Rheumatoid arthritis is one of the most severe joint diseases, occurring with many complications. Rheumatoid arthritis affects people of all ages, but most often those over 30. Among women, about 5 times more suffer from rheumatoid arthritis than among men. In general, according to various scientists, this disease affects 1-2% of the population.
The symptoms of rheumatoid arthritis are difficult to confuse with the symptoms of other joint diseases. In the vast majority of cases, at the onset of the disease, inflammation and swelling of the metacarpophalangeal joints of the index and middle fingers occurs. We are talking about the joints located at the base of these fingers, that is, in the area of \u200b\u200bthe protruding bones of a clenched fist.
This inflammation of the metacarpophalangeal joints is most often combined with inflammation and swelling of the wrist joints. And sometimes the wrist joints become inflamed and swollen first.
What is characteristic is that inflammation of the joints in rheumatoid arthritis is almost always symmetrical - that is, if the joints on the right hand are affected, then the same joints on the left hand are almost certainly affected. And, unlike rheumatism, with rheumatoid arthritis the inflammation in these joints is persistent, swelling and pain in them last from several months to several years.
Joint pain with rheumatoid arthritis intensifies most often in the second half of the night, in the morning. Until about noon the pain is very intense; patients compare them to toothache. However, in the afternoon the pain becomes weaker, and in the evening it is often insignificant. What is also characteristic is that at the beginning of the disease, joint pain often decreases after active movements or warm-up. And they do not get worse from stress, as happens with arthrosis. However, any relief from rheumatoid arthritis usually lasts only until the middle of the night, and around 3-4 hours the attacks of joint pain resume.
Along with inflammation of the joints of the upper extremities, rheumatoid arthritis almost always affects the small joints of the feet. The joints at the base of the toes become inflamed, which manifests itself as pain when pressing under the “pads” of the toes. It is symptomatic that the joints of the legs become inflamed as symmetrically (on the right and left limbs) as in the arms.
Large joints, such as the shoulders, knees, elbows and ankles, usually become inflamed later, after several weeks or months. Although there are other types of rheumatoid arthritis, in which the first to become inflamed are the shoulder or knee joints, or the heel tendons, and the inflammation of the small joints of the hands and feet “joins” later. This form of arthritis most often occurs in people over 65-70 years of age.
In addition to intense pain, rheumatoid arthritis is characterized by the symptom of morning stiffness . Patients describe morning stiffness as a feeling of “stiffness in the body and joints” or as a feeling of “tight gloves on the hands,” less often as a feeling of “a tight corset on the body.”
With a relatively mild course of rheumatoid arthritis, morning stiffness usually disappears within an hour or two after the patient gets out of bed. But in severe cases of the disease, this unpleasant sensation can persist until one o’clock in the afternoon or even longer.
Many patients develop rheumatoid nodules . They are quite dense to the touch, usually about the size of a pea, and are most often located just below the bend of the elbows. But sometimes rheumatoid nodules also appear on the hands, feet and other places. More often there are few of them (1-2), but sometimes they are formed in large quantities. Usually the nodules are relatively small (2-3 cm in diameter), but quite large ones are also found.
Note from Dr. Evdokimenko.
If a rheumatoid nodule is cut open and viewed under a microscope, you will see that it is a collection of immune cells that surround a small patch of dead tissue. It is not yet clear what attracted them there, but they behave quietly and do not cause much concern to the patients. The nodes may decrease in size, disappear completely and then reappear. In other cases, they remain for many years without significant changes. The knots do not pose any threat and are more of a cosmetic defect.
Very often, the symptoms listed above are accompanied in patients by a feeling of weakness, deterioration of sleep and appetite, a moderate increase in temperature (up to 37.2-38 ° C), and chills. Patients often lose weight, sometimes significantly.
As the disease develops, in its advanced stage, permanent deformation of the fingers and hands . More often than others, “ulnar deviation” of the hands develops, when the hands and fingers are fixed in the wrong position and deviate outward. The mobility of the wrist joints sharply decreases, the arms have difficulty bending and unbending at the wrists. Due to impaired blood supply, the skin on the hands and wrists becomes pale, dry, thinned, and the arm muscles atrophy. These phenomena intensify with increasing disease activity.
Gradually, more and more joints are involved in the pathological process. Knees, elbows, ankle and shoulder joints often become inflamed. Inflammation of the elbow, shoulder and ankle joints usually occurs relatively mildly, but leads to noticeable stiffness of the joint, sometimes to a rather sharp limitation of movements in the joint.
The situation is more complicated with the knee joints. Rheumatoid disease of the knees is often accompanied by the accumulation of a large amount of pathological fluid in the joint cavity, stretching the joint capsule. This type of fluid accumulation in the knee is called a Baker's cyst. In the most severe cases, excess fluid in the cyst can lead to its rupture, and then the contents of the cyst spill into the soft tissue of the lower leg along its back surface. In this case, swelling of the lower leg appears, and sharp pain occurs in the leg. After some time, acute manifestations of the rupture usually subside, pain and swelling decrease. But if the inflammatory process in the knee continues, then the joint can “swell” again and again with all the ensuing consequences. And only when the activity of the inflammatory process is suppressed, the increased production of pathological fluid stops, and the rupture gradually heals.
