because of which he can no longer move.

This severe disease is distinguished by the "creeping" of the onset of the course, signs of rheumatoid arthritis are manifested gradually, periods of exacerbation can be replaced by normal state of health, and outbreaks of pain appear and subside suddenly. However, the doctors identified some common clinic and symptoms of the disease:

• a feeling of characteristic stiffness in the small joints of the hands or feet, as if they were wearing a tight glove;
• Muscular pain with monotonous performance of any movements;
• general condition of weakness, malaise, possibly a fever, "aching in the bones similar to rheumatism;
• symmetrical lesion of several joints, polyarthritis;
• swelling and pain in the legs in a sitting position.

Among women

Medical statistics show that women are more likely than men to have RA disease, and get sick more often. Signs of rheumatoid arthritis in women include the following symptoms:

• sharp weight loss for no apparent reason;
• anemia, weakness, dizziness;
• morning pain in the joints, signs of rheumatism;
• increase in temperature, similar to ARVI.

In men

Although in men this dangerous disease is less common than in women, but the disease is more severe, affecting the internal organs. Signs of rheumatoid arthritis in men include the following manifestations:

• defeat of bronchi, pleurisy, the appearance of rheumatic nodules in the pleura, larynx, on the surface of the lungs;
• pneumosclerotic lung lesions, affecting their ability to diffuse;
• pneumonitis, visceritis, arteritis.

Diagnosis of rheumatoid arthritis

Complaints for rheumatoid arthritis for pain, joint swelling and movement difficulties help doctors diagnose rheumatoid arthritis. However, for a correct diagnosis of some visual examinations, the patient is not enough.

Since the trigger for starting an autoimmune reaction can serve a variety of mechanisms - from a stressful long situations before hypothermia and ARVI disease, rheumatologists tend to diagnose the disease as detailed as possible so that to be mistaken.

Analyzes for rheumatoid arthritis

Rheumatologists use a comprehensive laboratory diagnosis, which includes the following blood indicators for rheumatoid arthritis:

• General blood tests. Important factors for the detection of a creeping inflammatory process are ESR (increased), the number of platelets (it is increased), the presence of C-reactive protein in large quantities.
• Applied biochemical analyzes and tests showing the specific type of RA in the patient - the presence of a rheumatoid, antibodies to the anti-citrulline peptide, antinuclear antibodies in the blood. To clarify the data the doctor can take a biopsy material from the synovial articular bags.

In addition to these analyzes, which with a high degree reveal arthroid rheumatism and acute course of autoimmune reaction in the patient's body, the doctor recommends doing other examinations to differentiate RA from other diseases of similar pathology that can affect joints. These include:

• arthrogram;
• X-ray of the affected joints;
• magnetic resonance and computer studies;
• diagnostics with the help of echographic examinations.

Treatment of rheumatoid arthritis

The usual methods of treating rheumatoid arthritis are two stages: removal of the stage of exacerbation and subsequent treatment with basic drugs, which does not give rise to an autoimmune reaction. The acute stage is stopped with the following medicines:

• NSAIDs;
• analgesics;
• corticosteroid PVA.

The main therapy is antirheumatic drugs for joints, cytostatics and immunosuppressants based on:

• methotrexate;
• leflunomide;
• cyclosporine;
• the newest biological drugs that introduce the patient into a stable remission.

Complications of rheumatoid arthritis

If you do not start treatment in time, or try to apply homeopathy and folk medicine, the consequences of rheumatoid arthritis will be severe.

A person has not only severe deformity of the joints, all internal organs can also be affected - in their connective tissue there are nodules that hamper their normal functioning. Therefore, rheumatoarthritis is considered a systemic disease in rheumatology.

In the late stages, the patient may have difficulty in working the heart, lungs, kidneys, spleen, the risk of fatal outcome is high.

Prognosis of rheumatoid arthritis

Alas, rheumatologists do not yet know the methods how to get rid of such a scourge as rheumatic arthritis once and for all, therefore, the predictions of rheumatoid arthritis are very cautious.

This is not a fatal illness, however, used cytostatics with immunosuppressants reduce the life of the patient on average by 8 years.

