Rheumatoid arthritis: symptoms, diagnosis, treatment with drugs in children and adults. Rheumatoid arthritis

Course of the disease

Rheumatoid arthritis progresses in three stages. In the first stage, periarticular swelling of the synovial bursae occurs, causing pain, local fever and swelling around the joints. The second stage is rapid cell division, which leads to compaction of the synovial membrane. In the third stage, inflamed cells release an enzyme that attacks bone and cartilage, often leading to deformation of the affected joints, increased pain, and loss of motor function.

As a rule, at first the disease proceeds slowly, with gradual development clinical symptoms for several months or years, much less often - subacutely or acutely. About 2/3 of cases manifest as polyarthritis, the rest - mono- or oligoarthritis, and the articular syndrome often has no clinical specificity, which greatly complicates differential diagnosis. Articular syndrome is characterized by the presence of morning stiffness for more than 30 minutes and similar manifestations in the second half of the night - symptoms of “tight gloves”, “corset”; constant spontaneous pain in the joints, aggravated by active movements. The disappearance of stiffness depends on the activity of the process: the greater the activity, the longer the duration of stiffness. Articular syndrome in rheumatoid arthritis is characterized by monotony, duration, persistence residual effects after treatment.

There may be prodromal clinical manifestations (minor transient pain, pain associated with meteorological conditions, autonomic disorders). There are “joints of defeat” and “joints of exclusion.” The first include (in order of frequency of occurrence): II and III metacarpophalangeal, proximal interphalangeal metatarsophalangeal, knee and wrist, elbow and ankle. The “exclusion joints” are as follows: distal interphalangeal, first metacarpophalangeal (thumb).

Rheumatoid arthritis is often combined with other joint diseases - osteoarthritis, rheumatism, systemic diseases connective tissue.

Extra-articular manifestations

• From the outside of cardio-vascular system: pericarditis, vasculitis, granulomatous valve disease, atherosclerosis.
• Respiratory system: pleurisy, interstitial diseases.
• Leather: rheumatic nodules, thickening and hypotrophy, vasculitis, livedo reticularis.
• Nervous system: compression neuropathy, sensory-motor neuropathy, multiple mononeuritis, cervical myelitis.
• Organs of vision: dry keratoconjunctivitis, episcleritis, scleritis, peripheral ulcerative keratopathy.
• Kidneys: amyloidosis, vasculitis, nephritis, NSAID nephropathy
• Blood: anemia, thrombocytosis, neutropenia.

The following variants of the clinical course of rheumatoid arthritis are distinguished:

• Classic variant (symmetrical damage to both small and large joints, slowly progressive course).
• Mono- or oligoarthritis with predominant damage to large joints, most often the knees. Pronounced onset of the disease and reversibility of all manifestations within 1-1.5 months (arthralgia is migrating in nature, there are no radiological changes, anti-inflammatory drugs give relatively positive effect; subsequently all the symptoms characteristic of rheumatoid arthritis appear).
• Rheumatoid arthritis with pseudoseptic syndrome (accompanied by hectic fever, chills, hyperhidrosis, weight loss, development of amyotrophy, anemia, vasculitis, visceritis; in some cases Clinical signs arthritis fade into the background).
• Felty's syndrome (a combination of polyarthritis and splenomegaly; a variant without splenomegaly, but with leukocytopenia, neutropenia, visceritis is possible).
• Still's syndrome.
• Juvenile rheumatoid arthritis (onset before age 16):
  • allergic septic syndrome;
  • articular-visceral form with limited visceritis.
• Articular-visceral form:
  • rheumatoid vasculitis;
  • damage to the heart, lungs, kidneys, digestive organs;
  • damage to the nervous system.

Classification

I Stages of clinical manifestations

• - very early: duration up to 6 months;
• - early: 6 - 12 months;
• - expanded: more than a year;
• - late: more than two years.

II Disease activity (DAS28)

• 0 (remission): DAS28 less than 2.6;
• 1 (low): DAS28 2.6 - 3.2;
• 2 (average): DAS28 3.2 - 5.1;
• 3 (high): DAS28 greater than 5.1.

III Instrumental characteristics

• Presence of erosion
• X-ray stage (1-4)

IV Immunological characteristics

• Rheumatoid factor: sero-positive/sero-negative;
• Anti-CCP: sero-positive/sero-negative.

V Functional class

Diagnostics

Diagnosing rheumatoid arthritis (RA) is a process. For a long time, there was no specific test that could clearly confirm the presence of the disease. Currently, the diagnosis of the disease is based on a biochemical blood test, changes in the joints visible on x-rays, and the use of basic clinical markers, which include: joint syndrome as such, as well as in combination with general clinical manifestations - fever, weakness, weight loss and others.

A blood test examines ESR, rheumatoid factor (rheumatic factor), platelet count, etc. The most progressive analysis is the titer of antibodies to cyclic citrulline-containing peptide - ACCP, anti-CCP, anti-CCP(Mazurov, 2005, p. 103). The specificity of this indicator is about 90% (ibid.), while it is present in 79% of sera from RA patients.

Diagnostically important clinical features are the absence of changes in skin color over the inflamed joints, the development of tenosynovitis of the flexors or extensors of the fingers and the formation of amyotrophies, typical deformities of the hands, the so-called “rheumatoid hand”.

The criteria for an unfavorable prognosis are:

Symptoms

Rheumatoid arthritis can start in any joint, but most often begins in the small joints of the fingers, hands, and wrists. Usually the damage to the joints is symmetrical, that is, if a joint on the right hand hurts, then the same joint on the left should hurt. The more joints affected, the more advanced the stage of the disease.

