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Rheumatoid arthritis is an autoimmune disease in which symmetrical joints, primarily the joints of the hands and feet, become inflamed, which is accompanied by swelling, pain and often ends in the destruction of the internal structures of the joint.
Typical for this disease is symmetrical damage to the small joints of the hand and foot. As the disease progresses, the wrist, shoulder, hip, elbow, ankle joints, cervical spine and temporomandibular joints are gradually involved.
From the first weeks of the disease, the patient has a decrease in body weight to 10-20 kg over 4-6 months, febrile (above 38°C) body temperature. Fever occurs in the afternoon or evening and lasts from two weeks to several months. Cachexia (depletion of the body) may develop.
Rheumatoid arthritis affects women more often than men. In the future, the following complications can be observed:
With a careful analysis of anamnestic data, a prodromal period of the disease can be identified, which lasts several weeks or months and is characterized by fatigue, periodic arthralgia, weight loss, decreased appetite, sweating, low-grade body temperature, and in 1/3 of patients, morning stiffness caused by a violation of the circadian rhythm of glucocorticoid secretion (the maximum secretion of cortisol is observed not early in the morning, but much later) and the accumulation of cytokines in the synovial fluid of inflamed joints during sleep. An increase in ESR is possible.
The onset of the disease is most often subacute, less often - acute (with sharp pain in the joints, muscles, fever, morning stiffness) or subtle with gradual progression of joint damage without significant dysfunction. Most characteristic of rheumatoid arthritis is damage to the joints of the hands, feet, wrists, knees, and elbows. The shoulder, hip and spinal joints are rarely affected.
The early phase of the disease is characterized by a predominance of exudative phenomena with the presence of effusion in the joints (positive symptom of fluctuation), inflammatory swelling of the periarticular tissues, severe pain on palpation of the affected joints, and limitation of movements in them. The skin over the joints is hyperemic and hot to the touch. As the disease progresses, proliferative phenomena begin to significantly predominate, fibrous changes develop in the joint capsule, ligaments, and tendons, which leads to the development of joint deformities, subluxations, and contractures. Movements in the joints are limited, and later, as ankylosis develops, complete immobility of the joints occurs.
Damage to the hand in rheumatoid arthritis can be complicated by resorptive arthropathy, which is manifested by shortening of the fingers, hammering of one phalanx into another, and the development of flexion contracture.
Damage to the tendon sheaths of the hand - tenosynovitis - is often observed in rheumatoid arthritis. Tenosynovitis of the extensor digitorum on the dorsum of the hand manifests itself as swelling near the wrist joint. Tenosynovitis of the extensor pollicis longus, common flexor and extensor of the fingers is characterized by swelling, thickening of the corresponding tendon, pain and impaired mobility of the fingers and hand. In some patients, tenosynovitis of the hand is accompanied by the development of carpal tunnel syndrome. The median nerve passes among the flexor tendons in the carpal tunnel; with tenosynovitis of these tendons, it can be compressed, which causes the following characteristic signs of carpal tunnel syndrome:
Lesions of the distal interphalangeal joints, the first metacarpophalangeal joint of the thumb, and the proximal interphalangeal joint of the little finger (“exclusion joints”) are not typical for rheumatoid arthritis.
In miners, rheumatoid arthritis often develops against the background of silicosis. In this case, in the lungs, an X-ray examination reveals small foci of darkening scattered over all fields, and against their background there are numerous, large, well-defined foci from 0.5 to 5 cm in diameter, localized mainly along the periphery of the lungs. This symptom complex is called Kaplan syndrome.
Characteristic features of lung damage in rheumatoid arthritis are the rapid positive dynamics of clinical and radiological data under the influence of glucocorticoid treatment and the ineffectiveness of antibiotic therapy.
Pericarditis is most often adhesive, with high activity of the process - exudative, and the effusion is sterile, characterized by a low glucose content and a high level of γ-globulin and RF. Pericarditis develops more often in men. Typically, rheumatoid pericarditis is manifested by pain in the left half of the chest (with fibrinous pericarditis), with the accumulation of fluid in the pericardial cavity, the pain decreases or even disappears, a pericardial friction noise (characteristic of fibrinous pericarditis), and an increase in the size of the heart (with effusion pericarditis). With exudative pericarditis, effusion in the pericardial cavity is easily recognized using echocardiography. On the ECG with fibrinous pericarditis there is a concordant rise in the ST interval with its simultaneous concavity; in the presence of pericardial effusion, there is a low ECG voltage.