In addition to inflammation of the joints, in the active phase of rheumatoid arthritis, the vertebral joints are sometimes involved in the inflammatory process. More often the cervical spine becomes inflamed, and then pain appears in the neck and under the back of the head. Sometimes they even try to treat such patients, suffering from inflammatory pain in the spine, with massage, manual therapy or heating - which is a gross medical error. All these attempts often lead only to an exacerbation of the disease and increased pain, since such manipulations during an active inflammatory process only intensify the inflammation.
The disease has a wave-like nature: periods of deterioration in the patient’s well-being are followed by periods of spontaneous improvements. Without proper treatment, patients suffer for many years, sometimes throughout their lives.
Proper treatment, coupled with restoration of mental balance, can lead to long-term remissions, significant improvement in well-being, and sometimes even complete recovery. However, few patients are able to radically and permanently change their attitude to life, control their mental and physical state, and live in a state of “inner peace.” Therefore, either after the next unrest, or after a cold or hypothermia, the patient’s condition can again deteriorate significantly.
On top of this, over time, various complications in the functioning of internal organs are added to the damage to the joints. Rheumatoid damage to the lungs, heart, liver, kidneys, blood vessels and intestines often occurs. Sometimes rheumatic muscle inflammation develops - polymyalgia, which is a serious complication of arthritis. All of the above complications can not only seriously worsen the patient’s already imperfect condition, but can even pose a threat to his life. That is why it is important to begin treating rheumatoid arthritis as early as possible, and to treat the patient comprehensively and thoughtfully in order to interrupt the development of the disease at the initial stage, without leading to complications and without waiting for irreversible consequences.
This is useful to know.
In Finland, at the University of Turku, clinical studies were conducted under the guidance of Professor of Psychiatry R. Raymond. One hundred women suffering from rheumatoid arthritis were divided into 2 approximately equal groups. The first group included women whose development of arthritis was preceded by some serious problems, family troubles or troubles at work. Many of these women were experiencing anxiety, chronic sadness, or depression at the time of the study. The second group (which, by the way, turned out to be much more difficult to recruit) included women who had not experienced any special psychotraumatic situations on the eve of the disease. Most of these women from the second group fell ill after suffering from influenza or acute respiratory infections, or due to hypothermia.
Both groups of women were observed for several years, after which interesting circumstances emerged. It turned out that in the patients of the first, “problem” group, the disease progressed much faster, the symptoms grew rapidly, and the medications helped such patients much worse than the patients of the second group. Moreover, if some troubles continued to occur in the lives of these women, or if they were still in a chronically depressed state, many medications caused them intolerance or often “gave out” side effects. Moreover, in such cases, even changing medications often did not help - new drugs also often caused adverse reactions. Interestingly, women in the second, “problem-free” group had practically no such difficulties with medications. And in general, their arthritis progressed very slowly, it was much easier, with virtually no complications.
Article by Dr. Evdokimenko© for the book “Arthritis”, published in 2003.
Arthritis is a general medical term for inflammation of the joints, which is characterized by warmth, redness, and swelling.
Rheumatoid arthritis is one of the most common types of arthritis and is characterized by symmetrical inflammation of the small joints of the knees, hands and wrists. This symmetry makes it possible to distinguish this type of arthritis from other forms.
You can read about the treatment of rheumatoid arthritis here.
Rheumatoid arthritis (RA) is a disease that occurs in the joint tissues and is accompanied by swelling, stiffness, inflammation, and pain in the joints. After some time, this inflammation can completely destroy the joint tissue, which will lead to a decrease in daily activity, causing difficulties while walking, as well as performing manual actions.
The following signs are typical:
Rheumatoid arthritis most often affects symmetrical joints. Only in rare cases can it affect the eyes, heart, nerves, lungs and blood vessels. The joints that are most often affected by the disease can be seen in this picture:
In addition to affecting the joints, this disease also affects the eyes, lungs, skin, heart, blood, and nerves. In some cases, during rheumatoid arthritis, growths or rheumatoid nodules may appear on the joints of the fingers, elbows, lower joints of the legs and spine. Articular syndrome is not characterized by clinical specificity.
For many people, the disease develops slowly, with a gradual development of the clinical picture over several years. Sometimes rheumatoid arthritis has pronounced symptoms, starting from the first stages of its development. Some individuals may experience symptoms for a certain period of time, after which remission occurs.
The prevalence of this type of arthritis among the world population is 1%. At the same time, it occurs 2-3 times more often in women. In men, however, there is a more acute course of this type of disease. Often, the disease begins to develop in middle age, but sometimes the first signs can be observed in children, as well as the elderly.
It is believed that it can begin to develop under the influence of infectious, hormonal and genetic factors. Hypothetical triggers of rheumatic diseases that affect the function of the immune system may also contain an infectious factor.