The latest modern developments in the field of biological medicines give hope that improving the quality of life of the patient will not be accompanied by a reduction.

Prevention of rheumatoid arthritis

Since the exact etiology of RA is still in doubt, the prevention of rheumatoid arthritis measures to adhere to the rules of healthy eating and to refer to doctors in the case of infectious ailments.

In stages, when the disease has already been identified, a person has a sharp and rapid development, you can not engage in physical education, even more inflaming inflamed joints.

When coping with an acute process, it is important to follow all the recommendations of the doctor without exception, so that the period of remission runs as long as possible.

A source: http://sovets.net/11044-revmatoidnyj-artrit-simptomy-lechenie-diagnostika.html

Rheumatoid arthritis

The reasons for the development of rheumatoid arthritis are not reliably established. The hereditary nature of violations of immunological responses and the role of infectious etiophages (Epstein-Barr virus, retrovirus, cytomegalovirus, mycoplasma, herpes virus, rubella, etc.) are determined.

The basis of the pathogenesis of rheumatoid arthritis is autoimmune reactions that develop in response to the effect of unknown etiological factors.

These reactions are manifested by a chain of interrelated changes - inflammation of the synovial membrane (synovitis), formation of granulation tissue (pannus), its proliferation and penetration into cartilaginous structures with destruction the latter.

The outcome of rheumatoid arthritis is the development of ankylosis, chronic inflammation of pararticular tissue, contracture, deformity, subluxation of the joints.

Classification of rheumatoid arthritis

The clinical and anatomical features distinguish the forms of rheumatoid arthritis:

According to immunological characteristics, seropositive variants of rheumatoid arthritis and seronegative, which differ in the detection or absence of rheumatoid factor in the serum and articular fluid.

The dynamics of the course of rheumatoid arthritis can be different.

A rapidly progressive variant is characterized by high activity: erosion of bone tissues, deforming joints, systemic lesions during the first year of the disease.

Slowly developing rheumatoid arthritis, even many years later, does not cause gross morphological and functional changes in the joints, proceeds without systemic involvement.

According to the activity of clinico-morphological changes, three degrees of rheumatoid arthritis are differentiated. With minimal activity (stage I), minor pains in the joints, transient stiffness in the morning hours, absence of local hyperthermia are noted. Rheumatoid arthritis of average activity (II century) is characterized by pain in rest and in movement, many hours stiffness, painful limitation of mobility, stable exudative joints, moderate local skin hyperthermia. For high activity (III st.

) of rheumatoid arthritis is typical strong arthralgia, pronounced exudation in the joints, hyperemia and swelling of the skin, impassable stiffness, sharply restricting mobility.

At the stage of FN II, joint mobility is reduced dramatically, the development of persistent contractures limits self-service and leads to loss of efficiency.

Stage FN III of rheumatoid arthritis is determined by stiffness or total immobility of joints, loss of self-service and the need for constant care for such a patient.

The dominant in the clinic of rheumatoid arthritis is articular syndrome (arthritis) with characteristic bilateral symmetrical involvement of joints. At the prodromal stage, fatigue, periodic arthralgia, asthenia, sweating, subfebrile, morning stiffness are noted.

The debut of rheumatoid arthritis is usually associated with the change of metefactors, seasons of the year (autumn, spring), physiological periods (puberty, postpartum, menopause).

The provoking cause of rheumatoid arthritis can be infection, cooling, stress, trauma, etc.

With acute and subacute debut of rheumatoid arthritis, fever, sharp myalgia and arthralgia are observed; at unobtrusive progression - the changes are increasing for a long time and are not accompanied by significant functional violations. For the clinic of rheumatoid arthritis, the involvement of the joints of the feet and hands, wrists, knees and elbow joints; in some cases, the lesion affects the hip, shoulder and joints the spine.

Objective changes in rheumatoid arthritis include the accumulation of intraarticular exudates, puffiness, sharp palpatory tenderness, motor limitations, local hyperemia and skin hyperthermia.

In the outcome of rheumatoid arthritis, ankylosing and immobility of the joints occur.

When lesions of synovial vaginas tendon wrists - tenosynovitis often develops carpal tunnel syndrome channel, the pathogenetic basis of which is the neuropathy of the median nerve as a result of its compression. Paresthesia is noted, the sensitivity and mobility of the middle, index and big fingers of the hand are reduced; pain that spreads on all forearms.

Extra-articular lesions in rheumatoid arthritis

The development of extra-articular (systemic) manifestations is more typical for the seropositive form of rheumatoid arthritis of a severe long-term course.

The defeat of the musculature (interosseous, hypotenar and tenar, forearm extensors, straight femoral, gluteal) is manifested by atrophy, decreased muscle strength and tone, and focal myositis.

When involved in rheumatoid arthritis of the skin and soft tissues appears dryness and fatigue epidermis, hemorrhage; may occur meclocci necrosis of the subungual region leading to gangrene distal phalanges. Violation of the blood supply to the nail plates leads to their fragility, striation and degeneration.

Typical signs of rheumatoid arthritis are subcutaneous connective tissue nodules with a diameter of -2 cm.

Rheumatoid nodules are characterized by a rounded shape, dense consistency, mobility, painlessness, less often - immobility due to adhesion to the aponeurosis.

These formations can be single or multiple, have a symmetrical or asymmetrical localization in the region of the forearms and occiput.

Perhaps the formation of rheumatoid nodules in the myocardium, lungs, valvular structures of the heart. The appearance of nodules is associated with exacerbation of rheumatoid arthritis, and their disappearance - with remission.

In rheumatoid visceropathies due to panaritritis, skin symptoms are noted in the form of a polymorphic rash and ulceration; hemorrhagic syndrome (nasal, uterine bleeding), thrombotic syndrome (mesenteric thromboses).

Severe complications due to rheumatoid arthritis can include heart damage (myocardial infarction, mitral and aortic aortic stenosis), lungs (bronchopleural fistulas), chronic kidney failure, polyserositis, visceral amyloidosis.

Diagnosis of rheumatoid arthritis

Suspicion of rheumatoid arthritis is an indication for a rheumatologist.

Examination of peripheral blood reveals anemia; the increase in leukocytosis and ESR is directly related to the activity of rheumatoid arthritis.

Typical immunological markers for rheumatoid arthritis are the detection of RF, a decrease in the number of T-lymphocytes, an increase in cryoglobulins, the detection of anti-keratin antibodies (AKA).

X-ray criteria for rheumatoid arthritis include the detection of diffuse or spotted epiphyseal osteoporosis, narrowing of joint slits, and marginal erosion. According to the indications MRI of the joint is appointed.

To take a sample of the intra-articular fluid, puncture the joint. At a microscopy of an articulate liquid nonspecific inflammatory attributes are found out.

A study of the biopsy synovial membranes in rheumatoid arthritis demonstrates hypertrophy and an increase in the number of villi; proliferation of the plasma, lymphoid and integumentary cells (synoviocytes) of the articular membranes; fibrin deposits; zone necrosis.

Treatment of rheumatoid arthritis

At the heart of therapy for rheumatoid arthritis is the appointment of a course of high-speed (anti-inflammatory) and basic (modifying the course of the disease) drugs.

The fast-acting group includes NSAIDs (diclofenac, ibuprofen, naproxen), corticosteroids that stop inflammation and pain.

The use of basic drugs (sulfasalazine, hydroxychloroquine methotrexate, leflunomide) can achieve remission of rheumatoid arthritis and prevent / slow the degeneration of the joints.

Relatively new drugs used in the treatment of rheumatoid arthritis include biological drugs that block proinflammatory protein-cytokine-tumor necrosis factor (ethanercept, infliximab, adalimumab).

TNF-inactivating agents are administered in the form of injections and administered in combination with basic preparations.

A promising and promising technique for treating rheumatoid arthritis is stem cell therapy, aimed at improving trophic and joint regeneration.

Patients with rheumatoid arthritis are recommended exercise therapy, swimming.

To restore the function and structure of the joints, surgical interventions-arthroscopy and endoprosthetics of the damaged joints-are used.

