Arthritis( inflammation of the joints) - Causes, symptoms and treatment. MF.
Arthritis is a disease of the joints, accompanied by their inflammation.
The inflammatory process occurs mainly in the synovial( internal) shell( bag) of the joint. This condition is called synovitis and is accompanied by an accumulation of effusion in the synovial cavity - synovial fluid. Inflammatory exudate creates the conditions for an even greater stagnation of venous and lymphatic outflow in the joint area, which leads to the progression of arthritis. The process involves other components of the joint structure - the head( epiphyses) of the bones, cartilage, the tissues of the joint bag, ligaments, tendons and other periarticular soft tissue components. Arthritis of one joint in the medical literature is called monoarthritis, several( many) joints are polyarthritis.
Causes of arthritis development
The causes of arthritis development are manifold. These are joint infections and suffered injuries( both acute - strokes, auto accidents, falls on the joint, and chronic injuries, overloads), allergies and autoimmune processes with the formation of antibodies that destroy the body's own tissues - the components of the joint.
There are many different diseases accompanied by arthritis - such as rheumatoid arthritis, gout, psoriatic arthritis, arthritis with reiter syndrome. Many autoimmune processes with connective tissue damage - vasculitis, syphilis, gonorrhea, rheumatism, other systemic diseases can be accompanied by arthritis.
Symptoms of arthritis and diagnosis of arthritis
Symptoms of arthritis: the affected joint hurts, there is stiffness of movement, local increase in soft tissue temperature, hyperemia( reddening), swelling( swelling), there is an effusion of synovial fluid or specific exudate in the joint cavity with an increase in its size, swelling. Arthritis is associated with clinical manifestations of general intoxication and autoimmune processes( fever, general weakness).In the analyzes there is an increase in ESR and the number of leukocytes, there may be a c-reactive protein.
Unfortunately, the uniformity of the symptom-complex with different etiologies( causes) of the disease makes it difficult to accurately and timely diagnose. For the specialist doctor and the patient himself in the diagnosis, an important role is played by other signs of arthritis - the condition of the skin( rashes, etc.), the heart, kidneys, respiratory tract. The paroxysmal course of arthritis is especially characteristic for rheumatism, the development of arthritis is characteristic for Reiter's syndrome after an acute, but rapidly passing infectious urethritis( inflammation of the urethra, possibly a bladder with a cut during urination), enterocolitis( inflammation of the intestine with diarrhea and flatulence).Gout is indicative of the manifestation of the disease after taking alcohol. For rheumatic arthritis, symmetrical lesions of peripheral small articular systems of hands and feet are characteristic, for Bekhterev's disease or Reiter's syndrome - pain, limitation of mobility, feeling of stiffness in the spine. The defeat of the joint of the 1st toe is most characteristic of gout. In psoriatic arthritis, terminal interphalangeal joints are often affected, accompanied by pronounced edema( the finger is like a sausage) and a purplish-cyanotic shade of the skin. With systemic lupus erythematosus, arthritis is combined with reddening in the form of a butterfly on the face and kidney damage.
In the diagnosis there are special laboratory tests - research methods aimed at identifying specific immune complexes, bacterial antigens and other specific components of systemic damage. It is possible to perform arthroscopy, analysis of synovial effusion, biopsy of joint tissues.
Treatment of arthritis
The basis of the treatment of arthritis is the treatment of its causative disease .For the local treatment of joints, arthrology and rheumatologists use physiotherapeutic procedures, intra-articular medical injections, general non-specific anti-inflammatory treatment.
Good additional possibilities in the treatment of arthritis are provided by reflexology, su-dzhok method and during the period of remission of the disease - the method of osteopathy. Osteopathy allows to restore periarticular blood flow, contributes to the reduction of fibrosis of muscles, ligaments, prevention of clumping of periarticular bags. In the presence of concomitant mechanical damage to the joint( chronic microtraumatism with the displacement of the sacrum, lumbar spine, hip joints - with arthritis of the knee joint( gonarthritis) and arthritis of the joints of the foot, lesions of the cervical spine, collarbones, ribs and scapula in arthritis of the shoulder or elbow joint)-osteopath can significantly reduce pain syndrome and pathological symptoms, by harmonizing muscular and skeletal loads and relationships in adjacent joints.
