The best recipes and treatments for rheumatoid arthritis and gout, proven by many years of experience - an ambulance for muscles and joints. All of the following remedies should under no circumstances be used as independent treatment. Reducing joint inflammation does not mean curing the disease.
If you have any form of arthritis, there are general rules that you need to follow immediately after you are diagnosed. In addition to therapeutic treatment, special attention should be paid to diet. You need to exclude meat and fats from your diet, and also reduce your consumption of foods high in starch. It is recommended to consume lactic acid products (sour milk, yogurt). The diet should include fresh fruits and vegetables: tomatoes, cucumbers, apples, as well as blueberries and cranberries. You need to be careful about hypothermia. Some tips for patients suffering from rheumatoid arthritis and gout.
Material from Wikipedia - the free encyclopedia
Rheumatoid arthritis (eng. rheumatoid arthritis ) is a systemic disease of connective tissue with a predominant lesion of small joints, such as erosive-destructive polyarthritis of unknown etiology with a complex autoimmune pathogenesis.
The name comes from (Ancient Greek ?????) which means “flow”, the suffix -oid means “similar”, ?????? translated as “joint” and the suffix -itis (gr. -itis ) means “state of inflammation.”
The causes of the disease are unknown to this day. Indirect data: an increase in the number of leukocytes in the blood and erythrocyte sedimentation rate (ESR) indicate the infectious nature of the process. It is believed that the disease develops as a result of an infection that causes disorders of the immune system in hereditarily predisposed individuals; in this case, so-called immune complexes are formed (from antibodies, viruses, etc.), which are deposited in the tissues and lead to damage to the joints. But the ineffectiveness of antibiotic treatment for RA most likely indicates that this assumption is incorrect.
The disease is characterized by high disability (70%), which occurs quite early. The main causes of death from the disease are infectious complications and renal failure.
Treatment focuses primarily on relieving pain, slowing the progression of the disease, and repairing damage through surgery. Early detection of the disease using modern means can significantly reduce the damage that can be caused to joints and other tissues.
It may first appear after heavy physical exertion, emotional shock, fatigue, during a period of hormonal changes, exposure to adverse factors or infection.
The earliest traces of rheumatoid arthritis were found in 4500 BC. e. They were found on the remains of Indian skeletons in Tennessee, USA. The first document describing symptoms closely resembling those of rheumatoid arthritis dates back to 123 AD.
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Svetlana Guru (2817) 6 years ago
It is impossible to be cured completely; the disease is autoimmune. Periods of exacerbation and remission alternate, and constant complex treatment is required - with medications, exercise therapy, and physical therapy according to strict indications. Don't read the previous answer - it's complete nonsense.
Mhlu Oracle (59298) 6 years ago
Leko can get rid of this, you only need to strengthen the immune system and this mainly comes down to chafing of the legs and arms. WE STRENGTHEN ANTI-MICROBIAL IMMUNITY.
A signal of weakened antimicrobial immunity, in mild cases, is the presence of a burning sensation on the skin of the extremities (inflammatory processes in the lungs, larynx, throat, kidneys, etc.). The presence of aching, aching pain in the bones and joints of the legs and arms is already a signal of a strong suppression of antimicrobial immunity (rheumatism, polyarthritis, arthritis). Let's strengthen or restore immunity, that is, the body's defense mechanism. To do this, rub the back of the hand and the outer area of the forearm up to and including the elbow. When rubbing your legs, you should start by lifting your foot, rubbing your shin on all sides. We rub our knees, knead them between our palms. Rubbing is carried out day after day until the burning sensation completely disappears, and in case of severe weakening of the immune system, until complete relief from aches and pain in the bones and joints of both hands and feet. At elevated temperatures, rubbing should be carried out up to 8-10 times a day for 2-3 minutes of exposure to the limb. What effect can you expect? First of all, this is a decrease in temperature from high numbers to 37.5 degrees Celsius and below. The effect develops literally in 20-30 minutes. Pain and aches may go away, in some cases even after the first exposure.
Source: Doctor, more than 25 years of successful massage practice
LADY with a dog Artificial Intelligence (624618) 6 years ago
What's the point in rubbing? Physiotherapy will help to constantly smear sore areas with creams.
Ekaterina Koval (Lebedevskaya) Pro (665) 6 years ago
Rheumatoid arthritis, or RA, is a serious disease that affects the joints. Without treatment, a person quickly becomes disabled, but even with therapy, the disease does not always stop. Is it possible to recover completely from this pathology?
Rheumatoid arthritis is not simply inflammation of the joints associated with injury or infection. This is a serious systemic disease, which is based on a breakdown of the immune system. With RA, some of its components begin to function incorrectly, and this leads to auto-aggression of the body, destruction of it by its own antibodies.
Rheumatoid arthritis is characterized by increased production of special substances - tumor necrosis factor, various interleukins. They destroy connective tissue - joints and bones. This leads to inflammation of the joints, their fragility and deformation.
Over time, in addition to the musculoskeletal system, other organs are also involved. The heart, lungs, and gastrointestinal tract may suffer. The treatment of rheumatoid arthritis itself also causes a significant blow to the health of the body. The drugs used by rheumatologists have serious side effects and this affects the well-being and condition of patients.
Is there a need for such unsafe therapy? And is it possible to cure rheumatoid arthritis in principle?
How to cure rheumatoid arthritis? Rheumatologists encounter this question very often in their practice. It is asked on the Internet and in real life. Many patients have been searching for an answer for many years.
But, unfortunately, it is currently impossible to reassure patients with rheumatoid arthritis. Despite the successes of modern medicine, doctors have not yet learned to fully cope with autoimmune diseases - pathological processes in which the body destroys itself.
Intervention in the immune system is a very serious procedure that requires enormous knowledge and experience. And, although numerous clinical studies are being conducted around the world regarding autoimmune diseases, rheumatologists have not been able to achieve a final victory in this matter.
