Are antibiotics needed for knee arthritis? This disease is an inflammatory process in the joints, and people are accustomed to treating all such pathologies with antibacterial drugs. However, arthritis can be caused by various reasons, which experts divide into:
The first include factors under the influence of which the rheumatoid form of the disease occurs. It is impossible to completely get rid of it, but treatment helps to enter a period of remission. The cause of exacerbation of the disease is an infection that negatively affects the functions of the immune system. Treatment of rheumatoid arthritis with antibiotics should be combined with the use of anti-inflammatory drugs. However, antibacterial agents are prohibited from being prescribed when the pathological process is activated, leading to joint destruction.
The most effective antibacterial drug is Minocycline. The antibiotic has a pronounced anti-inflammatory effect and can stop the development of the pathological process. However, its use in rheumatoid arthritis is advisable only in the early stages of the disease. The therapeutic effect of Minocycline is explained by the fact that the active substance accumulates in the tissues, eliminating swelling and restoring joint mobility. A course of taking this antibiotic for rheumatoid arthritis can stop the destruction of the joint. It can be used in combination with anti-inflammatory drugs - Azathioprine or Cyclosporine.
If the temperature rises significantly, antipyretics are prescribed.
Infectious arthritis develops when pathogenic microorganisms enter the joint cavity. It is simply impossible to cure purulent and septic forms of the disease without antibacterial drugs. In reactive arthritis, the causative agent of infection is not detected in the joint cavity, and it is not the direct cause of inflammation. However, bacteria contribute to the launch of the pathological process.
The development of this form of the disease is facilitated by improper functioning of the immune system, which is associated with the presence of a certain gene. When bacteria enter the body, the immune system produces an excess amount of antibodies, and genetic pathology prevents their removal. Accumulating in the joint area, these substances begin to destroy healthy cells.
Whether antibiotics are effective for reactive arthritis is controversial. Nevertheless, the use of such drugs helps to destroy bacteria in chronic foci of infection, which normalizes the functioning of the immune system. Inflammatory processes that contribute to the development of reactive arthritis can occur in the upper respiratory tract, genitourinary or digestive system.
Antibiotics do not completely eliminate the symptoms of the disease, so they must be used in combination with anti-inflammatory drugs. Taking antibacterial agents improves the prognosis and reduces the frequency of exacerbations.
For arthritis caused by viral infections, such drugs are ineffective.
The inflammatory process contributes to severe pain and extensive swelling, as a result of which the joint (for example, the knee) becomes almost immobile. That is why it is important to quickly find the cause of the disease and eliminate it. However, in the early stages of the disease, it may be impossible to identify the bacterium and determine its sensitivity to the active substance. Therefore, the doctor may prescribe a broad-spectrum antibiotic. After an accurate diagnosis is made, the treatment regimen is supplemented or completely changed.
The choice of drug depends on:
For example, for diseases such as chlamydia and gonorrhea, the use of macrolides, fluoroquinolones (or tetracyclines) is indicated. For sore throat or pharyngitis, the most effective are penicillin antibiotics (or cephalosporins). Fluoroquinolones are used for intestinal infections. Penicillin can also be used for rheumatoid arthritis.
You should not prescribe the drug yourself or take it uncontrolled. In most cases, these remedies do not allow you to get rid of the symptoms of the disease, and improper use can harm the body.
Antibacterial drugs suppress the immune system, making the body vulnerable to viruses and bacteria. In addition, the medicine contributes to the appearance of side effects from the digestive, circulatory and nervous systems.
Long-term use of antibiotics contributes to the death of beneficial microflora that protects the body from pathogenic ones. Pathogenic bacteria are activated and cause diseases that are practically untreatable. At the same time, you should not refuse to take medications prescribed by your doctor. Lack of treatment worsens the condition of the joints, which can cause a person to become unable to work.
Arthritis is an inflammatory process in the joints, the appearance of acute pain, swelling and limited mobility. Treatment is carried out comprehensively, patients take medications, undergo physiotherapeutic procedures, and intra-articular injections. To strengthen bone and cartilage structures and prevent their destruction, it is useful to use vitamin complexes containing retinol, nicotinic acid, tocopherol, selenium, zinc, calcium, and polyunsaturated fatty acids.
Taking vitamins allows you to saturate the body with useful substances that can restore cartilage and protect the bone tissue of the articular surfaces from destruction and deformation. The drugs have an antioxidant effect, reduce inflammation, pain, and accelerate the regeneration of damaged cells.