Quite often, chondroprotectors are prescribed to fight arthritis and other joint diseases( especially at the initial stage).One of the most effective chondroprotectors is glucosamine. It is part of almost all drugs from joint pain. However, not all forms of glucosamine are equally effective. For example, glucosamine hydrochloride is a substance with unproven efficacy, and is produced primarily as a dietary supplement. While stable crystalline glucosamine sulfate is the only form of glucosamine that has successfully undergone clinical trials. For example, based on the stable form of glucosamine, the drug Don has been developed, which not only removes symptoms, but also slows the progression of the disease, which significantly improves the patient's quality of life and postpones the need for endoprosthetics.
Forecast
The prognosis during arthritis is ambiguous, depends on the state of the patient's immunity, the characteristics of the primary disease, the severity of local joint changes. Perhaps as a complete recovery with the restoration of all joint functions, and the destruction of the joint( deforming arthritis, arthrosis, joint destruction) with subsequent ankylosing( closure, immobility of the joint).In these situations, surgical treatment of the joint can be shown - endoprosthetics. After endoprosthetics, restoration of the function of the surrounding joints of soft tissues is necessary in most cases - along with other functional methods of treatment, osteopathy can quickly remove postoperative pain syndrome, normalize the tone of the surrounding joints of muscles, increase mobility in adjacent joints.
Treatment of arthritis with stem cells
In the future it will be possible to treat arthritis without complex operations, it is enough to use magnetic beads and stem cells, the British scientists believe. The new method is tried on mice.
Alicia El Haj from the University of Kile( UK) has developed, together with colleagues, magnetic beads less than two micrometers in diameter, which are attached to receptors on human mesenchymal stem cells. These cells, which are isolated from adipose tissue or bone marrow, can suppress the immune response of the body and give rise to different types of connective tissue: fatty and cartilaginous, muscular and bone. When the magnetic field is turned on, the beads begin to move, deforming the surface of the cells and forcing them to open the pores. As a result, the influx of potassium ions triggers a cascade of reactions within the cell that determine what it will turn into.
Scientists implanted human mesenchymal stem cells coated with magnetic beads into the backs of mice and used a magnetic field to turn the cells into cartilaginous tissues, El Hudge said at a meeting on stem cells in Oxford. Now her group plans to treat knee joints in goats with the help of magnetic stem cells, which were developed together with Magnecell. They hope that the magnetic field will deliver stem cells to the joints and promote their transformation into cartilage.
Beads, which the US Food and Drug Administration has already approved for use as an amplification of medical images, quickly decay and are eliminated from the body. By attaching magnetic beads to other receptors, other tissues can be grown from stem cells, El Hajj notes.
Rheumatoid arthritis
Rheumatoid arthritis affects people of all ages, but most often those over 30. Among women, about 5 times more suffer from rheumatoid arthritis than men. In general, according to different scientists, this disease affects 1 - 2% of the population.
Causes of rheumatoid arthritis
The causes of rheumatoid arthritis are not fully understood. However, it is obvious that there is a definite hereditary predisposition to this disease. That is, members of the family of a patient with rheumatoid arthritis have a slightly greater chance of getting sick than other residents of the area( country or city).But such a statement should not sound like a sentence. We are talking only about the theoretical probability. A person is ill only when several unfavorable circumstances occur.
Apparently, some latent infection can contribute to the development of rheumatoid arthritis. This is confirmed by the fact that approximately half of cases of this disease are preceded by acute respiratory disease( ARI), influenza, angina or exacerbation of chronic infectious diseases. In addition, often enough rheumatoid arthritis develops as a continuation of reactive or infectious arthritis.
Another significant factor that provokes the development of the disease is a strong emotional stress. About a third of my patients, the disease began after severe blows to fate: divorce, loss of loved ones, etc. And in 10% of patients the disease manifested itself after severe hypothermia.