But this does not mean that rheumatoid arthritis does not need to be treated. On the contrary, the characteristics of the disease are such that without adequate therapy, disability occurs very quickly. The person cannot move normally and take care of himself, in addition, he experiences excruciating pain.
Rheumatoid arthritis is a disease with a steadily progressive course. Along with the destruction of joints, this pathology affects the entire body. How to cope with an autoimmune disease? Are there effective treatments for RA?
Attempts to develop effective treatments for rheumatoid arthritis have been made for many years. Rheumatologists used traditional medicine, medications, physiotherapy, and combined methods.
Today, according to approved standards for the treatment of rheumatoid arthritis, 3 groups of drugs are used:
Of course, other drugs are also used to treat this disease. They influence the pathogenesis - the mechanism of development of RA - and play a significant role in complex therapy. Such drugs include:
However, the main three groups of drugs for the treatment of RA are basic and unchanged, without them it is impossible to slow down the development of the disease.
Each of these groups has its own side effects, and this must be taken into account when selecting therapy. Often the negative effects of drugs are cumulative. But this is not a reason to refuse treatment for rheumatoid arthritis, since the complications of the disease itself are much more serious than the side effects of the drugs.
RA is treated with drugs that inhibit the enzyme cyclooxygenase (COX). They are of general and selective action - non-selective and selective.
Non-selective COX inhibitors include long-standing and well-known anti-inflammatory drugs - for example, diclofenac. It is an effective treatment for rheumatoid arthritis, successfully combats pain, and inhibits the activity of the inflammatory process.
However, the indiscriminate nature of its action leads to damage to other organs. Thus, diclofenac has a significant effect on the blood coagulation system and thins it. This is why bleeding is not uncommon with long-term use of diclofenac. This is especially true for patients at risk:
Elderly people are also at risk. The older the patient, the higher his risk of side effects and the more invisible the manifestations of complications. In elderly people, bleeding often occurs smoothly, which leads to late seeking medical help and serious outcomes.
The second, no less dangerous side effect of non-selective NSAIDs is the ulcerogenic effect - the ability to cause the formation of ulcers in the stomach and intestines. In different people, this complication can occur in different ways - from a single erosion to numerous ulcers throughout the intestine. Combined with increased bleeding, this condition poses a serious threat to the life and health of the patient. Therefore, treatment with diclofenac and similar drugs is carried out under medical supervision with regular monitoring of blood tests.
Selective non-steroidal anti-inflammatory drugs are modern drugs for the treatment of rheumatoid arthritis. They are devoid of the main side effects of non-selective COX inhibitors, or rather, these effects are less pronounced.
But in practice, selective NSAIDs cannot be considered the gold standard of rheumatology. They have both advantages and certain disadvantages.
What medications belong to this group? These are nimesulide and oxicams. They are well tolerated, exhibit anti-inflammatory and analgesic activity, and are less likely to lead to serious complications or worsen the well-being of patients.
What can be attributed to the disadvantages of modern selective NSAIDs:
These properties are not observed in all patients using COX inhibitors for the treatment of RA, but they should be kept in mind, especially in the presence of risk factors.
The selection of anti-inflammatory and analgesic therapy for autoimmune pathology is carried out by a rheumatologist. It is he who makes the decision on the advisability of prescribing one or another group of NSAIDs, taking into account the patient’s health condition and the stage of the disease.
From the name it is clear that these are medications that are the mainstay of treatment for rheumatoid arthritis. They do not cure the disease completely, but they can slow down the process and make the prognosis more favorable. Basic therapy involves constant taking of pills throughout life.
What drugs are most often used as primary treatment? The following groups are distinguished:
All of these drugs are used in rheumatology to treat RA - to one degree or another. It is believed that their action significantly reduces the destruction of bones and joints. However, some doctors dispute this opinion. And yet, the positive effect of therapy with basic drugs is undoubted, although their side effects sometimes significantly limit the possibilities of use.
Quinoline drugs include chloroquine and hydroxychloroquine. They are used for a long time, more often with mild rheumatoid arthritis. As a rule, the first year of therapy involves taking pills daily, and then taking them every other day is possible, but only if a significant effect is achieved. Also, during the remission stage, breaks of one to three months a year are allowed.
Salazole drugs are sulfasalazine and salazopyridazine. Like quinoline drugs, this group of tablets has been used in rheumatology for quite a long time. Treatment begins with a starting dose and is gradually increased to the optimal dose.
Indications for prescribing salazal preparations include mild and, much less frequently, moderate forms of the disease.
One of the side effects that limits the use of these drugs is the increased formation of stones in the urinary tract and kidneys. Currently, salazole drugs are used less frequently in the basic treatment of rheumatoid arthritis than drugs from other groups.
D-penicillamine has recently been a widely used drug for the treatment of autoimmune diseases. However, today its popularity has waned, and it is used much less frequently in RA therapy. What is this connected with?
The use of D-penicillamine as a basic agent is associated with an increased risk of developing the following complications:
Also, the clinical effectiveness of D-penicillamine is questionable in some cases. All this has led to the fact that the drug has become much less used for the treatment of rheumatoid arthritis.
Gold-based drugs were first used to treat rheumatoid arthritis back in 1929. Rheumatologists pinned great hopes on them. Gold salts were considered a remedy that could permanently cure rheumatoid arthritis. Despite the fact that a complete cure could not be achieved, for many years these drugs were considered first-line therapy and were the drugs of choice for RA. To date, their effectiveness is considered controversial.
The mechanism of action of gold salts is to inhibit the immune response. However, this is precisely what causes another effect - the occurrence of hypersensitivity reactions to gold itself. Side effects during treatment with this medicine occur in a quarter of patients.