Attention! For arthritis and cartilage destruction (arthrosis), a supporting therapeutic effect is obtained by taking vitamins B??, B?, B?, A, C, E, nicotinic acid (B? or PP).
These substances nourish synovial joints, improve their mobility, restore blood circulation, due to which the inflammatory process passes faster.
Vitamin C helps relieve inflammation, participates in the synthesis of collagen structures that strengthen, and increases the elasticity of ligaments, cartilage tissue and muscle fibers. The dosage of the pharmaceutical drug is calculated taking into account the patient’s body weight with a gradual increase in the amount of the drug taken.
Natural sources of vitamin C are:
For arthritis, it is best to consume foods fresh or after minimal heat treatment, since high temperature destroys vitamins by 30% and weakens the therapeutic effect.
Vitamin A is involved in redox processes, strengthens bones, is responsible for the growth of new cells, regeneration of damaged membranes, and collagen synthesis. Necessary for the normal functioning of the immune system; in combination with tocopherol, it removes toxins from the body.
On a note! There is a lot of retinol in carrots, beef liver, pumpkin, avocados, parsley, apricots, grapes, butter, and whole milk.
Vitamin E has antioxidant and anti-inflammatory properties. The therapeutic effect is achieved by blocking the synthesis of prostaglandins and strengthening cell membranes.
Tocopherol can be used as a pharmaceutical preparation or added to the diet with vegetable oils, whole grain cereals, fish oil, nuts, and fish. For arthritis, it is useful to eat fresh vegetable salads with the addition of herbs and flaxseed oil, cauliflower, and broccoli.
Regular intake of vitamin E along with selenium can reduce pain and reduce the dosage of painkillers taken.
Taking vitamin B? for arthritis, it helps relieve discomfort, swelling, and increase mobility in the damaged joint by suppressing the production of inflammatory mediators.
Attention! Let me remind you that if you have any problem, you can seek advice from our specialists.
Attention! The drug must be taken for at least 2–6 weeks; treatment is especially effective for inflammation of the knee joints. The treatment regimen and dosage are selected by the doctor individually for each patient.
Nicotinic acid is found in yeast, nuts, wild rice, hard cheeses, sea fish, liver, legumes, meat, dairy products, and egg yolks. It is recommended to consume dietary varieties of meat and fish, this will ensure that the balance of harmful and beneficial cholesterol in the blood is restored, will help reduce excess weight, and reduce the load on joints affected by arthritis.
The vitamin is prescribed to patients with rheumatoid and reactive arthritis; the substance stimulates the production of steroid hormones, thereby reducing the inflammatory process in the joints. Treatment is most effective with the simultaneous use of pantothenic, folic acid and other B .
Pantothenic acid normalizes the functioning of the immune system, helps absorb other vitamins, and regulates metabolic processes.
An important role in the treatment of arthritis is played by minerals and trace elements, which strengthen articular surfaces and bone structures, have an antioxidant and regenerative effect, and improve the absorption of vitamins.
On a note! When treating arthritis, it is necessary to take calcium, organic sulfur, selenium, copper, boron, and zinc supplements.
Promotes the regeneration of synovial tissue, reduces pain, strengthens joint membranes, improves the absorption of other beneficial substances, and acts as a powerful antioxidant.
Selenium is part of many pharmaceutical dietary supplements and vitamin complexes used to treat arthritis and arthrosis. Due to its pronounced anesthetic effect, it is prescribed for pain in the lower extremities, spine, and hip joints.
When bone tissue is destroyed, it is necessary to take calcium; this microelement is absorbed in combination with cholecalciferol, strengthens and prevents the thinning of cartilage structures, and slows down the development of osteoporosis.
Zinc increases the body's immune defense, has antioxidant and antibacterial properties, and increases the elasticity of muscle tissue. The drug is effectively used to treat rheumatoid and infectious arthritis, synovitis and other inflammatory joint lesions.
This trace element has anti-inflammatory, antibacterial and antirheumatic properties.
Good to know! Copper’s ability to synthesize collagen and elastin, strengthen connective tissues, and saturate them with oxygen has been proven; it is used in the complex treatment of rheumatoid arthritis and to prevent demineralization of joints.
Dietary supplements are made on the basis of natural, plant components and have a therapeutic effect without causing the development of severe side effects. However, dietary supplements can be used only after consulting a doctor and carefully studying the composition of the drug. It is necessary to take into account the type of arthritis, the severity of the disease and the presence of joint deformities.