Symptoms of rheumatoid arthritis
The clinic of "classic" rheumatoid arthritis is difficult to confuse with the symptoms of other joint diseases. In the overwhelming majority of cases, at the onset of the disease, inflammation and swelling of the metacarpophalangeal joints of the index and middle fingers occurs( these are the joints at the base of these fingers, that is, in the region of the protruding bones of the compressed fist).This inflammation of the metacarpophalangeal joints is most often combined with inflammation and swelling of the wrist joints. What is characteristic, the inflammation of the joints is symmetrical, as in rheumatism - that is, if the joints on the right arm are affected, then almost the same joints on the left arm are affected. But unlike rheumatism in rheumatoid arthritis, inflammation in these joints is persistent, puffiness and pain in them last from several months to several years.
Simultaneously with inflammation of the joints of the upper extremities with rheumatoid arthritis, the small joints of the feet almost always occur. Inflammation of the joints located at the base of the fingers, which is manifested by pain when pressed under the "pads" of the toes. It is symptomatic that the joints of the feet are also inflamed symmetrically( on the right and left extremities), as well as on the arms.
Joint pains intensify more often in the second half of the night, in the morning. Approximately before noon pain is very intense;patients compare them to a toothache. However, after midday, the pain becomes weaker, and in the evening they are generally minor. Relief lasts until the middle of the night, but about 3 to 4 hours of joint pains are resumed.
In addition to intense pain for rheumatoid arthritis, the symptom of "morning stiffness" is characteristic. Patients describe the morning stiffness as a feeling of "sluggish body and joints" or as a feeling of tight gloves on the hands and a tight corset on the body. "
With a sluggish, mild course of rheumatoid arthritis, morning stiffness disappears usually in half an hour or so after the patient has gotten out of bedBut in case of severe illness this uncomfortable sensation can persist until one in the afternoon and even longer
Very often these symptoms are accompanied in patients with a feeling of weakness, a deterioration in sleep and appetite, a moderate increase in temperature( d37.2 - 38?), Chills, often losing weight, sometimes significantly
As the disease progresses, all new joints are involved in the pathological process, often knees, elbows, ankles and shoulder joints become inflamed.is worn-out: periods of deterioration of the patient's condition are replaced by periods of spontaneous improvement
After stress, colds or hypothermia, the patient's condition may again deteriorate significantly. In addition to all over time, various complications in the activity of internal organs are added to joint damage. Often occurs rheumatoid damage of the lungs, heart, liver, kidneys, blood vessels and intestines. Such complications not only can seriously worsen the already not ideal state of the patient, but can even threaten his life.
This is why it is important to take on the treatment of rheumatoid arthritis as early as possible in order to interrupt the development of the disease in the initial stage, not leading to complications and not waiting for irreversible consequences.
Treatment of rheumatoid arthritis
Principles of treatment of rheumatoid arthritis
Curing rheumatoid arthritis is not easy. Strictly speaking, it is possible to achieve complete cure of this disease in very rare cases, since most of the medicines used in our time have only symptomatic effect. Such drugs eliminate the manifestations of the disease( pain, inflammation of the joints), but do not affect its causes.
For example, as a first aid for joint pain, non-steroidal anti-inflammatory drugs( NSAIDs) are used: flexene, diclofenac, indomethacin, piroxicam, brufen, etc. NSAIDs can significantly alleviate the patient's life, although it is impossible to cure rheumatoid arthritis with the help of some non-steroidal anti-inflammatory drugs.
NSAIDs operate precisely during their period of application, without a clear vision for the future. And since taking rheumatoid arthritis takes medicine for a long time, "classic" non-steroidal anti-inflammatory drugs can cause various side effects. Most often they negatively affect the work of the stomach, provoking in some cases the development of gastritis or even peptic ulcer.
Fortunately, the development of pharmacology does not stand still, and scientists have developed a new group of non-steroidal anti-inflammatory drugs - there are so-called "selective" anti-inflammatory drugs. Selective NSAIDs( drug mohvalis) are much softer than "classical" and are much less likely to cause any complications. Movalis in rheumatoid arthritis in most cases can be used for a long time, for several months, and sometimes even years, with a minimal risk of side effects.
In addition to NSAIDs, many doctors, especially overseas doctors, without hesitation, prescribe anti-inflammatory corticosteroid hormones( prednisolone, methylpred, hydrocortisone, etc.) in order to provide rapid assistance to those suffering from rheumatoid arthritis.