Symptoms of deforming arthrosis of the knee joints here
Experts have still not been able to uncover the 100% exact cause that causes rheumatoid arthritis of the knee joint and other parts of the body. The most likely theory today implies that rheumatoid arthritis is the result of a combination of genetic and infectious factors.
Today's medicine has come to the conclusion that rheumatoid arthritis of the ankle joint and other areas occurs under the active influence of a bacterial or viral infection. The latter causes disturbances in the functioning of the immune system in people with a hereditary predisposition to this disease. However, there is currently no reliable information that would confirm the presence of microorganisms or infections in the affected joints.
As the clinical picture of this disease develops, cells of the immune system recognize proteins as elements foreign to the body. At the same time, it is impossible to determine the amount and type of proteins that the body can attack.
So, some of them are created as a result of a fungal, bacterial or viral infection, while others are natural particles of the human body that are attacked by immunocytes under genetic influence. Regardless of their origin, such proteins cause a reaction in the immune system, which subsequently begins to produce a cytokine, a chemical element that accelerates the destructive and inflammatory process.
In fact, we can say that rheumatoid arthritis of the hip joint and other varieties of the disease arise due to such an inadequate immune response. As the disease progresses, inflammation gradually begins to spread to the synovial membrane that covers the connecting areas.
In rheumatoid arthritis of the fingers, inflammation affects not only the joints themselves, but also extra-articular areas, thereby causing swelling, chronic pain, weakness and loss of mobility. There are many types of cytokines, but most cases of rheumatoid arthritis of the foot are caused by tumor necrosis factor and interleukin-1.
Experts believe that these substances significantly accelerate the degeneration of joint tissue in this disease. Therefore, treatment of acute rheumatoid arthritis often involves suppressing the production of cytokines in order to reduce tissue inflammation and the rate of joint degeneration.
With “classic” rheumatoid arthritis (it is also mistakenly called rheumatoid arthritis), the main symptoms are quite characteristic:
1. First, the metacarpophalangeal joints of the middle and index fingers become inflamed and swollen, which is often combined with the same damage to the wrist joints (or they are the first to begin to bother).
2. Almost always the joints are affected symmetrically (on the left and right hand, for example); joint pain intensifies at night, in the morning. It is quite intense until noon, and then practically disappears. At the beginning of the disease, pain in rheumatoid arthritis goes away after warming up, but pain relief never lasts long - after 3-4 hours or in the second half of the night, painful attacks resume.
3. Often, in parallel with the damage to the joints of the hands, the small joints of the feet, located at the base of the fingers, are affected and are manifested by pain when pressing the area of the “pads” of the toes. These joints are also affected symmetrically.
4. Later (after several weeks or months), as rheumatoid arthritis progresses, large joints become inflamed - knees, shoulders, ankles, elbows. In some types of rheumatoid arthritis, it is the large joints or heel tendons that first become inflamed, followed by damage to the joints of the feet and hands. This form of the disease is typical for people after 65-70 years of age.
5. Morning stiffness is also common in patients with rheumatoid arthritis. This is a “feeling of a stiff body,” “a tight corset on the body,” or “tight gloves on the hands,” according to the patients themselves. This symptom goes away a couple of hours after waking up, but in severe cases it can last until lunch or even longer.
6. So-called rheumatoid nodules appear - dense formations under the skin in the area of the bend of the elbows, hands, and feet, the size of a pea. These nodules may decrease in volume, disappear, appear again, or remain unchanged for years. Usually they do not cause concern and create only a cosmetic defect.
7. Periodically occurring symptoms of intoxication of the body also often accompany the disease. These are weakness, weakness, loss of appetite, chills, increased body temperature up to 38°C, and loss of body weight.
8. The advanced stage of the disease is accompanied by the occurrence of persistent deformation of the hands and fingers. Ulnar deviation is common: this is a phenomenon in which the hands and fingers deviate outward, are fixed in the wrong position, and mobility in the wrist joints deteriorates. Because of this pathology, the innervation and blood circulation of the hands are disrupted, they become pale, and the muscles atrophy.
