Rheumatoid arthritis: symptoms and treatment, diagnosis
Rheumatoid arthritis is a pathology of connective tissue that occurs most often in carriers of specific genes after a provoking factor and is systemic in nature.
Mostly several small joints are affected, in which an erosive-destructive process develops, which is irreversible. There are also extra-articular foci of inflammation. Women mostly are older than 40 years old.
What is the difference between arthritis and arthrosis?
In both these diseases, joint damage occurs, but the causes, mechanism of development and treatment of these pathologies vary widely.
Let's consider in more detail what is the difference between arthrosis and arthritis:
| Comparable symptom | Arthritis | Arthrosis |
| The essence of the process | The inflammatory process triggered by infection - general or local, as well as antibodies developed in response to infection | A degenerative process in which tissuejoint is destroyed due to circulatory disorders |
| "Favorite" age | Can develop at any age | More common in the elderly. At risk are those who have long engaged in activities accompanied by a monotonous load on the joint |
| The relationship of the two pathologies | May be a complication of arthrosis | Does not develop due to arthritis |
| Causes of | infection; repeated injuries; is a metabolic disorder; allergy; autoimmune processes in the body | Hereditary predisposition; increased joint load; infringement of a blood supply of a joint; injury; Limb subcooling |
| Symptoms | Joint pain, which is aggravated by physical exertion, prolonged exposure in one position. Increases local temperature above the joint | Arthritic pain at rest decreases or disappears, increases with changing weather conditions. There is also a crack, a click, a feeling of friction in the joint. The temperature above the joint is normal( in the absence of arthritis) |
| Laboratory diagnostics | A general blood test reveals an inflammatory process characterized by a change in the rheumatrophe | No specific deviations |
| Therapy | The anti-inflammatory and antibiotic therapy passed by the recommended protocol course causes complete regression of the disease | Anti-inflammatory drugs are used aspainkillers. Chondroprotectors( preparations of glucosamine and chondroitin) can stop the process, being appointed only in the presence of articular cartilage |
Diagnosis of arthritis
The American College of Rheumatology has proposed certain criteria for the diagnosis of rheumatoid arthritis, which are relevant in our time.
If four out of seven criteria are found, this diagnosis is confirmed:
- 1) Joint stiffness in the morning, which lasts more than 1 hour for 6 weeks;
- 2) Symmetry is a lesion, that is, a disease of the same joints on the left and right;
- 3) Positive rheumatoid factor;
- 4) Lesion of three or more joints;
- 5) Lesion of the joints of the hand;
- 6) Rheumatoid nodules;
- 7) Characteristic radiographic changes.
But, unfortunately, these signs can be found only at later stages of the disease.
Symptoms of rheumatoid arthritis
There are several forms of rheumatoid arthritis, depending on this the clinical symptoms will have significant differences.
The classical version of the flow, when the initial symptoms of the disease manifest themselves almost always in the cold season after the provoking factors, which include:
- infections - viral or bacterial;
- injury;
- allergic reactions;
- surgical interventions.
The first signs of rheumatoid arthritis are fatigue, weakness, minor pains in joints and muscles. Then the pain in one or several joints comes to the fore( usually the brushes, feet, wrist joint, elbow joint suffer):
- constant;
- noisy character;
- amplifies by the evening;
- when the weather changes, they recur;
- joints are often affected symmetrically - on the right and left limbs.
Less commonly, the disease begins to develop atypically. In one case, very quickly, without prodromal signs, the lesion of several joints can develop at once. In another - soreness, swelling and stiffness is revealed only in one, usually large, joint.
In addition to pain for rheumatoid arthritis, stiffness in the joint is characteristic: from the second half of the night and after a dream a person feels that it is difficult to make movement in the joint, then( after an hour or more) it passes.
The heavier the degree of the disease, the longer stiffness is felt. With the progression of arthritis, the joints irreversibly deform, become completely immobile.
Joints, the defeat of which, along with other symptoms, is a sign of rheumatoid arthritis:
- between the metacarpal and phalangeal bones on the second and third fingers of the hand;
- between the first and second phalanx on the feet;
- wrist band;
- ulnar;
- knees;
- ankle.
Joints that can be affected:
- between the sternum and clavicle;
- between the humerus and collarbone;
- is one of the joints of the larynx.
Joints that are not affected by rheumatoid arthritis:
- between the last and penultimate phalangeal bones;
- on the thumb of the brush.
The variant with lesions of one or a small number of joints( oligo- or monoarthritis) differs slightly in the development of its symptoms. In this case, the disease begins acutely, with an increase in body temperature and pain in one or more joints. The pains are unstable, they migrate. It is observed 1-1,5 months, then the symptomatology, characteristic for the classical form of the disease develops.