This substance is synthesized from the bark of pine trees, it has powerful antioxidant properties, improves joint function, strengthens blood vessels, and relieves acute inflammation. Pycnogenol is rich in procyanidins, which prevent free radical damage to joint cells. The drug is taken 1 capsule 1-2 times a day with meals.
The substance is involved in the absorption of calcium, its interaction with cholecalciferol, and plays an important role in metabolic processes occurring in the bones and cartilage tissues of the joints. Natural sources of vitamin K include any type of cabbage, wheat bran, kiwi, bananas, cow's milk, soybeans, eggs and olive oil.
Organic sulfur is often included in many dietary supplements and vitamin complexes for the treatment of arthritis due to its ability to form protein structures, which are the building material for muscles, bones and joints. The drug helps restore methylsulfonylmethane deficiency in the body, maintain the elasticity of connective tissues, and regenerate damaged cells.
Gout develops when metabolic processes are disrupted, excessive accumulation of urate in the joints, and frequent stress. To treat the disease, it is necessary to take folic acid, vitamin C, E.
Attention! Uncontrolled use of retinol and nicotinic acid can lead to exacerbation of a chronic disease.
Polyunsaturated fatty acids (Omega-3, 6, 9), glucosamine and chondroitin preparations, animal and plant collagen are also used to treat arthritis. These supplements are responsible for the condition of cartilage structures, strengthening the immune system, and are a means of preventing complications of deforming arthrosis.
PUFAs are not synthesized in the human body independently, but are supplied only with food. For rheumatoid arthritis, it is important to ensure regular consumption of unsaturated acids, as they normalize metabolic processes and the functioning of the immune system, increase the tone of blood vessels, and relieve inflammation.
Large amounts of PUFAs are found in fish oil, vegetable oils, sea fish, sprouted wheat, beans, walnuts, and flax seeds.
The drug promotes the synthesis of cartilage fibers, synovial fluid and hyaluronic acid, which ensure the sliding of articular surfaces and prevent their thinning and destruction. The use of Glucosamine after therapy with corticosteroids is especially effective.
The drug stimulates the regeneration of cartilage tissue, the production of hyaluronic acid, prevents the destruction of articular surfaces, and slows down destructive processes. As a result of the use of Chondroitin, pain and inflammation are reduced, and the need for NSAIDs is reduced.
Fibrillar protein is the basis of connective tissues that form cartilage, ligaments, and joint components. With its deficiency, the risk of injury, inflammation, and deformation of synovial joints increases.
Eating seaweed, jelly, red fish, cereals, turkey, chicken, and rabbit helps replenish collagen reserves during arthritis. To absorb the substance, the body must contain a sufficient amount of vitamin A, C, E, PP, essential amino acids, and unsaturated fatty acids, so they must be taken comprehensively.
Cholecalciferol promotes the absorption of minerals from food and their storage in bones and joints. Stimulates active cell growth, has a beneficial effect on the immune system, which makes it possible to effectively treat rheumatoid arthritis.
Many people wonder what vitamin deficiency causes rheumatoid arthritis? In fact, it has not been proven that vitamin deficiencies can directly provoke the development of autoimmune reactions.
This is interesting! If you already have rheumatoid arthritis, then vitamin D plays an important role in suppressing immune aggression towards the joints. It partially inhibits the production of “inflammatory proteins” - interleukin 1, 6 and 8, as well as TNF-a.
You can get vitamin D3 by eating salmon, herring, mushrooms, butter, and fish oil. Cholecalciferol is also synthesized under the influence of sunlight, so it is important to spend more time outdoors in the summer. The body accumulates vitamin reserves and uses them up during the autumn-winter period.
To eliminate the symptoms of arthritis and arthrosis, vitamin-mineral complexes and chondroprotectors based on glucosamine and chondroitin sulfate are used. These drugs not only reduce the manifestations of the disease, but also act on the immediate cause of the pathology, promote nutrition, restoration of cartilage tissue, and stimulate the production of synovial fluid.
The following drugs are used to treat arthritis:
Vitamin and mineral complexes are prescribed for treatment, prevention of exacerbations of chronic arthritis, prevention of demineralization and deformation, and to increase joint mobility.
Effective drugs for the treatment of inflammatory processes in the joints:
Attention! Chondroprotectors - drugs based on chondroitin and glucosamine - are especially useful for arthrosis, but to achieve an effect they are taken for a long time - 3-6 months or longer.