In addition to allergic reactions, aurotherapy is characterized by the following complications:
Cytostatic drugs are methotrexate, cyclosporine and azathioprine.
Today, methotrexate is rightfully considered the gold standard for basic therapy for RA. It effectively suppresses immune inflammation and exhibits fewer side effects than drugs from other groups. Current standards of treatment for rheumatoid arthritis require the use of higher doses of methotrexate than previously accepted. During treatment, it is necessary to check liver function and blood condition.
In severe forms of RA and a large number of complications, rheumatologists prescribe azathioprine or cyclosporine. However, these drugs can lead to the development of arterial hypertension, kidney damage and suppression of hematopoiesis, which limits their use in rheumatology.
This is the third main group of drugs for the treatment of RA. Steroid therapy is used for many autoimmune and endocrine diseases. It is unsafe and can cause the following complications:
However, it is glucocorticoids that have a pronounced and long-lasting anti-inflammatory effect and effectively fight pain and joint destruction.
Steroid therapy can be low-dose and continuous, or short-term and high-dose. In the second case, it is called pulse therapy and is used when it is necessary to quickly eliminate severe inflammation.
Are there any other modern highly effective drugs for the treatment of rheumatoid arthritis? Yes, in recent years special attention has been paid to biological therapies.
This term usually refers to agents that can influence immune inflammation at the molecular level. These include receptor antagonists and monoclonal antibodies.
Until recently, most of these drugs were experimental. However, some have proven themselves so well that they have begun to be widely used in rheumatological practice.
One of the most promising drugs in this area is infliximab – Remicade. It is often prescribed in combination with methotrexate.
Unfortunately, even with modern medicine, rheumatoid arthritis cannot be completely cured. However, adequate therapy allows one to achieve stable remission and delay complications.
A proper diet for rheumatoid arthritis of the joints is an integral part of therapy and helps to significantly improve the general condition of the patient. Many people underestimate its beneficial effects, but a properly formulated diet significantly alleviates symptoms, relieves pain, swelling and stiffness of movement.
Rheumatoid arthritis is a systemic disease characterized by a high degree of disability. Its treatment is based on relieving pain, slowing the progression of the disease and restoring damaged joints through surgery. An important role in therapy is played by proper nutrition for rheumatoid arthritis of the joints, which is designed to completely eliminate allergens from the diet and achieve a balance of nutrients entering the body.
The causes of the disease have not been reliably established, but it is well known that its etiology is based on an infectious factor and genetic predisposition. Having an autoimmune nature, the disease develops over a long period of time and progresses in 3 stages - from minor manifestations to complete damage to connective tissues. Symptoms of rheumatoid arthritis include:
Eating for this disease is based on the advice of doctors and provides for several generally accepted rules:
The diet has a lot of positive characteristics and is suitable for people of all ages. With its help, it is possible to strengthen joints, restore normal motor functions to them, increase immunity, and also significantly reduce the risk of complete tissue destruction. The diet for rheumatoid arthritis has no contraindications, but before using it it is advisable to consult an experienced specialist.
When considering what diet is recommended for rheumatoid arthritis, it should be borne in mind that significant improvement in the condition is observed when a few simple principles are followed.
Eliminating problematic products
It has been observed that foods that contribute to the development of an allergic reaction lead to an exacerbation of the disease. If a person does not know which food can have a negative effect, it is recommended to adhere to the so-called elimination diet for some time, that is, for one to two weeks, alternately exclude any product from the menu. For example, you can completely give up milk, and then reintroduce it into the diet for a few days and observe the condition of the body. If arthritis has worsened, then dairy products must be completely eliminated, if not forever, then at least for the period of exacerbation.
Making sure your body gets enough calcium
The use of certain foods and medications that contain hormones contributes to the leaching of calcium from bone tissue, which negatively affects the condition of the body in rheumatoid arthritis. To replenish your supply of this beneficial mineral, it is recommended to include plenty of leafy greens, soy, and low-fat dairy products in your diet.
Excess body weight creates increased stress on the limbs, which already suffer from inflammation. In addition, during the acute stage of the disease, a person moves little, therefore the total number of calories burned per day decreases. In order not to gain weight, during an exacerbation, you should reduce the calorie content of the food you eat, eliminating refined carbohydrates (sugar, ice cream, chocolates) and high-fat foods, including butter and baked goods, from your diet. Wheat flour products contain a lot of calories, so you should avoid them too.
At the acute stage of the disease, the body is characterized by symptoms such as fever, inflammation, and metabolic disorders. When figuring out what diet is recommended for rheumatoid arthritis, you should keep in mind that for such manifestations, the menu must include light and low-calorie foods:
Nutritionists note that a wide list of foods that help remove calcium from the body should be excluded from the menu for rheumatoid arthritis:
It has been noticed that inflammatory processes are significantly aggravated when citrus fruits, tomatoes, corn, and pork are used in the diet. If you are ill, it is not recommended to consume any proteins of plant origin, as well as salty and fatty cheeses, smoked meats, hard-boiled eggs, natural coffee, and any salty and spicy snacks.
If you follow the basic rules of the diet, the treatment of rheumatoid arthritis will be very effective and will alleviate the patient’s condition. When creating a menu, it is important to consult with your doctor, who will take into account individual intolerance to certain foods and will be able to reduce negative interactions between food and medications.
Rheumatoid arthritis is a fairly common pathology. Mostly women suffer from it. Statistics show that for every 1 sick man there are 4 women with rheumatoid arthritis. This disease is characterized by a chronic course and steady progression. The disease progresses with periods of exacerbation and remission. Treatment aimed at prolonging the period of remission can be either medication or physiotherapy. Physiotherapy for rheumatoid arthritis, as well as contraindications to it, will be discussed below.
Rheumatoid arthritis can develop in a person of any age. The causes of this pathology are currently unknown. It is believed that the cause of the disease may be the presence of the Epstein-Barr virus. Heredity also plays a big role.