The variant with pseudo-septic syndrome is unusual: the body temperature rises to high figures, chills appear, sweating.
The person sharply loses weight, he develops muscle atrophy, as well as complications from the blood. Against this background, pain or stiffness in the joints fades into the background.
There are other variants of the course of the disease when there is a combination of articular syndrome with the defeat of various organs:
Skin:
- is thinned;
- becomes dry;
- small hemorrhages appear under the skin;
- near the nails can develop areas of necrosis of the skin.
Defeat of muscles in the form of their atrophy.
Inflammation of one of the digestive tract, which may manifest itself:
- flatulence;
- decreased appetite;
- abdominal pain;
- heaviness "under the spoon".
Lesion of the broncho-pulmonary system in the form of pleurisy or pneumonia. Kidney can develop autoimmune inflammation - glomerulonephritis;kidney failure may develop slowly. Rheumatoid arthritis can manifest as a lesion of any heart membrane.
Read also how to treat arthritis of the knee joint.
Treatment of rheumatoid arthritis
The diagnosis "Rheumatoid arthritis" is confirmed by:
- by the presence in the blood of rheumatoid factor in high titre;
- high titre of antibodies to citrulline-containing protein( anti-CCP);
- a typical picture of joint damage( in their appearance and radiological);
- the presence of subcutaneous nodules that have this characteristic: dense, mobile, painless;
- morning stiffness in the joints for at least 1 hour;
- by the factor that there was inflammation of at least three "characteristic" joints, and this continues for at least 6 weeks.
First of all, treatment of rheumatoid arthritis begins with the appointment of anti-inflammatory drugs( "Indomethacin", "Orthofen", "Ibuprofen");In addition, intra-articular administration of hormones-glucocorticoids( "Kenalog", "Hydrocortisone") is performed several times.
If the disease is still progressing, a second series of drugs is prescribed, the so-called basic ones. These are slow acting, but effective anti-inflammatory drugs:
- "Hingamin";
- "Arava";
- "Plakvenil";
- Salazosulfapyridine, Salazopyridazine;
- Preparations of gold( "Krizanol");
- Penicillamine;
- The regulator of differentiation of the T-lymphocyte: "Halofuginon";
- Antibodies to the alpha factor of tumor necrosis: "Etanercept", "Infliximab".
If the above drugs are ineffective and evaluated after six months of continuous treatment, immunosuppressive medications are prescribed:
- 1) Methotrexate;
- 2) "Clorbutin";
- 3) "Prednisolone" or other glucocorticoid hormone.
In addition to medical treatment, also carried out:
- plasmapheresis;
- exercise therapy;
- balneotherapy;
- mud treatment;
- massage;
- surgical treatment - to restore, preserve and improve the function of the joints. Read also what is rheumatoid polyarthritis.
Complications of rheumatoid arthritis
They are conventionally divided into systemic and local. Local include contractures, joint deformities, which leads to disability of the patient. To the system include those manifestations that develop through 1-1,5 years in vital organs:
1) Felty's syndrome is a violation of the functions of the spleen, which leads to increased destruction of blood cells. Because of this,
- develops a decrease in platelet count, which is fraught with bleeding;
- decrease in the number of erythrocytes and hemoglobin, which causes fatigue, fatigue, hypoxia of organs;
- decrease in the number of leukocytes, which leads to a decrease in immune defense.
2) Amyloidosis - the deposition in the kidney of the pathological protein - amyloid. It is formed in the liver with prolonged chronic diseases, and, getting into the kidneys, blocks their normal structures. As a result, the kidneys gradually lose their function.
3) Eye diseases: scleritis, episcleritis, Sörgen's syndrome( autoimmune inflammation of the lacrimal glands).
4) Vascular inflammation - vasculitis. The process can involve vessels of the skin, eyes, nerve endings, heart.
5) Osteoporosis.
Against rheumatoid arthritis, malignant blood diseases often develop: lymphomas, myelomas, myelodysplastic syndrome.
Prevention of rheumatoid arthritis
There is no vaccine against this disease. Even if the carrier of a defective gene will avoid injuries, illnesses caused by infection, intoxications, stress, hyperinsurance throughout his life, this will not save him 100% from the development of rheumatoid arthritis. Prevent relapse of the disease can:
- regular physical activity( swimming, cycling);
- hydrotherapy;
- mud baths;
- consumes an increased number of berries, nuts and fruits, products with omega-3 fatty acids( soybean, flax seeds, pumpkin, red fish);
- exception from the diet of easily digestible carbohydrates, cooking fats