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Rheumatoid Arthritis: Symptoms and Treatment


“Life in motion” is probably the expression everyone has heard. Indeed, in order to carry out normal life activity, a person has to constantly move his body in space. In the course of evolution, the body acquired beautiful elements that provide this function at the highest level. These amazing parts of the body are joints. All human bones are surprisingly durable and resilient individually, which allows them to withstand enormous loads. Connecting together, they form a surprisingly mobile skeleton, which allows you to perform incredible movements. All this is achieved thanks to the coordinated work of the mass of the 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. It is a systemic disease that affects connective tissue. As a result of his development in a patient, the small joints of the erosive-destructive type are affected. Worldwide, about 60 million patients suffer from this disease, which makes up to 1% of the entire population.

Even more aggravating the whole situation is that doctors have not been able to determine the exact cause of the development of the disease so far. There are separate theories and assumptions, but none of them found a really weighty confirmation. Over time, all the symptoms of the disease are steadily aggravated, gradually leading to persistent loss of disability by a person. About three times more often women become ill. The average age of the patient in detecting the disease is 30-35 years.

Causes of Rheumatoid Arthritis

Currently, there are several of the most likely etiological factors of the disease. Each version has its advantages and disadvantages. In general, more and more physicians are inclined to believe that rheumatoid arthritis is a multifactorial disease that develops when several factors are combined at once.

- Genetic predisposition - in patients with this diagnosis, a predisposition was established to impair the activity of the immune system at the genetic level. Already discovered some antigens, the presence of which can lead to changes in humoral and cellular immunity due to exposure to certain infections. You can also trace the increased likelihood of developing rheumatoid arthritis in people whose immediate relatives also had it.

- Infectious agents that, as a result of their specific properties, cause changes in a person’s immunity, as a result of which their own protective factors attack their connective tissue. The role of these pathogens are advanced: Ebstein-Bar virus, retroviruses, rubella pathogens, herpes, cytomegalovirus , mycoplasma. Doctors have some evidence for this hypothesis:

  • Eighty antibody titers to the Ebstein-Bar virus are detected in 80% of patients.
  • In the lymphocytes of patients with rheumatoid arthritis, Ebstein-Bar is detected much more often than in healthy people.

Above mentioned factors that create the prerequisites for the development of the disease. Allocate also trigger factors that provoke its manifestation in a particular patient at a certain time.

  • Hypothermia
  • Increased exposure to sunlight (hyperinsolation).
  • Intoxication, including microorganism toxins.
  • Bacterial infection.
  • Acceptance of certain drugs.
  • Dysfunction of the endocrine glands.
  • Emotional strain and stress.

Interestingly, breastfeeding for two years or more reduces the likelihood of developing rheumatoid arthritis by half.

The mechanism of development of rheumatoid arthritis

It is established that when exposed to one or a combination of provoking factors in the patient's body triggers an incorrect immune response. Own cells produce substances that cause damage to the synovial membrane of the joints. First, synoviitis develops, which subsequently goes into the proliferative stage and causes damage to the cartilage and bones itself.

Also, the immune system 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;
  • I activate some enzymes that can destroy the cartilage that covers the joint and provides elastic sliding surfaces;
  • they supply special molecules to the membranes of fat cells that cause these leukocytes to show an autoimmune effect;
  • becoming involved in becoming additional immunocompetent cells, which also adversely affect the course of the disease in this case;
  • increased angiogenesis, which allows vessels to grow into cartilage and makes it easier for aggressive factors to penetrate deep into cartilage tissue.

Rheumatoid Arthritis Classification

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 the joints are damaged, and other organs function normally without dysfunction.
  • Rheumatoid arthritis with systemic manifestations - additionally autoimmune processes affect the serous membranes of the body (heart pericardium, pleura), lungs, blood vessels, kidneys, nervous system, causing deposition in the internal organs of the pathological protein - amyloid.
  • Rheumatoid arthritis, combined with deforming osteoarthritis, rheumatism.
  • Juvenile rheumatoid arthritis.

Immunology characteristic

Depending on whether the rheumatoid factor is detected in the patient's blood, all cases of the disease are divided into seropositive and seronegative. This is of great importance for doctors during the diagnosis and planning of the upcoming treatment.

Course of the disease

  • Slowly progressing - over the years, the disease slowly passes to other joints, patients with articulations are not severely damaged.
  • Rapidly progressive - the disease is often exacerbated, gradually involving more and more joints. Articular surfaces undergo significant changes for the worse. The treatment does not give much effect.
  • Without noticeable progression - the most favorable form. With which the patient can live a lifetime, maintaining a sufficiently high quality of life.

X-ray stage of the disease

  1. Periarticular osteoporosis is a decrease in bone density due to a decrease in the content of calcium salts in it.
  2. Osteoporosis, supplemented by a slight decrease in the joint space.
  3. The narrowing of the joint space and osteoporosis are complemented by multiple Uzuras.
  4. Bone ankylosis joins all of the above - the main and most persistent reason for the decrease in mobility up to its complete absence.

Uzury are deep erosions on the articular surface of cartilage.

The degree of functional insufficiency of the musculoskeletal system

  • 0 - the patient can make all movements in full.
  • 1 - a person cannot fully perform all movements that provide him with the opportunity to perform his professional duties.
  • 2 - the patient cannot work due to the loss of professional disability.
  • 3 - a person cannot fully serve himself.

