Rheumatoid arthritis is a systemic inflammatory disease of connective tissue that primarily affects the joints. The disease is characterized by a chronic, constantly progressive course.
This pathology occurs in approximately 0.5% - 1.0% of the planet's population. Middle-aged and elderly women suffer from it more often. Treatment of this disease is best done in the initial stages of its development.
The initial signs of rheumatoid arthritis can vary greatly from patient to patient. Depending on them, there are several variants of this disease:
This form is characterized by gradual development. The first manifestations most often are mild pain, stiffness in the morning and slight swelling of the joints.
At the same time, all these symptoms gradually progress. The classic version of rheumatoid arthritis is characterized by symmetrical joint damage.
This feature occurs in 90% of patients with this form of the disease. An isolated pathological process is observed much less frequently.
It is quite rare. This type of rheumatoid arthritis is characterized by a rise in temperature to high levels and chills. Against the background of hyperthermia, symptoms of intoxication occur (weakness, headache, malaise).
In the future, the clinical picture may be complemented by syrositis, carditis, enlargement of the liver, spleen and lymph nodes. As for the pain, it doesn’t bother me initially.
Patients sometimes note aching joints, but it is observed in almost any intoxication. Pain usually occurs only after several weeks and sometimes months.
If rational treatment is carried out for this form of arthritis, the disease quickly transforms into the classic version.
At the same time, in the future, the patient will still have a pathological process during an exacerbation, which will include hyperthermia and symptoms of intoxication.
This variant of the course of the disease is characterized by alternating stages of exacerbation and remission. In this case, initially only one joint may be affected. Remission occurs after a few days or weeks, even if no treatment was carried out.
In the future, the patient will periodically experience exacerbations with the same symptoms and course. After a few years, recurrent rheumatoid arthritis transforms into classic rheumatoid arthritis, which typically affects a large number of joints.
It is the most rare. With the development of just this variant of the disease, rheumatoid nodules form under the skin and/or in the internal organs.
Pain, stiffness in the joints and swelling occur a little later. Otherwise, this version of the flow is usually no different from the classic one. X-ray studies help determine the presence of this form of the disease.
Currently, the “geography” of lesions in rheumatoid arthritis has already been quite well studied. It has been established that this disease can affect a variety of organs and tissues, not just joints.
The most characteristic picture for rheumatoid arthritis is symmetrical damage to the proximal interphalangeal joints. The pathological process may also involve ligaments, tendons and muscles located nearby.
Very often, this disease affects the intercarpal, radiocarpal, wrist and metacarpal joints.
One of the early symptoms includes progressive wasting of the interosseous muscles on the back of the hand. Most often it is caused by a decrease in the functional activity of the hand and/or the formation of myositis.
Damage to the metatarsophalangeal joints, which occurs in rheumatoid arthritis, leads to “hammer” deformation of the toes, as well as subluxation of the metatarsal heads.
All this can contribute to the formation of “corns”, bursitis (usually in the area of the 1st metatarsophalangeal joint), as well as flat feet.
If rational treatment is not carried out, then all these symptoms progress quite quickly. As a result, the so-called “rheumatoid” foot is formed.
Damage to periarticular tissues occupies a rather important place in the clinical picture of this disease. The fact is that deformation of muscles and tendons changes the anatomy and functionality of the hands.
As a result, the fingers deviate in one direction or another, and flexor and extensor contractures occur. These symptoms fit into the concept of “rheumatoid” hand.
If the knee joint is affected, it is likely that a flexion contracture will develop. This pathology occurs as a result of fibrosis of adjacent tissues.
Also quite often there is an effusion of synovial fluid into the posterior parts of the joint. In this case, a Baker's cyst is formed, which can reach quite large sizes.
In extremely rare cases, the joints of the arytenoid cartilages are involved in the pathological process. As a result of their damage, the patient may experience hoarseness.
In addition, rheumatoid arthritis sometimes causes hearing loss. This occurs if the pathological process involves the joints of the auditory ossicles.
It is not uncommon for rheumatoid arthritis to involve damage to the joints of the spine in the cervical region. The result is that the patient experiences pain and a feeling of stiffness.
In some cases, subluxations of the cervical vertebrae may develop. If they reach significant severity, this will lead to sensory impairment, as well as movement disorders.
Nerve tissue sometimes also suffers with rheumatoid arthritis. Moreover, it can be affected both directly and as a result of a pathological process in the vessels that feed it. The peroneal nerves are most commonly affected.
In this case, patients feel numbness or burning in the heels. There may also be a decrease in sensitivity in this area. Movement disorders are extremely rare and only in cases where rheumatoid arthritis is accompanied by deposits in the periarticular tissue.
Vascular lesions are quite typical in this disease. Most often they manifest themselves in the formation of painless ulcers on the shins, as well as areas of necrosis in the area of the nail beds. More dangerous complications also occur. For example, the formation of microinfarctions in the basin of large vessels.
Sometimes rheumatoid arthritis affects various organs. In this case, the heart usually suffers. The development of pericarditis and myocarditis is typical here.
In exceptional cases, mitral and aortic defects may form. Sometimes this disease also affects the lungs. In this case, patients suffer from alveolitis and pleurisy. Moreover, the last of them are only helped by x-ray research methods.
One of the most dangerous but rare complication of rheumatoid arthritis is amyloidosis. It occurs in approximately 10% of patients. In the vast majority of cases, we are talking about people who have been suffering from this disease for a long time.
In order to verify the correctness of the proposed diagnosis and prescribe rational treatment, it is necessary to conduct some research.
