Rheumatoid arthritis is a systemic disease of unknown etiology with a widespread lesion of connective tissue, mainly in the joints, with erosive changes in them, with a chronic, often recurrent and progressive course. The trigger can be an infectious focus, cold, trauma.
The pathological process leads to the complete destruction of articular tissues, to gross deformities and the development of ankylosis, which leads to loss of joint function and disability.
In severe cases, internal organs (heart, kidneys, lungs, blood vessels, muscles, etc.) may be affected, which significantly worsens the prognosis for rheumatoid arthritis. The symptoms, the diagnosis and treatment of which we will examine in detail in this article.
The prevalence of rheumatoid arthritis among the adult population of different climatic and geographical zones is on average 0.6 - 1.3%. The annual incidence over the last decade remains at 0.02%.
An increase in rheumatoid arthritis is noted with age, women are more often ill than men. Among persons younger than 35 years, the prevalence of the disease is 0.38%, at the age of 55 and older - 1.4%. A high incidence of the disease was found in the relatives of patients with first-degree relatives (3.5%), especially in females (5.1%).
What it is: causes
Why does rheumatoid arthritis occur, and what is it? Rheumatoid arthritis refers to autoimmune diseases, that is, diseases that occur when the normal functioning of the immune system is disrupted. As with most autoimmune pathologies, the exact cause of the disease has not been identified.
It is believed that the provoking factors for the occurrence of the disease are:
- Genetic predisposition - in close relatives of patients with rheumatoid arthritis, this disease develops much more often.
- Infections - often arthritis occurs after suffering measles, herpes infection, hepatitis B, and mumps.
- Adverse factors of the external and internal environment - hypothermia, exposure to poisonous products, including occupational hazards, stress, and pregnancy, breastfeeding, menopause.
Under the influence of these factors, the cells of the immune system begin an attack on the cells of the sheath of the joint, which causes inflammation in them. As a result of this process, the joints swell up, become warm and painful when touched. The cells of the immune system also cause damage to the blood vessels, which explains the so-called extra-articular symptoms of rheumatoid arthritis.
Juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (Still's disease) is an inflammatory disease of the joints, it is characterized by a progressive course with a fairly rapid involvement of the internal organs in the process. Per 100,000 children, this disease occurs in 5-15 people.
There is a disease in children under 16 years and can last for many years. The appearance of the disease can be the result of various influences - viral and bacterial influences, cooling, drugs, increased sensitivity to certain environmental factors and many others.
Rheumatoid arthritis can begin acutely and subacutely, with the latter debut being observed in most cases.
The first signs of RA:
- chronic fatigue;
- persistent muscle weakness;
- weight loss;
- the appearance of pain in the muscles for no apparent reason;
- sudden and unreasonable temperature fluctuations to subfebrile level (37-38ºС);
- excessive sweating.
As a rule, such manifestations of the disease remain without attention, then articular syndrome and extra-articular manifestations of the disease develop.
Symptoms of rheumatoid arthritis: joint damage
In the case of rheumatoid arthritis, when examining the patient's complaints, particular attention is paid to the following symptoms:
- Joint pains, their nature (aching, gnawing), intensity (strong, moderate, weak), duration (periodic, permanent), connection with movement;
- Morning stiffness in the joints, its duration;
- The appearance of the joints (swelling, redness, deformities);
- Persistent limitation of joint mobility.
The patient with rheumatoid arthritis can also note the presence of other symptoms:
- Hyperemia of the skin over the inflamed joints;
- Atrophy of the surrounding muscles;
- With subluxations in the proximal interphalangeal joints, the brush has the appearance of “swan neck”, with subluxations in the metacarpophalangeal joints - “walrus flippers”.
Palpation can detect: an increase in skin temperature above the surface of the joints; soreness of affected joints; a symptom of “lateral contraction”; muscle atrophy and skin tightening; subcutaneous formations in the area of the joints often elbow, the so-called rheumatoid nodules; symptom of ballotting the patella to determine if there is fluid in the knee joint.
Depending on the clinical and laboratory data, there are 3 degrees of exacerbation of RA:
- Low (pain in the joints is assessed by the patient no more than 3 points on a 10-point scale, morning stiffness lasts 30-60 minutes, ESR 15-30 mm / hour, CRP - 2 plus);
- Medium (pain - 4-6 points, stiffness in the joints up to 12 hours after sleep, ESR - 30-45 mm / hour, CRP - 3 plus);
- High (pain - 6-10 points, stiffness is observed throughout the day, ESR - more than 45 mm / hour, CRP - 4 plus).