There is a mixed opinion about chondroprotectors, since many consider them ineffective and even dangerous. Here, for example, is what Boris Tsatsouline says about this in his video blog.
Medical practice shows that at stages 1-2 of arthrosis, chondroitin and glucosamine, with long-term and correct use, allow one to avoid joint replacement surgery. A rheumatologist with many years of experience, academician of the Russian Academy of Medical and Technical Sciences, Pavel Valerievich Evdokimenko, talks about these remedies and other methods of treating arthrosis.
Vitamins and mineral complexes for arthritis help strengthen joint tissues, restore mobility, replenish the deficiency of nutrients in the body and prevent joint deformation and the development of disability. The medications must be taken as prescribed by the attending physician in combination with other medications and physiotherapeutic procedures.
Gout is a condition where excess uric acid settles in the joints in the form of crystals. It is these crystals that cause pain and inflammation in the joints. The joints become sensitive, the skin on them may become red, they may become swollen, they are painful to move, and touching them is painful. In the case of gout, you need to think about regular and long-term treatment. Treatment should focus on the underlying cause of gout, not just the symptoms. Homeopathy looks not only at physical symptoms, but at the whole person in accordance with his lifestyle, character, mental and emotional state.
Homeopathy is a form of medical science that seeks to restore the body’s own defense system, in order not just to eliminate the symptoms of the disease, but to restore the overall health of the body, the balance of its vitality. A homeopathic medicine is prescribed in very small doses, which causes the patient to experience exactly the same symptoms of the disease as a large dose medicine. Thus, the drug provokes a so-called artificial disease that is not at all dangerous to the body, which in turn causes an increase in the natural vitality of a person, thanks to which the disease is defeated. A correctly prescribed drug can both reduce the frequency of painful attacks and help the body completely overcome the disease.
Homeopathic medicines are non-toxic and harmless. They are freely available without a prescription in many regular and specialty pharmacies. These remedies are mostly available in 6c or 30c potency. The dosage is determined by the doctor or according to the strength of the symptom. It is recommended to take the drug and wait for some symptomatic response (reaction) of the body, simultaneously with which there will be a surge in exacerbation, and perhaps a quick or immediate improvement. If there is no reaction of the body to the drug, you should try to choose another one.
The main homeopathic medicines used for attacks of gouty arthritis (gout)
Arnica: This remedy is generally indicated when pain is provoked by dampness. The pain intensifies while walking. The patient may be afraid of touch because even the slightest touch causes pain.
Aconite: This drug is generally indicated for gout in the joints of the legs and is best used at the very beginning of symptoms.
Belladonna: Prescribed when the patient is restless, the skin is red, and he has a fever. At the site of inflammation there is swelling with redness. The pain is worse when touched or shaken.
Berberis vulgaris: This drug is often prescribed to patients who have a history of kidney stones with attacks of stabbing pain. The pain is aggravated by changing position or walking.
Bryonia: A good choice for a person who is very irritated by pain and gets angry. The affected joints are swollen and hot when touched. The patient also complains of pain and stiffness of the knee joints.
Calcarea Fluorica: This drug is prescribed when the joints of the fingers become enlarged due to gout. Knees and toes are also affected. Feeling of acute pain; The joints may make a cracking sound when moving. The condition worsens in winter, but heat or warm weather may bring relief.
Colchicum: The patient suffers from joint pain that is swollen, red and hot. The joints are extremely sensitive to movement or touch. The pain is often worse in the evening and at night. Patients who need this drug often have a feeling of internal cold and severe fatigue and exhaustion.
Ledum: Ledum is given after Colchicum, when a person feels as if his joints have become cool, and he himself also feels chilly. This remedy is especially indicated when cold compresses relieve swelling and pain.
Nux vomica: Prescribed to a patient with gout who is prone to or has a chronic disorder of the stomach.
Rhododendron : A very valuable medicine for patients who suffer from rheumatic pain. It is prescribed when the right side of the body hurts and the joints typically swell before a storm or thunderstorm. The pain may be worse in the early morning. A little warmth and eating cause slight improvement.
Rhus toxicodendron: This remedy may be useful for patients with hot, painful swelling and stiff joints. The symptoms are worse from cold and damp weather, better from warmth and moderate movement.