We are talking about a biochemical blood test and x-rays of the affected joints. At the same time, the first of them will help to establish the presence of the disease in the early stages.
To determine the degree of its development, X-ray studies are necessary. At the same time, this pathology is characterized by a gradual development of symptoms:
At the same time, radiological signs make it possible not only to establish the very fact of the presence of the disease, but also to clarify the degree of its development.
This is extremely important for proper management of the patient in the future and determining his need for a particular therapeutic regimen.
Rational therapy begins after laboratory and radiological research methods have been carried out and it is possible to establish one or another degree of progression of rheumatoid arthritis. Only after this are certain medications prescribed.
Initial treatment includes one or more drugs from the group of non-steroidal anti-inflammatory drugs. It should be noted that these medications do not immediately relieve articular syndrome. Their maximum effect is observed only after a few weeks from the start of use.
If treatment with non-steroidal anti-inflammatory drugs is ineffective, then specialists prescribe so-called basic therapy. As part of its implementation, the patient receives several funds from certain groups.
First of all, we are talking about cytostatics. The most common of these is methotrexate. In addition, basic therapy also includes medications that contain gold ions (aurothiomalate and auranofin).
Currently, many rheumatologists consider them to be one of the best in the fight against this disease in the long term. At the same time, gold preparations have one rather big disadvantage - the late onset of the therapeutic effect.
In addition, they have a number of side effects, so a patient taking them on an ongoing basis must periodically visit a doctor and monitor the treatment.
Another group of drugs that are successfully used in the fight against rheumatoid arthritis are sulfonamides (salazopyridazine and sulfasalazine).
Despite their somewhat lesser therapeutic effect, these drugs are prescribed almost more often than others, since treatment with them is quite safe, because they do not cause adverse reactions.
Currently, in the fight against rheumatoid arthritis, especially during severe joint pain, drugs from the group of corticosteroids (prednisolone) are often prescribed.
Treatment with these drugs is very popular in Western countries, but in the post-Soviet space, experts have differing opinions about the rationality of their use.
Many believe that their long-term use can cause a number of side effects from internal organs. Moreover, after stopping corticosteroids, joint pain often returns.
Treatment of this disease requires more than just taking medications. Physiotherapy for rheumatoid arthritis is now very common. The main methods used include:
Only comprehensive treatment of rheumatoid arthritis will produce sufficient effect!
Rheumatoid arthritis is an extensive lesion of the connective tissue of predominantly small joints, characterized by a vague etiology and a complex course.
This disease is based on autoimmune inflammation, leading to the development of vasculitis and catabolic disorders.
There are 4 stages of rheumatoid arthritis. They reflect the progression of the disease in the joints and the degree of damage to bone tissue.
Early rheumatoid arthritis is associated with inflammation in the joints. The patient's movements are not limited and allow him to maintain the possibility of his usual professional activities. To properly diagnose and treat arthritis, you need to identify the cause of the disease.
The disease is diffuse in nature, localized in the long tubular bones. An important role in its occurrence is played by limited mobility and lack of load on the joint.
Periarticular osteoporosis can begin either as an independent disease or as a consequence of rheumatoid arthritis.
When examined by X-ray, a decrease in the volume of bone tissue is noted. The image clearly shows its liquefaction and increased transparency of the spongy substance.
To make an accurate diagnosis, consultation with an orthopedic traumatologist is also necessary. The doctor will prescribe several tests, including blood biochemistry and determination of hormone levels.
In case of endocrine system disorders, medications are prescribed that normalize the activity of the endocrine glands. If the hormonal balance is affected, then it is leveled out with the help of certain medications.
Whatever the reasons for periarticular osteoporosis, the leading role in its treatment is occupied by dosage forms containing calcium and vitamin D. These are irreplaceable drugs that are widely used at any stage of arthritis. Agents that stimulate bone formation (fluoride salts) and inhibit bone resorption (estrogens, bisphosphonates, strontium preparations) are actively used.
A characteristic feature of stage 2 arthritis is minor destruction of cartilage and bone. X-rays clearly show isolated bone patterns. Most often, damage occurs in the metacarpophalangeal regions, in the area of the ulna, and in the joints of the wrists.
If the inflammation has spread to the cartilage, the patient's mobility is limited. In the second stage of rheumatoid arthritis, only the bones around the joint are affected, where inflammation and swelling are local manifestations.
Changes in the joint space are expressed primarily in its narrowing. At each joint it has a certain shape and width. An x-ray image shows the appearance of a gap between the articulating bones. This indicates complete or partial destruction of cartilage. The patient complains of pain when walking, which goes away with rest.
As with stage 1, drug and calcium therapy have proven their effectiveness. In combination with these methods of treating arthritis, hormonal ointments and immunomodulators are used.
Using physical methods (plasmophoresis and lymphocytophoresis), the patient’s plasma, lymphocytes and monocytes are removed, which can significantly reduce the degree of inflammation.
At this stage, the degree of activity of rheumatoid arthritis is manifested by serious changes in bone tissue: it becomes thinner at the site of the lesion. X-ray examination reveals asymmetrical narrowing of the joint space, the presence of patterns and local sclerosis. The photographs show significant salt deposits.
The patient's general condition worsens, his movements are limited to an even greater extent. The pain syndrome is persistent and does not stop for a long time even at rest. Visual signs include lameness and joint deformity.
The third stage is characterized by a violation of skin trophism and the addition of secondary arthritis.
In drug therapy, painkillers (analgesics) are used. Hormonal, non-steroidal anti-inflammatory drugs and chondroprotectors that nourish and restore cartilage are widely used.