Other common symptoms:

• Fatigue
• Morning stiffness. Typically, the longer the stiffness lasts, the more active the disease.
• Weakness
• Flu-like symptoms, including low-grade fever.
• Pain when sitting for long periods of time
• Outbreaks of disease activity accompanied by remission.
• Muscle pain
• Loss of appetite, depression, weight loss, anemia, cold and/or sweaty palms and feet
• A disorder of the glands in the eye and mouth area, causing insufficient production of tears and saliva.

Treatment

If an infection is present or suspected (tuberculosis, yersiniosis, etc.), appropriate therapy is required antibacterial drug. In the absence of significant extra-articular manifestations (for example, high fever, Felty's syndrome or polyneuropathy), treatment of articular syndrome begins with the selection of non-steroidal anti-inflammatory drugs (NSAIDs). At the same time, corticosteroid drugs are injected into the most inflamed joints. The immunocomplex nature of the disease makes courses of plasmapheresis indicated, which in most cases gives a pronounced effect. The instability of the results of this therapy is an indication for the addition of so-called basic agents. These drugs act slowly, so they must be used for at least 6 months, and if there is a clear positive effect, treatment with them must continue further (for years).

An important point in the treatment of rheumatoid arthritis is the prevention of osteoporosis - restoration of the disturbed calcium balance in the direction of increasing its absorption in the intestines and reducing excretion from the body. A necessary component in the complex of anti-osteoporotic measures is a diet with increased content calcium. Sources of calcium are dairy products (especially hard cheese, containing from 600 to 1000 mg of calcium per 100 g of product, as well as processed cheese; to a lesser extent cottage cheese, milk, sour cream), almonds, hazelnuts and walnuts, etc., and also calcium supplements in combination with vitamin D or its active metabolites.

Physical therapy aimed at maintaining maximum joint mobility and preserving muscle mass is important in treatment.

Physiotherapeutic procedures (electrophoresis of non-steroidal anti-inflammatory drugs, phonophoresis of hydrocortisone, dimexide applications) and Spa treatment have an auxiliary value and are used only for mild arthritis.

In case of persistent mono- and oligoarthritis, synovectomy is performed either by introducing isotopes of gold, yttrium, etc. into the joint, or by surgery. For persistent joint deformities, reconstructive surgery is performed.

Modern therapy

System drug therapy includes the use of four groups of drugs:

1. non-steroidal anti-inflammatory drugs (NSAIDs),
2. basic drugs,
3. glucocorticosteroids (GCS),
4. biological agents.

Nonsteroidal anti-inflammatory drugs

NSAIDs are still the first-line treatment, which are aimed primarily at stopping acute manifestations disease, as well as to ensure stable clinical and laboratory remission.

In the acute period of the disease, NSAIDs, corticosteroids, pulse therapy with glucocorticosteroids or in combination with cytostatic immunosuppressants are used.

Modern NSAIDs have a pronounced anti-inflammatory effect, which is due to inhibition of the activity of cyclooxygenase (COX), a key enzyme in the metabolism of arachidonic acid. Of particular interest is the discovery of two isoforms of COX, which are defined as COX-1 and COX-2 and play different roles in the regulation of prostaglandin (PG) synthesis. It has been proven that NSAIDs inhibit the activity of COX isoforms, but their anti-inflammatory activity is due to the inhibition of COX-2.

Most known NSAIDs suppress primarily the activity of COX-1, which explains the occurrence of complications such as gastropathy, renal dysfunction, encephalopathy, and hepatotoxicity.

Thus, depending on the nature of COX blocking, NSAIDs are divided into selective and non-selective COX-2 inhibitors.

Representatives selective inhibitors COX-2 are meloxicam, nimesulide, celecoxib. These drugs have minimal side effects and retain high anti-inflammatory and analgesic activity. COX-2 inhibitors can be used in all rheumatoid arthritis treatment programs that require the use of NSAIDs. Meloxicam (Meloflex, Movalis, Lem) at the beginning of treatment, when the inflammatory process is active, is prescribed 15 mg/day, and subsequently switched to 7.5 mg/day as maintenance therapy. Nimesulide is prescribed at a dose of 100 mg twice a day.

Celecoxib (Celebrex), a specific COX-2 inhibitor, is prescribed 100-200 mg twice a day. For elderly people, selection of the dosage of the drug is not required. However, in patients with a body weight below average (50 kg), it is advisable to start treatment with the lowest recommended dose.

The combination of two or more NSAIDs should be avoided as their effectiveness remains unchanged and the risk of side effects increases.

Basic drugs

Basic drugs still play a primary role in the complex therapy of rheumatoid arthritis, but now a new approach to their administration has emerged. In contrast to the well-known tactics of gradually increasing the treatment of rheumatoid arthritis (the “pyramid principle”), early aggressive treatment with basic drugs immediately after diagnosis is now advocated, the goal of which is to modify the course of rheumatoid arthritis and ensure remission of the disease. The reason for this is the absence of pannus, deformities, osteopenia, and severe complications formed in the early stages of rheumatoid arthritis. autoimmune mechanisms, high probability of developing remission.

The main drugs for basic therapy of rheumatoid arthritis are: methotrexate, leflunomide (elarfa), sulfazalazine, gold preparations, D-penicillamine, aminoquinoline preparations. Reserve agents include cyclophosphamide, azathioprine, cyclosporine A (Sandimmune). The new group is represented by the following drugs: Remicade (infliximab) - chimeric monoclonal antibodies to human tumor necrosis factor (TNF)-a; enbrel (etanercept) - recombinant soluble receptors for TNF; thymodepressin is a selective peptide immunosuppressant acting at the level of T-lymphocytes; leflunomide (Arava) and others.