Repeated studies have not been able to accurately determine the role that genetic factors play in the development of this disease. However, rarely, rheumatoid arthritis occurs due to an inherited tendency to autoimmune reactions.
When the activity of the immune system increases, immunocytes move through the bloodstream into the synovial membrane (periarticular tissue) and the joint, releasing enzymes that have an inflammatory effect.
Many inflamed immunocytes and enzymes create an inflammatory focus near the joint, which leads to depletion of cartilage (the layer that softens the friction of adjacent bones), inflammation of the synovial membranes, which in turn leads to excessive secretion of synovial fluid within the joint itself.
Depletion of cartilage then leads to further narrowing of the interarticular space. In complex cases, this causes friction between adjacent bones against one another. The compaction of synovial fluid affects the adjacent bone, which leads to a destructive process that is irreversible.
Diagnosis of RA is based on a combination of the following criteria:
Many people who suffer from rheumatoid arthritis have antibodies against rheumatoid factor in their blood. It happens that this factor may be present in people who do not suffer from this disease.
Other diseases can also contribute to the formation of rheumatoid antibodies in the blood. Therefore, in addition to the rheumatoid factor, a combination of joint symptoms, laboratory tests and external manifestations may be fundamental in the diagnosis of this disease.
One of the newer types of blood tests that can more accurately determine the presence of signs of RA is the citrulline test. The presence of these antibodies in the blood also suggests the possibility of developing an acute form of rheumatoid arthritis.
Individuals who suffer from this disease may experience mild anemia. A blood test may also reveal an elevated erythrocyte sedimentation rate or elevated levels of C-reactive proteins, which are biological markers of inflammation.
Some individuals who have rheumatoid arthritis may also test positive for the presence of antinuclear antibodies. This test indicates that the disease is autoimmune.
The disease called rheumatoid arthritis is a very common disease that affects approximately 1.8% of the country's population. Women get sick much more often than the stronger sex. So, for one affected man, there are up to 4 women. At the same time, you should not think that rheumatoid arthritis is a disease of older people, it just gets worse over the years, and it begins to affect fairly young people, aged 35 years and older. The course of the disease is progressive, and ultimately leads to disability with limited ability to move.
Rheumatoid arthritis is one of the types of chronic arthritis, which is distinguished by the fact that it affects the joints on both sides of the body, which is its distinguishing feature. This is a disease that is almost impossible to ignore. Indeed, in addition to damage to the joints, it will ultimately affect the internal organs and affect their functionality.
There are many definitions of the disease, but they all boil down to the fact that it is a disease that is autoimmune in nature and affects small peripheral joints, which is characterized by an erosive-destructive nature.
Here are some facts about this disease:
This is an autoimmune disease, very dangerous and leading to inflammation of the joints, mainly in the legs and arms, as well as other parts of the human body.
The disease has no boundaries and affects people of any age, and even children.
It is not always possible to accurately determine the causes that led to the development of the disease.
The disease is characterized by frequent remissions and periods of outbreaks and extinction.
Most often, joints are affected symmetrically.
The rate of progression of the disease can be either small or rapid, and is not determined by the severity of symptoms.
Treatment is most successful if it is started before the disease becomes chronic.
In extremely rare cases, spontaneous remission of this disease (so-called “self-healing”) does occur.
If we turn to the classification of the disease, then according to clinical and anatomical characteristics the following types of arthritis are distinguished:
Disease of the type poly-, mono- or oligoarthritis.
Having systemically expressed symptoms.
Arthritis with diffuse damage to connective tissue, accompanied by osteoarthritis, which is deforming in nature, as well as rheumatism.
Special nonspecific forms are juvenile arthritis (that which affects children under the age of 16), Felty and Still syndrome (characterized by the addition of other diseases).
Based on immunological characteristics, rheumatoid arthritis can be divided into two types:
Seronegative, there is no rheumatoid factor in the joint fluid, or rather in its serum.
Seropositive when rheumatoid factor is present and can be detected.
Rheumatoid arthritis has plagued humanity for many centuries; for the first time, traces left by the disease were discovered on the bones of the skeletons of Indians who existed 4500 BC.
Features of the course of the disease include the following characteristics:
This is a chronic illness that haunts a person for many years, having a negative impact on his quality of life, and sometimes without any symptoms at all. But, unfortunately, the latter option is extremely rare. And most often, arthritis progresses and leads to a person becoming disabled.
Inflammation can occur both in the tissues of the joint located around them (muscles, ligaments and tendons are affected) and inside the synovial bursae themselves.
Sometimes the disease causes cartilage, ligaments, and bones to be destroyed and the joint to become severely deformed. Studies have shown that joints can become deformed even at the initial stage of the disease, regardless of the severity of pain and other symptoms. This concerns the progressive course of the disease.
The disease can affect people of any race, regardless of their lifestyle. Rheumatoid arthritis is often observed in all family members who adhere to an active daily routine, proper nutrition and give preference to sports. Which, according to scientists, proves the presence of genetic causes of the disease.
Surprisingly, despite the advanced age of this disease, the reasons leading to the development of the disease still remain unidentified.
Although, of course, modern scientists still have some assumptions:
Autoimmune diseases. One of the reasons for the development and progression of the disease is considered to be a variety of diseases that “confuse” the body’s immune cells. Instead of fighting bacteria and viruses that infect a person, the immune system begins to attack healthy tissue, and the joints are the first to suffer. Lymphocytes actively attack them, trying to destroy them as something foreign to the body. Any disease can cause such aggression, but rheumatologists note that almost half of the patients had persistent acute respiratory viral infections, frequent sore throats and influenza. There is a version that particles of viruses can accumulate in the joint capsules, and the immune system, mistaking them for enemies, tries to fight them.
Rheumatoid arthritis can become a logical “continuation” of infectious arthritis or of a reactive nature, which forms against the background of injuries or hypothermia.
There is also a version that the disease can occur against the background of severe emotional shock. Thus, half of the patients diagnosed with rheumatoid arthritis note that the disease arose after they suffered stress (the death of a loved one, divorce or other factor). Scientists also noticed some similar features in most patients. These people are very emotional and impulsive. That is why the disease most often affects women, with their hormonal changes in the body. In addition, it has been noticed that in those people whose arthritis began against the background of a cold and emotional shocks imposed on them, the disease is much more difficult to treat and progresses faster.
Some scientists believe that the cause of arthritis may lie in the intestines, when the immune system tries to eliminate opportunistic bacteria that live in it. As a result of this struggle, this disease may develop.
Genetics should not be ignored as a reason. So children whose older relatives suffered or are suffering from the disease are also more susceptible to developing rheumatoid arthritis in the future. Moreover, non-fast genes were even isolated.
Environmental factors are also conditional causes of the disease. Smoking and eating plants treated with chemicals, particularly silica, lead to oral diseases as well as arthritis.
Some experts express the opinion that rheumatoid arthritis is caused by certain viruses, which are already eliminated from the body at the time the disease is diagnosed. But so far this version has not been confirmed. Therefore, the main risk factors are considered to be genetic predisposition, infectious diseases, severe emotional shocks and adverse effects of the external environment.
If the causes of this disease are not fully established, the symptoms are definitely known:
The disease begins its development in the metacarpophalangeal joints, also affecting the wrist. In the early stages, small joints of the hands, legs, feet, wrists, legs and elbows are affected.
Both arms or legs are affected at once, which characterizes rheumatoid arthritis as a disease with symmetrical joint involvement.
The patient begins to experience pain, which may subside somewhat after active movements. This is a fundamentally important symptom that allows you to distinguish this type of arthritis from rheumatic arthritis. After some time, the disease progresses, and movements no longer help.
Pain syndrome often accompanies people in the first half of the day, especially in the morning, which makes performing usual procedures (brushing teeth, preparing breakfast) very difficult. By the evening the pain subsides, and in the morning everything repeats again. But in advanced stages of the disease, the pain does not subside even after dark.
A person experiences morning stiffness, the body seems to be numb.
During the acute phase of the disease, the skin around the joints may be red and feel hot to the touch.
Over time, larger joints become involved in the pathological process. Rheumatoid arthritis does not leave knees and shoulders unattended. They are almost never the first to be affected. In individual cases, the disease may affect the spine and hip joints.
General health deteriorates significantly, body temperature rises, appetite fades, patients complain of persistent weakness. Against this background, a person begins to lose weight.
A typical symptom is the presence of subcutaneous nodules that are located in the area of the diseased joints. They may disappear for a while and then appear again. Their diameter, as a rule, does not exceed 2 cm, they have the shape of a circle, are quite dense and most often mobile. Sometimes they can form in rather unexpected places - on the back of the head, in the forearm, and sometimes on internal organs (in the lungs and myocardium).
Rheumatoid arthritis causes joint deformation, poor circulation, and slow muscle atrophy. A person becomes not only incapacitated, but subsequently will not be able to take care of himself, as the joints lose their mobility.
Sometimes the symptoms are nonspecific and affect the salivary glands, causing inflammation in them. Some patients report pain in the eyes, numbness in the limbs and discomfort in the chest, especially when taking a deep breath.
Symptoms such as asthenia, arthralgia and increased sweating become constant companions of a sick person.
People become weather dependent and complain of increased pain when the weather, atmospheric pressure and season change.
Decreased sensitivity of the limbs.
Over time, if rheumatoid arthritis is severe enough and for a long time, patients experience the following symptoms:
Large muscles are affected, in particular the thigh and gluteal muscles, and the extensors of the forearm are affected.
The skin becomes dry and thin, necrosis forms under the nails, threatening to become gangrene. The nail plates themselves are constantly breaking, streaked and poorly restored.
The gastrointestinal tract, nervous, pulmonary and visual systems may be affected. There are disturbances in the functioning of the heart and blood vessels.
A rash and ulcers may form on the body, and bleeding may occur, both uterine and nasal.