Gradually, rheumatoid arthritis affects more and more new compounds. Large ones do not always become inflamed with significant discomfort, but nevertheless lead to significant stiffness in them.
Baker's cyst is the name of a symptom in which excess fluid accumulates in the capsule of the knee joint, stretching it. When there is too much of this exudate, it can lead to rupture of the cyst - the fluid saturates the tissues of the back of the leg, causing swelling and pain in this area.
Other manifestations of rheumatoid arthritis are also possible: inflammation of the salivary glands, burning in the eyes, numbness of the arms and legs, chest pain when breathing.
So let's figure out how the diagnosis of rheumatoid arthritis goes? In the early stages, rheumatoid arthritis is difficult to diagnose. There is no specific test that can definitively confirm the presence of the disease. Instead, doctors take into account factors directly related to the disease when diagnosing rheumatoid arthritis. The American College of Rheumatology has compiled a list of criteria to determine the symptoms of rheumatoid arthritis:
The presence of four or more of the listed signs indicates rheumatoid arthritis.
These criteria help diagnose rheumatoid arthritis, but it still remains quite challenging.
Symptoms may come and go. To identify RA, a doctor needs to examine the joint during an exacerbation of the disease for the following reasons:
Rheumatoid arthritis can mask various diseases that complicate diagnosis:
These complications may hinder early diagnosis of RA. In fact, the average time between initial symptoms of the disease and official diagnosis is nine months!
Although rheumatoid arthritis is difficult to diagnose, it is a crucial stage. A late diagnosis can lead to joint destruction in the early stages of RA. According to some experts, preventing early joint destruction can significantly improve the patient's condition for a long period.
The problem arises when rheumatoid arthritis develops without the presence of diagnostic criteria. If signs of RA are still present, it would be a mistake to start treatment with strong medications, as this can cause serious side effects.
If you or your doctor suspect rheumatoid arthritis, the doctor should analyze the situation and consider a plan of action - schedule a medical examination or begin treatment. This may take some time, but you will be given an accurate answer. The following recommendations for RA patients may provide valuable guidance to physicians when diagnosing rheumatoid arthritis.
In the early stages of rheumatoid arthritis, it may be difficult for you and your doctor to get immediate answers. Only a thorough medical examination can show certain results. If you suspect symptoms of rheumatoid arthritis, contact a rheumatologist or consult your primary care physician.
Most often, osteoarthritis is differentiated from arthritis of various origins - rheumatoid, infectious, metabolic.
Osteoarthritis is characterized by a gradual, sometimes imperceptible, onset of the disease; the onset of rheumatoid arthritis is often acute or subacute. Osteoarthritis is more often detected in women with a hypersthenic body type.
Morning stiffness with osteoarthritis is mild and does not exceed 30 minutes (usually 5-10 minutes).
Osteoarthritis is characterized by a “mechanical” nature of the pain syndrome: pain occurs/intensifies when walking and in the evening and decreases with rest. Rheumatoid arthritis is characterized by the “inflammatory” nature of the pain syndrome: pain occurs/intensifies at rest, in the second half of the night and in the morning, and decreases when walking.
Rheumatoid arthritis is characterized by predominant damage to the small joints of the hands and feet, with arthritis of the metacarpophalangeal and proximal interphalangeal joints of the hands being pathognomonic. Osteoarthritis most often affects the distal interphalangeal joints (Heberden's nodes); damage to the metacarpophalangeal joints is not typical for osteoarthritis. It predominantly affects large joints that bear the greatest physical load - the knees and hips.
X-ray examination is of great importance in the differential diagnosis of osteoarthritis and rheumatoid arthritis. Radiographs of joints affected by osteoarthritis show signs of destruction of articular cartilage and an increased reparative response: sclerosis of the subchondral bone, marginal osteophytes, subchondral cysts, narrowing of the joint space. Sometimes osteoarthritis of small joints of the hands occurs with erosion of the articular edges, which complicates differential diagnosis.
With osteoarthritis, deformities characteristic of rheumatoid arthritis do not develop. In osteoarthritis, the level of acute phase reactants (ESR, CRP, etc.) rarely and slightly increases; it is not typical for rheumatoid factor (RF) to be detected in the blood serum.