Prognosis and prevention of rheumatoid arthritis

Isolated, localized in 1-3 joints, not a pronounced inflammation in rheumatoid arthritis allows you to hope for a favorable prognosis. Aggravating factors of the disease include polyarthritis, expressed and resistant to inflammation, the presence of systemic manifestations.

In the absence of preventive methods, only secondary prevention of rheumatoid arthritis is possible, which includes prevention of exacerbations, dispensary control, suppression of persistent infection.

A source: http://www.krasotaimedicina.ru/diseases/rheumatology/rheumatoid-arthritis

What is rheumatoid arthritis: causes, symptoms and treatment

The group of diseases of the musculoskeletal system includes rheumatoid arthritis, symptoms, treatment, diagnosis of which is known to every experienced doctor.

This pathology is systemic. This means that several organs are involved in the process at once.

Affects mainly small joints located on the periphery.

Defeat of the joints of rheumatoid nature

Chronic rheumatoid arthritis is a disease that has an infectious and inflammatory genesis and is characterized by a progressive course.

With it, the cartilages in the joint region gradually degenerate. This is an autoimmune pathology.

It develops when the body is unable to distinguish its own cells from microbial cells.

Symptoms of rheumatoid arthritis are present in, - 2% of the population. The most common are residents of developed countries. This pathology reduces life expectancy by an average of 7 to 10 years.

In ICD-10, rheumatoid arthritis has codes M05 and M06. The disease is socially significant, as it leads to disability. The causative agent was not found.

The most common autoimmune theory of the origin of the disease.

Symptoms of joint damage

How does rheumatoid arthritis start? Not everyone knows. With this disease, all symptoms are divided into articular and extraarticular. The first group includes:

• pain;
• myalgia;
• swelling;
• stiffness in the morning;
• deformation of the joints;
• difficulty in movement.

The rheumatic process primarily affects the feet and hands. First, small joints are affected. Before the onset of symptoms of inflammation, there may be weakness, sweating, and general malaise. Signs of rheumatoid arthritis in women and men include pain. It has the following features:

1. symmetrical;
2. is caused by inflammation of the joints;
3. noisy;
4. is often amplified at night;
5. disappears after NSAID administration;
6. constant;
7. It is combined with stiffness and swelling.

Most often, the first complaints appear in the winter season. The triggers are allergic reactions, mechanical trauma and surgery.

The most common disease is subacute. First, small joints are affected (wrist, metacarpophalangeal).

Significantly less often the pathological process affects the knees.

Symptoms of inflammation occur immediately from two sides. If the foot is affected, pain may appear.

The development of rheumatoid arthritis is characterized by stiffness in the joints. Such people are not able to comb their hair, prepare food and fasten their clothes.

This is due to the fact that the fingers do not straighten.

If you do not treat the patient, then there is a pronounced deformation. The intensity of morning stiffness depends on the activity of the inflammatory process.

Skin color does not change. The local temperature is often increased.

Acute inflammation often occurs with severe myalgia. Such people complain of pain in the muscles. Deformation occurs on stage 2 of the disease.

It is visible to the naked eye. There are possible signs, such as "walrus fin "swan neck" and spindle-shaped fingers. Often inflamed tendon sheaths.

Extra-articular symptoms of the disease

You need to know not only the causes of rheumatoid arthritis, but also extraarticular signs.

This autoimmune pathology can affect any parts of the body in which there is connective tissue.

Rheumatoid nodules are a specific manifestation of the disease. In such patients, small formations appear under the skin.

They have a diameter of 1 to 3 cm and are painless on palpation. Most often the nodules are localized in the area of ​​the hands and elbows.

Every experienced doctor knows not only the causes of rheumatoid arthritis, but also what organs can be affected in this pathology.

The following extra-articular manifestations are possible:

• subcutaneous hemorrhage;
• brittle nails;
• dry skin;
• flatulence;
• decreased appetite;
• pain and heaviness in the upper abdomen;
• amyotrophy.

The attending physician must take into account that the rheumatoid arthritis often disrupts the cardiovascular system. Perhaps the development of myocarditis, endocarditis, pericarditis.

With rheumatoid arthritis complications develop very often. The main reason is non-compliance with medical prescriptions.