There are several criteria by which the stages of development of rheumatoid arthritis can be classified, but the most informative are those based on X-ray readings.
They are usually divided into four categories:
At the initial stage, the first signs of bone thinning are visible; this is practically the only manifestation that can be seen in the image. The soft tissue around the finger joints thickens and becomes somewhat thicker. Sometimes bright spots on the bone tissue are noticeable - these are formed cysts. When the joint spaces are narrow, then we can say that the disease is progressing and will soon move to the next stage. A characteristic feature of this stage of development of the disease is that it can occur at any age and last for quite a long time, practically without showing itself. Sometimes such conditions are detected even in childhood, and the disease first manifests itself after many years.
The second stage is characterized by the fact that in addition to the thinness of the bones, localized mainly around the joint, the bone itself begins to be affected in an erosive manner. The hands most affected are the elbows and wrists. If the erosion is located next to the cartilage, then in this case there is a limitation of mobility. In this case, the cartilage tissue itself may not be deformed, but the muscles begin to atrophy, primarily those that surround the diseased joint itself. The bursae are swollen and slightly inflamed. During an exacerbation, they can be hot, and patients in the second stage of the disease complain of pain and aches. The more erosions on the bone, the closer the third stage of disease progression.
At this stage, not only damage to the bone and its thinning are noticeable, here the image clearly shows muscle atrophy, which is extensive, and the joint itself is already undergoing deformation. If salt deposition begins at the first stage, then at the third stage calcification becomes noticeable on an x-ray. In this case, deposits can be of different sizes and shapes. Their structure can also vary from dense to rather loose. The joints at this stage are already significantly limited in movement.
The fourth stage is the stage at which bone abnormalities are noticeable. X-ray examination reveals osteoporosis; erosions and cysts are visible, which are multiple in nature; the cracks can grow together or have extremely narrow openings. The joint is completely deformed, the muscles and soft tissues around it are atrophied. The disease affects all limbs, and patients complain of severe, ongoing pain.
Depending on the person’s condition and his functional capabilities, there are also four stages of disease development:
At the first stage, patients are able to independently perform all daily activities, their general condition is not impaired, and there are no pain symptoms.
In the second stage, people remain able to work, but have difficulty coping with everyday activities, and sports become difficult to achieve.
At the third stage, patients are usually limited in work activities, but are able to cope with caring for themselves.
At the fourth stage, a person cannot fully perform any type of activity.
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Diagnosis of rheumatoid arthritis can be difficult, due to the similarity of its symptoms with a number of other diseases. Thus, this disease can be confused with acute rheumatism, Lyme disease, gout, osteoarthritis and other joint diseases.
Back in 1997, the College of Rheumatologists proposed criteria that were taken as the basis for the definition of rheumatoid arthritis.
If most of them are observed in a patient who comes for examination, then the doctor has the right to make this diagnosis:
More than three joints are affected.
The joints of the hand are affected.
In the morning, a person experiences a feeling of stiffness, which disappears after at least one hour. Such sensations bother the patient for more than 1.5 months.
There are specific nodules.
X-rays show characteristic changes, regardless of the stage of the disease.
Rheumatoid factor is positive.
As laboratory tests, it is customary to focus on the following indicators:
The blood test clearly shows a decrease in the level of hemoglobin and red blood cells, the ESR is accelerated, and the platelet count is reduced. Gamma globulin and C-reactive protein exceed the norm.
The blood is examined for the presence of rheumatoid factor; if this indicator is present, then it can also be used to understand how actively the process of disease development has started.
Doctors necessarily prescribe an x-ray examination, which is basic for determining the presence of this disease.
Sometimes there may be an enlargement of the spleen.
For examination under a microscope, doctors may collect joint fluid or biopsy nodules.
Timely diagnosis of the disease will make it possible to apply adequate therapy; the sooner it is started, the more effective the treatment regimen will be and the lower the risk of complications.
Meanwhile, they can be quite serious and are expressed as follows:
Skin diseases such as ulcerative vasculitis, dermatitis and rheumatoid nodules.
Diseases of the pulmonary system, which are expressed in pleurisy and the formation of the same nodules in them.
Diseases of the visual apparatus, which can be expressed either in minor irritation or in serious inflammation of the eyeball with subsequent loss of vision.
In diseases of the circulatory system, expressed in anemia and thrombocytopenia.
In pathologies of cardiovascular activity, which can result in both a heart attack and a stroke.
The main modern methods of treating rheumatoid arthritis are:
Use of anti-inflammatory drugs.
Physiotherapy in combination with local treatment.
Diet and traditional medicine.
Depending on the severity of the symptoms of the disease, as well as the nature of its course and the rate of progression, a wide variety of treatment methods are used. They vary widely, ranging from ordinary rest and good nutrition, which is advisory in nature, to potent medications. But, as a rule, therapy at the initial stage is gentle; if this does not help, then they move on to more radical methods of treatment.
The principle is to provide rest to the affected joints, since additional stress leads to increased inflammation. Sometimes patients are prescribed bed rest for a short time with several joints immobilized. To do this, rheumatologists apply splints to the affected areas.