Basic drugs that are ineffective for 1.5-3 months should be replaced or their combinations with GCS in small doses should be used, which allows reducing the activity of rheumatoid arthritis before the former begin to act. Six months is a critical period, no later than which effective basic therapy must be selected.

During treatment with basic drugs, disease activity is carefully monitored and side effects.

Glucocorticosteroids

A new approach is the use of high doses of GCS (pulse therapy) in combination with slow-acting agents, which can increase the effectiveness of the latter; combinations of methotrexate with aminoquinoline derivatives, gold salts, sulfasalazine, as well as the selective immunosuppressant cyclosporine A.

At high degree to control the activity of the inflammatory process, GCS is used, and in cases of systemic manifestations of rheumatoid arthritis - in the form of pulse therapy (GCS alone or in combination with a cytostatic - cyclophosphamide), without systemic manifestations - in the form of a course of treatment. GCS is also used as maintenance anti-inflammatory therapy when other drugs are ineffective.

In some cases, GCS are used as local therapy. Indications for their use are: predominantly mono- or oligoarthritis of large joints; prolonged exudative process in the joint; the predominance of “local status” over the systemic one; the presence of contraindications to the systemic use of GCS. When administered intra-articularly, depot forms of corticosteroids also have a systemic effect. The drug of choice is Diprospan, which has a prolonged effect.

Biological agents

In rheumatoid arthritis, synovial membranes, for unknown reasons, secrete large amounts of the enzyme glucose-6-phosphate dehydrogenase, which also breaks down disulfide bonds in the cell membrane. In this case, there is a “leakage” of proteolytic enzymes from cellular lysosomes, which cause damage to nearby bones and cartilage. The body responds to this by producing cytokines, which also include tumor necrosis factor α TNF-α. Cascades of reactions in cells that are triggered by cytokines further aggravate the symptoms of the disease. Chronic rheumatoid inflammation associated with TNF-α very often causes damage to cartilage and joints, leading to physical disability.

During the progression of rheumatoid arthritis, TNF occurs as a result of its presence on synoval membranes. Joint damage in patients with rheumatoid arthritis is observed as narrowing of the joint space between bones and erosion of bones in the joint space. Clinical trials of the monoclonal antibody have shown that its use slows both erosion and narrowing of the space between bones.

The use of specific regulators of T-lymphocyte differentiation - drugs such as, for example, halofuginone - is also promising.

Muscle relaxants

Muscle relaxants are not effective in relieving pain from rheumatoid arthritis.

Story

The earliest traces of rheumatoid arthritis were found in 4500 BC. e. They were found on the remains of Indian skeletons in Tennessee, USA. The first document describing symptoms closely resembling those of rheumatoid arthritis dates back to 123 AD.

The first description of rheumatoid arthritis as an independent nosological form (under the name of primary asthenic gout - la goutte asthénique primitive) was made in 1800 by A. J. Landre-Beauvais (English) Russian based on the results of observations at the Salpêtrière hospital under the leadership of F. Pinel. In the “Treatise on the nature and treatment of gout and rheumatic gout” published in 1859 by A.B. Garro (English) Russian the disease received its real name.

Rheumatoid arthritis is a very common joint disease, which is characterized by the presence of an inflammatory process inside the joint cavity. In addition, the symptoms of rheumatoid arthritis can affect the remaining structures of the joint: tendons, bursae, joint capsule, cartilage, epiphyses of bones, components of the joints.

Causes of the disease

The exact causes of rheumatoid arthritis are still unknown. The probable cause may include a variety of bacteria, viruses, trauma, heredity, allergies and other factors.

Symptoms of the disease

The first symptoms of rheumatoid arthritis appear individually, as a result of which this disease cannot be confused with other diseases. The main signs of the disease include:

1. The occurrence of inflammatory swelling of the metacarpal-flank joints of the middle and index finger both hands. Inflammation can also occur on wrist joints. The damage to the joints is symmetrical, since inflammation occurs simultaneously on both hands.

2. The occurrence of painful sensations in the joints, which intensify at night and closer to the morning. Painful sensations in the joints may persist in the first half of the day and decrease in the evening.

3. Symptoms of rheumatoid arthritis are characterized by damage to the small joints of the feet, and pain occurs when pressing on the balls of the toes.

4. As the disease progresses, inflammation of larger joints (elbows, knees, ankles and shoulders) appears. Certain forms of arthritis are characterized by damage not to small, but to large joints, and then inflammation reaches the small joints. This process can be seen in older people.

5. Symptoms of rheumatoid arthritis are characterized by stiffness in the affected joints in the morning. This feeling occurs for several hours after waking up, and then decreases or disappears completely.

6. In the areas of the bends of the elbows, hands and feet, subcutaneous formations may appear, presented in the form of rheumatoid nodules, the size of which does not exceed a pea. Rheumatoid nodes are a cosmetic defect; they do not cause concern to the patient and can change their size over the years or disappear and reappear.

7. Symptoms are accompanied by signs of intoxication of the body. This manifests itself in a feeling of weakness, decreased appetite, high or low body temperature, and weight loss.

8. Severe symptoms are characterized by persistent deformation of the fingers and hands. Ulnar deviation of the hands occurs, which is characterized by the fact that the fingers and hands deviate outward, the mobility of the hand is limited, and they become fixed in the wrong position. After a certain time, there is a violation of blood circulation and innervation of the hands, the skin becomes pale color and muscle atrophy occurs.

Rheumatoid arthritis in children

The presented disease, which affects children under the age of 16, is called juvenile rheumatoid arthritis of the joints. The presented disease can be inherited, and develop under the influence various infections environment. In most cases, this disease affects girls, as well as children whose relatives suffer from rheumatic diseases.