Treatment of third-degree arthritis with traditional methods can be supplemented with traditional medicine. Various ointments and rubs are used here that have anti-inflammatory and analgesic effects (herbal infusions and bee products).
The symptoms of the third stage of rheumatoid arthritis are complemented by the appearance of new symptoms in the fourth. Bone ankylosis is complete immobility of a joint due to fusion of its surfaces. Soft tissues thicken and become denser. Bone damage is local and can result in joint fusion. Complete muscle atrophy occurs.
On the x-ray, the joint space is greatly enlarged compared to the third stage. There are a lot of bone patterns, and they are clearly visible.
The fourth stage is characterized by a very persistent pain syndrome, which allows the patient to move only with the help of support.
At the late stage of rheumatoid arthritis, the following methods have proven to be very effective:
The patient’s diet depends on the degree of activity of rheumatoid arthritis. To alleviate symptoms and speed up recovery, you must adhere to the following recommendations:
It is better to steam, boil or stew products. Due to the fact that the patient’s mobility decreases, it is recommended to reduce the caloric intake of the diet. This is necessary primarily in order not to gain excess weight, as it creates additional stress on the affected joints.
But orthopedist Sergei Bubnovsky claims that a truly effective remedy for joint pain exists! Read more >>
Damage to small joints of the hands in rheumatology is of very important diagnostic importance. The nature of pathological changes, their localization and prevalence, which groups of joints change at the very beginning of the disease must be taken into account when assessing radiographs in order to correctly interpret the data obtained and make a differential diagnosis between various rheumatic diseases (RD). The X-ray method for examining small joints of the hands retains its leading position for diagnosing systemic inflammatory diseases and allows us to assess the degree and depth of anatomical disorders in the bones and joints.
Smirnov Alexander Viktorovich
Leading Researcher, Doctor of Medical Sciences
State Institute of Rheumatology of the Russian Academy of Medical Sciences
The joints of the hands are target organs for many systemic inflammatory diseases, where the first symptoms of rheumatic diseases can be detected. X-ray examination of joints is necessary to assess damage to bone structures and periarticular soft tissues, especially in cases where the manifestation of the disease is soft tissue calcification. In cases where the soft tissues are not calcified, standard radiographs of the hands show changes in the form of thickening and compaction of the soft tissues, but it is not possible to say conclusively which periarticular structures are changed. Along with standard radiography of joints, magnetic resonance imaging (MRI) is currently used to diagnose rheumatic diseases. MRI makes it possible to detect pathological changes in bones and periarticular soft tissues at earlier stages of disease development, when X-ray examination gives a normal picture. The sensitivity of MRI for detecting pathological changes in bones is undoubtedly higher than the standard x-ray examination method, which cannot be said about the specificity. Symptoms of joint damage on MRI have the same picture in various rheumatic diseases. The use of radiography and MRI makes it possible to make a correct diagnosis more accurately and at the early stages of the development of the disease and, accordingly, begin adequate treatment.
Figure 1. Rheumatoid arthritis, stage 2B. Survey radiography of hands in direct projection. Severe periarticular osteoporosis. Multiple cysts. The joint gaps are sharply narrowed. A few erosions of the articular surfaces. Symmetrical changes.
As a rule, the first erosions appear in the 2-3 metacarpophalangeal, in the area of the styloid process of the ulna, and somewhat later in the proximal interphalangeal joints of the hands and in the joints of the wrists. The detection of multiple erosions (more than 5) [7] in typical joints indicates that the patient has stage 3 RA. Stage 4 is characterized by the appearance of partial or complete bone ankylosis of the intercarpal or one of the carpometacarpal joints (except for the 1st carpometacarpal joint) (Fig. 2).
Figure 2. Rheumatoid arthritis, stage 4. Plain radiography of the hands in a direct projection. Severe widespread osteoporosis. Multiple cysts and erosions of bones and articular surfaces. The joint gaps are sharply narrowed. Joint contractures. Collapse of the wrists against the background of pronounced destructive changes, osteolysis, bone deformations and ankylosis of the joints. Symmetrical changes.
X-ray changes in different joints in one patient may be different, so the stage of RA is established by the maximum change in any joint (for the initial stages of RA) and by the total number of erosions in the joints of the hands and distal feet (for stages 2B and 3 of RA).
Figure 3. Rheumatoid arthritis, stage 4. Plain radiography of the hands. Complete bony ankylosis of the wrist joints. Erosive arthritis and dislocations of the metacarpophalangeal joints.
Psoriatic arthropathy (PsA).
Figure 4. Psoriatic arthropathy. Survey radiography of hands in direct projection. Arthritis mutilans. Multiple intra-articular osteolysis of the distal and proximal interphalangeal joints. Multiple joint subluxations.
Bone proliferation is a distinctive feature of PsA and other seronegative spondyloarthritis. Proliferations are found around bone erosions, as well as diaphyseal and metaphyseal periostitis. In fact, bone proliferation of the distal phalanges can significantly increase bone density (“ivory phalanx”). Intra-articular bone ankylosis, especially in the proximal and distal interphalangeal joints of the hands, are common findings and are pathogmonic symptoms of psoriatic arthritis (Fig. 5,6) with the exception of trauma and a history of purulent arthritis in the affected joint. Inflammatory enthesopathies are characteristic of PsA, which manifest themselves in the form of bone proliferations with varying degrees of severity at the sites of attachment of ligaments to the bones. In the hands, changes are often detected in the proximal and distal interphalangeal joints and can be either unilateral or bilateral, symmetrical or asymmetrical. Erosions are found at the edges of the articular surfaces of the bones and progress towards the center, with the formation of irregular destructive changes. Protrusion of one articular surface into the base of the articulating articular surface forms a “pencil in a cap” type deformity (Fig. 5). PsA is characterized by symmetrical or asymmetrical longitudinal erosive lesions of the joints of the hands at one level or axial lesions of three joints of one finger. A distinctive feature of psoriatic arthritis is multidirectional joint deformities.