As modern medicines, doctors prescribe several groups of drugs when there are indications for this:
Ibuprofen and aspirin are used as non-steroidal anti-inflammatory drugs. They are able to relieve swelling and swelling in tissues, and also significantly reduce pain. Aspirin is a rather outdated treatment for rheumatoid arthritis and has a lot of side effects, so in recent years doctors have been trying to replace it with modern drugs such as ibuprofen. It does not irritate the stomach to such an extent, but nevertheless it cannot be called absolutely harmless.
If NSAIDs do not bring relief and do not give the desired effect during their regular use of 3 months, then doctors supplement the treatment regimen with long-acting medications. These include sulfasalazine, penicillamine, planquenil and gold compounds. They most often have a pronounced effect on the course of the disease, but their significant drawback is that the side effects resulting from taking these drugs can be very serious. They have a negative effect on the kidneys and liver, cause skin itching and diarrhea, and can lead to bone deformation. If such side effects begin to appear, the medicine is immediately discontinued. But in some cases, it is possible to restrain the development of rheumatoid arthritis for quite a long time, while the drugs are used in low dosages and do not cause serious complications in other organs and systems.
Prednisolone, which belongs to the class of corticosteroids, is also used to treat rheumatoid arthritis. They are effective, but their disadvantage is that after a short time the drugs cease to have an effect on the course of the disease. Since this disease is chronic, corticosteroids are used only for short-term relief of sore joints.
Drugs such as azathioprine, methotrexate and cyclophosphamide belong to the class of immunosuppressants and are effective in cases of severe disease. They are very effective, but their significant drawback is severe side effects, which include damage to internal organs (lungs and liver), impaired hematopoietic function, increased risk of bleeding and even oncology.
Drug therapy gives the best therapeutic effect when it is combined with therapeutic exercises, physiotherapy and exposure to both high and low temperatures (cryotherapy). Sometimes surgery may be required. Water procedures are very effective when, during exercise in the pool, the joints actively move, but do not experience stress.
As for surgical treatment, modern medicine has the ability to completely replace a diseased joint with a similar, but artificial one. They are used to restore mobility in the knee or hip joint. Sometimes the operation is aimed at fusion of joints; this is especially often used when the feet are affected by rheumatoid arthritis. In this way, you can achieve a significant reduction in attacks of pain when walking.
Also, for those people who are affected by this disease, modern medicine offers various aids, for example, special shoes or means for grasping objects. All this significantly improves their quality of life and relieves pain symptoms.
Diet plays an important role in the treatment of the disease, since in such a situation the body more than ever needs a full supply of all nutritional components. As for restrictions, it is necessary to reduce the consumption of salts, protein foods and fats of animal origin. At the time of exacerbation of the disease, it is important to completely stop drinking sugar and alcohol.
It is imperative to eat cottage cheese and drink fermented milk drinks. Fresh fruits and vegetables, as well as herbs, should not be an exception on the table. Grain and fish dishes will be useful. Rheumatologists say that following a strict diet greatly contributes to recovery.
There are no specific preventive measures, however, doctors give some recommendations, following which you can somewhat reduce the risk of the disease:
Elimination of foci of inflammation in the body that lead to decreased immunity, namely: timely treatment of sore throat, tonsillitis, sinusitis and carious teeth.
Avoid hypothermia of the body.
Avoid prolonged exposure to stress.
Give up bad habits, in particular smoking.
Pay attention to the possible presence of hereditary factors and, if any, be more attentive to your health.
Treatment of viral infections under medical supervision.
The use of vitamin complexes during especially dangerous periods.
You should immediately consult a doctor if you experience such characteristic symptoms as bilateral inflammation of the joints and their pain. When bones are deformed, as well as small subcutaneous nodules are detected. You should immediately call an ambulance if the above symptoms are accompanied by fever, pain in the sternum, breathing becomes difficult, and cardiac activity is impaired.
It is worth remembering that if rheumatoid arthritis is not characterized by a rapid and aggressive course, then it is quite possible to cope with this disease, transform it into a chronic form and continue to live a full life, which ultimately will not lead to disability.
Author of the article: Muravitsky Igor Valerievich, rheumatologist
Conventional pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to relieve pain and stiffness. Selective COX-2 inhibitors have minimal gastrointestinal side effects. These include celecoxib. The safety profile of selective COX-2 inhibitors is more favorable than that of non-steroidal anti-inflammatory drugs. But people suffering from cardiovascular diseases should be careful with COX-2.
The use of disease-modifying (disease-modifying) antirheumatic drugs (DMAs) is necessary in the first stage of intensive care. These medications reduce damage to the joint. The most popular representative of this group of medications is methotrexate. This medicine was originally developed for chemotherapy. However, it has proven to be very effective in treating rheumatoid arthritis and now forms the basis of most treatment programs. Chloroquine, an antimalarial drug, and sulfasalazine are older drugs often used in combination with methotrexate. Leflunomide is a more expensive but very effective disease-modifying drug, often prescribed when methotrexate has not resulted in remission of the disease.
