Rheumatoid arthritis is a systemic disease of unknown etiology with widespread lesions of the connective tissue mainly in joints with erosive changes in chronic, often relapsing and progressive course. The trigger might be an infectious outbreak, a cold injury.
The pathological process leads to the complete destruction of the articular tissues to gross deformation and the development of ankylosis, which leads to loss of joint function and disability.
In severe cases may be affected and internal organs (heart, kidneys, lungs, blood vessels, muscles, etc.), which significantly worsens the prognosis in rheumatoid arthritis. Symptoms, diagnosis and treatment methods which we will examine in this article.
The prevalence of rheumatoid arthritis among the adult population in various climate and geographical zones is on average 0.6 — 1.3 percent. The annual incidence over the last decade, remains at the level to 0.02%.
Observed build-up of rheumatoid arthritis with age, get sick more often women than men. Among persons younger than 35 years, the prevalence of the disease is 0.38%, with age 55 years and older is 1.4%. High frequency disease was diagnosed in relatives patients first-degree relatives (3.5 per cent), especially in females (5.1 percent).
What causes rheumatoid arthritis and what is it? Rheumatoid arthritis belongs to autoimmune diseases, that is diseases arising from the malfunction of the immune system. As with most autoimmune pathologies, the exact cause of the disease have been identified.
It is believed that provoking factors for the occurrence of disease are:
Under the influence of these factors, cells of the immune system starts to attack the cell membrane of the joint, causing inflammation. In this process, the joints become swollen, warm and painful when touched. Cells of the immune system also cause damage to blood vessels, which explains the so-called extra-articular symptoms of rheumatoid arthritis.
Juvenile rheumatoid arthritis is an inflammatory disease of the joints, it is characterized by progressive course with the involvement of internal organs. Per 100 000 children the disease occurs in 5-15 people.
The disease occurs in children under 16 years of age and can last for many years. Its onset can be a result of different factors – viral and bacterial effects, cooling, drugs, increased sensitivity to some environmental factors, and many others.
Rheumatoid arthritis may begin as acute and subacute, and the latest version of the debut is observed in most cases.
The first signs of RA:
As a rule, such manifestations of the disease remain without attention, further developing articular syndrome and extra-articular manifestations of the disease.
In the case of rheumatoid arthritis in the study of patient complaints particular attention is drawn to the following symptoms
In a patient with rheumatoid arthritis you can also note the presence of other symptoms:
Palpation can detect: increase of skin temperature over the surface of the joint; tenderness of the affected joints; the symptom of "lateral compression"; atrophy of the muscles and thickening of the skin; subcutaneous education in the field of ulnar joints are often so-called rheumatoid nodules; symptom balloting of the patella to determine the presence of fluid in the knee joint.
Depending on the clinical and laboratory data, there are 3 degrees of exacerbation of RA:
In RA, primarily, affects the peripheral joints, but you cannot forget that this is a systemic disease and the pathological process can be drawn any organs and tissues, where there is connective tissue.
The development of extra-articular (systemic) manifestations are more characteristic of seropositive forms of rheumatoid arthritis severe long-term course.
The most severe course of rheumatoid arthritis different forms, occurring with lymphadenopathy, lesions of the gastrointestinal tract, nervous system (polyneuropathy, polyneuritis, functional vegetative disorders), involvement of the respiratory system (pleural effusion, diffuse fibrosis, pneumonitis, fibrosing alveolitis, bronchiolitis), kidneys (glomerulonephritis, amyloidosis), eyes.
From the great vessels and heart in rheumatoid arthritis can cause endocarditis, pericarditis, myocarditis, arteritis of the coronary vessels, granulomatous aorta.
Unlike rheumatism, in rheumatoid arthritis inflammation is persistent pain and swelling of the joints can last for years. Differs from osteoarthritis this type of arthritis because the pain does not increase with load and decrease after active movements.
Criteria for diagnosis of rheumatoid arthritis American rheumatologic Association. The presence of at least 4 of the following signs may indicate the presence of the disease:
A blood test shows the presence of inflammation in the body: the appearance of specific proteins of inflammation — seromucoid, fibrinogen, C-reactive protein and rheumatoid factor.
Diagnosis of rheumatoid arthritis is only possible when assessing the totality of the symptoms, radiological signs and results of laboratory diagnosis. With a positive result of treatment.
In the case of accurate diagnosis of rheumatoid arthritis, systemic treatment involves the use of certain groups of drugs:
At the present stage of development of medicine, in the treatment of rheumatoid arthritis put the following purposes:
Treatment consists of a complex of methods of medicamentous therapy, physiotherapy, therapeutic nutrition, surgery, sanatorium treatment and subsequent rehabilitation.
This group of drugs is not included in the basic therapy of rheumatoid arthritis, because it does not affect the destructive process in the joints. However, preparations of this group are appointed with the aim to reduce pain and eliminate stiffness
Appointed in acute pain and severe stiffness. With caution is prescribed in patients with gastritis.
In combination with hormones reduce the activity of rheumatoid arthritis.
Monoclonal antibodies to some cytokines provide neutralization of tumor necrosis factor, which in the case of rheumatoid arthritis provokes the defeat of their own tissues.
Also there are studies proposing to use as a treatment for rheumatoid arthritis regulators of differentiation of lymphocytes. This will avoid damage to the synovial membranes of T-lymphocytes that are wrong "sent" into the joints by the immune system.
This hormones. Are assigned as in the presence of systemic manifestations of the disease, and in their absence. Today in the treatment of rheumatoid arthritis treatment and practice in small and large doses of hormones (pulse therapy). Corticosteroids are well-docked pain syndrome.
Only after will be removed the acute form of the disease, blood tests and temperature are normalized – you can use massage and other methods of physiotherapy in rheumatoid arthritis. The fact that physiotherapy has a stimulating effect and can increase inflammation.
These methods improve blood flow to joints, increase mobility, reduce deformation. Used phonophoresis, diathermy, UHF, ozocerite and paraffin, infrared radiation, mud, balneotherapy resorts. Details on these methods, we shall not stop.
Surgery can correct health in a relatively early stage of the disease, if one large joint (knee or wrist) are constantly inflamed. During such operations (synovectomies) is the synovial membrane of the joint, resulting in occurs long-term relief of symptoms.
Surgery for prosthetic joint is carried out for patients with more severe joint damage. The most successful are operations on hips and knees.
Surgical intervention is aimed:
Rheumatoid arthritis is primarily a medical problem. Therefore, surgery to those who are under the supervision of an experienced rheumatologist or doctor.
Rheumatoid arthritis is recommended a special diet that will reduce inflammation and correct the metabolic disorders.
Rules of the diet are as follows: