Rheumatoid arthritis is a chronic systemic autoimmune disease that is accompanied by damage to the joints of the extremities with the development of destructive changes in them. This is one of the most common pathologies. The main symptoms of rheumatoid arthritis are inflammatory pain, as well as progressive dysfunction of the joints.
Rheumatoid arthritis leads to a decrease in the patient's quality of life and disability. Concomitant diseases, such as damage to the cardiovascular system, lungs, and kidneys, can significantly shorten the patient’s life. The causes of rheumatoid arthritis are poorly understood.
It is known that the Epstein-Bar virus plays a significant role in the development of the disease, which negatively affects lymphocytes involved in immune processes. Changed lymphocytes accept the cells of the synovial membrane of the joint as foreign and begin to attack them. As a result, the body destroys its own joints.
It has been revealed that 90% of patients with rheumatoid arthritis are carriers of the disease gene. Based on this, it is generally accepted that the disease is inherited. For a person whose relatives suffer from rheumatoid arthritis, the risk of getting the disease increases several times.
In addition, it has been studied that there is a certain connection between altered DNA sections and the progression of the disease. Hereditary factors also influence the severity and outcome of the disease. A person with a tendency to autoimmune diseases (systemic lupus) may also develop rheumatoid arthritis.
The risk of this disease increases several times in women. The reason for this is the hormonal characteristics of the female body. It has been established that in pregnant women the disease goes into stable remission. However, after childbirth, the disease can recur and occur with complications.
Breastfeeding stops the progression of the disease. The longer a woman breastfeeds, the more her risk of developing rheumatoid arthritis decreases. The risk has also been shown to be reduced among women taking hormonal contraceptives.
Old age is also a predisposing factor. People over 60 years of age suffer from the disease several times more often than at a young age. People who do not watch their diet or lead an unhealthy lifestyle are more likely to suffer from arthritis.
Initially, inflammation occurs in the joint capsule, where substances with autoimmune properties rush. The concentration of these substances increases over time in the joint cavity and becomes the cause of an immune-inflammatory reaction. The tissues of the joint begin to deteriorate. In turn, the immune system, in response to inflammation, begins to produce large quantities of antibodies.
Thus, predisposing factors involve almost all components of the immune system in the process of autoimmune reactions. The body produces substances that are responsible for the progression of changes in the joints.
Autoimmunity is a condition in which the human body begins to form substances (antibodies) that attack the cells of its own body. During normal functioning of the immune system, the reaction occurs only to foreign cells (antigens).
Functional disorders of the immune system cause the production of aggressive substances that enter into an immune reaction. In the synovial bursa of the joint, cells perceive these substances as foreign and produce specific antibodies called rheumatoid factors.
In the joint cavity, entire immune complexes are formed, which spread through the peripheral circulatory system, are deposited in tissues (synovium, soft tissues of the joint, cartilage, internal organs) and affect them. The progression of the disease forms a typical clinical picture involving not only joints, but also many organs and systems in the pathological process.
Sometimes such aggression from the immune system can be provoked by an acute infectious disease or a chronic, sluggish infection. After suffering respiratory diseases, viruses may remain inside the joints of patients, to which immune cells subsequently react. Viruses of hepatitis, herpes, measles, mumps can cause the development of the disease. In rare cases, rheumatoid arthritis can be triggered by hypothermia or injury.
In most cases, a malfunction of the immune system and the development of rheumatoid arthritis begins after suffering strong emotional stress, depression, and constant stress. The body produces stress hormones that can increase the immune response by attacking its own joints.
Rheumatoid arthritis is a pathological process expressed systemically: connective tissue is affected. The patient’s immune system itself initiates a process that damages the body’s own tissues. First, small joints suffer, then the disease spreads to others. This disease leads to disability in almost 70% of cases, and the death of patients with rheumatoid arthritis often occurs from renal failure or infectious complications of the disease.
Unfortunately, it is impossible to stop rheumatoid arthritis forever. The picture of the disease may change, but attacks of acute pain and periods of remission are inevitable. All medications only help relieve pain, slow down the progression of the disease, adapt to this condition and restore damage caused by pathological processes. The sooner a doctor makes a diagnosis, the greater the chance of minimizing damage to your joints.