Hydrocortisone in low doses is useful in treating symptoms of rheumatoid arthritis while waiting for the results of treatment with disease-modifying drugs. It acts quickly and counters all aspects of the disease. However, side effects are dose dependent, so long-term use of hydrocortisone is not advisable. The continued need to use oral hydrocortisone indicates that the disease is not completely under control, so more intensive therapy with disease-modifying drugs is required.
Rheumatoid arthritis is a rheumatic process characterized by erosive and destructive lesions of predominantly peripheral small joints. Articular signs of rheumatoid arthritis include symmetrical involvement of the joints of the feet and hands, and their deforming changes. Extra-articular systemic manifestations include serositis, subcutaneous nodules, lymphadenopathy, vasculitis, and peripheral neuropathy. Diagnosis includes assessment of clinical, biochemical, and radiological markers. Treatment of rheumatoid arthritis requires long courses of NSAIDs, corticosteroids, basic medications, and sometimes surgical reconstruction of joints. The disease often leads to disability.
The reasons causing the development of rheumatoid arthritis have not been reliably established. The hereditary nature of disturbances in immunological responses and the role of infectious etiofactors (Epstein-Barr virus, retrovirus, cytomegalovirus, mycoplasma, herpes virus, rubella, etc.) were determined.
The basis of the pathogenesis of rheumatoid arthritis is autoimmune reactions that develop in response to the action of unknown etiological factors. These reactions are manifested by a chain of interconnected changes - inflammation of the synovial membrane (synovitis), the formation of granulation tissue (pannus), its growth and penetration into cartilaginous structures with the destruction of the latter. The outcome of rheumatoid arthritis is the development of ankylosis, chronic inflammation of the periarticular tissues, contracture, deformation, and subluxation of the joints.
According to clinical and anatomical features, forms of rheumatoid arthritis are distinguished:
According to immunological characteristics, there are seropositive and seronegative variants of rheumatoid arthritis, which differ in the detection or absence of rheumatoid factor in serum and joint fluid.
The course of rheumatoid arthritis can vary. The rapidly progressing variant is characterized by high activity: erosion of bone tissue, deformation of joints, systemic lesions during the 1st year of the disease. Slowly developing rheumatoid arthritis, even many years later, does not cause gross morphological and functional changes in the joints and proceeds without systemic involvement.
Based on the activity of clinical and morphological changes, three degrees of rheumatoid arthritis are differentiated. With minimal activity (stage I) of the process, minor pain in the joints, transient stiffness in the morning, and the absence of local hyperthermia are noted. Moderately active rheumatoid arthritis (grade II) is characterized by pain at rest and during movement, many hours of stiffness, painful limitation of mobility, stable exudative phenomena in the joints, and moderate local hyperthermia of the skin. High activity (grade III) rheumatoid arthritis is characterized by severe arthralgia, severe exudation in the joints, hyperemia and swelling of the skin, persistent stiffness, severely limiting mobility.
According to the degree of impairment of support functions in rheumatoid arthritis, stages of FN I, FN II and FN III are distinguished. Functional disorders, Art. I characterized by minimal motor restrictions while maintaining professional fitness. At the FN II stage, joint mobility is sharply reduced, the development of persistent contractures limits self-care and leads to loss of performance. Stage FN III of rheumatoid arthritis is determined by stiffness or total immobility of the joints, loss of self-care and the need for constant care for such a patient.
The dominant clinical picture of rheumatoid arthritis is articular syndrome (arthritis) with characteristic bilateral symmetrical involvement of the joints. At the prodromal stage, fatigue, periodic arthralgia, asthenia, sweating, low-grade fever, and morning stiffness are noted. The onset of rheumatoid arthritis is usually associated by patients with changes in meteorological factors, seasons of the year (autumn, spring), and physiological periods (puberty, postpartum, menopause). The provoking cause of rheumatoid arthritis can be infection, cold, stress, injury, etc.
With acute and subacute debut of rheumatoid arthritis, fever, severe myalgia and arthralgia are observed; with subtle progression, changes develop over a long period of time and are not accompanied by significant functional impairments. For the clinic of rheumatoid arthritis, involvement of the joints of the feet and hands, wrists, knee and elbow joints is typical; in some cases, the lesion affects the hip, shoulder and spinal joints.
Objective changes in rheumatoid arthritis include accumulation of intra-articular exudate, swelling, sharp palpation pain, motor limitations, local hyperemia and hyperthermia of the skin. The progression of rheumatoid arthritis leads to fibrosis of the synovial membrane and periarticular tissues and, as a consequence, to the development of joint deformities, contractures, and subluxations. The outcome of rheumatoid arthritis is ankylosis and immobility of the joints.
When the synovial sheaths of the tendons of the hand are affected - tenosynovitis - carpal tunnel syndrome often develops, the pathogenetic basis of which is neuropathy of the median nerve as a result of its compression. In this case, paresthesia, decreased sensitivity and mobility of the middle, index and thumb are noted; pain spreading to the entire forearm.