The disease is characterized by damage to the connective tissue by its own antibodies. The consequence of this is swelling in the joint area, stiffness of movement after a state of rest, and fatigue. It is known that in some cases the disease may not manifest itself for a long time.
If symptoms of the disease are present, it must be treated immediately. Otherwise, complete loss of ability to work occurs, sometimes leading to disability.
Treatment is carried out using medicinal methods (chondroprotectors, glucocorticosteroids, NSAIDs), and surgical methods (for completely destroyed joints). In addition, it is necessary to follow a diet and limit the consumption of protein foods. It is also necessary to get rid of bad habits and excess weight. Excessive loads should also be avoided. In the middle of the day, resting for 1.5-2 hours is useful.
The purpose of certain physical procedures for rheumatoid arthritis depends on the stage of the process: exacerbation or remission.
During an exacerbation, the following may be prescribed:
During remission the following are used:
Ultraviolet irradiation of the joint with a medium wavelength helps reduce pain. This occurs due to a decrease in the sensitivity of the nerve fiber in the lesion. In addition, vitamin D3 is synthesized due to UV exposure. The impact is applied to the lesion until the skin turns red.
The course requires 6 procedures, which are carried out every other day. There are the following contraindications to this method of treatment: cerebrovascular accident, kidney and liver pathology, lupus erythematosus.
This physiotherapy for rheumatoid arthritis is necessary to reduce the amount of drugs taken orally. This result is achieved by supplying direct current. Using electrophoresis, novocaine is administered, which causes an analgesic effect.
In addition to novocaine, glucocorticosteroids (Dexon, Prednisolone) can be injected into the joint using electrophoresis. The course of treatment is 12 days, the procedure is carried out daily, lasts about 20 minutes. Contraindications include high temperature, insufficient renal function, blood diseases, the active phase of the tuberculosis process, and the presence of tumors.
Magnetic therapy for rheumatoid arthritis helps improve blood supply to the affected joint cavity. The effect is achieved even if the articular cavity is located at a great distance from the skin (up to 12 cm). Improving blood circulation is possible by warming up the lesion by 3 degrees. The consequence is a reduction in tissue swelling and acceleration of regeneration processes.
For treatment, you should undergo about 12 procedures. Magnetic therapy is one of the main methods of physical therapy for foot arthritis. Contraindications to this procedure include neoplasms, pregnancy, cardiac dysfunction, and tuberculosis.
Laser irradiation of the affected area accelerates the restoration of damaged intra-articular structures. For treatment it is necessary to undergo 30 daily procedures. Contraindications include cancer and endocrine diseases.
Light therapy helps reduce swelling, accelerate regeneration, and enhance local protection. The course of treatment is selected individually. The duration of exposure to the affected area is up to half an hour. Contraindications – neoplasms, high fever, pregnancy, active phase of tuberculosis.
UHF therapy has an analgesic effect, reduces swelling and prevents the development and spread of the inflammatory process. Achieving the listed effects is possible due to the exposure of the pathological focus to a high-frequency magnetic field, which penetrates deep into the layers of the skin.
The course consists of 15 daily procedures, each of which lasts 12 minutes. Contraindications include vegetative-vascular dystonia, arrhythmias, and high blood pressure.
Ultrasound has a therapeutic effect by improving and accelerating metabolic processes. This leads to the resorption of swelling, a reduction in inflammation and the rapid restoration of damaged joint structures.
During the procedure, contact media (for example, Vaseline) are used. For arthritis, ultraphonophoresis with hydrocortisone can be used, then hydrocortisone ointment becomes the contact medium. The course requires about 12 procedures. Ultrasound should not be used for heart pain and ankylosing spondylitis.
This method helps reduce pain, spasms and cramps. There are two treatment methods: tonization and sedation.
The inhibitory method (sedation) is based on the introduction of 3 needles to a depth of more than 1.5 cm. The needles remain in the body for a long time, sometimes up to 30 minutes or more. The tonic method is based on the very superficial introduction of several needles (up to 10) for a short time (up to 2 minutes).
Through this treatment method, it is possible to accelerate the delivery of nutrients to the affected area. This effect is possible due to improved blood supply to the lesion. The course requires about 20 procedures. Each of them lasts up to half an hour. The procedures are carried out every 2-3 days. Contraindications include neoplasms, high blood pressure, tuberculosis, high body temperature, and impaired renal and cardiac function.
This method of physiotherapy for rheumatoid arthritis increases blood circulation, which results in accelerated delivery of substances necessary for the regeneration of the affected joint. Hydrogen sulfide baths have the best effect.
The course requires 15 procedures. The water temperature is 36 degrees. Contraindications are skin lesions (various dermatitis), tumors, diabetes mellitus, atherosclerosis.
Some people, especially older people, confuse arthritis with rheumatoid arthritis. When they complain about a disease, they mean severe joint pain, and although the symptoms are similar, there is still a difference between rheumatoid arthritis and arthritis. It is very important to know these differences in order to understand the processes that occur in the cartilage tissues of the joints and take the right actions to treat ailments.
This disease is the most common joint disease and is an inflammatory process in nature. Leads to joint deformation. Most often, the arms, feet, knees, and elbow joints are affected. The disease occurs more often in women than in men; it happens that the pathology is found in children.
The most common causes of the disease are infectious diseases. People who have had a cold are automatically at risk. This zone includes tuberculosis patients and diabetics.
The next reason is previous injuries and joint surgeries. Arthritis often occurs in areas of surgery or severe bruises.
Hereditary joint diseases cannot be discounted. This does not mean that the disease can be inherited, but the structure of the joints is genetically determined.
Factors that cause the appearance of such a disease include: high weight, constant hypothermia, smoking, weak immunity.
During the rheumatic type of lesion, various symptoms can be observed, but the general picture is as follows: cardiac, mixed, nervous, articular.