Destructive erosive processes associated with joints and rheumatoid arthritis can occur for a number of reasons. But modern medicine still does not have a concrete answer to the question of what exactly leads to systemic disease.
Science does not have an answer to the question about the specific causes of rheumatoid arthritis. But doctors, in the course of observing patients, have identified some patterns, the presence of which with a high degree of probability suggests the development of rheumatoid arthritis. What exactly triggers the immune reaction that destroys joints is not clear, but it is possible to identify 3 main factors that provoke the disease:
With a genetic predisposition, a defect in the immune system is inherited, which causes the body's defense cells to “attack” its own cells. A large number of damaged cells and fluid provoke destructive and inflammatory changes in the synovium and cartilage.
An increase in the number of leukocytes in the blood and indicators of erythrocyte sedimentation rate - ESR - detected in patient tests indicate the infectious roots of the process. But practice shows that treatment of rheumatoid arthritis with antibiotics is ineffective, which means that the assumption about the exclusively infectious nature of RA is incorrect.
The first attack occurs, as a rule, after heavy physical labor, or due to emotional shock and fatigue, exposure to any unfavorable factors, during a hormonal imbalance, or due to infection.
Despite the fact that infections and heredity are classified as separate points, it is usually a combination of these factors that leads to illness. A combination of factors, coupled with the cause of illness, which can be any reaction of the body (stress, overload, etc.), apparently triggers the process of the body “attacking” its own tissues.
There is no reliable information that joint damage is caused solely by the presence of infections or microorganisms. However, many people suffering from rheumatoid arthritis have bacterial, fungal or viral infections that become a catalyst for the development of inflammatory and destructive processes.
It happens that autoimmune aggression is preceded by a sore throat, acute respiratory infection or flu, an acute attack of any chronic infection. Immune cell receptors respond to microbial particles remaining in the joints. Rheumatoid arthritis can develop after infectious or reactive arthritis.
Often the onset of the disease is associated with severe emotional shock. Almost 40% of patients say that they suffered severe stress and experiences before the disease made itself felt. There are even a number of scientific works exploring the role of emotions in the development of RA. Scientists of the early twentieth century. L. Shapiro and F.A. Johnson described the characteristic behavior of patients with RA.
The habit of restraining emotions, masking irritation, excessive emotional restraint, long-held anger, guilt, chronic resentment, a negative outlook on life, anger - can lead to the development of arthritis, in the presence of a triad of risk factors.
And although not every person who controls their emotions gets arthritis, this factor can still be the cause of the disease.
If nothing can be done about heredity, then you can work with the other two factors of the triad. It is important to detect the disease as early as possible so as not to give it a chance to “eat” the joints. Pay attention to your condition. The disease is preceded by a period characterized by increased fatigue, weight loss, decreased appetite, sweating, morning stiffness, and periodic arthralgia.
The disease begins to develop only when several unfavorable circumstances coincide, therefore, knowing your predisposition to autoimmune diseases, protect yourself from stress, heavy workload, etc. Calmness, confidence, a joyful mood and a positive attitude towards life are the best therapy for any illness. Try not to hold back strong emotions, normalize your state of mind, allow yourself to be yourself. This may require the help of a psychologist.
And by the way, there are medical statistics indicating that the duration of breastfeeding significantly reduces the chances of developing RA in women. And if a woman breastfeeds her child for more than 24 months, then the risk of rheumatoid arthritis is reduced by half.
Rheumatoid arthritis is a chronic autoimmune disease with persistent, symmetrical damage to small and large joints, involving internal organs and systems (lungs, heart and blood vessels, kidneys, skin, eyes) in the inflammatory process.
The course of rheumatoid arthritis is most often progressive, which leads to the destruction of articular cartilage in the form of erosions and destruction of the bones that form the joint, followed by deformation of the joints and disruption of their function.
The autoimmune nature of inflammation suggests that the immune system perceives its own tissues as foreign and actively attacks and damages them.
Characteristic manifestations of articular syndrome in rheumatoid arthritis include:
The most common systemic manifestations of rheumatoid arthritis:
If swelling of the joints is persistent for several days or more, morning stiffness in the hands for more than 30 minutes, you should consult a rheumatologist.
The causes of rheumatoid arthritis have not yet been established.
It is only known that the immune system malfunctions and begins to attack its own tissues, which leads to their inflammation. In rheumatoid arthritis, joints and periarticular structures are affected, which is caused by the accumulation of inflammatory intra-articular fluid in them.
Objective examination: will allow you to clarify the number of painful and swollen joints. Assess the function of the joints: range of motion in them, muscle strength in the limbs, muscle condition, identify rheumatoid nodules.
Laboratory research methods
Instrumental research methods
Ultrasound of the joints: will determine the presence of excess fluid in the joint, signs of inflammation of the periarticular tissues, tendons, proliferation of the synovial membrane, damage to the articular cartilage - in the form of its erosion.
X-ray of joints: at the early stages may not be informative, later it reveals the presence of bone erosions of the articular surfaces, deformation of the joints.
Magnetic resonance imaging (MRI): in the early stages of the disease will help determine the presence of initial erosive changes in the joints.
With early diagnosis, timely diagnosis and the appointment of adequate therapy, it is possible to slow down the destruction of articular cartilage and bone structure.
Drug treatment of rheumatoid arthritis
Complex therapy for rheumatoid arthritis includes the use of several classes of medications:
Synthetic base drugs include methotrexate, leflunomide, sulfasalazine, hydroxychloroquine. Their combination is also possible: methotrexate + leflunomide or methotrexate + sulfasalazine. If a positive result is obtained, it is recommended to take them for several years while maintaining effectiveness.
Modern basic therapy is represented by immunobiological drugs that provide targeted blocking of immune system factors that trigger an autoimmune inflammatory process in the joints.
These include:
With the help of these drugs, you can quickly achieve remission of the disease and prevent the progression of arthritis.
Intra-articular administration of glucocorticoids is an effective treatment method used for persistent swelling of one or more joints. It is an auxiliary method of treating rheumatoid arthritis. Before administering drugs, it is necessary to remove excess synovial fluid. The manipulation must be carried out under ultrasound guidance.
Non-drug treatment of rheumatoid arthritis
Much attention must be paid to physical therapy to preserve joint function, strengthen the muscles surrounding the joints, and prevent subluxations. Rational and timely use of orthoses, canes, crutches to reduce stress on joints.
Surgical treatment of rheumatoid arthritis
Arthroscopic removal of hypertrophied synovial membrane for persistent swelling of the knee joints (synovitis); corrective surgeries for joint deformities.
In case of severe disorders in the joints, leading to loss of their function, total joint replacement is indicated to completely restore the functions of the limbs.
The most important thing is to prevent the development of disability.
There is no specific prevention.
Prevention of rheumatoid arthritis consists primarily in the sanitation of foci of chronic infection (chronic tonsillitis, etc.).
Constant monitoring by a rheumatologist.
Maintaining a healthy lifestyle (observing sleep and wakefulness, rational, high-quality nutrition, giving up bad habits and excessive physical and psycho-emotional stress).
Engaging in physical therapy, which aims to delay or even prevent the development of contractures, immobilization and deformation of joints, and muscle atrophy.
It is necessary to limit the consumption of fats, sugar, salt, eat more vegetables and fruits, dairy products, and cereals.
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Rheumatoid arthritis is a chronic inflammation of the joints caused by a person's own immune system. According to statistics, about 20 million people in the world suffer from RA. In Russia, the annual increase in cases (only with an established diagnosis) increases by 3-4%. Moreover, up to 50% of patients become disabled within the first five years.
The highest incidence falls on the active working age of 30-45 years, which makes the problem acute not only from the point of view of the sick person, but also brings it to the state level. Since this not only takes away the labor of the state, but also requires active investment for the treatment of such patients.
In general, the relevance of the problem is quite transparent.
Risk factors for rheumatoid arthritis include the following:
A protein (immunoglobulin M) constantly floats in the human blood, which is the first to recognize a stranger (bacterium, virus, etc.). It comes into contact with a stranger, as a result of which it changes in such a way that it itself becomes alien to the body. A large number of such proteins begin to form.
The protein of the second line of defense (immunoglobulin G), the one that catches those who are already reliably known not to be theirs. Since the altered first protein has already received a slander, the second protein begins to actively catch it, bind it (forming rheumatoid factor) and transfer it to the articular cartilage and vascular wall. There they are attached together to special cell receptors. This is the red button for nuclear war. They press it.
As a result, inflammation is triggered, which indiscriminately damages the entire area around the attached proteins along with them. Here is the most simplified diagram of the onset of the development of rheumatoid arthritis.
Once the process starts, shifts occur at many levels of the body. This starts the course of the disease in a vicious circle. That is, the resulting inflammation provokes increased inflammation and so on. Characteristic of autoimmune pathology is symmetrical damage to the joints. The small joints of the hands and feet are involved in the initial stages. As the disease progresses, the pathology moves to new joints.
The inflamed tissues of the joint itself and those around it begin to change and grow with connective tissue, thus disrupting the normal structure and function of the joints.
The patient begins to feel stiffness when moving and pain. In the future, this leads to pronounced specific deformations of the joints. This is clearly noticeable on the fingers of the hands, in which subluxation of the phalangeal joints occurs, and deviation of the wrist joint towards the elbow, which in ancient times was figuratively called the “swan neck”. Also, a figurative expression like “walrus flippers” characterized the deformation of the feet.
Unfortunately for everyone, no one knows for sure a stranger who changes immunoglobulin in person. The disease is characterized by a smart word - polyetiological, which means the presence of several causes causing the development of the problem. In fact, the exact reason is unknown.
There are several theories that may trigger the onset of the disease:
The disease most often develops after hypothermia, joint injury or severe stress.
Rheumatoid arthritis is a systemic disease. This implies damage not only to joints, but to other organs and systems:
As you can see, the exact causes of rheumatoid arthritis are not known. The scientific community continues to question its origins and search for effective treatments. However, the disease has not yet been completely cured. Using complex methods, it is possible to put it into remission (when the disease seems to go to sleep and does not harm the carrier), sometimes stable, sometimes not so much.
The most important thing is to recognize the disease as early as possible and begin individual effective treatment as soon as possible.
Tags: rheumatism, joints
Reactive arthritis , known as Reiter's syndrome, is a rheumatological disease characterized by combined damage to the joints (mono- or polyarthritis), the urogenital tract and the ocular mucosa.
Reactive arthritis is a general term for inflammatory diseases of the ligaments, tendons and joints. One of the most noticeable signs of this disease is that it can affect the eyes, bladder, and urethra. The condition is called "reactive" because it develops in response to a bacterial infection.
Symptoms of reactive arthritis usually appear 2-4 weeks after a genitourinary or digestive tract infection. Symptoms associated with reactive arthritis include:
Urinary problems are often the first symptoms in men. Symptoms may recur in some people, and in rare cases, reactive arthritis can become a chronic condition.
Reactive arthritis is more common among people 20–40 years old, and men are three times more likely to be affected than women. Chlamydia, which causes infection and is usually spread through sexual contact, is most often associated with reactive arthritis.
Eating contaminated food can cause diseases of the gastrointestinal tract and result in reactive arthritis. Bacteria that are responsible for the disease:
Not every person who is exposed to bacteria develops reactive arthritis.
Reactive arthritis is also one of the first symptoms of HIV infection.
There are currently no special laboratory methods for detecting reactive arthritis. To make a diagnosis, doctors use:
Because reactive arthritis is difficult to diagnose, less severe cases may not be detected.
Treatment for reactive arthritis is as follows:
Scientists have found that if chlamydia is the cause of reactive arthritis, early treatment may be especially helpful and stop the disease from progressing.
Medicines include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are used to reduce swelling and discomfort.
Corticosteroids are used to reduce inflammation. The drug can be injected into the joints.
Antirheumatic drugs are used for chronic and serious cases.
Sulfasalazine is used for gastrointestinal tract infections.
Combination therapy includes several antibiotics.
Symptoms of reactive arthritis gradually disappear over 3 months to 1 year.
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About 25 million Russian adults currently suffer from some form of arthritis , a chronic condition that causes pain and stiffness in and around one or more joints of the body.
Some known risk factors for arthritis—including your age and gender—are inevitable; while others, such as being overweight or obese, are under your control. But there are other factors you may not be aware of that can ultimately lead to arthritis pain.