Figure 5. Psoriatic arthropathy. Survey radiography of hands in direct projection. Asymmetrical erosive polyarthritis. Deformity of the 3rd left distal interphalangeal joint of the “pencil in a glass” type. Bone ankylosis of the 5th right proximal interphalangeal joint and the joints of the right wrist. Osteolysis of the 1st left metacarpophalangeal and 3rd right proximal interphalangeal joints.
Figure 6. Psoriatic arthropathy. Sight radiography of the proximal and distal interphalangeal joints in direct projection with direct image magnification. Severe periarticular osteoporosis. Formation of bone ankylosis of the 2nd and 3rd proximal interphalangeal joints. Erosive arthritis of the 2nd and 5th distal interphalangeal joints.
Radiological signs that help distinguish psoriatic arthritis from other inflammatory rheumatic joint diseases:
Figure 7. Systemic scleroderma. Survey radiography of hands in direct projection. Complete osteolysis of the distal phalanges and incomplete osteolysis of the middle phalanges of the left hand. Complete osteolysis of the middle and distal phalanx and incomplete osteolysis of the main phalanx of the 2nd right finger. Contractures of the joints of the right hand. Multiple soft tissue calcifications. Severe widespread osteoporosis.
Osteolysis of the phalanges of the fingers is a common radiological symptom of SSc. The most common and early localization of osteolysis is the nail tuberosities of the distal phalanges of the fingers (acroosteolysis) and is usually combined with Raynaud's syndrome and soft tissue calcification. Initially, osteolysis involves only part of the nail tuberosities (Fig. 7), but over time the pathological process spreads to the entire distal, then proximal phalanges and partially the distal epiphysis of the main phalanx of the finger (Fig. 8). It should be noted that the resorption of the phalanges of the fingers in SSD has its own strict direction, described above. This osteolysis differs from intra-articular osteolysis in the proximal and distal interphalangeal joints of the hands with psoriatic arthropathy, which can be detected in any of these joints with unchanged nail tuberosity (Fig. 4).
Figure 8. Systemic scleroderma. Survey radiography of hands in direct projection. Acroosteolysis of the nail tubercles of the 1st and 2nd distal phalanges.
Systemic lupus erythematosus (SLE).
Figure 9. Systemic lupus erythematosus, chronic course. Jaccou's syndrome. Survey radiography of hands in direct projection. Common osteoporosis. Multiple joint deformities. Dislocations of the 1st carpometacarpal joints.
In SLE, linear and round calcifications can be found in the subcutaneous fat and periarticular soft tissues in the area of the wrists and metacarpophalangeal joints [21] (Fig. 10).
Figure 10. Systemic lupus erythematosus, chronic course. Jaccou's syndrome. Sight radiography of the wrist in a direct projection with direct image magnification. Large, oval-shaped calcification in the soft tissues in the area of the epiphysis of the ulna and linear calcification in the area of the outer trapezoid bone. Deformations of the epiphyses of the radius and ulna. Secondary arthrosis of the radioulnar joint. Subluxation of the wrist joint.
Intraosseous osteosclerosis of the distal phalanges (acrosclerosis) is a fairly common radiological symptom that is detected in SLE. X-rays of the hands reveal multiple sclerotic densities of bone tissue, localized in the central parts of the distal phalanges of the fingers [32].
Figure 11. Systemic lupus erythematosus, subacute course. Survey radiography of hands in direct projection. Minor periarticular osteoporosis. Aseptic necrosis of the right scaphoid bone.
Chronic polyarthritis, lupus arthropathy and osteonecrosis of bones lead in their final stage to secondary osteoarthritis of the joints of the hands.
Figure 12. Polyosteoarthrosis, nodular form. Sight radiography of the proximal and distal interphalangeal joints in direct projection with direct image magnification. Multiple osteophytes. Narrowing of joint spaces to varying degrees. Multiple cysts with a sclerotic rim. Subchondral osteosclerosis of the 2nd proximal and 3rd distal interphalangeal joints.
Pronounced changes (correspond to 3-4 stages of arthrosis according to Kellgren):
Figure 13. Polyosteoarthrosis, nodular form. Sight radiography of the proximal and distal interphalangeal joints in direct projection with direct image magnification. Pronounced changes in the 2nd and 3rd distal and 2nd proximal interphalangeal joints. Symptom of “inverted T” of the 2nd distal interphalangeal joint. “Flying seagull” symptom of the 3rd distal interphalangeal joint.
Osteophytes, calcifications and perifocal compaction of soft tissues in the marginal parts of the articular surfaces form Heberden's nodes in the distal interphalangeal joints and Bouchard's nodes in the proximal interphalangeal joints.
Joint damage of non-traumatic origin at a young age is quite rare. One such disease is rheumatoid arthritis in children. The disease occurs in 6-19 people per 100 thousand children under 18 years of age. Girls get sick 2-3 times more often than boys. In some cases, the disease is hereditary.
Despite numerous studies, the causes of the development of childhood or juvenile rheumatoid arthritis are still not clear. The pathology is based on a defect in the immune system, as a result of which the joint cells begin to be perceived by the child’s body as foreign.