The use of such hormones almost always contributes to a clear improvement in the patient's condition. At once the pain in joints decreases, the morning stiffness, weakness and chills disappear. Naturally, for such a quick result, any patient is ready to pay money, not small ones, which is the main stimulus of Western medicine.
Unfortunately, patients who take corticosteroid hormones often do not know that they get a powerful enough impact on all body systems. After all, corticosteroids are stress hormones. And while the patient takes such hormones, it's good for him. But if they are to be canceled or lowered, the disease will attack a person literally with a doubled or tripled force. In addition, these hormones have a huge number of contraindications, and in addition, they reduce immunity.
So before a hormone therapy is prescribed to a patient, the doctor must weigh three times what will be more from such treatment - harm or benefit.
You can ask me: if anti-inflammatory and hormonal drugs relieve pain and inflammation only during the period of their application, they act "for now", then what should I try to cure the patient?
The main treatment for rheumatoid arthritis is the so-called basic drugs. They affect the soil that generates the disease, its "basis."These funds are used with an eye to the future, based on their ability to influence the causes of the disease and interrupt its development. But you need to keep in mind that, in contrast to hormones and NSAIDs, the basic drugs do not give a momentary positive effect, that is, they do not eliminate the symptoms of the disease in the first days and weeks of drug use. As a rule, they are able to act no earlier than a month, this is a significant drawback of basic drugs.
Currently, as a basic therapy, the most commonly used drugs are five groups: gold salts, antimalarials, antimicrobial sulfasalazine, immunosuppressive agents and penicillamine.
Gold preparations( crisanol, auranofin) - the most popular group of rheumatologists in the basic drugs for the treatment of rheumatoid arthritis. Gold preparations bring significant relief to approximately 70% of patients, but a third of patients may experience complications in the treatment of rheumatoid arthritis: an allergic skin rash, inflammation of the oral mucosa, oppression of hematopoiesis and impairment in kidney activity.
D-penicillamine( kurenenil) is usually prescribed in cases where gold therapy does not bring relief to the patient or when gold preparations have to be canceled because of adverse reactions. However, D-penicillamine, which is not inferior to gold preparations, is a rather toxic drug that causes complications much more often. Usually they appear in the first two months of the drug, but, fortunately, quickly disappear after the drug is discontinued.
Complications can be manifested by skin rash, upset stomach and intestines, inflammation of the kidneys, jaundice arising from stagnation of bile, and changes in blood composition. Therefore, when using D-penicillamine as a "basic" remedy, the patient needs to take a blood test once a week and once every two weeks - urinalysis. It is important to consider that D-penicillamine is contraindicated in pregnant women and those patients who have blood and kidney diseases.
Sulfasalazine( salazopyridazine) is an antimicrobial drug that is somewhat less effective than gold preparations, but successfully competes with D-penicillamine, especially since it is much better tolerated than these drugs. Side effects from sulfasalazine develop only in 10-20% of patients, and these complications are never severe. They manifest mainly in the disorder of the stool and skin rash.
Makes the dignity of the drug only a slow development of its therapeutic effect. Improvement in the treatment of rheumatoid arthritis with sulfasalazine usually occurs only after three months of therapy, and the "peak form" is reached after six months, after which treatment of rheumatoid arthritis with sulfasalazine is terminated.
Antimalarial drugs delagil and plaquenyl were once used by infectious disease specialists for the treatment of tropical fever( malaria).However, in the twentieth century, they were also attracted by rheumatologists. They noticed that with very long-lasting use, dojagil and plakvenil are able to influence the activity of the rheumatoid process.
Although the effectiveness of these drugs is not very high and they act slowly, we are forced to use them even now, because we feel a relative deficit of anti-rheumatic drugs. After all, sometimes there are situations when other basic means are unsuccessfully tried and canceled because of inefficiency or pronounced side effect. Then it is necessary to use delicate, but nevertheless, having a specific anti-arthritic effect, delagil and plakvenil.
Cytostatic drugs, or so-called immunosuppressants( methotrexant, azathioprine, cyclophosphamide, chlorbutin, leukeran) are borrowed by rheumatologists in oncologists. Cytostatics are used in oncology to suppress the immune system and inhibit cell division, including cancer. And oncological patients, these funds are prescribed in huge doses, which leads to a large number of complications. In this regard, both doctors and patients are very wary of the use of cytostatics, for fear of serious side effects.