Symptoms of Rheumatoid Arthritis

At the initial stages, the disease proceeds without a vivid clinical picture. For years, the patient may 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 are somewhat inflamed by reducing the secretion of glucocorticoids at night. Sometimes patients simply can not, normally remove the blanket. After about an hour, all the symptoms disappear and the 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 a patient begins to have a disease. Most often affects the joints of the hands and feet, wrists, knee and elbow. Other joints are less common. Near the joint swelling is noted, and the surface of the skin has a higher temperature than the rest of the body. Also, the joint area is hyperemic due to the occurrence of inflammatory processes.
  • Palpation of the joints painful, movement in them is limited. As the disease progresses, proliferative processes begin to predominate, and there may be a significant limitation of mobility, deformity and subluxation of the joints.
  • Rheumatoid nodules are a specific manifestation of the disease, in which dense subcutaneous growths can be palpated on the extensor surface of the joint. This symptom is one of the important diagnostic criteria for rheumatoid arthritis.

Also, the patient may be affected almost all organs in the body, depending on the degree of activity of the process, but this is relatively rare.

Diagnosis of Rheumatoid Arthritis

Laboratory research

  • Complete blood count - detect anemia, an increase in the erythrocyte sedimentation rate, an increase in the number of leukocytes.
  • Biochemical blood test - allows you to determine the degree of activity of the inflammatory process.
  • Immunological examination of the blood - rheumatoid factor can be determined, sometimes immune complexes are detected.

Instrumental diagnostics

  • X-ray examination of the joints - the classification describes all the criteria by which doctors are guided in setting the radiological stage of the disease.
  • Radioisotope research - the injected element actively accumulates in the affected joints, and normal synovial tissue attracts not many atoms.
  • Puncture of the joint and the study of synovial fluid.
  • In the most severe cases - biopsy of the synovial membrane.

Rheumatoid Arthritis Treatment

Systemic treatment of this disease involves the use of the following main groups of drugs:

  • nonsteroidal anti-inflammatory substances;
  • basic drugs;
  • hormonal substances (glucocorticoids);
  • biological agents.

Nonsteroidal anti-inflammatory substances

These drugs have long been well proven in the treatment of rheumatoid arthritis and are still the first-line remedies. They allow relatively quickly to stop acute manifestations of the disease and sometimes to 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 the acute period of the disease, then nonsteroidal anti-inflammatory drugs alone are not enough - they are supplemented with high doses of glucocorticoids. This method of treatment is called pulse therapy.

The effect is achieved by blocking cyclooxygenase, an enzyme that normally arachidonic acid decomposes to form prostaglandins and other biologically active substances that are important in the development of the inflammatory response.

Older drugs inactivate cyclooxygenase-1, as a result of which overdose can impair the function of the kidneys, the 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 nonsteroidal anti-inflammatory drugs with each other, because in this case the probability of adverse reactions in the patient increases significantly, but the therapeutic effect remains almost unchanged.

Basic preparations for the treatment of rheumatoid arthritis

The most popular and effective drugs for the treatment of rheumatoid arthritis currently are: gold medications, methotrexate, leflunomide, penicillamine, sulfasalazine. There are also reserve agents: cyclophosphamide, azathioprine, cyclosporine - they are used when basic drugs have not yielded the desired effect.

More recently, doctors have chosen to gradually increase the dose of the drug received by the patient (pyramid principle). At present, it has been proven that at the beginning of treatment with the use of high doses it is possible to achieve more impressive results by changing the nature of the course of the disease. The newly discovered rheumatoid arthritis is characterized by an almost complete absence of changes in the patient’s joints and a high probability of the onset of long-term remission.

If during the first months of the disease treatment with basic drugs does not bring the desired effect, then 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 find an effective treatment for rheumatoid arthritis with drugs of this group for six months.

In the course of treatment, the patient must periodically undergo a medical examination for the presence of side effects from taking the drugs and assess 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 receives high doses of the drug in combination with substances of the basic therapy of the disease. This allows you to very quickly reduce the activity of the process and remove inflammation. In this case, the course of taking the drug can not be long due to the high probability of side effects.
  • In the form of a course of treatment in order to inhibit the inflammatory reaction with the ineffectiveness of other substances. In this case, the dose is significantly different down, and doctors try to pick it up so that the patient takes a minimum of the hormone, which at the same time will have the necessary effect.
  • Local therapy - in the composition of ointments, which lubricate the affected joints. The indication in most cases is oligoarthritis or monoarthritis of large joints. They can also be used if there are contraindications to systemic hormone therapy and a significant predominance of local symptoms over general ones.
  • Intra-articular administration of a gel containing hormonal preparations. This allows for a relatively long (up to a month) time to ensure continuous exposure of the drug to the damaged articular surface.

Biological agents

Monoclonal antibodies to certain cytokines neutralize the tumor necrosis factor, which in the case of rheumatoid arthritis provokes damage to its own tissues.

There are also studies that suggest using lymphocyte differentiation regulators as a treatment for rheumatoid arthritis. This will avoid damage to the synovial membranes by T-lymphocytes, which are incorrectly “sent” to the joints by immunity.

Other therapeutic measures

  • Physiotherapy procedures.
  • Prevention of osteoporosis.
  • Therapeutic gymnastics in remission.
  • Surgical correction of joint pathology.

| 9 June 2013 | | 3,861 | Uncategorized
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