Symptoms of rheumatoid arthritis in children are determined taking into account the degree of damage and localization of the disease:

1. Oligoarticular arthritis is accompanied by damage to a maximum of 4 joints. The disease affects girls of preschool age and boys at an older age. The presented form of arthritis has a favorable course. Symptoms begin to appear in the first and second degrees, functional impairment is minimal. This form of the disease can become polyarticular.

2. Polyarticular arthritis can affect 5 joints over 6 months. The disease can manifest itself acutely or subacutely, is characterized by multiple lesions of the joints of the extremities, and often leads to disability.

3. The articular-visceral form affects young children. A third of patients do not even suspect that they have this disease. Characteristic symptoms of this form of the disease are fever and joint pain.

Diagnostic tests

The disease can be diagnosed by conducting appropriate studies: blood tests and x-rays. In the case of a general and biochemical blood test, the following may be observed:

• anemia,
• increase in ESR,
• increase in the amount of C-reactive protein.

A characteristic factor for making this diagnosis is joint fluid. With this disease, it is cloudy, with low viscosity, and the number of leukocytes and neutrophils is increased.

In order to make a diagnosis: rheumatoid arthritis of the hand or rheumatoid arthritis of the knee, it is necessary that the patient has at least 4 signs of the following:

• stiffness in the morning for more than 1 hour;
• arthritis of 3 or more joints;
• arthritis of the joints of the hands;
• symmetrical arthritis;
• presence of rheumatoid nodules;
• positive rheumatoid factor;
• radiographic changes.

Effective treatment of the disease

How to treat rheumatoid arthritis? This part of the question raises some difficulties, since treatment can only be aimed at preventing the symptoms of the disease. This is due to the fact that the causes of arthritis are still unknown. However, the disease itself cannot be eliminated.

The success of therapy depends on how early treatment begins, because it is known that the disease has a negative effect on the body and symptoms at its first manifestation.

Modern medicine, when treating rheumatoid arthritis, sets itself the following goals:

1. reduction or elimination signs of disease,
2. protection against destruction of joint tissue, disruption of its functions, development of adhesions (ankylosis) and deformations,
3. achieving long-term and sustainable improvement patients' conditions,
4. increase lifespan,
5. improving quality of life indicators.

Used to treat arthritis:

• drug therapy,
• physiotherapy,
• diet for rheumatoid arthritis,
• surgery,
• sanatorium-resort treatment and further rehabilitation.

Prevention measures

Prevention of this disease usually includes preventing and eliminating the triggering factors of the disease. These include the presence of hidden permanent foci of infection in the body (sinusitis, caries, tonsillitis), prolonged stress, bad habits, and hypothermia. This is of particular importance if there are hereditary risks, as well as if rheumatoid factor is detected, but there is no clinical symptoms illness.

Rheumatoid arthritis is considered chronic incurable diseases, however, the prognosis for its course can vary greatly. In approximately 15% of patients, it may be in a “dormant” form and have no effect on the quality of life. In case of successful and timely treatment, the duration of remissions increases significantly. But under unfavorable circumstances (early onset, unsuccessful treatment, the addition of serious complications, aggressive form) the prognosis may noticeably worsen.

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Diseases with similar symptoms:

Still's disease (syn. juvenile rheumatoid arthritis, juvenile rheumatoid arthritis) is an autoimmune disease that is often diagnosed in persons under 16 years of age. Pathology belongs to the category of systemic diseases, that is, it can affect internal organs.

Deforming osteoarthritis is considered a common pathology of the joints, against the background of which a degenerative-inflammatory process develops, leading to the destruction of their structures and their premature aging. The main reason for the development of this pathology is excessive physical activity, but there are a number of other predisposing factors. These include excess body weight, professional sports, sedentary working conditions and many other sources.

Osteoarthritis is a fairly common disease in which joints are subject to degenerative-dystrophic damage. Osteoarthritis, the symptoms of which are initially associated with the gradual breakdown of cartilage tissue, and then with the breakdown of subchondral bone and other structural components of the joint, develops against the background of a lack of oxygen in them and can manifest itself in various forms with different areas of localization of the pathological process. This disease is mainly diagnosed in patients aged 40 to 60 years.

Today we will talk about:

Refers to systemic connective tissue diseases. This is a chronic disease of infectious-inflammatory origin, which mainly affects peripheral small joints. Characterized by destructive processes in the articular tissue, a progressive course with the development of ankylosis (complete immobility in the joint). Among other things, rheumatoid arthritis is considered an autoimmune disease, that is, the defense system ceases to distinguish foreign microorganisms (viruses, bacteria) from its own cells, and thus directs its aggression towards its own body.

For many decades, attempts have been made to find the pathogenic infectious agent that causes rheumatoid arthritis.

In favor of availability infectious process Symptoms of the disease include:

Acute onset
Increased body temperature and sweating
Enlarged lymph nodes

On the other hand, there are no clear criteria for rheumatoid arthritis to be an infectious disease:

The disease has no seasonality
Not transmitted through blood transfusion or organ transplantation
No effectiveness in antibiotic treatment

If a family member has rheumatoid arthritis, the risk of other members becoming ill is very low.

Causes and predisposing factors in the development of rheumatoid arthritis

Genetic predisposition

This theory is supported by the fact that patients suffering from rheumatoid arthritis have special genes that modify receptors on the surface of the body's cell membranes. As a result, the immune system does not recognize its cells and produces special antibodies against them to destroy and remove them from the body. These genes include DRB1.

Infectious diseases

Exist various viruses, the presence of which in the body increases the risk of developing rheumatoid arthritis. These include:

Rubella virus
Herpes virus
Epstein-Barr virus
Hepatitis B virus, etc.