With complicated rheumatoid arthritis, the prognosis is often unfavorable.

Against this background, the following pathologies can develop:

1. thrombocytopenia;
2. anemia;
3. amyloidosis;
4. leukopenia;
5. glomerulonephritis.

If the diagnosis is made untimely, then the nervous system is affected.

How to identify the disease

The early diagnosis of rheumatoid arthritis largely depends on the prognosis of treatment. The presence of pain and stiffness in the joints is the basis for going to the doctor. To clarify the diagnosis, the following studies are required:

• blood test for rheumatoid factor;
• general clinical studies of blood and urine;
• radiography;
• studying the density of bone tissue;
• physical research;
• test for anti-citrulline and antinuclear antibodies;
• analysis of intra-articular fluid;
• arthroscopy;
• Joint tomography;
• ultrasonography;
• biopsy.

The easiest way to assess the condition of the joints is to perform an X-ray. During the analysis of the snapshot, the following changes can be detected:

1. thinning and destruction of articular cartilage;
2. presence of erosion;
3. reduction of the lumen of the joint space;
4. signs of osteoporosis;
5. ankylosis.

Diagnosis of rheumatoid arthritis at an early stage is difficult due to a nonspecific clinical picture. There are certain criteria by which the doctor makes a verdict. The most prominent signs of rheumatoid arthritis are:

• swelling of 3 or more joints;
• stiffness in the morning;
• presence of subcutaneous nodules;
• signs of deformation and the presence of erosion on the roentgenogram;
• symmetry of defeat;
• involvement in the process of predominantly small joints.

Such a diagnostic criterion, as the detection of rheumatoid factor, is of great value. His absence in the blood does not exclude the presence of a person's illness.

Seronegative rheumatoid arthritis is diagnosed quite often.

The doctor determines the class of the disease on the basis of the results of the research, interview and examination of the patient.

There are 4 of them. At the heart of this division are such features as ability to self-service, non-professional activities, the ability to work. The most dangerous class 4 disease.

With him, there is a restriction of all three activities. In rheumatoid arthritis, differential diagnosis is performed with other inflammatory diseases of the joints.

It is necessary to exclude psoriasis, gonorrhea and osteoarthritis.

Methods of treatment of patients

Unlike other forms of arthritis, the treatment of rheumatoid inflammation has some peculiarities. In the stage of exacerbation, symptomatic therapy is performed.

After the elimination of complaints, supportive treatment is required. Recommendations should be given to the patient by the doctor.

Even the most modern methods of treating rheumatoid arthritis do not completely eliminate this pathology.

The following groups of medicines are used:

1. NSAIDs in the form of tablets and ointments;
2. corticosteroids;
3. basic drugs.

In the treatment of rheumatoid arthritis in the phase of exacerbation, anti-inflammatory drugs are used. These include NSAIDs. They suppress the synthesis of the enzyme, which is responsible for the development of the inflammatory reaction. The most commonly used medications are diclofenac based.

Is it possible to cure rheumatoid arthritis alone with NSAIDs? These medications can only eliminate pain and reduce inflammation. They do not affect the pathogenesis of the disease.

Treatment of rheumatoid arthritis with a pronounced articular syndrome is often carried out with such medications as Mig 400, Nurofen, Ibuprofen, Naproxen-Acry, Indomethacin Sopharma.

Recommendations for treatment include the intake of glucocorticoids.

Its peculiarity is in the application of a high dose of medication. Treatment of rheumatoid arthritis outside the stage of exacerbation is carried out by basic medications.

These include Sulfasalazine-EH, Methotrexate-Ebwee, Remicade, Ciclosporin Sandoz, Ecoral, Endoxane, Kuprenil.

Sometimes the scheme of therapy includes antimalarial drugs. Treatment recommendations include the use of monoclonal antibodies. To such medicines belongs Humira.

To prevent complications of rheumatoid arthritis, you must follow the treatment scheme prescribed by the doctor. Often systemic therapy is combined with a local one.

Used ointments and gels based on NSAIDs, anesthetics and anticoagulants.