The development of extra-articular (systemic) manifestations is more typical for the seropositive form of rheumatoid arthritis with a severe long-term course. Damage to the muscles (interosseous, hypothenar and thenar, forearm extensors, rectus femoris, gluteal) is manifested by atrophy, decreased muscle strength and tone, and focal myositis. When the skin and soft tissues are involved in rheumatoid arthritis, dryness and thinning of the epidermis and hemorrhages appear; Fine-focal necrosis of the subungual area may occur, leading to gangrene of the distal phalanges. Impaired blood supply to the nail plates leads to their fragility, striations and degeneration.
Typical signs of rheumatoid arthritis are subcutaneously located connective tissue nodules with a diameter of 0.5-2 cm. Rheumatoid nodules are characterized by a round shape, dense consistency, mobility, painlessness, less often - immobility due to adhesion to the aponeurosis. These formations can be single or multiple in nature, have a symmetrical or asymmetrical localization in the area of the forearms and the back of the head. The formation of rheumatoid nodules in the myocardium, lungs, and valvular structures of the heart is possible. The appearance of nodules is associated with exacerbation of rheumatoid arthritis, and their disappearance is associated with remission.
The most severe course of rheumatoid arthritis is characterized by forms that occur with lymphadenopathy, damage to the gastrointestinal tract (enetritis, colitis, amyloidosis of the rectal mucosa), nervous system (neuropathy, polyneuritis, functional autonomic disorders), involvement of the respiratory system (pleurisy, diffuse fibrosis, pneumonitis, fibrosing alveolitis , bronchiolitis), kidneys (glomerulonephritis, amyloidosis), eyes. On the part of the great vessels and the heart, endocarditis, pericarditis, myocarditis, arteritis of the coronary vessels, and granulomatous aortitis may occur in rheumatoid arthritis.
In rheumatoid visceropathies due to panarteritis, skin symptoms are observed in the form of polymorphic rashes and ulcerations; hemorrhagic syndrome (nasal, uterine bleeding), thrombotic syndrome (mesenteric thrombosis).
Severe complications caused by rheumatoid arthritis can include damage to the heart (myocardial infarction, mitral and aortic insufficiency, aortic stenosis), lungs (bronchopleural fistulas), chronic kidney failure, polyserositis, visceral amyloidosis.
Suspicion of rheumatoid arthritis is an indication for consultation with a rheumatologist. Peripheral blood examination reveals anemia; the increase in leukocytosis and ESR is directly related to the activity of rheumatoid arthritis. Typical immunological markers for rheumatoid arthritis are the detection of RF, a decrease in the number of T-lymphocytes, an increase in cryoglobulins, and the detection of antikeratin antibodies (AKA).
Radiological criteria for rheumatoid arthritis include the detection of diffuse or patchy epiphyseal osteoporosis, narrowing of joint spaces, and marginal erosions. According to indications, an MRI of the joint is prescribed. To take a sample of intra-articular fluid, a puncture of the joint is performed. Microscopy of the joint fluid reveals nonspecific inflammatory signs. Examination of a biopsy of synovial membranes in rheumatoid arthritis demonstrates hypertrophy and an increase in the number of villi; proliferation of plasmatic, lymphoid and integumentary cells (synoviocytes) of the articular membranes; fibrin deposits; zones of necrosis.
The basis of therapy for rheumatoid arthritis is the prescription of a course of fast-acting (anti-inflammatory) and basic (disease-modifying) drugs. The fast-acting group includes NSAIDs (diclofenac, ibuprofen, naproxen), corticosteroids that relieve inflammation and pain. The use of basic drugs (sulfasalazine, hydroxychloroquine methotrexate, leflunomide) allows one to achieve remission of rheumatoid arthritis and prevent/slow down joint degeneration.
Relatively new drugs used in the treatment of rheumatoid arthritis include biological agents that block the proinflammatory cytokine protein tumor necrosis factor (etanercept, infliximab, adalimumab). TNF inactivating drugs are administered in the form of injections and are prescribed in combination with basic drugs. A promising and promising method for treating rheumatoid arthritis is stem cell therapy, aimed at improving trophism and regeneration of joints.
In addition to taking medications for rheumatoid arthritis, extracorporeal hemocorrection is indicated - cryoapheresis, membrane plasmapheresis, extracorporeal pharmacotherapy, cascade filtration of plasma. For patients with rheumatoid arthritis, exercise therapy and swimming are recommended. To restore the function and structure of joints, surgical interventions are used - arthroscopy, endoprosthetics of damaged joints.
Isolated, localized in 1-3 joints, not pronounced inflammation in rheumatoid arthritis allows us to hope for a favorable prognosis. Factors that aggravate the prospects of the disease include polyarthritis, severe and treatment-resistant inflammation, and the presence of systemic manifestations.
Due to the lack of preventive methods, only secondary prevention of rheumatoid arthritis is possible, which includes the prevention of exacerbations, clinical monitoring, and suppression of persistent infection.