Symptoms of rheumatoid arthritis

When considering clinical symptoms, it should be borne in mind that rheumatoid arthritis is primarily a systemic disease, which can affect both joints and various organs and systems.

Clinical manifestations depend on a number of factors:

The severity of the current
Localization of the pathological focus
Reversibility of the process
Pathological changes
Presence of complications

In 70% of cases, the disease begins in the cold season. Provoking factors are: viral, bacterial infections, injuries, surgical interventions, food allergies, etc. It is characterized by a slow course with a gradual increase in clinical symptoms. In rheumatoid arthritis, small peripheral joints of the hands and feet are predominantly affected. Subsequently, other organs and systems are involved in the pathological process - the so-called extra-articular manifestations of rheumatoid arthritis.

In the latent (hidden) period of the disease, even before the appearance of pronounced clinical symptoms of joint damage, the following are noted:

Fatigue
Weakness
Weight loss
Unreasonable increase in body temperature
Muscle pain
Sweating

There are several options for the onset of the disease: acute, subacute

In most cases, rheumatoid arthritis is characterized by a subacute onset. In this case, the patient complains of:

1) Joint pain

Joint pain is characterized by a number of symptoms:

The pain wears inflammatory nature
Constant
Aching
Wavy character - pain may intensify in the evening
Eliminated by taking anti-inflammatory drugs
Characteristic symmetrical joint damage

More often, the process involves small joints of the hands, feet, wrists, knees, and elbows. Less commonly, the hip, shoulder and spinal joints become inflamed. The number of affected joints varies depending on the activity of the disease. Most often it manifests itself as polyarthritis (affecting 3 or more joints). Less common are injuries to 2 (oligoarthritis) or one (monoarthritis) joints.

2) Muscle pain

The symptom that accompanies acute inflammation. Has an aching, long-lasting character.

3) Fever

Fever reflects the presence of an inflammatory process. The more actively the disease develops, the higher the body temperature rises.

4) morning stiffness

Morning stiffness, which lasts from 30 minutes to an hour or more, appears in the morning after sleep. It is characterized by limited mobility and increased pain in the affected joints when trying to make any movement. This is explained by the fact that inflammatory exudate (fluid) accumulates in the joint cavity overnight, as well as by the disrupted daily rhythm of the release of glucocorticoid hormones.

Glucocorticoids reduce inflammatory reactions and the amount of exudate in the joints. Normally, the peak release of these hormones is observed in the morning.

Gradually, the symptoms progress, joint function is impaired, and deformities appear.

Pathological changes in individual joints

Damage to the joints of the hand

In 90% of cases with rheumatoid arthritis, the joints of the hand are damaged. Typically changes are noted in:

Proximal (closer to the metacarpus) interphalangeal joints
second and third metacarpophalangeal joints
wrist joints

In the initial stage, swelling develops around the joints involved in the process. Along with damage to the joints, inflammation and swelling of the muscle tendons attached to these joints are observed. Mobility is impaired due to pain. The patient complains of the inability to clench his hand into a fist. With frequent exacerbations or treatment failure, other signs and symptoms of the disease appear.

The second stage of the process is characterized by the progression of the rheumatoid process. In addition to the primary manifestations of the disease in the initial stage, there are symptoms associated with various deformities of the hand and fingers. These include types such as:

• “walrus fin” - deformation of the metacarpophalangeal joints and deviation of 1-4 fingers to the medial side (towards the ulna)
• “Swan neck” is a deformity in the form of flexion of the metacarpophalangeal joints, hyperextension of the proximal interphalangeal joints and flexion of the distal (extreme) finger joints.
• Spindle fingers are thickenings in the area of ​​the finger joints.

Other symptoms include:

Tenosynovitis of the hand is an inflammation of the tendon sheaths (the sheaths within which the tendons pass). They attach to joints and provide motor function. Main symptoms:

Pain on palpation
swelling in the tendon area
thickening of inflamed tendons
impaired motor function of the fingers and hand

Carpal tunnel syndrome

This sign occurs due to compression of the median nerve. The tendons of the finger flexor muscles pass through a special canal, which is located between the forearm and hand and is called the carpal tunnel. The median nerve, which innervates the palm and part of the fingers, passes through the same canal. With synovitis, the finger flexor tendons thicken and put pressure on the median nerve. In this case, the sensitivity and motor function of the first three fingers of the hand are impaired.

The syndrome includes:

Pain that extends to the forearm area
Paresthesia (numbness), sensitivity of the first 3 fingers is impaired

Damage to the elbow and radioulnar joints is manifested by pain and limited mobility. As the process progresses, contracture may develop (restriction of mobility when the joint is in a certain position for a long time), more often the elbow joint is in a semi-flexed position.

Damage to the shoulder joint involves inflammation of the muscles of the shoulder girdle, collarbone, neck. It manifests itself as an increase in local temperature, swelling, and limited mobility in the joint. Immobility caused by pain entails atrophy (loss of mass, lack of function) of the muscles, weakness of the joint capsule and the appearance of subluxation of the head of the humerus.

Damage to the joints of the feet is accompanied by pain when walking and running. Deformities of the toes (usually 2, 3, 4) complicate the selection of comfortable shoes for walking. With rheumatoid arthritis of the feet, as well as with lesions of the hands, there is a displacement of the fingers to the outside, pathological bending of the fingers, which, in combination with pain, further reduces stability, maintaining balance and a uniform gait.