Other medical treatments

You need to know not only why rheumatoid arthritis develops, what it is, but also auxiliary therapies. These include:

• physiotherapy;
• drainage of the lymphatic duct;
• lymphocytophore;
• plasmapheresis;
• irradiation;
• intraarticular injections;
• laser exposure;
• cryotherapy;
• diet.

After the diagnosis, physiotherapy can begin. It is shown in the stage of remission. Diathermy, exposure to infrared rays, paraffin applications, phonophoresis and ultrasound therapy are most often performed.

In connection with the fact that in rheumatoid arthritis, the reasons lie in the violation of the immune system and inflammation, they often appoint Wobenzym. This is a multifenznoe medicine.

It has an immunomodulatory effect and helps reduce inflammation.

To reduce the risk of complications and to stop the disease, you need to radically change your lifestyle. All patients with rheumatoid arthritis are recommended:

1. normalize weight;
2. to refuse from alcohol and smoking;
3. avoid static load;
4. move more;
5. hold gymnastics;
6. adhere to proper nutrition.

Some foods can exacerbate the disease and worsen a person's condition.

It is necessary to limit the consumption of milk and sour-milk products, cereals, citrus, fatty meat (pork).

It is recommended to enrich the diet with fish, seafood, vegetables, fruits, eggs, buckwheat and pearl barley. Food can be boiled, stewed and baked.

If a photo (X-ray) in rheumatoid arthritis reveals a rough deformity of the joint, surgical treatment may be required.

The operation is often carried out with the development of the "fin of the walrus "neck of the swan" and strong bending of the fingers of the hand.

Often, dangerous complications develop in the form of osteoporosis and kidney failure. Thus, arthritis of rheumatoid nature is a common disease. In the presence of stiffness and joint pain, it is recommended to visit a doctor and be examined.

A source: https://OrtoCure.ru/kosti-i-sustavy/artrit/revmatoidnyj-simptomy-lechenie-diagnostika.html

Rheumatoid arthritis: symptoms, treatment, diagnosis, folk treatment of rheumatoid arthritis

Rheumatoid arthritis is a systemic disease of connective tissue with lesions of mainly peripheral joints, as well as internal organs.

According to statistics, rheumatoid arthritis affects approximately 1% of people around the globe. The average age of the onset of the disease is forty to fifty years.

Women are more often ill than men.

1. Causes of occurrence 2. Symptoms of rheumatoid arthritis - Articular symptoms - Extraarticular symptoms 3. Diagnosis of rheumatoid arthritis - Nonspecific diagnostic methods - Specific diagnostic methods - Auxiliary diagnostic methods 4. Treatment of rheumatoid arthritis - Symptom-modifying drugs - Basic antirheumatic drugs - Disease-controlling drugs - Non-drug therapy

Causes

The nature of rheumatoid arthritis is very complicated.

The main cause of the pathology is considered autoimmune process, when the immune system perceives its cells alien and attacks them.

It is assumed that such anomalous activity of the immune system is due to a genetic predisposition.

Factors triggering the disease include:

Symptoms of rheumatoid arthritis

Rheumatoid arthritis occurs with joint damage, as well as internal organs.The severity of the clinical picture of the disease depends on the degree of activity of the pathological process:

• I - Low activity;
• I I - Moderate;
• III - High;
• 0 - Remission.

The disease first manifests itself in the form of general, nonspecific symptoms. The person notes that he began to get tired quickly, feels weak. Periodically slightly increases the temperature, it would seem, without any apparent cause, there is sweating.

Muscular pains, aches in the body are noted. Often the disease develops slowly, the clinical symptoms unfold within a few months, and sometimes even years. At this time, signs of joint damage begin to appear.

Much less often the disease develops sharply or subacute.

Articular symptoms

Rheumatoid arthritis has several features that allow it to accurately differentiate it from other diseases.

In most cases, the disease manifests itself in polyarthritis (lesion of more than three joints), less often with oligoarthritis (involvement of two joints) or with monoarthritis (a lesion of only one joint).

