Rheumatoid arthritis: symptoms and treatment
- Causes of rheumatoid arthritis
- Mechanism of development of rheumatoid arthritis
- Classification of rheumatoid arthritis
- Symptoms of rheumatoid arthritis
- Diagnosis of rheumatoid arthritis
- Treatment of rheumatoid arthritis
"In the movement of life" - this expression is probably heard by everyone. Indeed, for the realization of normal vital activity, a person must constantly move his body in space. In the course of evolution, the body acquired beautiful elements that ensure this function at the highest level. These amazing parts of the body are the joints. All human bones are surprisingly strong and elastic individually, which allows them to withstand enormous loads. Connecting together, they form an amazingly moving skeleton, which allows you to perform incredible movements. All this is achieved thanks to the well-coordinated work of the mass of joints.
Unfortunately, there are diseases, as a result of the progression of which the joints of the body are affected and lose their mobility. As a result, the patient's quality of life is significantly reduced. Rheumatoid arthritis is a very urgent problem of modern rheumatology. This is a systemic disease that affects the connective tissue. As a result of its development, the patient is affected by small joints in an erosive-destructive type. Around the world, this disease affects about 60 million patients, which is up to 1% of the entire population.
Even more exacerbating the whole situation is that doctors have not been able to determine the exact cause of the disease to date. There are separate theories and assumptions, but none of them has found really weighty confirmation. Over time, all the symptoms of the disease are steadily worsening, gradually leading to a permanent loss of incapacity for work by a person. About three times more often women fall ill. The average age of the patient in detecting the disease is 30-35 years.
Causes of rheumatoid arthritis
At present, there are several most probable etiological factors of the disease. Each version has its advantages and disadvantages. In general, more and more physicians tend to believe that rheumatoid arthritis is a multifactorial disease that develops when combining several causes at once.
- Genetic predisposition - in patients with this diagnosis a predisposition to impairment of the activity of the immune system at the genetic level has been established. Some antigens have already been detected, the presence of which can lead to a change in humoral and cellular immunity due to the effect of certain infections. It is also possible to trace the increased likelihood of developing rheumatoid arthritis in people whose immediate relatives also suffered from it.
- Infectious agents capable of causing changes in human immunity as a result of their specific properties, as a result of which their own protective factors attack their connective tissue. The role of these pathogens are advanced: the Ebstein-Bar virus, retroviruses, rubella, herpes, cytomegalovirus , mycoplasma. Doctors have some evidence in favor of this hypothesis:
- In 80% of patients, higher titers of antibodies to the Ebstein-Bar virus are detected.
- In lymphocytes in patients with rheumatoid arthritis, Ebstein-Bara is detected much more often than in healthy people.
Above, we indicated the factors that create the prerequisites for the development of the disease. There are also trigger factors that provoke its manifestation in a particular patient at a certain time.
- Increased exposure to sunlight (hyperinsolation).
- Intoxication, including toxins of microorganisms.
- Bacterial infection.
- Acceptance of certain medications.
- Dysfunction of the endocrine glands.
- Emotional stress and stress.
Mechanism of development of rheumatoid arthritis
It is established that when one or a combination of provoking factors in the patient's body triggers an incorrect immune reaction. Own cells produce substances that cause damage to the synovial membrane of the joints. First, a synovitis develops, which subsequently passes into the proliferative stage and causes damage to the cartilage itself and bones.
Also, immunity produces pathological cytokines, which have a number of negative properties:
- provoke the production of an increased number of pro-inflammatory factors contributing to the further progression of the disease;
- activate some enzymes that are able to destroy the cartilage covering the joint and providing elastic sliding surfaces;
- deliver special membranes to membranes of fat matings, which cause these leukocytes to manifest an autoimmune effect;
- involve in becoming additional immunocompetent cells, which also adversely affect the course of the disease in this case;
- intensification of angiogenesis, which allows the vessels to germinate into the cartilage and facilitates for aggressive factors entry into the cartilaginous tissue.
Classification of rheumatoid arthritis
There are several criteria by which this disease is classified.