Initially, the pathological process is localized in the synovial membrane, which lines the inner surface of the articular cavity. It occurs in the form of inflammation and microcirculation disorders. In response, the body produces a large amount of autoantibodies (substances that destroy its own cells), which further damage the joint tissue - arthritis develops - inflammation of all joint structures. These substances are called rheumatoid factor.
The onset of the disease can be triggered by:
At an early age, rheumatoid arthritis can occur in two clinical forms: articular and articular-visceral.
In the articular form, the onset of the disease is gradual. It usually begins with inflammation of one large joint (monoarthritis) - the ankle or knee. The joint swells greatly, its function is sharply impaired, the child’s gait changes, and young children may stop walking altogether. However, pain in the affected area may not always be observed. A characteristic symptom of rheumatoid arthritis is morning stiffness, when the patient complains of limited mobility of a limb after a night's sleep, which decreases or disappears completely within an hour after getting out of bed.
Sometimes the articular form can occur with the involvement of 2-4 joints in the pathological process - the so-called oligoarticular variant of the disease. The lesion is characterized by asymmetry: simultaneous inflammation of various joints (knee, ankle, elbow, wrist). As with monoarthritis, the pain syndrome is moderate, body temperature does not increase, and the lymph nodes enlarge slightly.
Often the articular form of rheumatoid arthritis in childhood is accompanied by symptoms of a specific eye lesion - rheumatoid uveitis - inflammation of the membranes of the eye, which quickly leads to a decrease or complete loss of vision.
The articular form of the disease is more benign because it progresses quite slowly with infrequent exacerbations of the process.
Possible swelling of the joints (in the photo the left knee is affected)
This variant of the disease is the most severe. It is characterized by a violent, acute onset, accompanied by a high rise in temperature, severe pain in the joints and their swelling. More often the lesion is symmetrical and affects large joints - knee, ankle or wrist. But sometimes the onset of the disease is characterized by inflammation of the small joints of the foot and hand. A typical manifestation of the articular-visceral form of rheumatoid arthritis is the involvement of the joints of the cervical spine in the inflammatory process. The child notices sharp pain in the affected area and the inability to make any movements in the limb.
With this variant of the disease, in addition to joint manifestations, there may be allergic rashes on the skin, significant enlargement of the lymph nodes (up to several centimeters), and an increase in the size of the liver and spleen. A blood test reveals inflammatory changes. With the involvement of internal organs in the pathological process, symptoms associated with their damage appear.
The articular-visceral variant of rheumatoid arthritis in childhood is unfavorable, since internal organs are often affected: heart, kidneys, lungs, liver. Damage to the musculoskeletal system progresses rapidly: persistent impairment of limb function develops, which can lead to disability of the patient.
Detection of the disease is quite a difficult task, especially in its early stages, when the symptoms are nonspecific and joint damage is very similar to rheumatoid arthritis. The difference is that rheumatic damage to joint structures is of a bacterial nature and is caused by the microorganism staphylococcus, while rheumatoid inflammation is caused by an incorrect reaction of the body’s own.
To facilitate diagnosis, rheumatologists use special diagnostic criteria:
If a young patient has only 3 of the signs listed above, then the likelihood of having the disease is quite high. If 4 or more signs are present, the diagnosis of rheumatoid arthritis is beyond doubt.
Additionally, electrocardiography, ultrasound examination of internal organs and the heart, and chest x-ray are performed. Also, all children with joint damage are required to be examined for viral and bacterial infections.
It is very important to diagnose the disease as early as possible, but at the same time, early diagnosis is the most difficult
Treatment of rheumatoid arthritis is a long and very painstaking process, especially in children. Timely initiation of therapy can stop the progression of the disease, reduce the likelihood of complications and significantly improve the prognosis of the disease.
Treatment includes a set of measures aimed at:
Drug therapy includes the following types: symptomatic (taking non-steroidal anti-inflammatory drugs and glucocorticoid hormones) and immunosuppressive (immunosuppressive). Taking anti-inflammatory and hormonal drugs quickly eliminate pain and inflammation. But they do not prevent the destruction of joint structures. Immunosuppressive drugs stop the destruction processes.
Treatment of children with rheumatoid arthritis is an urgent and difficult task in pediatrics
In children, it is preferable to use new generation NSAIDs, which have a selective effect on cartilage and bone tissue, but do not affect the gastrointestinal tract. This allows you to take them for a long time without a high risk of side effects.
Hormonal drugs have a fairly strong anti-inflammatory effect and quickly relieve acute symptoms of arthritis. In children, it is advisable to inject glucocorticoids directly into the joint cavity. Taking such drugs orally should be prescribed only if other methods of administration are ineffective. Oral (by mouth) administration of hormonal drugs at the age of under 5 years is undesirable. Glucocorticoids are prescribed to children under 3 years of age only in extremely severe cases.
The use of immunosuppressive drugs is the basis of treatment of the disease in children. The prognosis for the patient’s life and health depends on how effective it is. The prescription of drugs in this group should be made shortly after the diagnosis has been made. Their use should be long-term and continuous. Even outside of an exacerbation, patients should use “maintenance doses” of medications to prevent relapses.
During the period of remission, methods for restoring the normal functioning of joint structures come to the fore in treatment:
Below is a video with a detailed story about the disease. The video contains complex terms, but don’t be afraid of them - the topic in this video is covered very well.