In RA, peripheral joints are primarily affected, but we must not forget that this is a systemic disease, and any organs and tissues where connective tissue is present can be drawn into the pathological process.
Extra-articular symptoms in rheumatoid arthritis
The development of extra-articular (systemic) manifestations is more characteristic of the seropositive form of rheumatoid arthritis of a severe, long-term course.
- The defeat of the muscles is manifested by atrophy, decreased muscle strength and tone, focal myositis.
- Skin lesions are manifested by dryness, thinning of the skin, subcutaneous hemorrhages and small focal necrosis.
- Violation of the blood supply to the nail plates leads to their fragility, striation and degeneration.
- The presence of rheumatoid nodules - subcutaneously located connective tissue nodules with a diameter of 0.5-2 cm. Characteristic is a rounded shape, dense texture, mobility, painlessness, less often - immobility due to cohesion with aponeurosis.
The presence of rheumatoid vasculitis, which occurs in 10-20% of cases.
The most severe forms of rheumatoid arthritis are the forms that occur with lymphadenopathy, gastrointestinal lesions (enetritis, colitis, amyloidosis of the rectal mucosa), the nervous system (neuropathy, polyneuritis, functional autonomic disorders), and respiratory organs involvement (diffuse fibrosis, diffuse fibrosis) (imitation of an inhalation fibrinosis), respiratory tract involvement (diffuse fibrosis, inflammatory fibrosis), an inhalation of an inhalation arthritis syndrome, respiratory tract involvement (diffuse fibrosis, diffuse fibrosis), an inhalation syndrome, an inhalation fibrosis of a respiratory syndrome , bronchiolitis), kidney (glomerulonephritis, amyloidosis), eye.
Endocarditis, pericarditis, myocarditis, coronary arteritis, granulomatous aortitis can occur on the side of the great vessels and heart in rheumatoid arthritis.
- pathology of the cardiovascular system;
- dysfunction of the nervous system;
- blood diseases;
- lesions of the respiratory system;
- kidney disease;
- lesions of the joints and musculoskeletal system;
- skin lesions;
- eye diseases;
- gastrointestinal dysfunction;
- mental disorders;
- other pathologies.
How to distinguish RA from other diseases?
Unlike rheumatism, in rheumatoid arthritis, inflammation is persistent - pain and swelling of the joints can last for years. This type of arthritis differs from arthrosis in that the pain does not increase from the load, but, on the contrary, decreases after active movements.
Criteria for the diagnosis of rheumatoid arthritis of the American Rheumatological Association (1987). The presence of at least 4 of the following symptoms may indicate the presence of the disease:
- morning stiffness more than 1 hour;
- arthritis of 3 or more joints;
- arthritis of the joints of the hands;
- symmetric arthritis;
- rheumatoid nodules;
- positive rheumatoid factor;
- radiological changes.
A blood test shows the presence of inflammation in the body: the appearance of specific inflammatory proteins - seromucoid, fibrinogen, C-reactive protein, as well as rheumatoid factor.
The diagnosis of rheumatoid arthritis is possible only when assessing the totality of symptoms, radiological signs and laboratory diagnostic results. With a positive result, treatment is prescribed.
Rheumatoid Arthritis Treatment
In the case of accurate diagnosis of rheumatoid arthritis, systemic treatment involves the use of certain groups of drugs:
- nonsteroidal anti-inflammatory substances;
- basic drugs;
- hormonal substances (glucocorticoids);
- biological agents.
At the present stage of development of medicine, in the treatment of rheumatoid arthritis set the following goals:
- reduction and, if possible, elimination of symptoms of the disease,
- prevention of destruction of joint tissues, impairment of its functions, development of deformities and adhesions (ankylosis),
- achieving a stable and long-term improvement of the patients;
- increase in life,
- improving life quality indicators.
Treatment consists of a set of methods of drug therapy, physiotherapy, clinical nutrition, surgical treatment, spa treatment and subsequent rehabilitation.
Nonsteroidal anti-inflammatory drugs
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, drugs from this group are prescribed to reduce pain and eliminate stiffness.
in the joints.
Most often used:
Appointed in the period of exacerbation of pain and severe stiffness. Caution is prescribed to patients with gastritis.
In combination with hormones, they contribute to a decrease in the activity of rheumatoid arthritis. The most common drugs for treatment currently are:
- gold preparations;
There are also reserve agents: cyclophosphamide, azathioprine, cyclosporine - they are used when basic drugs have not yielded the desired effect.
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.
These are hormonal drugs:
Appointed as in the presence of systemic manifestations of the disease, and in their absence. Today, in the treatment of rheumatoid arthritis, treatment is carried out with small and large doses of hormones (pulse therapy). Corticosteroids perfectly relieve pain.