With rheumatism, the heart is almost always affected, but the cause of this complication is tonsillitis and sinusitis. Symptoms of a rheumatic type of pathology appear 14 days after illness, or after severe hypothermia. If the infection is in the human body, then the exacerbation of rheumatism occurs at the time of hypothermia. The cause of exacerbation of the disease can be nervous shock and severe fatigue.
In children, the symptoms of rheumatic disease occur in the same way as in adults, most often as a result of a cold or a reaction to vaccinations.
Symptoms include any inflammation in the joint area:
This disease can be divided into acute and chronic. It is very difficult to determine which of them is more dangerous for humans; acute is easier to determine; chronic can develop over many years.
Medicine divides arthritis into infectious (the disease appears as a result of an infection) and rheumatoid type (affects small joints and joint tissues). There is also osteoarthritis, which means the cartilage tissue wears out.
Timely treatment, which is carried out comprehensively, can save not only from changes in the joints, but also from disability. Therefore, if you experience the slightest discomfort in the joints, you should consult a rheumatologist. Timely diagnosis and treatment guarantee a complete cure. Treatments may include:
There are no uncompromising methods of treating the disease in question; they simply eliminate infections and inflammation of the joints. Treatment is divided into 2 groups:
Rheumatoid arthritis is a chronic systemic disease. It can range from severe to mild forms of the disease. The disease can lead to complex bone and muscle deformities. The result is complex joint damage. The name “rheumatoid arthritis” was proposed so as not to be confused with other joint diseases - gout and rheumatism.
The cause of the disease is unknown. But there are factors that can trigger the development of rheumatoid type of pathology. One of the factors is antigens that are similar to retro viruses. Even now, the search for agents that contribute to the appearance of rheumatoid arthritis continues. Autoimmune disorders have been found to be present during rheumatoid arthritis.
There is an opinion that during rheumatoid arthritis there is a congenital or acquired defect of immunity, which leads to the development of impaired autoimmune processes. This is evidenced by the treatment of rheumatoid arthritis using immunostimulating drugs.
Treatment of patients with rheumatoid arthritis may include the use of drugs with different mechanisms of action. Among them are fast-acting anti-inflammatory drugs that suppress nonspecific inflammation. There are also basic drugs that have an effect on the immune chains of the process. Among them, corticosteroids are in first place. There are ways to effectively treat rheumatoid arthritis:
General medications. Anti-inflammatory, corticosteroid drugs, immunosuppressants, gold drugs and others.
Treatment of rheumatoid arthritis must have several stages. The first of them is a hospital, a resort. Balneological clinics and mud resorts, which are located in Odessa and Evpatoria, are very popular. They are especially indicated if changes in the joints have occurred during rheumatoid arthritis.
There is a misconception that rheumatic and rheumatoid arthritis are the same. These are 2 completely different diseases, they have one thing in common - joint syndrome. The form of rheumatoid arthritis is considered to be a simple ailment, and the form of rheumatoid disease contains a multiprocessor lesion of the body.
The difference between these 2 diseases is that the appearance of rheumatoid arthritis is hidden in rheumatism, which appears as a consequence of sore throat or flu. It is dangerous because it affects the heart valve, and there is a risk of heart disease. With proper antibiotic treatment, the effect is visible within a few days.
And when a rheumatoid disease is identified, everything becomes much more complicated, because there is no exact cause that provokes the appearance of this disease - it is unknown. The development of symptoms takes longer and is more gradual than with rheumatoid arthritis.
The main features that characterize the difference are:
For any joint pain, it is better to consult a doctor rather than make a diagnosis yourself.
Rheumatoid arthritis is a disease that has been the focus of attention of rheumatologists around the world for decades. This is due to the great medical and social significance of this disease. Its prevalence reaches
Rheumatoid arthritis is a disease that has been the focus of attention of rheumatologists around the world for decades. This is due to the great medical and social significance of this disease. Its prevalence reaches 0.5–2% of the total population in industrialized countries [1, 2]. Patients with rheumatoid arthritis experience a decrease in life expectancy compared to the general population by 3–7 years [3]. It is difficult to overestimate the colossal damage caused by this disease to society due to the early disability of patients, which, in the absence of timely active therapy, can occur in the first 5 years from the onset of the disease.
Rheumatoid arthritis is a chronic inflammatory disease of unknown etiology, which is characterized by damage to peripheral synovial joints and periarticular tissues, accompanied by autoimmune disorders and can lead to destruction of articular cartilage and bone, as well as systemic inflammatory changes.
The pathogenesis of the disease is very complex and largely insufficiently studied. Despite this, by now some key points in the development of rheumatoid inflammation are well known, which determine the main methods of therapeutic intervention against it ( Fig. 1 ). The development of chronic inflammation in this case is associated with the activation and proliferation of immunocompetent cells (macrophages, T- and B-lymphocytes), which is accompanied by the release of cellular mediators - cytokines, growth factors, adhesion molecules, as well as the synthesis of autoantibodies (for example, anticitrullinated antibodies) and the formation immune complexes (rheumatoid factors). These processes lead to the formation of new capillary vessels (angiogenesis) and the proliferation of connective tissue in the synovial membrane, to the activation of cyclooxygenase-2 (COX-2) with an increase in the synthesis of prostaglandins and the development of an inflammatory reaction, to the release of proteolytic enzymes, activation of osteoclasts, and as a result - to the destruction of normal joint tissues and the occurrence of deformities.
Based on the pathogenesis of the disease, it becomes obvious that it is possible to effectively influence the development of the disease at two levels:
Since, in addition to inflammation itself, activation of the immune system is accompanied by many other pathological processes, the effect at the first level is significantly deeper and more effective than at the second. Drug immunosuppression is the mainstay of treatment for rheumatoid arthritis. Immunosuppressive drugs used to treat this disease include disease-modifying anti-inflammatory drugs (DMARDs), biological agents, and glucocorticosteroids. At the second level, non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids act.