Since a reliable cause for the development of rheumatoid arthritis in childhood has not been identified, it is impossible to prevent its initial occurrence. If the pathology is in remission, it is possible to prevent exacerbations:
Unfortunately, rheumatoid arthritis in children is a lifelong disease. But with timely initiation and properly selected treatment, it is possible to achieve a state of long-term remission while maintaining a satisfactory quality of life. However, it must be recognized that with frequent relapses with damage to internal organs, disability and limitation of active life quickly occur.
At the top of the comments feed are the last 25 question-answer blocks. I answer only those questions where I can give practical advice in absentia - this is often impossible without personal consultation.
Hello, my child was diagnosed with rheumatoid arthritis 10 years ago a year ago, now he was prescribed Bicelin-5 for six months. He has fluid in his left knee.. They took an Aslo-600 test. Please tell me to treat correctly.
Hello, Aigul. The child's ASL-O is greatly elevated. The effusion in the joint must be removed (a puncture is performed). The use of Bicillin-5 (a combined bactericidal antibiotic) is especially indicated for year-round prevention of relapses of rheumatism in adults and children. For children over 8 years of age, the drug is prescribed at a dose of 1,200,000 units once every 4 weeks. Injecting Bicillin-5 more frequently is contraindicated. Typically, the duration of treatment depends on the severity of the disease and ranges from 3 to 12 months, so prescribing for 6 months is correct, and then it will be determined by the situation. Additional prescriptions can only be made by a doctor who knows your child’s entire medical history.
Good afternoon Yesterday we had an appointment with an orthopedic doctor. The child began to limp on one leg, as if throwing it forward. The fingers on the arms stopped completely straightening. Three shoulders on the left and one on the right handle. Straightening is painful, the muscle is stretched like a string. There is stiffness in the morning. We do exercise therapy. On one arm the boy became more pliable, began to fully unbend, and on the others it also became a little better. No changes were detected on the R-graph. The stride is shortened. The inguinal muscles are slightly separated. The doctor referred me for a consultation with a rheumatologist. How dangerous is this disease, if it is present and is a complete cure possible? And could it just be muscle tone of a different etiology? Not rheumatoid
Good afternoon, Yulia. It’s difficult to answer in absentia; you need to be examined by a rheumatologist. If it is rheumatism, the disease is usually difficult to treat and has complications, but if a diagnosis is made in a timely manner and intensive comprehensive treatment is prescribed, then the chances are good. The best treatment is inpatient.
Hello, a 7-year-old child, when he was 5-6 years old, he complained of pain in his knees in the morning, we went to a pediatrician, a neuropathologist, and a cardiologist. But such diagnoses are not made only by increased intracranial pressure and treatment. I wanted to ask a very active child who wants to go to karate and asks if we can exercise if our knees hurt. Diagnosis according to the description of rheumatoid arthritis coincides with what to do
Bota, if a child has knee pain, then treatment is needed. Active sports are not recommended. Take your child to a rheumatologist and have him prescribe an examination.
Hello. The child is 2 years old; at the age of one and a half he suffered from acute bronchitis and a purulent pimple appeared on his forehead. We were cured (injected with antibiotics) and did an ultrasound of the abdominal cavity, they said that the liver was slightly enlarged, but after treatment they said it was normal. at 10 months the child’s weight stopped (either they gained 200-400 g or lost it), although the appetite is normal and he eats. It also grows slowly. When the pediatrician listened to the lungs, she noticed that the heart was noisy. We went to a cardiologist (they did an ECG and ultrasound of the heart), diagnosed muscle dysplasia (she said that his muscles are too flexible and soft, which is why he hears heart murmurs, but his heart is healthy and said protein is not absorbed). She prescribed treatment, took half the course (half a year), the result was insignificant, weight increased with minor changes.
A couple of months ago, during the day after a walk, he began to complain of pain in his right leg, lifts his leg and cries “Wawa” and refuses to get up on his feet (especially in the morning) and limps. He was given ibuprofen at that time and complained again two months later. My knees did not swell or turn red. Please advise me something, because at that moment when there were first pains in the knee, we went to the orthopedist, he said that nothing is wrong with you, everything is fine, that’s how he plays. But will a 2-year-old child just cry and limp?
Lyalya, you cannot prescribe treatment over the Internet, especially for a child, without knowing the exact diagnosis. Based on the symptoms you described, the child is clearly progressing to some kind of disease. It is possible that this is a complication after acute bronchitis; antibacterial drugs could also cause complications. There can be many reasons. Visit a rheumatologist and get your urine and blood tested.
A 3-year-old child, a girl, after a viral infection and high fever, after two or three days, her knee began to hurt at night. I cried a lot. The pediatric surgeon, having done only a general blood test, diagnosed rheumatoid arthropathy. She was treated with Nise tablets, 0.25 mg, and dimexide lotions with indomethacin ointment. Everything went away after a few days. She complained at the same time only at night, and was very active in the morning and during the day. During the pain, the temperature did not rise. And two months later, now everything is repeating itself, again after a two-day fever. During the fever, she complained about her legs, now a week after the fever (there was still only scanty snot), her legs hurt again at night, only now both knees, she holds on to both. What should we do and which doctor should we contact?
Valentina, specialists in the treatment of joints, is an orthopedic traumatologist and rheumatologist. A more extensive examination is needed, as there are many causes of knee pain. It is also necessary to see an infectious disease specialist, especially since the problems appeared after a viral infection. Most likely, some virus remains in the body and undermines the joints.
The child complains of knee pain, the knees do not swell or redden, there is a Becker cyst under the left knee, the tests are normal, the doctor wants to prescribe methotrexate, I do not agree, maybe there are some alternatives to pills?