The putative causative factor (external or internal) triggers a heterospecific immune response. Damage to the joint begins with inflammation of its synovial membrane, which acquires the character of proliferation (pannus) with destruction of cartilage and bone tissue. In some cases, regression of the inflammatory-proliferative process can be observed during treatment or spontaneously. The nature of inflammation largely depends on the determining influence of immune response genes.
Neutrophils release free radicals and hydrolytic enzymes that destroy cartilage. 80% of patients have antibodies (rheumatoid factor) to the Fc fragment of Ig in their blood. Antibodies accumulate in the synovium and activate complement in the synovial fluid. Uptake of rheumatoid factor by macrophages and neutrophils stimulates the formation of cytokines and the release of proteolytic enzymes, which enhance the inflammatory process.
Pannus (a conglomerate of fibroblasts, inflammatory and vascular cells) in interaction with various growth factors are formed at the border of the synovium and cartilage, which causes erosion of cartilage and bone.
Destructive processes of cartilage are unpredictable. In most cases, compensatory mechanisms cannot resist the process of inflammation and the proliferative factor destroys the cartilage and the joint as a whole. Due to ongoing inflammation and impaired perception of biomechanical loads by the joint, secondary osteoarthritis develops.
Juvenile rheumatoid arthritis is a chronic inflammatory disease of the joints in children under 16 years of age with an unknown etiology and complex pathogenesis, characterized by a steadily progressive course and accompanied in some patients by the involvement of internal organs, often resulting in disability.
Among rheumatic diseases of childhood, juvenile rheumatoid arthritis ranks first in prevalence. The disease is observed in various regions of the globe with a frequency of 0.05 to 0.6% in the population. Primary incidence also varies widely, ranging from 6 to 19 cases per 100,000 children.
Symptoms of juvenile rheumatoid arthritis
The clinical picture of juvenile rheumatoid arthritis is varied. The onset of the disease can be acute or subacute. With an acute onset, body temperature usually rises, pain appears, and then swelling in one or more joints, often symmetrical. However, the symmetry of the lesions sometimes does not become obvious immediately, but within several days or weeks from the onset of the disease. As a rule, large joints are affected - knees, ankles, wrists, but sometimes small joints of the arms and legs (metatarsophalangeal, interphalangeal) are affected from the very beginning of the disease.
Typically for juvenile rheumatoid arthritis, damage to the joints of the cervical spine. All joints are sharply painful, swollen, and in rare cases the skin around them is hyperemic. Body temperature gradually increases and can reach 38-39 °C. In this case, a polymorphic allergic rash often appears on the skin of the torso and limbs, and the peripheral lymph nodes, liver and spleen enlarge. A general blood test reveals anemia, often neutrophilic leukocytosis with a shift in the leukocyte formula to the left, an increase in ESR to 40-60 mm/h, an increase in the concentration of Ig, mainly IgG.
The acute onset of the disease is usually characteristic of severe forms - a generalized articular or articular-visceral (systemic) form of the disease with an often recurrent course and an unfavorable prognosis. This form is most often observed in children of preschool and primary school age, but it can also occur in adolescents.
Subacute onset of the disease is characterized by less severe symptoms. Arthritis usually begins in one joint—the knee or ankle. The joint swells, its function is impaired, sometimes even without severe pain.
The child's gait changes, and children under 2 years of age stop walking. So-called morning stiffness in the joints is observed, which is expressed in the fact that after a night's sleep the patient feels for some time difficulty moving the joints and self-care. He gets up with difficulty, his gait is slow. Morning stiffness can last from a few minutes to 1 hour or more. The process may be limited to one joint for a long time (rheumatoid monoarthritis).
This form of the disease, especially in girls of preschool age, is often accompanied by rheumatoid eye damage - rheumatoid uveitis, unilateral or bilateral. With rheumatoid uveitis, all membranes of the eye are affected, as a result of which visual acuity drops sharply until it is completely lost, sometimes within six months. In rare cases, the development of rheumatoid uveitis may precede the articular process, which makes timely diagnosis extremely difficult.