In general, immunosuppressive therapy is accompanied by a slower development of the clinical effect (in a broad framework - from several days in the case of biological therapy to several months in the case of some DMARDs), which at the same time can be very pronounced (up to the development of clinical remission) and persistent, and is also characterized by inhibition of joint destruction.
Anti-inflammatory therapy itself (NSAIDs) can produce a clinical effect (pain relief, reduction of stiffness) very quickly - within 1-2 hours, however, with the help of such treatment it is almost impossible to completely stop the symptoms of active rheumatoid arthritis and, apparently, it has no effect at all on the development of destructive processes in tissues.
Glucocorticosteroids have both immunosuppressive and direct anti-inflammatory effects, so clinical improvement can develop quickly (within a few hours when administered intravenously or intra-articularly). There is evidence of suppression of the progression of the erosive process in joints during long-term therapy with low doses of glucocorticosteroids and their positive effect on the functional status of the patient. At the same time, it is well known from practice that prescribing only glucocorticosteroids, without other immunosuppressive drugs (DMARDs), rarely provides an opportunity to effectively control the course of the disease.
Non-drug methods of treating rheumatoid arthritis (physiotherapy, balneotherapy, diet therapy, acupuncture, etc.) are additional methods that can slightly improve the patient’s well-being and functional status, but do not relieve symptoms and significantly influence joint destruction.
Orthopedic treatment, including orthotics and surgical correction of joint deformities, as well as rehabilitation measures (physical therapy, etc.) are of particular importance, mainly in the later stages of the disease, to maintain functional ability and improve the patient’s quality of life.
The main goals of treatment for RA are [2, 6]:
It must be kept in mind that treatment goals may vary significantly depending on the duration of the disease. At an early stage of the disease, i.e., with a disease duration of 6–12 months, achieving clinical remission is a very realistic goal, as well as inhibiting the development of erosions in the joints. With the help of modern methods of active drug therapy, it is possible to achieve remission in 40–50% of patients [4, 5], and the absence of the appearance of new erosions according to radiography [7] and magnetic resonance imaging [8] has also been shown in a significant number of patients with a follow-up duration of 1 -2 years.
With long-term rheumatoid arthritis, especially with insufficiently active therapy in the first years of the disease, achieving complete remission is theoretically also possible, but the likelihood of this is much lower. The same can be said about the possibility of stopping the progression of destruction in joints that have already been significantly destroyed over several years of illness. Therefore, with advanced rheumatoid arthritis, the role of rehabilitation measures and orthopedic surgery increases. In addition, in the later stages of the disease, long-term basic maintenance therapy can be used for secondary prevention of complications of the disease, such as systemic manifestations (vasculitis, etc.), secondary amyloidosis.
Basic therapy for rheumatoid arthritis. DMARDs (synonyms: disease-modifying antirheumatic drugs, slow-acting drugs) are the main component of the treatment of rheumatoid arthritis and, in the absence of contraindications, should be prescribed to every patient with this diagnosis [9]. It is especially important to prescribe DMARDs as quickly as possible (immediately after diagnosis) at an early stage, when there is a limited period of time (several months from the onset of symptoms) to achieve the best long-term results - the so-called “therapeutic window” [10].
Classic DMARDs have the following properties.
DMARDs differ significantly in their mechanism of action and features of use. The main parameters characterizing DMARDs are presented in Table 1 .
DMARDs can be roughly divided into first-line and second-line drugs. First-line drugs have the best balance of effectiveness (reliably suppress both clinical symptoms and the progression of the erosive process in the joints) and tolerability, and therefore are prescribed to most patients.
First-line DMARDs include the following.
Second-line DMARDs are used much less frequently due to lower clinical efficacy and/or greater toxicity. They are prescribed, as a rule, when first-line DMARDs are ineffective or intolerable.
DMARDs can cause significant improvement (good clinical response) in approximately 60% of patients. Due to the slow development of the clinical effect, the prescription of DMARDs for periods of less than 6 months is not recommended. The duration of treatment is determined individually; the typical duration of a “course” of treatment with one drug (in case of a satisfactory response to therapy) is 2–3 years or more. Most clinical recommendations suggest indefinite use of maintenance dosages of DMARDs to maintain the achieved improvement.
If monotherapy with any basic drug is insufficiently effective, a combination basic therapy regimen, i.e., a combination of two or three DMARDs, can be chosen. The following combinations have proven themselves to be the most effective:
In combination regimens, drugs are usually used in moderate dosages. A number of clinical studies have demonstrated the superiority of combination basic therapy over monotherapy, but the higher effectiveness of combination regimens is not considered strictly proven. Combination DMARDs are associated with a moderate increase in side effects.
Biological drugs in the treatment of rheumatoid arthritis. The term biological drugs (from the English biologics ) is used in relation to drugs produced using biotechnology and carrying out targeted (“point”) blocking of key moments of inflammation using antibodies or soluble receptors to cytokines, as well as other biologically active molecules. Thus, biological products have nothing to do with “dietary supplements.” Due to the large number of “target molecules” that can potentially suppress immune inflammation, a number of drugs from this group have been developed and several more are undergoing clinical trials.
The main biological drugs registered in the world for the treatment of rheumatoid arthritis include:
Biological drugs are characterized by a pronounced clinical effect and reliably proven inhibition of joint destruction. These signs allow biological drugs to be classified as DMARDs. At the same time, a feature of the group is the rapid (often within a few days) development of significant improvement, which combines biological therapy with intensive care methods. A characteristic feature of biological agents is the potentiation of the effect in combination with DMARDs, primarily methotrexate. Due to its high effectiveness in rheumatoid arthritis, including in patients resistant to conventional therapy, biological therapy has now moved to second place (after DMARDs) in the treatment of this disease.
The negative aspects of biological therapy include:
Biological therapies are indicated if treatment with DMARDs (such as methotrexate) is not adequate due to lack of effectiveness or poor tolerability.
One of the most important target molecules is TNF-a, which has many pro-inflammatory biological effects and contributes to the persistence of the inflammatory process in the synovium, destruction of cartilage and bone tissue through a direct effect on synovial fibroblasts, chondrocytes and osteoclasts. TNF-α blockers are the most widely used biological agents in the world.
A drug from this group, infliximab (Remicade), which is a chimeric monoclonal antibody to TNF-α, has been registered in Russia. The drug is usually prescribed in combination with methotrexate. In patients with insufficient effectiveness of therapy with medium and high doses of methotrexate, infliximab significantly improves the response to treatment and functional indicators, and also leads to a significant inhibition of the progression of joint space narrowing and the development of the erosive process.
The indication for the use of infliximab in combination with methotrexate is the ineffectiveness of one or more DMARDs used at full dose (primarily methotrexate), with the persistence of high inflammatory activity (five or more swollen joints, erythrocyte sedimentation rate (ESR) more than 30 mm/h, C-reactive protein (CRP) more than 20 mg/l). In early rheumatoid arthritis with high inflammatory activity and a rapid increase in structural disorders in the joints, combination therapy with methotrexate and infliximab can be prescribed immediately.
Before prescribing infliximab, a screening examination for tuberculosis (chest x-ray, tuberculin test) is required. Recommended regimen: initial dose of 3 mg/kg of the patient’s body weight intravenously, then 3 mg/kg of body weight after 2, 6 and 8 weeks, then 3 mg/kg of body weight every 8 weeks, if the dose is insufficiently effective may increase up to 10 mg/kg body weight. The duration of treatment is determined individually, usually at least 1 year. After discontinuation of infliximab, maintenance therapy with methotrexate is continued. It should be kept in mind that re-administration of infliximab after completion of treatment with this drug is associated with an increased likelihood of delayed-type hypersensitivity reactions.
The second drug registered in our country for biological therapy is rituximab (Mabthera). The action of rituximab is aimed at suppressing B lymphocytes, which are not only the key cells responsible for the synthesis of autoantibodies, but also perform important regulatory functions in the early stages of immune reactions. The drug has pronounced clinical efficacy, including in patients who do not respond sufficiently to infliximab therapy.
For the treatment of rheumatoid arthritis, the drug is used at a dose of 2000 mg per course (two infusions of 1000 mg, each with an interval of 2 weeks). Rituximab is administered intravenously slowly; infusion in a hospital setting is recommended with the possibility of precise control over the rate of administration. To prevent infusion reactions, it is advisable to pre-administer methylprednisolone 100 mg. If necessary, a second course of rituximab infusions can be performed after 6–12 months.
According to European clinical guidelines, it is advisable to prescribe rituximab in cases of ineffectiveness or impossibility of infliximab therapy. The possibility of using rituximab as the first biological drug is currently the subject of research.
Glucocorticosteroids. Glucocorticosteroids have a multifaceted anti-inflammatory effect due to the blockade of the synthesis of proinflammatory cytokines and prostaglandins, as well as inhibition of proliferation due to their effect on the genetic apparatus of cells. Glucocorticosteroids have a rapid and pronounced dose-dependent effect on the clinical and laboratory manifestations of inflammation. The use of glucocorticosteroids is fraught with the development of undesirable reactions, the frequency of which also increases with increasing doses of the drug (steroid osteoporosis, drug-induced Itsenko-Cushing syndrome, damage to the gastrointestinal mucosa). These drugs alone in most cases cannot provide complete control over the course of rheumatoid arthritis and must be prescribed together with DMARDs.
Glucocorticosteroids for this disease are used systemically and locally. For systemic use, the main method of treatment is the administration of low doses orally (prednisolone - up to 10 mg/day, methylprednisolone - up to 8 mg/day) for a long period with high inflammatory activity, polyarticular lesions, and insufficient effectiveness of DMARDs.
Medium and high doses of glucocorticosteroids orally (15 mg/day or more, usually 30-40 mg/day in terms of prednisolone), as well as pulse therapy with glucocorticosteroids - intravenous administration of high doses of methylprednisolone (250-1000 mg) or dexamethasone (40-1000 mg). 120 mg) can be used to treat severe systemic manifestations of rheumatoid arthritis (effusive serositis, hemolytic anemia, cutaneous vasculitis, fever, etc.), as well as some special forms of the disease. The duration of treatment is determined by the time required to relieve symptoms and is usually 4–6 weeks, after which a gradual stepwise dose reduction is carried out with a transition to treatment with low doses of glucocorticosteroids.
Glucocorticosteroids in medium and high doses, pulse therapy, apparently, do not have an independent effect on the course of rheumatoid arthritis and the development of the erosive process in the joints.
For local therapy, drugs are used in microcrystalline form, prescribed in the form of intra-articular and periarticular injections: betamethasone, triamsinolone, methylprednisolone, hydrocortisone.
Glucocorticosteroids for local use have a pronounced anti-inflammatory effect, mainly at the injection site, and in some cases - a systemic effect. Recommended daily doses are: 7 mg for betamethasone, 40 mg for triamsinolone and methylprednisolone, 125 mg for hydrocortisone. This dose (in total) can be used for intra-articular injection into one large (knee) joint, two medium-sized joints (elbows, ankles, etc.), 4-5 small joints (metacarpophalangeal, etc.), or for periarticular administration of the drug at 3–4 points.
The effect after a single injection usually occurs within 1–3 days and lasts for 2–4 weeks if well tolerated.
