Rheumatoid arthritis — symptoms, treatment, diagnosis and prognosis

The name of this disease seems to be the sound of two words: arthritis and rheumatism. Rheumatoid means "similar to rheumatism". What is this disease and how to treat it?

It is known that the disease is evenly distributed in the human population, it has no national preferences. As a rule, the average sick every hundredth person, and in old age, it is normal diagnosis – one in twenty.

rheumatoid arthritis

According to statistics, depending on the geographic location, in every city with a population of 1 million people every year there are 500 new cases of rheumatoid arthritis.

Except that this disease reduces the quality of life, it can flow difficult, and even lead to death. So, on average, every year rheumatoid arthritis and its complications kill up to 50 thousand people.

Most often the disease begins at the age of 40-50 years and older. While rheumatoid arthritis (RA) is considered a "women's" disease: the number of women exceeds that of men by 4-5 times. But men "take vengeance" on women with ankylosing spondylitis. It is known that the number of men with this disorder in contrast, far exceeds the number of women.

Rheumatoid arthritis — what is it?

Rheumatoid arthritis is the systemic lesions of connective tissue. This means that affected all ligamentous and articular tissues in the body, which was subjected to autoimmune inflammation.

This disease most often affects the small joints in which there is a symmetrical erosive-destructive process that leads to their destruction. When the disease high risk of extra-articular immune lesions of the connective tissue.

It is known that patients with RA often have cardiovascular disaster. Rheumatoid arthritis is the cause of early disability, osteoporosis and fractures, and premature death, which is caused by chronic renal failure and the addition of a secondary infection.

This disease, despite the seriousness of, successfully treated, however, life, but only if timely diagnosis and correctly chosen tactics of treatment. The most favorable are the outcomes, when RA began to treat not later than 3 months after the diagnosis, that is, in an early stage.

Why rheumatoid arthritis develops, and how to detect the presence of risk factors?

The reasons for the development of the disease

Unfortunately, the reasons remain cryptogenic, that is hidden. This files most often suggest that an autoimmune mechanism starts the infection. But this provision may be challenged by the fact that the antibiotics for the RA does not help.

Sometimes the onset of the disease may occur after stress, after trauma or heavy physical exertion. Infection, trauma, hormonal changes (menopause) can also contribute to the onset of the disease.

Often patients indicate that rheumatoid arthritis began after the intense sun, or cold exposure, side effects of drugs.

causes
  • There is evidence that RA may be inherited, or rather a type of autoimmune reactions. Isolated juvenile rheumatoid arthritis, the debut of which can begin at the age of 16 years.

Stage of rheumatoid arthritis

Doctors and researchers have spent a lot of effort to provide clinicians and researchers the classification stages of arthritis. Currently, there are:

  1. Very early stage (first six months of the course);
  2. Early stage – before the disease runs a year;
  3. Advanced stages rheumatoid arthritis more than a year ago;
  4. Late stage – for two years or more.

This classification shows that the disease progresses quite quickly, just for a later stage need only 2 years.

In addition, special indexes klassificeret the disease process activity, presence of signs of erosion small joints and x-ray pattern, the presence or absence of rheumatoid factor.

In this case, has both seronegative and seropositive options. Rheumatoid factor – autoantibodies directed against immunoglobulin G.

In the later stages of the disease there is a classification by functional class, which is based on self preservation, household and professional activities.

Symptoms of rheumatoid arthritis in adults

There are several variants of rheumatoid arthritis (shape):

  • Normal variant, or classic (small, symmetrically affected joints, slow flow);
  • Pseudoseptic form (with fever, muscle atrophy, anaemia, damage blood vessels and internal organs). Flowing hard;
  • Oligo-or monoarthritis, with the first defeat of the large joints, often the knee. Considered as a variant of the debut of the classic shapes;
  • Juvenile form;
  • Syndromes Steele., Sjogren's and Felty (splenomegaly, visceral – viscinity, leukopenia);

Some researchers distinguish visceral – articular form, which occurs in vessels and there are various lesions of the heart, kidneys and other organs.

the symptoms on hands

The characteristics and main symptoms

The classic version of rheumatoid arthritis occurs with a lesion of joints. Initially there is swelling of the small joints, there is pain, signs of arthritis are fever, swelling, tenderness, and redness. Then there is the seal of the joint capsule, and at the end of the process is affected cartilage and bone tissue, which leads to severe deformation of the joints.

