Rheumatoid arthritis: symptoms, treatment, diagnosis.
- Causes of Rheumatoid Arthritis.
- The mechanism of development of rheumatoid arthritis.
- Classification of rheumatoid arthritis.
- Symptoms of rheumatoid arthritis.
- Diagnosis of rheumatoid arthritis.
- Rheumatoid arthritis: treatment.
“Life in motion” is an expression that probably everyone has heard. Indeed, to carry out normal life activities, a person has to constantly move his body in space. During evolution, the body has acquired beautiful elements that provide this function at the highest level. These amazing parts of the body are joints. All human bones are surprisingly strong and resilient separately, which allows them to withstand enormous loads. Combining 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 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 connective tissue. As a result of its development, the patient is affected by small joints of an erosive-destructive type. Around the world, about 60 million patients suffer from this disease, which is up to 1% of the entire population.
To make matters worse, doctors have not been able to determine the exact cause of the disease to date. There are separate theories and assumptions, but not one of them has found really significant support. Over time, all the symptoms of the disease are steadily aggravated, gradually leading to a permanent loss of disability by a person. About three times more often women get sick. The average age of the patient in detecting the disease is 30-35 years.
Causes of Rheumatoid Arthritis
Currently, there are several most likely etiological factors for the disease. Each version has its advantages and disadvantages. In general, more and more doctors are inclined to believe that rheumatoid arthritis is a multifactorial disease that develops when several factors are combined at once.
- Genetic predisposition – patients with this diagnosis have a predisposition to impaired immune system activity at the genetic level. Some antigens have already been discovered, the presence of which can lead to a change in humoral and cellular immunity due to exposure to some infections. You can also trace the increased likelihood of developing rheumatoid arthritis in people whose immediate family members also suffered from it.
- Infectious agents, which, as a result of their specific properties, can cause changes in human immunity, as a result of which their own protective factors attack their connective tissue. The roles of these pathogens are: Ebstein-Bar virus, retroviruses, rubella, herpes, cytomegalovirus, mycoplasma pathogens. Doctors have some evidence in favor of this hypothesis:
In 80% of patients, elevated titers of antibodies to the Ebstein-Bar virus are detected.
In the lymphocytes of patients with rheumatoid arthritis, Ebstein-Bara is detected much more often than in healthy people.
The factors that create the prerequisites for the development of the disease were indicated above. Trigger factors are also identified that provoke its manifestation in a particular patient at a certain time.
Increased exposure to sunlight (hyperinsolation).
Intoxication, including toxins of microorganisms.
Taking certain medications.
Endocrine gland dysfunction.
Emotional overstrain 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, an incorrect immune response is triggered. Own cells produce substances that cause damage to the synovial membrane of the joints. At first, synovitis develops, which subsequently passes into the proliferative stage and causes damage to the cartilage 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 that contribute to the further progression of the disease;
- I activate some enzymes that can destroy the cartilage that covers the joint and provides elastic gliding surfaces;
- Deliver special molecules to the membranes of the mast cells, which cause these leukocytes to exhibit an autoimmune effect;
- they attract additional immunocompetent cells, which also adversely affect the course of the disease in this case;
- increased angiogenesis, which allows vessels to grow into the cartilage and makes it easier for aggressive factors to penetrate deep into the cartilage tissue.
Classification of Rheumatoid Arthritis
There are several criteria by which this disease is classified.
Clinical and anatomical forms
- arthritis (oligoarthritis, monoarthritis, polyarthritis) – a form of the disease in which only joints are affected, and other organs function normally without impaired function.
- Rheumatoid arthritis with systemic manifestations – additionally autoimmune processes affect the body’s serous membranes (heart pericardium, pleura), lungs, blood vessels, kidneys, nervous system, and cause deposition of an amyloid pathological protein in the internal organs.
- Rheumatoid arthritis, combined with deforming osteoarthrosis, rheumatism.
- Juvenile rheumatoid arthritis.
Characterization in terms of immunology
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 upcoming treatment.
Course of the disease
- Slowly progressing – the disease over the years slowly moves to other joints, diseased joints are not much damaged.
- Fast progressing – the disease very often worsens, gradually involving more and more joints. Joint surfaces undergo significant changes for the worse. Treatment does not give much effect.
- Without noticeable progression – the most favorable form. With which the patient can live his whole life, maintaining a fairly high quality of life.
X-ray stage of the disease
- Periarticular osteoporosis – a decrease in bone density due to a decrease in the content of calcium salts in it.
- Osteoporosis, complemented by a slight decrease in the joint space.