Read on to uncover some surprising things that may contribute to the development of arthritis.
Research has suggested a strong link between drinking decaffeinated coffee and the risk of developing rheumatoid arthritis (RA). Another study found that women who drank large amounts of tea also had an increased risk of developing RA. Whether the risk is in the tea itself or the preparation method remains unclear.
By wearing high heels, women increase the stress [pressure] on their knee, which can increase the development of knee arthritis. Narrow toe boxes are likely to contribute to arthritis in the feet.
One small study found that a heel length of 4cm may affect the rate and progression of osteoarthritis, a type of arthritis caused by aging. Wear heels less frequently after age 40 to reduce your risk of developing arthritis.
The habit of writing unlimited amounts of text on your phone (SMS) may increase your risk of developing arthritis in your hand. It's right. Frequently texting makes your thumb sore.
Data are not yet available, in part because arthritis can take many decades to develop and texting is a relatively recent phenomenon. But it's still a good idea to give your thumbs a break when you can.
Many people know that broken bones contribute to arthritis pain. It's true that not all bone fractures are a risk factor for arthritis, but broken bones increase the risk of arthritis in the joint near the bone.
The reason for this is a change in the way joints are loaded. The load across the fracture is no longer distributed properly, especially if the fracture passes through the joint.
Take time to heal and do all recommended physical therapy to prevent arthritis from developing.
You probably know how important your knees are.
The knee is a complex joint and is vulnerable to injury because it is not surrounded by much soft tissue. As a result, even a torn ligament in the knee can contribute to the risk of arthritis. Protect your knees and take proper care of them if they are injured.
People with flat feet have a higher risk of developing knee pain and an increased risk of arthritis on the inside of the knee.
This occurs because flat feet change the weight bearing of the body from the foot to the hip and knee. If you have flat feet, you may be able to reduce your risk of arthritis by adding support to your shoes to correct the imbalance.
The cause of rheumatoid arthritis is an autoimmune reaction that damages joint tissue. Perhaps the trigger for such an immune reaction is a hereditary predisposition.
The pathogenesis of this disease is based on an autoimmune process. Currently, scientists do not yet know what exactly causes the immune system to attack its own cartilage cells. There is no doubt that such an immune reaction is genetically determined, but, in addition to genes, there must be some factor that would trigger the disease program. Perhaps the factor is a virus. Although there is no exact data on this yet.
Typically, joint damage begins with inflammation of the synovium, after which the pathological process progresses, affecting the entire joint.
There are several categories of people who have a relatively high chance of developing rheumatoid arthritis. Factors in the development of this disease include:
Rheumatoid arthritis is a disease for which you need to see a doctor as early as possible. Unfortunately, it is impossible to completely get rid of rheumatoid arthritis. This is a chronic progressive disease. However, adequate treatment of arthritis and strict adherence to all the requirements and recommendations of the doctor, which may include taking NSAIDs (meloxicam), glucocorticosteroids (Diprospan, etc.) and enzyme preparations (Wobenzym), will significantly improve the patient’s quality of life and help achieve long-term remission.
With the onset of cold weather, many diseases worsen, one of which is rheumatism. What are its risk factors, what is the treatment and is it possible to avoid this scourge altogether?
Rheumatism: risk factors. Rheumatism has been known to mankind for a very long time. The symptoms of this disease are described in the treatises of Ancient Chinese medicine and the works of Hippocrates. Nowadays, when we mention rheumatism, we immediately think of inflamed, swollen joints. However, in reality the disease is more multifaceted.
In medical terms, rheumatism is a systemic infectious-allergic disease affecting the tissues of the cardiovascular system and joints. Interestingly, women suffer from rheumatism approximately 3 times more often than men, but in the mature age category this difference disappears. Recently, cases of rheumatism in children and adolescents have become more frequent , and the disease usually develops after untreated respiratory viral infections or tonsillitis. The main cause of rheumatism is considered to be streptococcal infection , which affects an organism with reduced immunity. Such damage by streptococcus (group A) is responsible for the acute phase of the disease. Subsequently, with prolonged manifestations of rheumatism, allergic and autoimmune causes of unpleasant symptoms come to the fore. It has also been shown that certain genetic factors play a key role in the predisposition to rheumatism, which means that blood relatives are more likely to suffer from rheumatism.
Symptoms of rheumatism . As we noticed, rheumatism primarily affects the joints, and such a lesion is called rheumatoid arthritis . By the way, among joint disorders, rheumatoid arthritis is the most common. If the disease affects several joints at once, it is called polyarthritis . The ankle and wrist joints are especially vulnerable to this form of rheumatoid arthritis. If only one type of joint suffers (usually a large joint, for example, the knee or elbow), then this is rheumatoid monoarthritis . Interestingly, the joints become inflamed symmetrically, that is, on both limbs simultaneously.
The first symptom of acute rheumatoid polyarthritis is increasing, acute pain in the joints, which intensifies even with small movements. Against the background of pain, swelling of the articular area and soft tissues above the articular joint appears. The pain worsens when touched, and the skin warms up. Often the acute phase of rheumatism is accompanied by a high temperature of up to 38-40C and profuse sweating. Interestingly, the manifestations of arthritis are very “volatile”: they can quickly disappear in some joints and just as quickly move to others. Without treatment, over time, rheumatoid arthritis affects more and more joints, becoming chronic. At the same time, it is difficult for patients to move, and in the morning they feel particularly stiff in their limbs.
With rheumatism, in addition to arthritis, enlarged lymph nodes, as well as disturbances in the functioning of the peripheral nervous system (neuritis), are possible. Such extra-articular symptoms indicate reduced body resistance and high disease activity. With timely treatment, which we will discuss below, unpleasant symptoms eventually subside. The most dangerous complication of rheumatism is damage to internal organs: kidneys, lungs and heart ( myo- and endocarditis ). Thus, rheumatism accounts for about 80% of acquired (that is, acquired after birth) heart defects . Disturbances in the functioning of the heart muscle and valves lead to shortness of breath, increased heart rate, various arrhythmias, and chest pain.
Drug treatment. At the first signs of acute rheumatism, bed rest or even hospitalization is indicated, which takes up to several weeks. During this period, it is especially important to follow the doctor's instructions and regularly take a number of medications. Typically, to relieve the symptoms of rheumatism, use:
If heart damage is detected, it is possible to use drugs to stimulate cardiac activity - cardiac glycosides ( strophanthin, digoxin ), as well as diuretics ( furosemide ). Diet is also of great importance: it is necessary to enrich the diet with fruits, vegetables, eggs, easily digestible proteins (chicken meat, lean veal, fish). To maintain cardiac function, you should pay attention to foods with a high content of potassium ions (dried apricots, potatoes, buckwheat porridge), and to stimulate the immune and anti-inflammatory response - with vitamin C (rose hips, bell peppers, cauliflower, citrus fruits). It is important to limit your intake of table salt and excess fluids, as they contribute to swelling and increase the load on the heart.
Physiotherapeutic procedures ( warming with UHF lamps, medicinal electrophoresis, infrared radiation ) are also widely used to eliminate rheumatism. Paraffin and mud applications to affected joints, as well as radon, oxygen, and hydrogen sulfide baths are effective . The listed procedures are included in the offer of many sanatoriums, which is why spa treatment is very popular among those suffering from rheumatism. When acute symptoms subside, it is important to perform therapeutic massage and exercise to maintain joint function.
People's first aid kit. Traditional medicine recipes offer effective remedies for relieving pain, eliminating swelling, and saturating joints with anti-inflammatory components.
Arthritis (from the Latin arthritis - aching joints) is a general designation for all types of inflammatory processes in the joints, acting as independent nosological forms or manifestations of systemic pathology. As the disease progresses, inflammation spreads to adjacent tissues: synovium, bursa, ligaments, tendons, muscles and bones.
The reasons for the development of inflammatory processes in the joints can be very diverse. Acute inflammation can be caused by injury, infection, an allergic reaction, or toxic substances entering the joint cavity from snake, spider, and poisonous insect bites. The chronic form often develops against the background of various disorders in the functioning of internal organs and systems:
The occurrence of reactive arthritis is most often associated with enterobacteria, chlamydia and mycoplasma. In the case of rheumatoid arthritis, genetic predisposition is of paramount importance.