The subacute onset of the disease can occur with the involvement of several joints - usually 2-4. This form of the disease is called oligoarticular. Joint pain can be moderate, as can exudative changes. The process may involve, for example, two ankle and one knee joints, and vice versa. Body temperature does not increase, polyadenitis is moderate. This form of juvenile rheumatoid arthritis is more benign, with less frequent exacerbations.
Subsequently, as the disease progresses, two main forms are possible - predominantly articular and articular-visceral in a ratio of 65-70% and 35-30%, respectively.
The articular-visceral (systemic form) includes five signs: persistent high fever, polymorphic allergic rash, lymphadenopathy, hepatolienal syndrome, arthralgia/arthritis. This form of juvenile rheumatoid arthritis has two main variants - Still's syndrome, which most often develops in preschool children, and Wieseler-Fanconi syndrome, usually observed in schoolchildren.
Depending on the severity of the course, there are 4 degrees of arthritis. The extent of the damage can only be determined during an X-ray examination.
In the first phase of the disease, slight pain in the diarthrosis and difficulty moving in the morning are observed.
A patient with grade 1 arthritis of the joints of the fingers is surprised to notice that the simplest actions (opening a water tap, turning the gas tap under the kettle) are difficult for him. Inactivity of the hands in the morning (“glove symptom”) is a characteristic sign of stage 1 of the disease.
Stage 1 of the ankle joint disease is characterized by pain during flexion and extension. Shoes that suddenly become tight around the ankle indicate the development of characteristic swelling.
The pain that occurs in the ankle is periodic. Constant tension in the joint leads to the patient feeling unwell and quickly getting tired. As a rule, with grade 1 ankle inflammation, he does not go to the doctor.
At stage 1 of inflammation of the shoulder joint, after physical activity, mild pain occurs in it, which goes away almost immediately.
Aching pain in the knee joint, sometimes occurring at stage 1 of inflammation of the knee diarthrosis, intensifies with exercise, but quickly passes.
Stage 1 of psoriatic arthritis is marked by the occurrence of short-term painful sensations in the joints of the legs and arms, mainly during sleep.
A sign of inflammation of the hip joint (coxitis) of the 1st degree in children can be the child’s refusal to walk, fear of standing on his feet, constant stumbling and frequent falls. If you notice these signs, you must immediately show your baby to the doctor.
With grade 2 arthritis of the fingers, swelling of the joints is observed. A musician begins to feel pain while playing a musical instrument. The fingers begin to make crunching and cracking noises.
Stage 2 of gonitis (inflammation of the knee joint) is characterized by obvious swelling in the joint area, difficulty in moving in the morning, and the appearance of sharp painful sensations. The skin over the joint is red and hot.
Stage 2 of inflammation of the ankle joint is marked by the appearance of severe pain that does not subside even at night, during sleep. The injured ankle swells and turns red and crunches when moving.
The inflammatory process at stage 2 of coxitis development is accompanied by a pronounced pain syndrome, which often leads to immobility of the hip joint. Errors in diagnosis are often explained by the fact that the pain is transmitted (radiates) to the knee joint, forcing the patient to limp.
Grade 2 shoulder arthritis leads to limited hand dexterity. The patient cannot raise his hand high, remove the item he needs from a high-hanging shelf, or comb his hair. The skin in the area of the shoulder joint is hyperemic and swollen. The damaged joint hurts all the time, even without stress. Night attacks of pain are characteristic, intensifying before the onset of morning. During the movement of the diarthrosis, a cracking sound can be heard. It is at stage 2 of the disease that the patient seeks medical help.
Gouty arthritis is characterized by severe attacks of pain at night.
Stage 2 psoriatic arthritis is characterized by swelling and deformation of the big toes (it is in these places that uric acid salts are deposited).
Stage 2 of rheumatoid arthritis is marked by the development of a tumor around the damaged joint, caused by the influx of a large amount of synovial fluid.
Stage 3 of the development of arthritis of the fingers demonstrates symmetrical deformation of the joints on both hands. The patient experiences severe pain in the fingers, especially after a period of rest. The skin over the inflamed joints is red and swollen. Finger movements are constrained.
Stage 3 inflammation of knee diarthrosis leads to its deformation. The pain experienced by the patient is so severe that it provokes muscle spasm, and this entails deformation of the knee joint. The progression of arthrosis at stage 3 gradually leads to fixation of the bones in the wrong position.