However, when it comes to the use of these drugs in the treatment of rheumatoid arthritis, the danger is clearly exaggerated, because in artrology, cytotoxic drugs are used in much smaller doses than in oncology - about 3 to 10 times smaller! Such small amounts of immunosuppressants rarely cause side effects, but the therapeutic effect is often significant. The use of cytostatics helps at least 70% of patients, with the greatest benefit of the medication is to those suffering a rapidly progressive severe form of rheumatoid arthritis.
Adverse events are possible in 15-20% of patients, and are rarely severe. Most often these are allergic rashes, a feeling of "goosebumps" on the skin, a disorder of the stool and mild urination disorders. All these manifestations usually disappear immediately after the withdrawal of drugs.
If everything is in order and the patient easily tolerates cytostatic therapy, you can expect a clear improvement in the state of health within 2 to 4 weeks after the start of treatment for rheumatoid arthritis.
Remedies for the treatment of rheumatoid arthritis
So, there are five groups of basic agents for the treatment of rheumatoid arthritis. Their advantages and disadvantages we have just considered. But what is the preferred drug in each case? This question can only answer your treating rheumatologist. Only he knows( in any case, he should know) when and which basic tool should be used in your case. Although the lack of basic means is that it is difficult to guess with a hundred percent probability, will the medicine give a therapeutic effect. Only after a month or two of using the drug can you get an answer to this question. And if the drug does not work, you have to change it and wait for a month or two again.
Thus, the selection of basic therapy sometimes takes four to six months. The term, of course, is extremely long for the sick person, but we have to reconcile ourselves - we have no other choice. It is possible, however, to try to improve the patient's condition for this period with the help of local action on the joints. Dimexide applications, laser therapy, cryotherapy and intra-articular corticosteroid hormones are used for this purpose.
Dimexide applications are applied to the most inflamed and painful joints. In rheumatoid patients, improvement is observed after 6-7 days of dimexide therapy and becomes even more noticeable after a two-week series of applications. In total, a positive effect is expressed in 80% of patients.
Intra-articular administration of corticosteroid hormones( kenalog, hydrocortisone, diprospan, flosteron) helps the patient survive the period of particularly acute inflammation of individual joints. With intraarticular administration, hormones quickly relieve pain and reduce inflammation of the joint, but usually the healing effect lasts only two to three weeks. Then the inflammation again starts to increase gradually.
Warning! It is advisable to conduct no more than two or three injections of corticosteroids in each joint. In addition, you need to remember that you can not get too involved with hormone injections and do them too often - otherwise hormones will start to have a negative effect on the entire body. Therefore, the intervals between such procedures should not be less than 7 to 10 days. But, of course, intra-articular injections can greatly facilitate the patient's life, even in particularly severe cases of rheumatoid arthritis.
Laser therapy has a mild anti-inflammatory effect in rheumatoid arthritis. Laser therapy is used as a separate treatment for rheumatoid arthritis, and in combination with basic therapy.
The laser irradiates not the joints of the patient, but the area of the ulnar vein - that is, the radiation affects the blood circulating inside the body. It is believed that after irradiation of the blood by the laser, various positive changes occur in the body: immunity normalizes, blood supply of organs and tissues improves, any inflammation decreases and foci of infection are suppressed.
The most favorable results are observed in patients with a slow, mild form of rheumatoid arthritis. In severe forms of the disease the laser is ineffective
The course of treatment of rheumatoid arthritis consists of 15 to 20 procedures performed every other day.
Cryotherapy( local freezing treatment) is successfully used in both acute and chronic phases of rheumatoid arthritis. Treatment is practically harmless and has no contraindications;unfortunately, it is expensive. Improvement after cryotherapy is noted in 60 - 70% of patients with rheumatoid arthritis.
Other physiotherapeutic procedures, including massage, are performed only when the rheumatoid arthritis escalates and the blood counts return to normal. Physiotherapy is done exclusively at normal body temperature, good blood tests and in the absence of redness and swelling of the joints.