Among the statistically significant risk factors for the development of arthritis, WHO names age over 65 years, overweight, arterial hypertension, kidney disease and being female: due to sudden changes in hormonal levels during menopause, women get sick more often than men. In Russia, inflammation of the joints is observed in approximately 60% of people of retirement age against the backdrop of a trend toward increasing incidence and decreasing age of first manifestation of the disease. Diagnosis of neuroarthritic diathesis in childhood increases the likelihood of developing arthritis in adulthood.
Often the cause of arthritis is constant microtrauma of joint structures during professional sports and heavy physical labor, when there is intense stress on the same muscle groups. On the other hand, a sedentary lifestyle also contributes to the development of inflammatory processes in the joints, especially when physical inactivity is combined with alcohol abuse, an unbalanced diet and a lack of vitamins in the diet.
Due to the variety of manifestations of arthritis, in clinical practice it is customary to distinguish different forms of the disease, which differ in the specific clinical picture and therapeutic measures. Depending on the nature of the course, acute and chronic arthritis are distinguished, and three forms of the disease are differentiated based on the number of affected joints:
Based on the prevailing etiological factor, a distinction is made between primary arthritis with an independent pathogenesis and secondary arthritis as a consequence of the underlying disease. Primary forms include infectious, traumatic and rheumatoid arthritis, juvenile idiopathic arthritis, Still's disease, as well as inflammation of the joints due to osteoarthritis and spondylitis.
Secondary arthritis occurs against the background of a number of diseases, the most famous of which are dysentery, tuberculosis, gout, diabetes mellitus, systemic lupus erythematosus, gonorrhea, borreliosis, psoriasis, purpura, hepatitis, granulomatosis, hemochromatosis, Reiter's syndrome and others. Inflammation of the joints that develops after suffering nasopharyngeal, intestinal and genitourinary infections is called reactive arthritis.
In the early stages, acute infectious arthritis responds well to treatment until complete restoration of joint function.
In the dynamics of the pathological process in arthritis, four stages are distinguished:
The symptoms of arthritis depend on the stage and form of the disease. General signs of joint inflammation are nonspecific: in the early stages of the pathological process, moderate pain and stiffness in the joints are often attributed to fatigue, hypothermia and age-related changes. When some joints become inflamed, warning signs may appear:
Most patients consult a doctor at stage II of the disease. Constant discomfort in the joint area, the appearance of sensitive swelling caused by excess production of synovial fluid, a characteristic crunch, erythema and swelling of problem areas are clear signs of inflammation. Forced positioning of the body and limbs may indicate severe muscle spasms due to loss of joint mobility.
Specific symptoms are inherent only in some forms of the disease. Reactive arthritis is characterized by asymmetrical inflammation of the joints of the extremities accompanied by fever, headache and conjunctivitis. In some cases, signs of a urinary tract infection are added. Valgus deformities of the thumbs and toes give reason to suspect gouty arthritis, and in the case of psoriatic arthritis, the joints of the hand are severely deformed and thickened.
In rheumatoid arthritis, the joints are affected symmetrically, and dense nodules form in the flexure areas. During the period of remission, discomfort is felt mainly in the morning and practically disappears by the afternoon. Exacerbations are accompanied by fever, numbness of the extremities, pain when inhaling, inflammation of the lymph nodes and salivary glands, photophobia and pain in the eyes.
There are two forms of arthritis that are diagnosed exclusively in childhood - juvenile idiopathic arthritis and juvenile rheumatoid arthritis, or Still's disease. Both diseases are characterized by a persistent course and poor response to therapy; with Still's disease, in addition to the joints, internal organs are often affected.
Diagnosis of neuroarthritic diathesis in childhood increases the likelihood of developing arthritis in adulthood.
Children also tend to have a more acute course of infectious arthritis compared to adult patients. Soreness and severe deformation of the joints are accompanied by high fever and severe intoxication of the body - severe headache and muscle pain, confusion, nausea and vomiting.
Although signs of joint inflammation are clearly visible even to a non-specialist, it is not possible to accurately determine the form and stage of arthritis, as well as develop the correct treatment strategy, based solely on history and physical examination.