Involvement of the ankle joint is rare and manifests itself with the same basic symptoms as with inflammation of other joints

Gonarthrosis- inflammation of the knee joint is of a special nature. Deformations that occur in the joint significantly impair the patient’s motor activity. With prolonged immobility, flexion contracture of the joint and atrophy of the quadriceps muscle (performs extension in the knee joint) develop.
Inflammatory exudate accumulates in the interarticular cavity. When bending the knee joint, the pressure of the inflammatory fluid increases, which protrudes into the popliteal fossa. This symptom was first described by Baker, in whose honor it was named (Baker's cyst).

Coxarthrosis– arthritis of the hip joint. Develops in in rare cases and is of a severe, protracted nature. Important symptoms are pain that radiates (spreads) to groin area, a feeling of shortening of the affected limb and associated lameness when walking. In recent years, ischemic necrosis (death from insufficient blood supply) of the femoral head has been increasingly observed. Involvement of the hip joint in the process has serious consequences and leads to disability of the patient.

Damage to the spinal column. A rather rare manifestation of the disease, it occurs in advanced stages of the process. In rheumatoid arthritis, the cervical spine is affected, mainly the atlas joint (the first cervical vertebra). The disease is expressed in the appearance of pain in the neck area, radiating to the back of the head, shoulder and arm. As deformities develop, crepitus (crunching) and subluxation of the cervical segments occur, which leads to limited mobility of the neck.

Damage to other joints

Among the rarest manifestations of the disease, lesions of the following joints are noted:

Sternoclavicular
Acromioclavicular
cricoarytenoid

The listed joints have a poorly developed articular apparatus. The rarity of damage to the corresponding joints is explained by the fact that in rheumatoid arthritis, the process mainly involves joints in which there is an articular capsule, fluid and a significant layer of intra-articular cartilage.

Extra-articular manifestations of rheumatoid arthritis

Rheumatoid arthritis primarily affects the joints. But we must not forget that this is an autoimmune disease that affects all organs and systems where connective tissue is present. These can be: blood vessels, skin, muscles, respiratory, cardiovascular systems and other organs. As a rule, extra-articular lesions begin to appear after some time, with complications of the rheumatoid process.

Skin lesions

The condition for skin manifestations is inflammation of the peripheral small arteries and veins. This disrupts nutrition and metabolism in the skin and subcutaneous fat. The main symptoms are:

Thinning and dry skin
Ecchymoses (small subcutaneous hemorrhages)
Brittle nails
Tissue necrosis in the periungual area

Rheumatoid nodules– these are subcutaneous dense formations of small diameter (up to 2 cm). According to one of the most common theories, rheumatoid nodules are nothing more than tissue necrosis around inflamed small blood vessels, with the accumulation of immune complexes and rheumatoid factor in them. The appearance of nodules is associated with an exacerbation of the chronic process. When inflammation subsides, they disappear or significantly decrease in size.

Characteristics of nodules:

density
painlessness
mobility
the nodes are not fused with the surrounding tissue

Appear on the outer surfaces of the extremities or in places of constant pressure (elbows, back of the head, sacrum). The number of nodules varies from one to ten. The formation of rheumatoid nodules in internal organs: heart, lungs, nervous system is possible.

Muscle damage

Approximately 75% of patients experience pain varying intensity and localization. Rheumatoid arthritis affects the muscle groups that attach to damaged joints. Gradually, due to weakening functional ability, the tone and strength of muscle contractions decreases. Long-term loss of capacity leads to muscle atrophy and the development of additional deformations in the osteoarticular system.

Damage to the gastrointestinal tract (GIT)

There are no specific manifestations from the gastrointestinal tract in rheumatoid arthritis. There may only be general digestive disorders, loss of appetite, flatulence (increased gas formation in the intestines). Less common are abdominal pain and heaviness in the epigastric region (upper third of the abdomen). These and some other symptoms most often appear during the use of anti-inflammatory drugs, which have an irritating effect, causing erosions and ulcers of the gastrointestinal mucosa. In 20-30% of cases, an increase in the borders of the liver is observed.

Respiratory system damage

The targets for rheumatoid arthritis when the pulmonary system is affected are the pleura (organ capsule) and interstitial tissue (the intermediate structural tissue of the lungs).
Damage to the pleura is accompanied by dry or exudative pleurisy.
Pleurisy is an inflammation of the layers of the pleura: the inner and outer layers, between which inflammatory exudate can accumulate.
Damage to the interstitium of the lung tissue manifests itself in the form of interstitial pneumonia, in which the exchange of gases and pulmonary blood flow become difficult.

Damage to the cardiovascular system

Clinically rare. The rheumatoid process can affect all layers of the heart: endocardium, myocardium, pericardium, as well as coronary (heart) vessels.

Endocarditis– inflammation of the inner wall of the heart. Rheumatoid nodules that form here attach to the heart valves and cause various types of defects with impaired hemodynamics (blood circulation) and heart failure.

Myocarditis– inflammation of the muscular wall of the heart. With myocarditis, disorders most often develop heart rate in the form of arrhythmias, extrasystoles, etc.

Pericarditis– inflammation of the pericardial sac. When exudate forms inside the pericardium, the functioning of the heart is significantly impaired.

Kidney damage

The most severe and progressive course is characterized by renal pathology. In rheumatoid arthritis, it manifests itself in the form of glomerulonephritis.

Rheumatoid glomerulonephritis is an inflammation of the glomeruli of the kidneys. Immune complexes circulating in the blood accumulate in the renal glomeruli and, thus, exert their destructive effect. The kidneys stop filtering harmful substances that accumulate in the body and have a toxic effect on organs and systems. Kidney failure gradually develops.

Damage to the nervous system

It occurs when the pathological process affects the blood capillaries supplying the brain and the sheaths of the spinal and cranial nerves. The disease is accompanied by various sensory disturbances, paralysis, disturbances of thermoregulation, sweating, etc.