Sulfur: Suitable for patients with painful itching of the joints with a burning sensation in the legs. Most often the knees and other joints of the lower extremities suffer. Worse from heat in any form, also often worse in damp weather and spring
Diet for gouty arthritis plays a big role in the treatment of this disease. Pathology develops with excessive formation of uric acid in the body. When proteins enter, they are broken down in the gastrointestinal tract with the formation of purine compounds. They produce uric acid.
Mechanism of formation of uric acid
With gout, the metatarsophalangeal joints of the foot are affected, and due to the deposition of uric acid salts, arthritis develops, mainly I. Pain and swelling of the joints of the foot occur, which intensify after long walking or physical activity.
In addition to the above, hypothermia and stress contribute to exacerbation of the disease. According to the description of patients, there is a feeling of “legs in a trap.” The pathology is more common in men and is considered a “disease of aristocrats.”
Risk factors for developing the disease:
The patient's sensations arising from gouty arthritis
When protein is consumed in small portions with food, the resulting uric acid salts have time to be excreted from the body through the kidneys in the urine. This prevents the deposition of uric acid crystals in the joints, so those suffering from gout are advised to eat small meals frequently.
Throughout the day you should consume a sufficient amount of liquid - at least 2 liters per day (not counting soups and third courses).
Diet for gout: classification of recommended and prohibited foods
For gouty arthritis, some foods should be completely abandoned, others can be taken outside the phase of exacerbation of the disease with some restrictions, and others can be taken without restrictions.
It is recommended to arrange weekly “fasting days”, during which you should consume fruits, vegetables, cereals, compotes, fruit drinks, and mineral water.
You should not eat veal and lamb meat, jellied meat, fatty fish, the entrails of birds and animals, animal fats, smoked meats, and canned legumes.
Alcoholic drinks, spicy seasonings, products made from yeast dough, soups from bags, tonic drinks (tea, coffee, cocoa) are prohibited.
You should limit the consumption of boiled sausage, boiled trout or salmon, boiled poultry, mushrooms, spinach, and sorrel. These products can be taken no more than 1-2 times a week.
If you have arthritis, you can eat rabbit and turkey dishes in unlimited quantities. The permitted list of products includes:
If you have gout, you should count your caloric intake. You can eat a diet that includes no more than 2800 calories per day. The daily composition of proteins and fats should be 80g, carbohydrates - 400g. It is necessary to limit the amount of table salt to 5g per day.
Changes in the first metatarsophalangeal joint, characteristic of gout
Gouty arthritis and diet should become constant companions. Proper nutrition can significantly alleviate the patient’s condition and reduce the amount of medications used. For gout, table 6 according to Pevzner is recommended. With concomitant obesity, table 8 is prescribed (low-calorie diet with limitation of easily digestible carbohydrates and animal fats).
Dishes recommended by table 6:
Recommended foods for gouty arthritis
Many patients are interested in whether it is possible to eat mushrooms for gout. Doctors give a clear answer to this question: mushrooms are included in the list of prohibited foods for gouty arthritis. Like other protein-rich foods, they promote increased formation of purine compounds. Instead, it is better to eat fruits and vegetables.
There is a so-called kombucha. It does not grow in the forest, on the ground. It is bred at home for medicinal purposes. This is perhaps the only mushroom allowed for gouty arthritis. It is recommended to drink an infusion prepared with kombucha, and also apply it to the affected joints for gout.
Following a diet for gouty arthritis reduces the formation of uric acid, the deposition of its crystals in the soft tissues of the joints of the foot, and significantly improves the course of the disease.
Gouty arthritis is a disease characterized by inflammation of the joints. The pathology is caused by the accumulation of uric acid in the joints, which provokes the development of the inflammatory process. Gradually, uric acid destroys hyaline cartilage and periarticular tissue.
Gouty arthritis is also characterized by kidney damage. As a rule, nephritis and urolithiasis develop because uric acid crystals are deposited in the renal pelvis and ureters. In medical practice, cases of gouty arthritis are rare, in which there is severe intoxication and massive destructive processes in several joints at once. In severe cases, long-term gout with obvious joint damage leads to disability of the patient.
In most cases, gouty arthritis affects small joints, such as the toes. Less commonly, gouty arthritis affects the ankle, knee, wrist and elbow joints. There are also forms of gouty arthritis in which all large and small joints are involved in the pathological process.
According to medical statistics, gouty arthritis is more common in men. The disease begins at an early age (25-45 years). The pathology is characterized by a long course with relapses.