When making a preliminary diagnosis, the doctor pays attention to the size, shape and sensitivity and mobility of the joints, the color and temperature of the skin, muscle tone; conducts functional tests. The next stage of the diagnostic search should be instrumental techniques that visualize the characteristic signs of arthritis:
MRI guarantees maximum accuracy in diagnosing articular pathologies due to high-quality visualization of hard and soft tissues. X-ray and CT scans of the joint in direct, lateral and oblique projections make it possible to identify changes in the bone apparatus. To assess the condition of cartilage, tendons, ligaments, muscles and nerves, an ultrasound of large joints is additionally prescribed. If the knee joint is damaged, arthroscopy with collection of synovial fluid and biopsy may be required. In order to monitor the dynamics of the process in the absence of exacerbations, contrast arthrography may be appropriate.
Laboratory diagnosis of arthritis involves general, biochemical and immunological blood tests. A high erythrocyte sedimentation rate and increased fibrinogen concentration confirm the presence of an inflammatory process; an increased number of white blood cells – a bacterial infection. With eosinophilia, the likelihood of an allergic reaction is high. The detection of rheumatoid factor in the blood serum, along with exceeding the permissible level of antibodies and circulating immune complexes, clearly indicates rheumatoid arthritis. In gouty arthritis, sialic and uric acid levels increase.
In Russia, inflammation of the joints is observed in approximately 60% of people of retirement age against the backdrop of a trend toward increasing incidence and decreasing age of first manifestation of the disease.
The choice of therapeutic strategy depends on the form, etiology and stage of the disease, localization of inflammation, as well as the age, health status and constitutional characteristics of the patient. To relieve the inflammatory process and pain, a complex of non-steroidal anti-inflammatory drugs, muscle relaxants and painkillers is selected in combination with physiotherapeutic procedures. Electrophoresis and ultraphonophoresis, Hilt therapy, amplipulse therapy, magnetic therapy and SMT therapy (treatment with sinusoidal modulated currents) have a good effect.
An important component of complex treatment is taking chondroprotectors - for example, the drug Alflutop. The injection form ensures maximum bioavailability and rapid action of the drug, which helps stop the progression of cartilage destruction, relieves inflammation and stimulates the synthesis of hyaluronic acid. Due to the rapid onset of effect, there is no need for long courses of the drug - only 20 injections 2 times a year. Supplementing it with the treatment of arthritis allows you to reduce the dosage and duration of NSAID use.
Corticosteroids in rheumatological practice are used with great caution, limited to injections into the affected joint in the absence of response to gentle treatment methods. In the case of infectious arthritis, courses of antibiotics or antiviral drugs are prescribed, and in case of rheumatoid arthritis, immunosuppressants and immunomodulators are prescribed. If purulent complications occur, arthrocentesis is performed daily.
A therapeutic diet for arthritis involves avoiding high-calorie foods, red meat and organ meats, legumes, salt, spices and alcohol. If you have rheumatoid arthritis, you should also avoid tomatoes, potatoes, eggplants and other vegetables from the nightshade family that contain solanine. The patient's diet should contain foods rich in fiber and vitamins, as well as sources of easily digestible protein - poultry and dairy products.
To consolidate the therapeutic effect, massage, group exercise therapy and a course of balneotherapy in a specialized sanatorium are recommended. It is permissible to turn to folk remedies and unconventional methods only after consultation with your doctor.
Early complications in the form of panarthritis, phlegmon and other purulent processes develop mainly with infectious arthritis. Late complications include contractures, pathological dislocations, osteomyelitis, osteolysis, bone necrosis and generalized sepsis. In the absence of adequate treatment, progressive chronic arthritis can lead to disability: the patient loses the ability to self-care and free movement.
In the early stages, acute infectious arthritis responds well to treatment until complete restoration of joint function. If the development of the inflammatory process is associated with endogenous factors, it is more difficult to achieve recovery, but it is possible to slow down the rate of progression of the disease, prevent the development of complications and avoid disability.
Preventing arthritis is not particularly difficult. It is enough to lead a moderately active lifestyle, give up bad habits, eat a balanced diet and control your weight. For infectious diseases and joint injuries, you should consult a doctor without relying on home remedies. To prevent exacerbations of chronic arthritis, it is important to follow a diet, avoid hypothermia, not lift heavy loads, and undergo sanatorium-resort treatment according to your profile at least once every two years.