Natalya, Methotrexate is, of course, a complex drug, but effective. If a doctor has prescribed it, then he must have experience in using this drug. Before use, it is important to check the child’s platelet levels, determine the values of liver enzymes and bilirubin, and check kidney function. As for alternatives, usually, if conservative treatment is not effective, which is what your child was prescribed, drainage is performed: the cyst is punctured and the contents are removed through a catheter. The intervention is minimally invasive. At the same time, it is necessary in any case to treat the underlying disease that caused the formation of the cyst. But you cannot replace Methotrexate with an analogue on your own; only a doctor can do this.
zdravstvuyte.rebenku 4 goda.uvenialniy revmatoidniy artrir.segodnya podnyalas temperatura38.kak ee lechit?shto nujno dat
In order to alleviate the child's condition and relieve acute symptoms, non-steroidal anti-inflammatory drugs are used. A more specific drug can only be recommended to you by a doctor during an in-person appointment, taking into account the baby’s height, weight, and general health indicators.
After relieving acute symptoms, laser therapy, massage and UHF are indicated for the affected joints. Also, do not forget about following your diet.
In children under 16 years of age, the disease is called juvenile rheumatoid arthritis. It is characterized by damage to large and medium-sized joints, in particular the knee, ankle, wrist, elbow, hip, and, less commonly, small joints of the hand. The joints are painful and swollen. The body temperature reaches 39 °C, and a polymorphic allergic rash often appears on the skin of the torso and limbs, and the lymph nodes, liver and spleen are enlarged. When treating the disease, long-term and constant use of anti-inflammatory drugs is prescribed. Rheumatoid arthritis is often disabling, so it is extremely important to see a doctor promptly.
Yulia Viktorovna Kulak, pediatrician at the Nearmedic network of clinics, Ph.D.
Dislocations, subluxations and flexion contractures
compaction of soft tissues.
Is an early radiological symptom
Most often found in small joints of the hands and
distal parts of the feet.
Indirectly confirms the presence of fluid in the joint
tissues in the area
ulna.
Cyst-like clearings of bone tissue (cysts).
Narrowing of the joint space.
Erosion of joints (marginal, compression, in place
Multiple subluxations, dislocations and flexion
Periarticular - increased radiographic
transparency of bone tissue in the epiphyses of short and
long tubular bones.
Changes in the trabecular pattern of bones.
Thinning, partial disappearance of trabeculae,
a decrease in their number per unit volume of bone,
thinning of the articular endplates
Minor periarticular osteoporosis.
Severe periarticular osteoporosis.
Generalized - changes not only in
trabecular, but also in cortical bone tissue.
Manifested by thinning of the cortical bone layer
due to endosteal and subendosteal resorption
bones, expansion of the bone marrow space
and spongioization of the cortical layer in short and
long tubular bones.
metacarpal bones.
Defined as various sizes round
forms of X-ray negative formations, in
subchondral or central parts of the epiphyses
During exacerbation, cyst-like clearing of the bone
fabrics do not have clear boundaries and the background
periarticular osteoporosis further increases
radiolucency of bones and may merge with
porous bone tissue.
In remission around cystic clearings
sometimes a thin bony rim appears,
separating it from the surrounding bone tissue.
Single cyst-like clearings of bone tissue in the metacarpals
heads. Minor periarticular osteoporosis.
Multiple cyst-like clearings of bone tissue in the 2nd - 4th metacarpophalangeal joints (more in the 3rd). Individual cysts with
Multiple cysts with a sclerotic rim in
BONE TISSUE (CYSTS)
Multiple local cysts with
sclerotic rim in the first
interphalangeal joint of the large
Large cysts in the scaphoid
bones of the wrist.
Uniform narrowing of the joint space –
distinctive feature of arthritis.
The narrowing can be classified as
slight, moderate and pronounced.
The width of the x-ray joint space should be
measure in the most narrowed area.
Thickening of soft tissues in
area of the wrist and 3rd metacarpophalangeal joint. Moderate
periarticular and osteoporosis in
Moderate narrowing of joints
cracks of the 1st, 4th and 5th metacarpophalangeal joints;
Pronounced narrowing of the 3rd fissure
Pronounced symmetrical narrowing of the joint spaces,
multiple cyst-like clearings of bone tissue and erosions
in the metacarpophalangeal joints.
Multiple narrowing of the joint spaces in the wrist joints and 2-5 carpometacarpal joints. A few bone cysts
The appearance of erosion is associated with destruction
subchondral endplate and area
spongy bone of the epiphysis of the joint.
Edge surface erosions are detected in those
places of the intra-articular part of the bone, where usually
the bone is not protected by the cartilage covering the joint.
Compression erosion occurs when
when failure (collapse) of the subchondral
parts of the cancellous bone against the background of the periarticular
osteoporosis, cystic bone reconstruction
structure, which leads to intussusception of the joint
surfaces inside the epiphysis.
Based on their severity, they distinguish between superficial and
deep erosions, in number - single and
Actively forming erosions have sharp edges
and unclear boundaries.
“Old” erosions are characterized by rounded edges
and sclerotic base.
Erosive arthritis of the 2nd metacarpophalangeal joint
(periarticular osteoporosis, multiple cysts, severe
narrowing of the joint space, single superficial erosion).
Multiple marginal erosions in the 1st and 2nd metacarpophalangeal
joints. Moderate widespread osteoporosis (thinned
cortical layer of the 2 metacarpal bones).
Marginal erosions of the 2nd and 5th
Multiple erosive arthritis of the 2nd metacarpophalangeal and 3rd
proximal interphalangeal joints.