Until now, scientists and doctors do not know the main reasons for the development of gouty arthritis. Currently, the following factors contribute to the development of gouty arthritis:
As for the factors contributing to the exacerbation of gouty arthritis, these include:
The following types of gouty arthritis are distinguished:
As for the manifestations of gouty arthritis, three periods are distinguished in the development of pathology:
The frequency of attacks with gouty arthritis in different patients varies from once a week to once a year.
Since the clinical picture of gouty arthritis is typical, and almost all patients follow the same scenario, it is necessary to diagnose the disease. As a rule, the first symptoms of gouty arthritis are:
It is noteworthy that in 90% of cases with gouty arthritis, the big toe is the first toe to suffer. If treatment and preventive measures are not taken at this stage, the disease will certainly progress. Gradually, urates will accumulate in other joints, contributing to the development of the inflammatory process in them.
As the disease progresses, the cartilage in the joint is gradually destroyed, which leads to the formation of cavities in them, which are filled with uric acid salts. In addition, uric acid crystals are deposited in the thickness of the skin, forming whitish nodules - tophi. With this development of pathology, the appearance of the leg changes, and in the absence of adequate treatment, the patient may completely lose his ability to work.
It is noteworthy that in women the disease is much milder than in men. In this regard, in women it is quite difficult to differentiate gouty arthritis from arthrosis.
When the first symptoms of gouty arthritis appear, you should consult a doctor. If treatment of the disease is started late, the disease progresses. You should strictly adhere to your doctor’s recommendations regarding medication, diet and exercise.
A characteristic feature of gouty arthritis is hyperuricemia - an increased level of urate in the blood. Therefore, a blood test for urate may indirectly indicate the development of this pathology.
A key indicator in the diagnosis of gouty arthritis is the determination of urate crystals in the synovial fluid. Synovial fluid can be collected from any joint, even if it has not undergone an inflammatory process. The contents of tophi can also be taken for research.
If gouty arthritis lasts a long time, then there is a point in X-ray examination. In the early stages, radiography is usually not performed.
Gouty arthritis is a difficult disease to treat. Here, a lot depends on the discipline of the patient himself and strict adherence to all medical recommendations.
Treatment of gouty arthritis is complex, including the following steps:
With gouty arthritis, there may be some limitation in the patient’s work activity. In particular, with exacerbations of the disease and severe inflammatory processes, disability is possible.
Prevention of gouty arthritis consists of following the principles of a balanced diet and a healthy lifestyle. The consumption of meat products should be minimized. You should regularly undergo preventive examinations, determine the level of urate in the blood and monitor the condition of the joints. If you have a history of gout in your family, then, without waiting for the first symptoms, you should consult a doctor and get examined.
Department of Rheumatology, Faculty for Postgraduate Training of Physicians
Research Institute of Rheumatology RAMS, Moscow
The problem of treating rheumatoid arthritis (RA) is discussed. Modern concepts concerning the pathogenesis and methods of treatment of this serious disease are covered. Modern genetically engineered biological drugs used for the treatment of RA are considered. including tumor necrosis factor inhibitors. (TNF-alpha), as well as a group of chimeric monoclonal antibodies, the main focus of which is rituximab. A review of studies assessing the effectiveness of rituximab for the treatment of patients with RA is given, the results of which allow us to consider this drug as worthy of widespread practical use and actively competing with TNF-alpha inhibitors.
Rheumatoid arthritis (RA) remains important as one of the most important problems in scientific and practical rheumatology. The disease is characterized by widespread prevalence (about 1% of the population), persistent progressive course, complex pathogenetic mechanisms, and heterogeneity of clinical and immunological forms. In the absence of adequate treatment, patient disability may occur in the first years of the disease. Due to potentially dangerous systemic manifestations and complications (vasculitis, amyloidosis, etc.), as well as the accelerated development of atherosclerosis and the high incidence of severe cardiovascular pathology, patients with RA experience a decrease in life expectancy compared to the general population by 3–7 years [1, 2] . All these factors make RA therapy a major challenge.
For a long time, RA was considered a steadily progressive disease, the course of which is extremely difficult to control. Since the mid-1990s. Significant changes have been observed in approaches to the treatment of RA, which have led to a significant improvement in prognosis.
The following strategically important concepts were substantiated [3, 4]:
There are a lot of joint diseases. Rheumatoid arthritis is one of the diseases, early diagnosis and timely treatment of which is of great importance for the quality of future life.
A rheumatologist will conduct a diagnosis and determine the type of disease.