Clinical and anatomical forms
- Rheumatoid arthritis (oligoarthritis, monoarthritis, polyarthritis) is a form of the disease in which only joints are affected, and other organs function normally without disrupting function.
- Rheumatoid arthritis with systemic manifestations - in addition, autoimmune processes affect the body's serous membranes (pericardium of the heart, pleura), lungs, blood vessels, kidneys, nervous system, causes deposition in the internal organs of the pathological protein - amyloid.
- Rheumatoid arthritis, combined with deforming osteoarthritis, rheumatism.
- Juvenile rheumatoid arthritis.
Characteristics from the point of view of immunology
Depending on whether the rheumatoid factor is detected in the patient's blood, all cases are divided into seropositive and seronegative. This is of great importance for physicians during the diagnosis and planning of the forthcoming treatment.
Course of the disease
- Slowly progressing - the disease over many years slowly shifts to other joints, the diseased joints are not severely damaged.
- Rapidly progressive - the disease is often exacerbated, gradually involving more and more joints. The articular surfaces undergo significant changes for the worse. Treatment does not have much effect.
- Without a noticeable progression - the most favorable form. With which the patient can live a lifetime, while maintaining a sufficiently high quality of life.
X-ray stage of the disease
- Periarticular osteoporosis is a decrease in the density of bone tissue due to a decrease in the content of calcium salts in it.
- Osteoporosis, supplemented by a slight decrease in the joint space.
- The narrowing of the joint gap and osteoporosis is supplemented by multiple usuras.
- Bone ankyloses join the whole of the above, which is the main and most persistent reason for the decrease in mobility, up to its complete absence.
Usuras are deep erosions on the articular surface of the cartilage.
Degree of functional insufficiency of the musculoskeletal system
- 0 - the patient can make all movements in full.
- 1 - a person can not fully implement all the movements that enable him to fulfill his professional duties.
- 2 - the patient can not work due to loss of professional capacity for work.
- 3 - a person can not serve himself fully.
Symptoms of rheumatoid arthritis
At the initial stages of the disease occurs without a vivid clinical picture. The patient can for years and not suspect that he has rheumatoid arthritis. The leading clinical manifestation of the disease is articular syndrome.
- Morning stiffness is a specific manifestation of the disease, on which the patient does not focus attention. During sleep, the synovial membranes of the joints become somewhat inflamed due to a decrease in the secretion of glucocorticoids at night. Sometimes patients simply can not, normally take off the blanket. After about an hour, all the symptoms pass, and a person can actively move.
- Periodic pain in the joints, loss of appetite, fatigue, weight loss - all this can be noted in the prodromal period.
- Acute pain in the joints, fever - this is how the patient begins the disease. Most often affected joints of hands and feet, wrists, knees and elbows. Other joints are less likely to be affected. Near the joint, swelling is noted, and the skin surface has a higher temperature than the rest of the body. Also, the joint region is hyperemic due to the course of inflammatory processes.
- When palpation joints are painful, movement in them is limited. As the disease progresses, the proliferative processes begin to predominate, and a significant limitation of mobility, deformation and subluxation of the joints can occur.
- Rheumatoid nodules are a specific manifestation of the disease, in which dense subcutaneous formations can be palpated on the extensor surface of the joint. This symptom is one of the important diagnostic criteria for rheumatoid arthritis.
Diagnosis of rheumatoid arthritis
- A general blood test - reveal anemia, an increase in the rate of erythrocyte sedimentation, an increase in the number of leukocytes.
- Biochemical blood test - allows to determine the degree of activity of the inflammatory process.
- Immunological examination of blood - can be determined rheumatoid factor, sometimes detect immune complexes.
- X-ray examination of joints - the classification describes all the criteria that guide doctors when exhibiting the radiographic stage of the disease.
- Radioisotope study - the injected element actively accumulates in the affected joints, and normal synovial tissue attracts not so many atoms.
- Puncture of the joint and investigation of the synovial fluid.
- In the most severe cases - a biopsy of the synovium.
