Rheumatoid arthritis is a chronic systemic inflammatory disease of the connective tissue of autoimmune origin, in which a group of joints is affected by the type of erosive-destructive progressive polyarthritis. As a rule, several symmetrical joints are affected at once. Joints of the hands, feet, wrist, knee, intervertebral joints of the neck become inflamed Arthritis develops, leading to joint deformity and impaired function. about 1% of the population suffers . Causes. Genetic predisposition to rheumatoid atritis. Infectious agents . These are the Epstein-Barr virus, retroviruses, rubella, herpes, cytomegalovirus, mycoplasma viruses and others. The researchers pay most attention to the Epstein-Barr virus. Symptoms The most characteristic manifestation is polyarthritis, i.e. inflammation of several joints at once. Typical for rheumatoid arthritis is bilateral symmetrical joint damage. The onset of the disease can be triggered by bad weather conditions, hormonal changes in the body, stress, any transmitted infection (flu, tonsillitis, etc.) overcooling. As a rule, several symmetrical joints are affected at once. The joints of the hands, feet, wrist, knee, intervertebral joints of the neck become inflamed. Pain on palpation, swelling, stiffness, an increase in skin temperature above the joint, stiffness of movements in the joints after prolonged rest are noted. Morning stiffness for more than 1 hour is a characteristic sign of arthritis.
Arthritis goes away with periods of exacerbation and remission. As progression develops, joint deformities associated with partial destruction of the articular cartilage, stretching of the joint capsule develop. Over time, with the progression of the disease, in addition to joints, systemic damage to other organs also begins to appear .
Extraarticular manifestations of Rheumatoid Arthritis.
- Muscle, skin,
- Rheumatoid nodules
- Lymphadenopathy
- Damage to the gastrointestinal tract ( enteritis, colitis, proctitis, impaired gastric secretion, etc.),
- Damage to the lungs and pleura
- Heart damage (pericarditis, myocarditis , endocarditis, granulomatous aortitis),
- Kidney damage ( glomerulonephritis, amyloidosis),
- Rheumatoid vasculitis
- Damage to the nervous system ( peripheral ischemic neuropathy, polyneuritis, compression neuropathy, encephalopathy).
Diagnosis of Rheumatoid Arthritis.
- Detailed history, examination,
- General blood test, Biochemical blood test, Immunological tests,
- Joint X-ray,
- Synovial fluid examination
- Synovial biopsy.
TREATMENT.
Drug therapy.
- Non-narcotic analgesics,
- Narcotic analgesics with strong pains: acetaminophen in combination with codeine (Tylenol in combination with codeine) , Propoxyphene (Darvon) in combination with acetaminophen (Darvotset) and others.
- Nonsteroidal anti-inflammatory drugs .
Acetylsalicylic acid (75-100 mg / kg per day), Indomethacin (daily dose 1-3 mg / kg ), ibuprofen (20-30 m / kg ). - Steroidal anti-inflammatory drugs.
Hydrocortisone – 25-50 mg intraarticular injection, Triamcinolone acetonide – 5-20 mg intraarticular injection.
Taking low doses of glucocorticoids inward suppresses inflammation, slows down the destruction of bone tissue. But due to side effects, you can take it for a short time.
- Basic anti-rheumatic drugs that modify the course of rheumatoid arthritis (BDP).
Since these drugs prevent joint erosion, one or more of the BDPs are prescribed immediately after diagnosis.
Methotrexate (Revmateks and Foleks) Biological agents: Humira (adalimumab), Kineret (anakinra), Remicade (infliximab) and Rituxan (rituximab), Plaquenil (hydroxychloroquine), Minocin (minocycline) – an antibiotic, Arava (leflunomide), sulfasalazine (Azulfidin ), Azathioprine (Imunar), Cyclosporine (Neoral and Sandimun), Golden salts (Ridaura).
Limiting the load on the joint with otropedic and other devices. Physiotherapy exercises, Physiotherapeutic procedures (ultrasound, UHF, diathermy, paraffin, ozokerite, etc.). Balneological treatment methods (spa treatment is recommended for attenuation of the acute inflammatory process.).