Below is a list of diseases that may have the same symptoms as RA, but are treated differently:
There are a number of laboratory and radiological signs that are specific to rheumatoid arthritis and do not occur with joint lesions of a different nature.
RA is an autoimmune rheumatic disease of unknown etiology, characterized by chronic erosive arthritis (synovitis) and systemic inflammatory damage to internal organs.
Epidemiology. RA is one of the most common inflammatory joint diseases; its frequency in the population is 1-2%. According to the Central Research Institute for Organization and Informatization of Health Care of the Ministry of Health of the Russian Federation, the prevalence of RA in 2011 was 240.1: 100,000 adults. The disease is often accompanied by the development of complications, including cardiovascular ones, and decreased ability to work; After 10-15 years from the onset of the disease, approximately 90% of RA patients are diagnosed with disability. The average life expectancy of patients is 5-20 years lower than the population.
The etiology has not been established. The role of the infectious factor (group B streptococci, mycoplasmas, Epstein-Bar virus), among others, is discussed. A genetic predisposition can be traced: in families of patients with RA, this disease occurs 2 times more often than in control groups; in patients with RA, HLA DR4 and HLA Dw4 antigens are detected twice as often as in the general population; in the presence of B18 and B35 antigens, systemic manifestations of the disease more often develop. Risk factors for the development and progression of Ra include influenza, sore throat, hypothermia, insolation, joint injury, pregnancy, childbirth, menopause, mental trauma, and smoking.
Pathogenesis. It is based on the development of immunopathological reactions in the synovial membrane of the joints. In response to damage to the synovial membrane by an unspecified agent, autoantibodies to the Fc fragment of IgG (rheumatoid factor - Rf), as well as ACCP, are synthesized. Complement is activated, immune complexes are formed, which are fixed on the synovial membrane, on the endothelium of the arteries, and spread through the bloodstream, causing systemic damage involving the lungs, heart, kidneys, skin, nervous system, etc. in the pathological process.
The beginning of the 21st century was marked by the rapid development of pharmacology, immunology and molecular biology, which was reflected in the principles of treatment of many autoimmune diseases. Autoimmune diseases also include rheumatoid arthritis, the treatment of which has always been considered one of the most pressing problems of scientific medicine. How have views on the pharmacotherapy of RA changed over the past 10 years, what new drugs have become available to rheumatologists? We dedicate this material to a review of progressive methods of treating RA.
In this material we will not talk about common truths, but will consider those drugs on which modern treatment of rheumatoid arthritis is based. As a rule, patients diagnosed with RA know a lot about their disease, and therefore we will not talk about the role of autoimmune inflammation. Instead, let's immediately move on to new methods of treating the disease, because, unfortunately, there are not enough reviews of innovative drugs on the Internet. If you want to learn more about the basic methods of pharmacotherapy for RA, read the material “Rheumatoid Arthritis: Symptoms and Treatment”.
So, genetically engineered biological drugs (GEBPs) for targeted therapy are a new word in the treatment of RA. These drugs are also often called "anti-cytokine therapy" agents. For seropositive rheumatoid arthritis, treatment usually begins with disease-modifying anti-inflammatory drugs (DMARDs); anti-cytokine drugs are included in treatment regimens for severe and moderate forms of the disease, as well as in the presence of contraindications for the use of methotrexate and other cytostatics.
Diet for gouty arthritis is one of the main points that makes treatment more effective.
Treatment, or rather a diet for gout and arthritis, is based on complete abstinence from eating certain foods, other foods should be eaten occasionally, and some can be eaten every day. Moreover, the effectiveness of gout treatment as a whole depends on how accurately the patient follows these recommendations. We must remember that a large number of proteins that enter the body during processing in the gastrointestinal tract are broken down, thereby stimulating the production of purines. It is purines that are “to blame” for the formation of uric acid in the gastrointestinal tract. However, if proteins enter the human body in small portions, then the resulting uric acid has time to be eliminated from the body without accumulating in soft tissues.
Therefore, patients with gout should eat often, but in small portions. And once a week it is necessary to give the body a deload; on this day you can eat vegetables or fruits (do not salt the vegetables), from porridge it is better to cook rice in water, compotes, fruit drinks, herbal teas without sugar, mineral water.
In order for uric acid to quickly leave the body of a person with gouty arthritis, it is necessary to consume a large amount of fluid, at least two liters per day. Moreover, liquid in soups, main courses and teas or compotes does not count.