Methotrexate for rheumatoid arthritis
According to reviews, methotrexate for rheumatoid arthritis is actively prescribed in Russia and European countries. This is a drug that inhibits the cells of the immune system, prevents the occurrence of inflammatory processes in the joints and aggravate the course of the disease. Now it is applied very widely.
The drug has several side effects, so it is used under the close supervision of the attending physician, during the course of treatment the patient must regularly undergo blood tests. Despite this, methotrexate for rheumatoid arthritis is the most appropriate solution, in some cases it is simply indispensable.
The price of the drug varies depending on the form of release in the range from 200 to 1000 rubles.
Only after the acute form of the disease has been removed, blood tests and temperature will normalize - can massage and other physiotherapy methods be used for rheumatoid arthritis. The fact is that physiotherapy has a stimulating effect and can enhance the inflammatory process.
These methods improve the blood supply to the joints, increase their mobility, and reduce deformity. Phonophoresis, diathermy, UHF, ozokerite and paraffin, infrared irradiation, therapeutic mud, balneotherapy at resorts are used. We will not dwell on these methods in detail.
A surgery can correct a health situation in relatively early stages of the disease if one large joint (knee or wrist) is constantly inflamed. During such an operation (synovectomy), the synovial membrane of the joint is removed, resulting in long-term relief of symptoms.
A joint prosthesis surgery is performed for patients with a more severe degree of joint damage. The most successful are operations on the hips and knees.
Surgical intervention has the following objectives:
- relieve pain
- correct deformations
- improve the functional state of the joints.
Rheumatoid arthritis is primarily a medical problem. Therefore, surgery is assigned to those who are under the supervision of an experienced rheumatologist or doctor.
In rheumatoid arthritis, a special diet is recommended, which will reduce inflammation and correct metabolic disorders.
The rules of the diet are as follows:
- the inclusion of a sufficient amount of fruits and vegetables;
- reducing the burden on the kidneys, liver and stomach;
- exclusion of products that cause allergies;
- meat replacement with dairy and vegetable products;
- eating foods high in calcium;
- rejection of overweight foods.
Rheumatoid arthritis treatment of folk remedies
Treatment with folk remedies involves the use of medicinal plants with analgesic and anti-inflammatory properties.
- In order to relieve pain in rheumatoid arthritis, one should take equal parts of elderberry, parsley root, nettle leaf and willow bark. Chop everything, and then 1-tbsp of collection to brew with 1 cup of boiling water, then boil for 5-7 minutes on low heat, then cool and strain. Take two glasses of broth, morning and evening.
- Collected during the flowering of chestnut flowers are filled with high-quality vodka (for two parts of flowers you need to take one part of vodka). The mixture is infused for two weeks in a dark place, filtered and after that the tincture is ready for use. Take the tincture need 5 drops three times a day an hour before meals.
- 50 grams of camphor oil is dissolved in one hundred grams of alcohol and 50 grams of mustard powder is added. Separately beat the protein from two eggs and add to the mixture. The resulting ointment is rubbed into the affected joint and relieves pain symptoms well.
- Burdock will help relieve joint pain. It can be used in the form of tinctures. Grind the leaves of the plant in a meat grinder and pour in vodka (for 500 g leaves 500 ml of vodka). Stir the mixture and put in the fridge. At night, we apply gauze abundantly soaked in this solution to the sore spot. The pain after a few compresses passes.Treatment of rheumatoid arthritis with folk remedies can also be carried out with overnight wraps with whole burdock leaves.
At home, you can make compresses, rub in your own homemade ointment, prepare decoctions. It is important to comply with the correct eating style, contributing to the restoration of metabolism in the body.
Prevention of the disease and its exacerbations is aimed, first of all, at eliminating risk factors (stress, smoking, toxins), normalization of body weight and adherence to a balanced diet.
Compliance with these rules will help prevent disability and prevent rapid progression of RA.
Rheumatoid arthritis reduces life expectancy from an average of 3 to 12 years. A 2005 study by the Mayo Clinic showed that the risk of heart disease is twice as high in people suffering from rheumatoid arthritis, regardless of other risk factors such as diabetes, alcoholism, high cholesterol and obesity.
The mechanism by which the risk of heart disease increases is unknown; the presence of chronic inflammation is considered a significant factor. Perhaps the use of new biological drugs can increase the life expectancy and reduce the risks to the cardiovascular system, as well as slow the development of atherosclerosis.
Limited studies demonstrate a reduction in the risk of cardiovascular diseases, with an increase in total cholesterol levels with a constant atherogenic index.