Rheumatoid arthritis - Causes, symptoms and treatment. MF.
Rheumatoid arthritis is a disease of the joints, in which, as a rule, the symmetrical joints of the hands and feet are affected. This disease occurs in 1-2% of the world's population, mainly middle-aged and elderly women.
Causes of rheumatoid arthritis
Rheumatoid arthritis refers to autoimmune diseases, that is, diseases that result from a malfunction of the immune system. As with most autoimmune pathologies, the exact cause of the disease has not been identified. It is believed that the provoking factors for the onset of the disease are:
• Genetic predisposition of .It is established that in close relatives of patients with rheumatoid arthritis this disease develops much more often. The likelihood of developing rheumatoid arthritis also increases in patients with some other autoimmune disease( systemic lupus erythematosus, glomerulonephritis).
• Infections of .As a rule, rheumatoid arthritis occurs after the transferred measles, herpetic infection, hepatitis B, mumps.
• Adverse factors of external and internal environment
Under the influence of these factors, the cells of the immune system begin an attack on the cells of the joint membrane, which causes inflammation. In this case the joints swell, become hot and painful to the touch. Cells of the immune system also cause damage to the blood vessels, which explains the so-called extraarticular manifestations of rheumatoid arthritis.
Possible symptoms of rheumatoid arthritis
The disease begins gradually. At the initial stage small hand joints( phalanges of fingers) are affected, less often stop.
Favorite location of inflammation on the wrist with rheumatoid arthritis
In the morning, patients complain of morning stiffness - it is impossible to comb their hair, take a toothbrush, button up their buttons, make breakfast, since the fingers do not straighten. Depending on the time during which the stiffness in joints stays, the following degrees of activity of rheumatoid arthritis are distinguished.
For , the first degree of activity of is characterized by the duration of morning stiffness of joints 30-60 minutes, with of second degree - up to 12 hours. With the third maximum activity stiffness is constant, does not pass all day long. Affected joints moderately swollen, the skin above them hot to the touch, but the usual color.
Rheumatoid arthritis is characterized by pain in the joints, which appear first when moving, and when the disease progresses and at rest. In medicine, for the convenience of patients, a visual analogue scale( VAS) of pain is accepted. It is a 10 centimeter ruler, on the front side of which there are only two marks.0 corresponds to the inscription "no pain", 10 - "maximum pain".The patient is asked to assess the intensity of his pain, considering how far away his pain is compared to the pain of such force that he can imagine. Then the doctor measures the distance in centimeters from zero to the patient's mark. Less than 3 cm on the VAS scale corresponds to the first degree of activity of rheumatoid arthritis, more than 3-6 cm-second, and more than 6 cm indicate a third degree of activity.
Unfortunately, joint pain severely disrupts their function. The ability to self-service, perform professional and non-professional activities underlies the allocation of functional classes of the disease.
Functional classes of rheumatoid arthritis
As the disease progresses, various deformations of the joints develop, the most characteristic of which are presented in the figures below. Unfortunately, these changes are irreversible.
Deformation of the wrist joints by the type of "walrus fin"
Deformity of the joints of the brush as "swan neck"
Deformation of the brush joints by the "buttoned loop" type
Extra-articular manifestations of rheumatoid arthritis are also characteristic. Since the first weeks of the disease, weight loss has been observed in patients. With a high degree of arthritis activity, weight loss can reach 10-20 kg in 5 months. Patients are concerned about an increase in body temperature to 37-39 ° C, more often in the evening and at night. Also, the muscles are affected: patients complain of pain during movement, expressed muscle weakness. A characteristic feature of rheumatoid arthritis is rheumatoid nodules.
Rheumatoid nodules on the fingers of the hand with rheumatoid arthritis
These are dense rounded painless formations up to 2-3 cm in diameter. They are located subcutaneously in the area of the joints of the fingers of the hands, elbows. The appearance of rheumatoid nodules suggests a high degree of disease activity. In addition, patients with rheumatoid arthritis may have an increase in the spleen, lymph nodes, pleurisy, interstitial pneumonitis, myocarditis, pericarditis, glomerulonephritis.
Diagnosis of rheumatoid arthritis
In 1997, the American College of Rheumatology proposed criteria for the diagnosis of rheumatoid arthritis, which are relevant to this day. If you identify 4 out of 7 of these criteria, this diagnosis is considered reliable.
• Morning stiffness of the joints, which lasts more than 1 hour for 6 weeks.
• Lesion of three or more joints.
• Lesion of the joints of the hand.
• Symmetry is a lesion, that is, a disease of the same joints left and right.
• Rheumatoid nodules.
• Positive rheumatoid factor.
• Characteristic radiographic changes.
But, unfortunately, these signs can be found only at later stages of the disease. Therefore, , when there is a symptom of morning stiffness, swelling or tenderness in the joints of the hand, it is recommended to consult a rheumatologist as soon as possible. Early forms of rheumatoid arthritis are much more amenable to treatment.
In laboratory tests, the following changes are detected:
In the blood test: decrease in hemoglobin concentration and decrease in the number of erythrocytes, platelets against accelerated ESR( erythrocyte sedimentation rate).In addition, in patients with rheumatoid arthritis, the concentration of inflammatory factors, such as C-reactive protein, gamma globulin, increases.
Attention is drawn to the presence of a rheumatoid factor in the blood. Rheumatoid factor is a special substance that is secreted by the immune system to fight the cells of the joint membrane. The detection of this indicator in the blood speaks not only of the presence of rheumatoid arthritis, but also characterizes the degree of activity of the process.