Of course, to professional and consumer activities the most adverse of rheumatoid arthritis of the hands, or rather, the small joints of the hand and fingers, since this localization often leads to disability.

The characteristic feature of the disease is severe morning stiffness in the affected joints, which can last about half an hour or more. By night, closer to morning, patients feel they are on the hands or on the affected joints, wearing tight gloves, in joints there is a constant pain.

At movement the pain increases. This pain is of a monotonous character, and not in a hurry to completely disappear after treatment.

  • Often patients complain of weather dependent with joint pain.

To complications and a severe course include extra-articular lesions. These include lesions of the heart, lungs, blood vessels and peripheral nerves. There are pericarditis, pleurisy, vasculitis, vessels, neuritis. The blood is caused anemia and increased erythrocyte sedimentation rate.

In addition to local articular and extra-articular lesions often have General symptoms of autoimmune inflammation. These include:

  • lethargy, fatigue, decreased performance;
  • flu-like febrile syndrome;
  • loss of appetite, depression;
  • myalgia;
  • insufficiency of the exocrine glands: dry mouth and lack of production of saliva.

Diagnosis of rheumatoid arthritis

No decisive pathognomonic symptom or analysis that would confidently 100% say that it is rheumatoid arthritis. Therefore, an integrated approach: assessment of joint damage, age of onset of disease, the radiological picture.

Important are the findings: antibodies to cyclic peptide containing citrulline. This analysis at 90% gives the correct result. In addition, dynamic monitoring of the patient allows also to draw conclusions.

The treatment of rheumatoid arthritis, drugs

Regardless of stage, treatment of rheumatoid arthritis is a lifelong, because at the moment cures are not fixed. The best that can be long – term, life-long remission.

treatment of rheumatoid arthritis

Therefore, the objectives of treatment are:

  • good pain relief;
  • stop the progression;
  • surgical correction of deformities of the joints if you have them.

What drugs are indicated for rheumatoid arthritis? It depends on the stage of the disease.

For the first time revealed the process

So, when you first identified the disease not older than 3 months, assigned to the basic therapy.

Basic drugs are prescribed when first identified, the "fresh" process. These tools can prevent destruction of the joints and erosion.

A detailed process that are resistant to traditional means

In that case, if the process lasts more than a year, in the joints there are signs of erosion, and conventional drugs are ineffective, that this for rheumatoid arthritis prescribe drugs of new generation. This is a genetically engineered biological drugs that are very expensive.

These include:

  • antibodies – inhibitors of TNF (tumor necrosis factor);
  • blockers of receptors of lymphocytes;
  • inhibitors of receptors of interleukin-6;
  • blockers stimulation of T-lymphocytes.

As you can see, these monoclonal antibodies are embedded in the pathological autoimmune process, breaking it at different levels.

In the case of a combination of genetically modified drugs with the tools of the baseline it is possible to achieve more rapid and sustainable effect of treatment.

Particularly problematic for elderly patients with osteoporosis, deformation of joints and gastropathy. For them developed a special treatment strategy.

the prognosis of the disease

Forecast

There are a number of criteria that allow you to make correct prediction in rheumatoid arthritis. Criteria of high risk, to speak for expressed activity, the involvement of internal organs and early disability are:

  • onset of the disease at a young age (juvenile form);
  • female;
  • the presence of high levels of rheumatoid factor or antibodies to citrulline peptide;
  • rapid and early erosion in the joints;
  • the presence of a high erythrocyte sedimentation rate and C – reactive protein in the blood;
  • the presence of extra-articular manifestations;
  • involvement of lymph nodes;
  • the presence of lupus cells and antinuclear antibodies;
  • high resistance to the treatment of basic drugs.

In conclusion, I want to note that rheumatoid arthritis, symptoms, diagnosis and treatment of which, we understand, refers to diseases, control of which tells about a developed health care system.

The disease is "testing the strength" all parts of the system, starting from diagnosis, the availability of qualified rheumatologists, proper treatment regimens, the use of expensive modern drugs, and to schemes of rehabilitation, disability and social benefits.

13.12.2018