In this regard, it is not advisable to prescribe repeated injections of glucocorticosteroids into one joint earlier than after 3-4 weeks. Carrying out a course of several intra-articular injections into the same joint has no therapeutic meaning and is fraught with complications (local osteoporosis, increased destruction of cartilage, osteonecrosis, suppuration). Due to the increased risk of osteonecrosis, intra-articular injection of glucocorticosteroids into the hip joint is generally not recommended.
Glucocorticosteroids for local use are prescribed as an additional method for relieving exacerbations of rheumatoid arthritis and cannot serve as a replacement for systemic therapy.
NSAIDs. The importance of NSAIDs in the treatment of rheumatoid arthritis has decreased significantly in recent years due to the emergence of new effective pathogenetic therapy regimens. The anti-inflammatory effect of NSAIDs is achieved by suppressing the activity of COX, or selectively COX-2, and thereby reducing the synthesis of prostaglandins. Thus, NSAIDs act on the final link of rheumatoid inflammation.
The effect of NSAIDs in rheumatoid arthritis is to reduce the severity of symptoms of the disease (pain, stiffness, swelling of the joints). NSAIDs have an analgesic, anti-inflammatory, and antipyretic effect, but have little effect on laboratory parameters of inflammation. In the vast majority of cases, NSAIDs are not able to significantly change the course of the disease. Their prescription as the only antirheumatic drug for a definite diagnosis of rheumatoid arthritis is currently considered a mistake. However, NSAIDs are the mainstay of symptomatic therapy for this disease and in most cases are prescribed in combination with DMARDs.
Along with the therapeutic effect, all NSAIDs, including selective ones (COX-2 inhibitors), can cause erosive and ulcerative damage to the gastrointestinal tract (primarily its upper parts - “NSAID gastropathy”) with possible complications (bleeding, perforation, etc.), as well as nephrotoxic and other adverse reactions.
The main characteristics that must be considered when prescribing NSAIDs are as follows.
There is individual sensitivity to various NSAIDs in terms of both effectiveness and tolerability of treatment. Doses of NSAIDs for rheumatoid arthritis correspond to standard doses. The duration of NSAID treatment is determined individually and depends on the patient’s need for symptomatic therapy. If there is a good response to DMARD therapy, the NSAID drug may be discontinued.
The most commonly used NSAIDs for rheumatoid arthritis include:
Selective NSAIDs, while not significantly different in effectiveness from non-selective ones, are less likely to cause NSAID gastropathy and serious adverse reactions from the gastrointestinal tract, although they do not exclude the development of these complications. A number of clinical studies have demonstrated an increased likelihood of developing severe vascular pathology (myocardial infarction, stroke) in patients receiving drugs from the coxib group, and therefore the possibility of treatment with celecoxib should be discussed with particular caution in patients with coronary artery disease and other serious cardiovascular pathologies.
Additional drug treatments. As a symptomatic analgesic (or an additional analgesic if NSAIDs are insufficiently effective), paracetamol (acetaminophen) can be used at a dose of 500–1500 mg/day, which has relatively low toxicity. For local symptomatic therapy, NSAIDs are used in the form of gels and ointments, as well as dimethyl sulfoxide in the form of a 30–50% aqueous solution in the form of applications. In the presence of osteoporosis, appropriate treatment with calcium, vitamin D3, bisphosphonates, and calcitonin is indicated.
A patient diagnosed with rheumatoid arthritis should be prescribed a drug from the DMARD group, which, with a good clinical effect, can be used as the only method of therapy [9]. Other medications are used as needed.
The patient should be informed about the nature of his disease, course, prognosis, the need for long-term complex treatment, as well as possible adverse reactions and a treatment monitoring scheme, unfavorable combinations with other drugs (in particular, alcohol), possible activation of foci of chronic infection during treatment , the advisability of temporarily discontinuing immunosuppressive drugs in the event of acute infectious diseases, the need for contraception during treatment.
Therapy for rheumatoid arthritis should be prescribed by a rheumatologist and carried out under his supervision. Treatment with biological drugs can only be carried out under the supervision of a rheumatologist who has sufficient knowledge and experience to carry it out. Therapy is long-term and involves periodic monitoring of disease activity and assessment of response to therapy. A simplified algorithm is presented in Figure 2 .
Monitoring disease activity and response to therapy includes assessment of joint status indicators (number of painful and swollen joints, etc.), acute-phase blood parameters (ESR, CRP), assessment of pain and disease activity using a visual analogue scale, assessment of the patient’s functional activity in daily activities with using the Russian version of the Health Questionnaire (HAQ). There are internationally recognized methods for quantifying response to treatment using the DAS (Disease Activity Score) recommended by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) criteria [1]. In addition, the safety of the therapy administered to the patient should be monitored (in accordance with both the formulary and existing clinical guidelines). Due to the fact that the erosive process can develop even with low inflammatory activity, in addition to assessing the activity of the disease and response to therapy, radiography of the joints is mandatory. The progression of destructive changes in the joints is assessed by standard radiography of the hands and feet using the radiological classification of the stages of rheumatoid arthritis, quantitative methods using the Sharp and Larsen indices. In order to monitor the patient’s condition, examinations are recommended to be carried out at certain intervals ( Table 2 ).
It is advisable to consider a patient resistant to treatment if there is ineffectiveness (lack of 20% improvement in the main indicators) of at least two standard DMARDs in sufficiently high doses (methotrexate - 15-20 mg/week, sulfasalazine - 2000 mg/day, leflunomide - 20 mg/day) . Failure can be primary or secondary (occurring after a period of satisfactory response to therapy or when the drug is re-prescribed). There are the following ways to overcome resistance to therapy:
From the point of view of long-term results in relation to functional impairment, quality of life and its duration, the optimal treatment strategy for rheumatoid arthritis is long-term treatment with DMARDs with a systematic change in the regimen of their use as needed [11].
D. E. Karateev , Doctor of Medical Sciences