The fundamental for the diagnosis of rheumatoid arthritis is radiography of joints, usually joints of hands and feet. The narrowing of the joint cracks, as well as signs of the destruction of the bones adjacent to the joint, speaks in favor of rheumatoid arthritis.
Treatment of rheumatoid arthritis
Treatment should be aimed at reducing the degree of activity of the process, reducing pain, joint stiffness, and preventing complications.
Features of nutrition and lifestyle in the treatment of rheumatoid arthritis
Proper nutrition plays a big role in the treatment of rheumatoid arthritis. It is established that some products in most patients contribute to the occurrence of complications. Patients with rheumatoid arthritis are recommended to completely exclude them from the diet. Such products include: fatty meat, milk, citrus fruits, corn, oat and rye cereals. Vegetarian low-calorie diet has a positive effect. Variants of proper diets are Donga diet, Eskimo diet, or cheese-vegetable diet, which is successfully used in Finland.
Drug-induced treatment of rheumatoid arthritis
Non-steroidal anti-inflammatory drugs( NSAIDs) such as diclofenac, dexalgin, nimesulide, meloxicam, and glucocorticoids-prednisolone have a pronounced anti-inflammatory and analgesic effect. These drugs can be used already in the early stages of the development of the disease according to a certain scheme. The side effect of NSAIDs is their negative effect on the mucous membrane of the gastrointestinal tract, which is manifested by the development of ulcers. Glucocorticosteroids reduce immunity, cause bone destruction, diabetes mellitus, a specific type of obesity, and exacerbation of already existing chronic diseases.
To reduce the activity of the rheumatoid process, drugs such as D-penicillamine, methotrexate, azathioprine, cyclophosphamide are used. Their common property is the suppression of the activity of the immune system. Therefore, during treatment, the patient becomes sufficiently susceptible to infectious diseases. In addition, these drugs have great toxicity, which is manifested by changes in blood, damage to the kidneys, liver, lungs and other organs.
In addition to drug therapy, hemosorption( removal of certain substances from the blood by fixing them on sorbents) and plasmapheresis( removing plasma with harmful substances and replacing it with the same volume of donor plasma) is shown to remove circulating inflammatory provokers.
Local treatment consists in administering anti-inflammatory drugs( diprospan) in the joint cavity, as well as applying to ointment joints, gels containing NSAIDs.
The main cause of the development of degenerative and inflammatory diseases of the musculoskeletal system is a decrease in the level of glucosamine and chondroitin, the natural components of the cartilage of the joint. Therefore, along with drugs that relieve pain syndrome, the means restoring joints are used. The optimal dose for these components is available in the complex "Glucosamine Maximum" from Natur Product, which helps to restore and protect against the destruction of cartilaginous tissue. The drug is widely used in modern medicine for the treatment and prevention of various joint diseases.
In combination with medications for local treatment of inflammation, physiotherapy is used. It can be recommended ultraviolet irradiation of joints, magnetotherapy, electrophoresis of anti-inflammatory drugs, laser therapy. Massage and physiotherapy exercises are prescribed when the inflammatory process stops.
In severe joint deformities, surgical treatment is indicated. Currently, the removal of the area of the damaged shell, or the whole joint with subsequent prosthetics, is successfully applied. As a supportive treatment, it is recommended to wear orthoses - special devices that are worn on the affected limb, as a rule, at night, and due to the maintenance of a certain form they do not allow deforming the joints.
Possible complications of rheumatoid arthritis
Most of the complications associated with rheumatoid arthritis are associated with the toxic effects of drugs for treatment. Along with this, patients can develop secondary amyloidosis, osteoporosis( bone destruction) or a disorder in the hematopoiesis system.
Amyloid is a large insoluble protein, which in excess amounts is formed by inflammation and deposited in various organs and tissues. The most dramatic is the deposition of amyloid in the kidneys. This condition is not amenable to treatment, the terminal stage of renal failure is soon formed in patients.
Due to chronic inflammation, the density of bone tissue decreases, the bones become brittle. For this complication fractures are characteristic even with minimal impact, including spontaneous ones. After fractures, the bones coalesce very long, often forming false joints.
The causes of the abnormality in the hematopoiesis system have not yet been studied. But in patients with high activity of the disease, the bone marrow is replaced by scar tissue. In the blood, the concentration of all cells decreases, a serious incurable condition develops.
In addition, with late treatment, a pronounced deformation of the joints of the hand is formed. This dramatically reduces the work capacity of patients, ultimately leading to disability.
Prognosis for the development of rheumatoid arthritis
Rheumatoid arthritis refers to diseases with an unfavorable prognosis. This means that, despite the ongoing treatment, it is impossible to achieve full recovery. In addition, drugs for treatment are extremely toxic. The life expectancy of patients with rheumatoid arthritis is on average 5-10 years less than in the general population. In such patients, due to chronic chronic inflammation, the risk of sudden cardiovascular death, internal bleeding, and infectious complications is increased.
Prevention of rheumatoid arthritis
Given the autoimmune nature of the lesion, specific preventive measures can not be developed. The general recommendations include: avoiding hypothermia, exposure to toxic substances, psycho-emotional overstrain, timely and effective treatment of infections. To prevent the development of complications, it is necessary to turn to a rheumatologist, even with minimal signs of the disease.
Doctor therapist Sirotkina EV