Complications of rheumatoid arthritis are divided into systemic and local changes.
For local complications characterized by dysfunction of the musculoskeletal system. Joint deformities lead to long-term disability and disability of the patient.
Systemic complications occur after 10-15 years after the onset of the disease. These include damage to vital organs in varying degrees. The most common include:

Felty's syndrome

Long-term activation of the immune system leads to enlargement and dysfunction of the spleen. Blood levels change significantly shaped elements. When passing through the altered spleen, red blood cells, leukocytes, and platelets are destroyed. In this case, the following syndromes are observed:

Thrombocytopenic syndrome.

Thrombocytopenia is a decrease in the number of platelets in the blood. A lack of platelets leads to blood clotting disorders. Manifests itself in the form of pinpoint hemorrhages, increased capillary fragility, etc.

Anemic syndrome.

– this is a decrease in the number of red blood cells and hemoglobin in the blood. Red blood cells are involved in the delivery of oxygen to tissues and excretion in return carbon dioxide. Manifested by increased fatigue, fatigue, pallor skin etc.

Leukopenic syndrome.

Leukopenia is a decrease in the number of leukocytes in the blood, which have protective function, when substances foreign to the body enter. Manifested by frequent infections. Patients lose weight and their ability to work decreases.

Secondary amyloidosis

Amyloid is a pathologically altered protein that is formed in the liver during long-term chronic diseases. Amyloidosis is considered one of the most serious complications of rheumatoid arthritis, leading to the death of the patient. Amyloid is deposited in various organs and systems, accumulates and disrupts the normal function of the latter. The most common and serious complication is kidney damage. The kidneys gradually lose their filtration ability, which leads to chronic renal failure.

Diagnostics of rheumatoid arthritis, laboratory and instrumental methods

Laboratory research

Laboratory data is divided into two categories:

• Decrease in hemoglobin level (Hb norm 120-140g/l). Characteristic for a long, severe course of the disease.
• Moderate leukocytosis (increased leukocyte count, normal 4000-9000/ml)
• Increased erythrocyte sedimentation rate (SOE norm 2-15mm/hour). The higher the SOE level, the more active the inflammatory process.

Blood chemistry

An increase in the synthesis of proteins specific to the active phase of inflammation is characteristic.

• Increased fibrinogen levels (normal 2-4 g/l)
• Increased sialic acids (normal 2-2.36 mmol/l for neuraminic acid, or 620-730 mg/l)
• Increased haptoglobin level (normal 0.44-3.03 g/l)
• Promotion C-reactive protein(norm less than 5 mg/l)

The second category includes laboratory tests that directly indicate the presence of specific markers of rheumatoid arthritis.

Blood tests for rheumatoid arthritis

• Rheumatoid factor in the blood
• It is detected in 60% of cases with rheumatoid arthritis.
• When an inflammatory process occurs, under the influence of an unknown pathogenic agent, the structure of part of the B lymphocytes (cells responsible for the formation of antibodies, that is, Ig) changes. However, damaged lymphocytes retain the ability to synthesize Ig class M, G. These Igs are recognized as foreign proteins to the body, with the production normal immunoglobulins against them. Thus, immune complexes called rheumatoid factor are formed.
• Anticitrullinated Antibody Test (ACAT)
• It is the earliest and one of the most sensitive tests for early diagnosis of the disease. In rheumatoid arthritis, the test is positive in 80-90% of cases.

What are anticitrullinated antibodies

Citrulline is an amino acid that is formed during the inflammatory process. Structural proteins of cells in which citrulline is present are recognized by the immune system as a foreign protein, with the formation of specific antibodies, with the development of autoimmune inflammatory processes.

Antinuclear antibodies (ANA)

They are detected very rarely, in approximately 10% of cases. These antibodies are formed against cell nuclei and are often misleading in making a correct diagnosis, as they are markers of a disease known as Lupus eritematos sistemic (systemic lupus erythematosus).

Analysis of synovial fluid (fluid contained in the joint cavity).

This study reveals the following signs of inflammation:

• Change color and transparency
• Moderate leukocytosis (20-40 thousand/ml)
• Rheumatoid factor
• Ragocytes (leukocytes containing inside the remnants of immune complexes, rheumatoid factor, etc.)

Instrumental research methods

Arthroscopy

This is visualization of the joint cavity using a special optical device.

Allows you to assess the extent of damage
Defines volume surgical intervention
If necessary, takes material for biopsy
For differential diagnosis(tuberculosis, sarcoidosis)

X-ray of joints

They are basic for instrumental examination of the patient, and are also used as one of the criteria for making a diagnosis. Several techniques have been developed to determine the stage of radiographic changes. Among them are the following methods: Steibrocker, Sharp, Larsen. Each method has General characteristics(counting the number of erosions, cysts, degree of deformation), and serves to determine the degree of destruction of the joints.

X-ray of joints

• In the early stages of the disease, no significant osteo-articular changes are detected
• The articular cartilages gradually become thinner, and single erosions appear in them.
• The interarticular space narrows
• Osteoporosis and joint destruction subsequently appear.
• Ankyloses form (fusion of articular surfaces and complete immobility in the joints)

Joint scintigraphy

Technetium is a radioactive substance that accumulates in inflamed joints. The more active the pathological process, the greater the technetium content in the joint. The method is very sensitive and allows diagnosis in the early stages of the disease.
Biopsy of the synovium of the joint
A biopsy is a microscopic examination of a piece of tissue from a pathological lesion. It is carried out in rare cases for the purpose of differential diagnosis with other diseases (tumors, tuberculosis). A biopsy of the synovial membrane reveals changes characteristic of the inflammatory process:

• Hypertrophy (enlargement) of villi that produce synovial fluid
• Proliferation (growth) of synovial tissue
• Deposition of an inflammatory protein, fibrin, on the walls of the synovial membrane

Magnetic resonance imaging

It also allows you to determine the degree of joint deformation, but taking into account high cost has not received widespread use.