A complete and unconditional refusal of the following products is necessary: veal and lamb meat, any dishes from the internal organs of animals and birds. You cannot eat jellied meat and other similar dishes made from meat and fish; any alcohol is also strictly prohibited. If you have gout, do not eat fatty fish: herring, sardine or mackerel. Smoked products, any seasonings with a spicy taste, beans, peas, soy, any products made from yeast dough are also strictly prohibited.
There are a number of foods that can be eaten several times a week. You shouldn't eat them all the time, as they can cause gouty joint pain, but you can still eat them several times a week. These are boiled sausages, boiled trout or salmon, any boiled poultry, butter, any mushrooms, radishes, spinach, sorrel, cauliflower. But it’s better to add milk to tea or cook porridge.
It seems that people with gout have nothing to eat. But this is not true at all. You can eat any vegetarian dishes, best of all soups, you can cook any dishes from rabbit or turkey, low-fat varieties of cheeses, and vegetables you can eat are cabbage, potatoes, carrots and eggplants. You can cook any cereal or pasta as a side dish. As for drinks, it is better to give preference to fruit and berry compotes and fruit drinks, any mineral water, and juices from vegetables and fruits. Watermelons and green apples are especially useful.
The main condition of a diet for gout is to count the calorie content of food consumed per day. A person should eat no more than 2800 kcal per day, but the daily chemical composition should be distributed as follows: 80 g of fat and protein each, carbohydrates should be 5 times more. Despite limiting the caloric content of food, the diet of a person with gout is quite varied.
If a patient with gout does not have cardiovascular diseases, then he should drink 2 liters of fluid per day, but the amount of salt should not be more than 5 g per day.
Usually, for gout, diet No. 6 is prescribed. Below are the dishes that are included in it:
Any fermented milk products with a low fat content can be consumed every day. Cheeses can be eaten only of low-fat varieties, and curd cheeses should not contain salt. The fat content of sour cream consumed as food should not exceed 10%, and cottage cheese - 3%.
You cannot eat oatmeal, beans or peas, but all other grains can be eaten every day. You can eat one chicken egg per day. For second courses, you can prepare sauces based on vegetable decoctions or based on sour cream, milk or tomato juice without salt.
Vegetables can be eaten in any form: raw or stewed, boiled or steamed, and they can also be baked in the oven. But any fried food is strictly prohibited.
You can eat any vegetable salads or purees, any greens, as well as sandwiches with low-fat cheeses as snacks. The more fruits and berries you eat, the better, as they are the main source of vitamins. Just don’t forget that some of them are not suitable for gout.
For dessert, you can eat any preserves, confitures and jams, candies without adding cocoa, marmalade or marshmallows. You can eat any nuts (but not peanuts), about 20 g/day. You can drink any drinks except coffee and black tea. But it is advisable to reduce the amount of sugar.
At night you need to drink one glass of any liquid.
Nutritionists have developed different types of diets for different groups of diseases. For gout, either diet No. 6 (described above) or diet No. 8 is prescribed. The second diet is prescribed to gouty people who are overweight. Excess weight in a person occurs either due to overeating or due to metabolic disorders. It is the extra pounds, settling in the body, that create additional stress on all internal organs, on the lower limbs, and any diseases only worsen under the influence of excess weight.
The essence of diet No. 8 is that with its help, excess fat is removed from tissues and from the body as a whole. This diet is low in calories by reducing the content of fats and carbohydrates and increasing the amount of proteins.
Table No. 8 allows the consumption of a small amount of rye bread, only vegetable soups, meat and fish low-fat dishes, it is recommended to eat no more than twice a week. Fish and meat should never be fried, but can be subjected to any other types of heat treatment.
Cereal or pasta dishes are limited.
Kefir and low-fat cottage cheese are the only fermented milk products that can be eaten during this diet. Fruits, berries and any drinks based on them are shown.
What is not allowed on diet number 8? Sweet and rich pastries, all sweets, dishes based on semolina or rice, grapes and other fruits containing large amounts of sugar, as well as fatty, smoked foods with hot spices are strictly not allowed on the gout table for overweight people.
Any dishes that are served to a patient with gouty arthritis do not require refined products and are easy to prepare. The range of products that such patients are allowed to consume is quite large and allows you to prepare a variety of dishes based on them.
Gouty arthritis is not a death sentence; it can be successfully treated, but the main thing is the willpower of the patient to withstand the above dietary requirements and follow the appropriate diet for a sufficiently long time.