In rheumatoid arthritis joints are affected symmetrically, that is, if the joint of the finger on the left arm is affected, then on the right arm also inflammation of the analogous joint is observed.Most commonly affected are the following joints:

1. Pseudo-phalanx (with the exception of the joint of the thumb);
2. Proximal interphalangeal;
3. Plyusnefalangovye;
4. The knees;
5. Wrist-wrist;
6. Elbow;
7. Ankles.

A characteristic sign of rheumatoid arthritis is the appearance of morning stiffness.

This symptom is characterized by the fact that after awakening a person notes the difficulty of mobility and increased pain in the joints.

This symptom develops due to the fact that inflammatory exudate accumulates in the cavity of the affected joint at night, which limits the function of the joint. This condition lasts more than half an hour.

Gradually, the stiffness disappears and the person begins to feel more comfortable, the mobility in the joint is restored. In general, rheumatoid arthritis is characterized by persistent aching joint pain.

Rheumatoid arthritis progresses in three stages.

Onfirst stageedema of the synovial bag of the joint develops and inflammatory exudate is produced, which is manifested externally by swelling of the joint, local increase in skin temperature, and pain.

Onthe second stagethe cells of connective tissue are actively divided, which causes the synovial membrane to thicken.

Onthe third stageinflamed cells produce a special enzyme that leads to deformity of the joints, increased pain and loss of motor function. Depending on the location of the pathological process, such types of deformities of the hand as spindle-shaped fingers, the neck of a swan, and the type of a buttonhole can be observed.

Extra-articular symptoms

Because rheumatoid arthritis is a systemic disease, many patients develop a defeat of many internal organs.Often, organs such as:

• Leather;
• A heart;
• Lungs;
• Kidneys;
• Body of sight;
• Nervous system.

In 20-50% of patients ariserheumatoid subcutaneous nodules. They are dense subcutaneous painless formations up to two centimeters in diameter. Often, nodules arise in the area of ​​the elbow, the Achilles tendon, over the small joints of the hand.

Rheumatoid nodules can also occur in internal organs, for example, in the lungs.

Often, patients with rheumatoid arthritis are affected by pleural pleura with the development of pleurisy and interstitial tissue with the development of interstitial pneumonia.

It is believed that mortality from pulmonary pathology among patients with rheumatoid arthritis is twice higher than in the general population.

Vascular damage manifests itself in the form of vasculitis, which underlies diseases of many organs. On the skin, vasculitis is manifested by hemorrhagic rash.

With rheumatoid arthritis, any layer of the heart can be affected: endocardium, pericardium, myocardium.

Most often there is pericarditis - inflammation of the pericardial sac, sometimes accompanied by effusion.

It should be noted that in patients with rheumatoid arthritis, atherosclerotic vascular lesions are observed in young years.

A serious threat to life is kidney damage.

In patients with a long-term form of rheumatoid arthritis, amyloidosis of the kidneys can occur - the deposition of the pathological protein amyloid in them.

In addition, with this disease, the organ of vision can be affected in the form of dry keratoconjunctivitis, the nervous system in the form of neuropathy, and the defeat of muscles in the form of muscle weakness and pain.

Diagnosis of rheumatoid arthritis

Diagnosis of rheumatoid arthritis is very extensive. Nonspecific, specific and auxiliary methods of investigation can be used to detect the disease.

Nonspecific methods of diagnosis

First of all, traditional clinical trials are conducted. The clinical analysis of blood determines the increase in the number of leukocytes, the acceleration of ESR, the reduction of hemoglobin.

When biochemical blood test can detect an increase in the level of fibrinogen, sialic acids, as well as C-reactive protein, haptoglobin. However, such changes are not specific and can be observed in various diseases.

Specific diagnostic methods

Confirm the diagnosis of rheumatoid arthritis allows the identification of specificmarkers of the rheumatoid process. In particular, approximately 60% of patients in the blood show uprheumatoid factor.

This is an autoantibody to own immunoglobulins G. High factor titers correlate with the severity, rapid progression of the pathological process.

If the patient was able to detect a rheumatoid factor - doctors say about seropositive rheumatoid arthritis, if the factor is not found - about seronegative.

One of the most sensitive methods, which makes it possible to use it in diagnosing the disease at an early stage of the disease, isdefinition of anti-citrulline antibodies (ATSTSP).