- The narrowing of the joint space and osteoporosis are supplemented by multiple usuras.
- To all of the above, bone ankyloses join – the main and most persistent reason for the decrease in mobility up to its complete absence.
Uzury is a deep erosion 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 the movements that provide him with the opportunity to fulfill his professional duties.
2 – the patient cannot work due to the loss of professional disability.
3 – a person cannot service himself fully.
Symptoms of Rheumatoid Arthritis
At the initial stages, the disease proceeds without a vivid clinical picture. The patient may not suspect for years 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 pay attention, the synovial membranes of the joints become somewhat inflamed due to a decrease in the secretion of glucocorticoids at night. Sometimes patients simply cannot, normally take off the blanket. After about an hour, all symptoms disappear, and the person can actively move.
- Periodic joint pain, loss of appetite, fatigue, weight loss – all this can be noted in the prodromal period.
- Acute joint pain, fever – this is how the patient begins the disease. Most often, joints of the hands and feet, wrists, knees and elbows are affected. Other joints are less commonly affected. Edema is noted near the joint, and the surface of the skin has a higher temperature than on the rest of the body. Also, the joint area is hyperemic due to the course of inflammatory processes.
- On palpation, the joints are painful, movement in them is limited. As the disease progresses, proliferative processes begin to prevail, and significant limitation of mobility, deformation, and subluxation of joints can occur.
- Rheumatoid nodules are a specific manifestation of a 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.
Also, the patient can be affected by almost all organs in the body, depending on the degree of activity of the process, but this is relatively rare.
Diagnosis of Rheumatoid Arthritis
- General blood test – detect anemia, an increase in the erythrocyte sedimentation rate, an increase in the number of white blood cells.
- Biochemical blood test – allows you to determine the degree of activity of the inflammatory process.
- Immunological blood tests – rheumatoid factor can be determined, sometimes immune complexes are detected.
- X-ray examination of the joints – the classification describes all the criteria that doctors follow when setting the x-ray stage of the disease.
- Radioisotope research – the introduced element actively accumulates in the affected joints, and normal synovial tissue does not attract as many atoms.
- Puncture of the joint and the study of synovial fluid.
In the most severe cases, a biopsy of the site of the synovial membrane.
Rheumatoid Arthritis: Treatment
Systemic treatment of this disease involves the use of the following main groups of drugs:
- non-steroidal anti-inflammatory substances;
- basic drugs;
- hormonal substances (glucocorticoids);
- biological agents.
Nonsteroidal anti-inflammatory substances
These drugs have proven themselves relatively well in the treatment of rheumatoid arthritis for a relatively long time and are still first-line therapeutic agents. They allow you to quickly relieve acute manifestations of the disease and sometimes achieve the onset of stable remission – a condition in which there are no symptoms of the disease, and the patient can live a full life.
If the patient goes to a rheumatologist in the acute period of the disease, then non-steroidal anti-inflammatory drugs alone are not enough – they are supplemented with high doses of glucocorticoids. This treatment is called pulse therapy.
The effect is achieved by blocking cyclooxygenase, an enzyme that normally arachidonic acid breaks down to form prostaglandins and other biologically active substances that play an important role in the development of the inflammatory reaction.
Older drugs inactivate cyclooxygenase-1, due to which, with an overdose, impaired renal function, liver function, and encephalopathy develop. 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 almost unchanged.
The basic drugs for the treatment of rheumatoid arthritis
The most popular and effective medications for treating rheumatoid arthritis are currently: Pills
Until relatively 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 at the start of treatment using high doses, more impressive results can be achieved 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 prolonged 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 choose an effective treatment for rheumatoid arthritis with drugs of this group for six months.
During treatment, the patient should periodically undergo a medical examination for any side effects from taking the drugs 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 takes high doses of the drug in combination with the 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 suppress the inflammatory reaction with the ineffectiveness of other substances. In this case, the dose is significantly smaller, and doctors are trying to choose it so that the patient takes a minimum of the hormone, which will have the necessary effect.
- Local therapy – as part of ointments that lubricate affected joints. The indication in most cases is oligoarthritis or monoarthritis of large joints. They can also be used in the presence of contraindications to systemic treatment with hormones 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 to the damaged joint surface.
Monoclonal antibodies to some cytokines neutralize tumor necrosis factor, which in the case of rheumatoid arthritis provokes damage to their own tissues.
There are also studies suggesting the use of 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
- Physiotherapeutic procedures.
- Prevention of osteoporosis.
- Therapeutic exercises in remission.
- Surgical correction of joint pathology.