Multiple erosions of the 2nd, 4th, 5th left metatarsophalangeal
joints and the 1st interphalangeal joint of the left toe.
Non-erosive arthritis of the joints of the right foot.
Multiple erosions of the metacarpophalangeal joints.
Compression erosion of the 2nd metacarpophalangeal joint.
Multiple compression erosions of the metacarpophalangeal
Multiple cysts and erosions of the wrist bones.
Erosion at the sites of attachment of ligaments to the styloid processes
Multiple erosive
arthritis of the wrist joints and
Complete destruction
styloid process olecranon
Fusion of 2 or more bones into a single bone block.
With this disorder, the joint space on
not determined on radiographs, bone
trabeculae connect with each other and pass from
one bone to another.
Bone ankylosis is combined with deformities and
osteosclerotic changes in bones
wrist bones.
Multiple ankylosis of the bones of the wrist, carpometacarpal
Bone ankylosis of the 2nd and 3rd carpometacarpal joints (on the left) and
radiolunate joint (right).
Any sharpening of the edges of the articular surfaces.
Marginal defects of bone tissue.
Irregularities in bone contours.
Reduction or increase in bone volume.
Violation of the internal structure of the spongy and
Multiple deformities of the wrist bones.
With rapidly progressive or long-term
course of rheumatoid arthritis on radiographs
large erosions of the joints are detected
surfaces, up to complete destruction and
disappearance of bone epiphyses.
lunate
bone deformities
With extensive and multiple destructive
joint lesions develop multiple
subluxations, dislocations and flexion contractures
joints and are formed typical for RA
Changes such as deformations are formed
fingers like “boutonniere”, “swan neck” and
valgus deviation of the phalanges in the metatarsophalangeal and
metacarpophalangeal joints, bone displacement and
phalanges of the fingers along the axis of the joints.
Valgus deviation and dislocations of 2–5 metatarsophalangeal joints.
DISLOCATIONS AND FLEXIONS
Valgus deviation, flexion
contractures and subluxations in the metacarpophalangeal joints.
Erosive polyarthritis. Severe deformities, dislocations and
subluxation of the metatarsophalangeal joints.
Minor periarticular osteoporosis.
Single cyst-like lucencies of the bone
Slight narrowing of the joint spaces in individual joints.
Few or (multiple) different
the severity of narrowing of joint spaces.
Single erosions (1–4) of the articular surfaces.
Minor bone deformities.
Multiple erosions of articular surfaces (5 and
Multiple moderate (severe)
Moderate (severe) periarticular
Multiple cystic lucencies
Multiple pronounced narrowing of the joints
Multiple erosions of bones and joints
Multiple severe bone deformities.
Subluxations and dislocations of joints.
Single (or multiple) bone ankylosis.
Osteophytes on the edges of the articular surfaces.
determined by X-ray changes
in small joints of the hands and distal parts
The multiplicity and
symmetry of joint damage.
The disease begins in typical RA
In the classic course of RA, erosion in the joints is not
precede periarticular osteoporosis, cysts
and narrowing of joint spaces.
Bone ankylosis in RA is detected only in
joints of the wrists and in the 2nd–5th carpometacarpal
joints, rarely in the wrist and joints
interphalangeal joints of the hands and feet, in the first
carpometacarpal and metatarsophalangeal joints.
The stage of RA is determined according to the maximum
changed joint (for the initial stages of RA) and
by the total number of erosions in the joints
hands and distal feet (for erosive
stage 2 and stage 3).
IN CLASSICAL RA
The first radiological symptoms of RA
found: in the 2nd and 3rd metacarpophalangeal, 3rd
proximal interphalangeal joints of the hands, in
wrists, wrist joints, styloid
processes of the ulna, 5th metatarsophalangeal
Symmetrical changes in the wrists, metacarpophalangeal, proximal, interphalangeal,
metatarsophalangeal joints, first interphalangeal
In more advanced stages of RA, changes may
found in the distal interphalangeal joints
RA never begins with distal lesions
interphalangeal hands and feet and proximal
interphalangeal joints of the feet.
Thickening of soft tissues.
Single cyst-like clearings of bone tissue
Slight narrowing of the joint spaces in
1st and 2nd right metacarpophalangeal joints.
RA, stage 1. Minor periarticular osteoporosis.
The fissures of the first interphalangeal and
X-ray stage 2.
Narrowing of joint spaces.
Single erosions (up to 5).
Single subluxations of the joints are possible.
RA, stage 2 (non-erosive form).
RA, stage 2. Moderate
common osteoporosis.
The gap of the 5th metatarsophalangeal joint is sharply narrowed.
Single cysts. Thinning
cortical layer of bones.
RA, stage 2. Thickened
soft tissue in the area
o Steoporosis. The gaps are narrowed
intercarpal, metacarpophalangeal and proximal
Erosive RA, stage 2. Single erosion of the first right
Erosive RA, stage 2. Single erosions of the wrist bones.
Erosive RA, stage 2.
periarticular and osteoporosis.
Joint spaces are narrowed
wrist and metacarpophalangeal joints.
Single cysts. Regional
erosion of the 2nd right metacarpal
X-ray stage 3.
Dislocations and subluxations of joints.
bones and joints of the wrist.
RA, stage 3. Symmetrical
RA, stage 3. Dislocations of the 2nd–4th metatarsophalangeal joint (left)
X-ray stage 4.
Narrowing of the gaps of most joints.
Deformations of the epiphyses of bones.
Single or multiple bone ankylosis.