Citrulline is an amino acid that forms during inflammation. Cells containing citrulline are recognized by the immune system as foreign, which is why antibodies are produced to them.

In rheumatoid arthritis, the test for ACP is positive in about 80% of cases.

Auxiliary diagnostic methods

Auxiliary diagnostic method issynovial fluid research.

In the liquid, it is possible to detect such changes as a decrease in its viscosity, an increase in leukocytes and neutrophils, a change in color, transparency.

For the examination of affected joints, X-ray examination and arthroscopy are used. Early X-ray indications are periarticular osteoporosis, fuzzy joint contours, erosion on articular surfaces.

Treatment of rheumatoid arthritis

Recommended reading:Diet for rheumatoid arthritis

Patients with rheumatoid arthritis need to undergo treatment in a rheumatological hospital.The following groups of drugs are used in therapy:

1. Symptom-modifying drugs;
2. Disease-modifying (they are basic) antirheumatic drugs;
3. Disease-controlling drugs.

Symptom-modifying drugs

The purpose of this group of drugs is a rapid reduction of local inflammatory phenomena, pain, until the basic drugs act. This group of drugs include NSAIDs and glucocorticoids.

NSAIDs have anti-inflammatory, antipyretic and analgesic effects.

The anti-inflammatory effect is realized due to inhibition of the enzyme cyclooxygenase, which takes part in the synthesis of inflammatory mediators. There are two of its isoforms: COG1 and COX2.

Accordingly, NSAIDs are distinguished which primarily affect COX1 or COX2. The first include Ibuprofen, Diclofenac, Indomethacin, the second - Meloxicam, Celecoxib.

Both have an anti-inflammatory effect. However, the blockers of COX2 do not have an aggressive effect on the mucosa of the gastrointestinal tract, in contrast to the blockers of COX1.

Glucocorticosteroids have an expressed anti-inflammatory effect. Low doses of glucocorticoids are used as "bridge therapy" until the basic antirheumatic drugs begin to act.

In some cases, large doses of glucocorticoids are administered in a few days, called "pulsterapia." Glucocorticoids are also used topically - by insertion into the affected joint.

However, in this case, it is possible to suppress only local inflammation.

Basic antirheumatic drugs

These are drugs that have an effect not immediately, but due to their ability to interfere with the immune mechanisms of the disease, they can lead to a prolonged remission.

The basic drugs include:

• D-penicillamine;
• Preparations of gold;
• Salazo compounds;
• Cytotoxic drugs;
• Quinoline derivatives.

Principle of therapy with basic drugs: first, high doses of the drug are prescribed to suppress the inflammatory process.

In the future, the dose of the drug is gradually reduced and reaches a therapeutic dose, which should be used for a long time.

If after four to six months of treatment with one or another basic drug, a positive result can not be achieved - then it is necessary to change the medication.

Disease-controlling drugs

The action of these drugs (they are also called biological agents) is aimed at inhibiting the synthesis of "anti-inflammatory" cytokines - TNF-a and IL-1. These are modern genetic engineering preparations that allow patients to be cured with resistance to the action of other drugs.

This group includes the following drugs:

1. Remicade;
2. Humirah;
3. Rituxan;
4. Kinneret;
5. Embryla.

Despite its undeniable effectiveness, disease-controlling drugs also have disadvantages. The most important drawback is the high cost of drugs. Since it is necessary to be treated with these medicines for a long time, it turns out that not everyone can afford this kind of treatment.

Non-drug therapy

Non-drug therapy plays no less a role than treatment with medicines.

Thus, patients with rheumatoid arthritis need to follow a diet that is described in detail in the article "Diet for Rheumatoid Arthritis."

Those who want to recover need to give up smoking, because it worsens the course of the disease.

Patients are shown moderate (not excessive!) Gymnastic exercises, massage.

Favorably affects the course of the disease, sanatorium treatment and physiotherapy (balneotherapy, mud therapy, laser therapy, magnetotherapy, UHF, electrophoresis).

A source: http://OkeyDoc.ru/revmatoidnyj-artrit-simptomy-lechenie-i-diagnostika/