Treatment of rheumatoid arthritis
Systemic treatment of this disease involves the use of the following major groups of drugs:
- non-steroidal anti-inflammatory substances;
- basic preparations;
- hormonal substances (glucocorticoids);
- biological agents.
Non-steroidal anti-inflammatory substances
These medicines have already proven themselves in the treatment of rheumatoid arthritis for a relatively long time and are still the first line treatment products. They allow relatively quick reversal of acute manifestations of the disease and sometimes achieve the onset of persistent remission - a condition in which the symptoms of the disease are absent, and the patient can live a full life.
If a patient gets to a rheumatologist in an acute period of the disease, then only non-steroidal anti-inflammatory drugs can not do - supplement them with high doses of glucocorticoids. This method of treatment is called pulse therapy.
The effect is achieved due to the blocking of cyclooxygenase enzyme, due to which in norm arachidonic acid breaks down with the formation of prostaglandins and other biologically active substances, which play an important role in the development of inflammatory reaction.
Older drugs inactivate cyclooxygenase-1, due to which an overdose can lead to impaired renal function, liver, develop encephalopathy. Modern drugs used to treat rheumatoid arthritis have a high selectivity and are not so dangerous, so patients have nothing to fear.
Doctors avoid combining non-steroidal anti-inflammatory drugs with each other, since in this case the probability of developing adverse reactions in the patient is significantly increased, but the therapeutic effect remains practically unchanged.
Basic preparations for the treatment of rheumatoid arthritis
The most popular and effective medicines for the treatment of rheumatoid arthritis are currently: gold preparations, methotrexate, leflunomide, penicillamine, sulfasalazine. There are also reserve resources: cyclophosphamide, azathioprine, cyclosporine - they are used when the basic drugs did not give the desired effect.
More recently, doctors preferred to gradually increase the dose of the drug received by the patient (the principle of the pyramid). It has now been proven that when treatment starts with high doses, more impressive results can be achieved by changing the course of the disease. The newly discovered rheumatoid arthritis is characterized by almost complete absence of changes in the joints of the patient and a high probability of long-term remission.
If during the first months of the disease treatment with basic drugs does not bring the desired effect, the doctors combine them with glucocorticoids. Hormonal drugs reduce the activity of the inflammatory process and allow you to choose an effective basic therapy. It is believed that doctors should choose the effective treatment of rheumatoid arthritis with drugs of this group for six months.
During the treatment, the patient should periodically undergo a medical examination for the presence of side effects from taking medications and assessing the degree of activity of the disease itself.
This group of drugs can be used in different ways.
- In the form of pulse therapy - the patient receiving high doses of the drug in combination with the substances of basic therapy of the disease. This allows very quickly reduce the activity of the process and remove inflammation. In this case, the course of taking the drug can not be long because of the high probability of developing side effects.
- In the form of course treatment for the purpose of suppressing the inflammatory reaction with ineffectiveness of other substances. In this case, the dose is significantly different in the smaller direction, and the doctors try to pick it up in such a way that the patient takes the minimum of the hormone, which at the same time will have the necessary action.
- Local therapy - in the composition of ointments, which lubricate the affected joints. Indication in most cases is oligoarthritis or monoarthritis of large joints. They can also be used in the presence of contraindications to systemic hormone treatment and a significant prevalence of local symptoms over the general.
- Intra-articular injection of a gel containing hormonal preparations. This allows for a relatively long (up to a month) time to ensure a continuous effect of the drug on the damaged joint surface.
Monoclonal antibodies to some cytokines provide neutralization of the tumor necrosis factor, which in case of rheumatoid arthritis provokes the destruction of their own tissues.
There are also studies suggesting the use of regulators of lymphocyte differentiation as a treatment for rheumatoid arthritis. This will avoid damage to the synovial membranes of T-lymphocytes, which are incorrectly "directed" to the joints by immunity.
Other medical treatments
- Physiotherapeutic procedures.
- Prevention of osteoporosis.
- Medical gymnastics during remission.
- Surgical correction of joint pathology.
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