Stage 3 arthritis of the ankle joint leads to its complete deformation. There is a restriction of mobility in the area of the articulation of the foot with the bones of the lower leg.
Damage to the shoulder joint at stage 3 of the disease is characterized by its deformation, as a result of which the patient is almost unable to move his arm. When you try to move, you can hear a click in the shoulder. The pain syndrome persists. Palpation causes severe pain in the patient.
Inflammation of the hip joint at stage 3 leads to atrophy of the gluteal and femoral muscles. Deformation of the joint causes limited and difficult movements; prerequisites for the development of muscle contracture appear.
Arthritis of the 3rd degree is often an indication for disability.
Stage 4 arthritis of the ankle joint leads to complete loss of ability to work and disability, as the patient is unable to walk.
Arthritis of the fingers at stage 4 often ends with fusion of the articular cartilages, which leads to loss of finger mobility and loss of self-care skills. A patient with stage 4 arthritis of the fingers is often completely helpless.
Stage 4 arthritis of the shoulder joint ends with complete immobility. The radiograph of this period reflects irreversible deformations of the joint itself and the cartilage surrounding it.
Inflammation of the knee joint at the 4th stage of development of the disease leads to the formation of tendon-muscular contracture.
Arthritis of the hip joint at stage 4 ends with the development of fibrous or bone ankylosis (complete immobility of the affected joint as a result of intra-articular adhesions).
The pain syndrome in grade 4 arthritis intensifies even more and causes unbearable suffering to the patient.
The disease has various forms depending on a number of criteria characterizing its course. The classification of rheumatoid arthritis was first adopted in 1961 by Academician A. Nesterov and revised in 1980. As the disease is studied, it may change and be supplemented.
According to clinical and anatomical forms, the disease is divided into:
According to the nature of the course, the disease is divided into:
According to the degree of damage to the musculoskeletal system, the disease is divided into the following stages:
Based on the results of X-ray examination, the disease is divided into:
According to the immunological characteristics of the disease, they are distinguished:
Classification of rheumatoid arthritis allows the doctor to obtain the most complete picture of the patient’s disease course and prescribe effective therapy. My patients followed the advice of Elena Malysheva, thanks to which they can get rid of pain in 2 weeks without much effort.
Due to the fact that the causes of the disease are not well understood, the prevention of rheumatoid arthritis is quite difficult. If you have a hereditary predisposition, you should carefully monitor your health: avoid hypothermia and excessive sun exposure, promptly and completely treat viral infections, take vitamins in the winter-spring season.
To overcome the disease, you will need time, patience and strict adherence to all the recommendations of your doctor.
Prevention of rheumatoid arthritis is divided into:
Primary prevention of rheumatoid arthritis is inextricably linked with the prevention of rheumatism in general:
Secondary prevention includes:
When you think of rheumatoid arthritis, you probably think of stiff, painful, and inflamed joints as characteristic signs of the disease. However, you may not be aware that RA can also affect extra-articular areas of the body. An autoimmune process that affects the joints can also affect the eyes, lungs, skin, heart, blood vessels and other organs. The medications you use for RA may also cause unwanted effects. Finally, coping with RA on a daily basis can be emotionally draining. Many people with RA suffer from depression.
To control the complications caused by rheumatoid arthritis, early diagnosis and appropriate treatment are necessary. Possible complications of rheumatoid arthritis:
One in five people with rheumatoid arthritis develop lupus or rheumatoid nodules, mostly under the skin in the elbows, forearms, heels and fingers. Rheumatoid nodules may develop gradually or appear suddenly. They can also appear in other areas of the body, such as the heart and lungs.
Inflammation of the blood vessels, or vasculitis, caused by RA can cause changes such as ulcers in the skin and surrounding tissue.
There are different types of skin rashes and changes associated with RA and medication side effects. It is important to tell your doctor about any skin changes or bruising.
Eye damage in RA manifests itself in different ways. A typical complication is inflammation of the episclera, the thin membrane covering the sclera or white of the eye. The disease has moderate symptoms, but the eyes may become inflamed and red. Scleritis, inflammation of the eyeball, is a more serious disease that can lead to vision loss.
If you have rheumatoid arthritis, you are also at risk of developing Sørgen's syndrome, a condition in which the immune system begins to attack the lacrimal glands that secrete tears. You may experience a feeling of sand and dryness in your eyes. Without proper treatment, dryness can lead to infection and scarring of the conjunctiva (eye lining) and cornea. If you have rheumatoid arthritis, ask your doctor if you need regular eye exams.
Diseases of the cardiovascular system
In many people with rheumatoid arthritis, fluid accumulates between the pericardium and the heart (pericardial effusion). In this case, there may be no symptoms of the disease. Signs of pericarditis (inflammation of the lining of the heart) usually appear during flares or disease activity.
Chronic pericarditis can cause the lining to harden, which can affect the normal functioning of the heart. In this case, pathological changes similar to rheumatoid nodules may also develop. In rare cases, inflammation of the heart muscle (myocarditis) develops.
Drugs used to treat RA can also weaken the heart and other muscles.
Systemic inflammation increases the risk of developing cardiovascular disease in people with RA. Recent research shows that people with RA are at risk of heart attack, just like people with type 2 diabetes. RA also increases the risk of stroke.
Inflammation of the blood vessels, or vasculitis, is rare but is a serious complication of RA. RA vasculitis, or rheumatoid vasculitis, primarily affects the small blood vessels of the skin, but it can also affect other organs, including the eyes, heart, and nerves.
Blood disease and effect on red blood cell formation
Most people with active RA do not produce enough red blood cells (anemia). Anemia may be accompanied by symptoms such as weakness, rapid heartbeat, shortness of breath, dizziness, claudication and insomnia. During an active inflammatory process, excessive platelet production may occur. Taking medications that suppress the immune system can cause a low platelet count in the blood (thrombocytopenia).
A less common complication of RA is Felty's syndrome, a condition characterized by an enlarged spleen and low white blood cell count. Felty syndrome increases the likelihood of lymphoma, tumors, and lymph nodes.
The inflammatory process can affect both the lining of the heart and the lining of the lungs, causing pleurisy and accumulation of mucus in the lungs.
Rheumatoid nodules may also appear in the lungs. Nodules are usually not dangerous, but in some cases they can cause a ruptured lung, coughing up blood, an infection, or a pleural effusion, a collection of fluid between the lining of the lung and the chest. RA can also cause complications such as interstitial lung disease and pulmonary hypertension.
Drug therapy for RA can also negatively affect the lungs. For example, one of the most widely used drugs for RA, methotrexate, can cause complications such as difficulty breathing, cough and fever. After stopping use of the drug, the symptoms disappear.
People with RA are more susceptible to infections, which may indicate another disease or be due to the use of immunosuppressive medications. Treatment with biologic agents, including new, potent antirheumatic drugs, may significantly increase the risk of serious infections in people with RA, according to research.
Dealing with the daily pain and limitations of a chronic illness can take a toll on you emotionally and physically. According to one recent study, nearly 11% of people with RA had moderate to severe symptoms of depression. People with more disabilities were more depressed. According to the study, only one in five patients with symptoms of depression discussed their condition with a doctor.
Based on the description of this disease, it may seem that the prognosis for the outcome of this disease is very bleak. Fortunately, rheumatoid arthritis does not develop so badly. This is due to very large variability and the influence of individual factors. A study of thousands of patients shows that of our patients, 20% recover without any residual damage to the joints, 20% recover with minimal changes in the joints, in 50% the disease becomes chronic with periodic, varying rates of progression and changes in the joint, and only in 10% of patients experience severe functional impairment.
The prognosis of rheumatoid arthritis is determined, therefore, based on the nature of the disease and further comprehensive treatment and care, implying consistent monitoring of the course of the disease. We will talk about this in more detail in the section on the treatment of rheumatoid arthritis. Today's treatment options, the ever-deepening understanding of the problems brought by this disease, both on the part of the patient, his family, immediate environment, and on the part of the whole society, have significantly improved the patient's prospects for living a full, albeit sometimes slightly changed, life again. Over the years of illness, its activity gradually decreases, and new joints are not affected by it.
Nevertheless, the resulting changes in the joints, including their deformation, remain, and for the prognosis of the disease it is very important to identify it at the initial stage, when it is necessary to actively apply all available treatment methods, including careful prevention of the occurrence of deformities.