Ultrasonographic examination (ultrasound) of joints and internal organs
It is used for severe progressive disease, when internal organs are involved in the pathological process. You can see on ultrasound pathological changes in organs such as the heart, liver, pancreas, spleen and other organs.
What criteria does a doctor use to diagnose rheumatoid arthritis?

All signs are taken into account: patient complaints, laboratory and instrumental research results.

1. morning stiffness that lasts an hour or more

2. arthritis of small wrist joints. Swelling of one or more of the following joints:

Between the proximal phalanges of the fingers
wrist
metacarpophalangeal

3. symmetrical arthritis. Symmetrical damage to the joints most often involved in the pathological process.
4. Swelling of at least three of the following groups of joints, on both sides:

Hand joints

Interphalangeal proximal
Metacarpophalangeal
Radiocarpal
Elbows

Leg joints

Knees
Ankle
Metatarsophalangeal

5. The presence of rheumatoid nodules, which can only be diagnosed by a doctor
6. Determination of rheumatoid factor in the blood by any available laboratory method
7. Inherent radiographic changes in joints and bones, for rheumatoid arthritis. (Erosions, subchondral - that is, subchondral osteoporosis of the bone, various deformations in the joint).

The presence of four or more of the above criteria allows a diagnosis of rheumatoid arthritis.

Drug treatment of rheumatoid arthritis during exacerbation - anti-inflammatory drugs, tumor necrosis factor inhibitors, steroid drugs

Treatment of rheumatoid arthritis is divided into two stages:

The first stage includes stopping the acute phase of the disease
The second stage is maintenance therapy

Treatment of the acute phase consists of reducing the inflammatory process. For this purpose, non-steroidal anti-inflammatory drugs (NSAIDs) are primarily prescribed.

Anti-inflammatory drugs from the group of cyclooxygenase inhibitors (COX) 1-2 - a group of drugs that inhibit the enzyme responsible for physiological and inflammatory reactions.
Diclofenac is rightfully considered the gold standard when choosing a drug from this group. The drug has the most optimal properties in the treatment of exacerbation of the disease.

Diclofenac reduces pain to a greater extent, relieves swelling of inflamed tissues, and reduces local hyperemia (redness). Maximum dose the drug is 150 mg/day.

The most commonly used drugs, in order of decreasing severity of the anti-inflammatory effect, are the following:

Diclofenac 100-150 mg/day
Indomethacin 150 mg/day
Naproxen 0.75-1.0 mg/day
Ibuprofen 1200-1600 mg/day

Features of taking drugs in this group

• The choice of drug is made sequentially
• The effect occurs on the 3-4th day of use
• If there is no effect, a drug with a weak effect is replaced
• It is undesirable to use two or more drugs in this group in combination (increased risk of side effects)
• (NSAIDs) are always taken after meals
• (NSAIDs) have a strong irritant effect on the mucous membrane of the gastrointestinal tract, and therefore, with long-term use, can cause the appearance of erosive gastritis, gastric and duodenal ulcers. In this regard, at the same time, before meals, gastroprotectors (protect the mucous membrane) omeprazole 20 mg or lansoprazole 30 mg are taken.

Selective COX 2 inhibitors are drugs that inhibit an enzyme that is involved only when an inflammatory process occurs. These include:

Meloxicam (movalis) 7.5-15 mg/day
Piroxicam 30-40 mg/day
Rofecoxib 12.5 mg/day

These drugs have fewer side effects and act only at the level of the inflammatory process. They are used for intolerance to first-generation drugs, diseases of the gastrointestinal tract, liver and other internal organs. The features of administration are the same as for drugs from the first group.

Glucocorticosteroids (GCST)

Glucocorticosteroids are hormones of natural or synthetic origin. They participate in all types of metabolism and have immunosuppressive and anti-inflammatory activity.
If non-steroidal anti-inflammatory drugs are ineffective, glucocorticoids are prescribed to reduce the symptoms of not only articular syndrome, but also damage to internal organs in the systemic form of the disease.
Prednisolone and methylprednisolone are more often used in practice. Prednisolone is the reference drug (optimal dose 10-15 mg per day), so the rest of the glucocorticoids are equal to it in an equivalent dose. For example: 5 mg of prednisolone equals

When approaching the issue of prescribing glucocorticoid hormones, you should consider:

Level blood pressure(should not be higher than normal)
Immune system status
Electrolyte balance (content of K, Ca, Na, CL ions in the blood)
Patient's age and gender

To avoid numerous side effects from taking drugs in this group, you need to know the basic principles of use:

• Start taking small doses, gradually increasing the amount of the drug taken
• Taken in a strictly defined dose
• Compliance with the daily rhythm when taking the drug (maximum dose in the morning, gradually reduced in the evening)
• When a therapeutic effect is achieved, they begin to slightly reduce the amount of glucocorticosteroids every 5-7 days until the drug is completely stopped, or to the minimum maintenance dose.

Pulsetherapy

The method is based on the administration of large doses of drugs over several days. This method is justified from the point of view that in severe acute processes it is impossible to reduce inflammatory phenomena, usual doses drugs. There are several methods and groups of drugs for this purpose. To avoid unwanted and sometimes life-threatening side effects, pulse therapy is carried out in a hospital setting, and under the strict supervision of the attending physician.
Method using glucocorticoids
For three days in a row, 1000 mg of methylprednisolone (Medrol) is administered intravenously. Therapy often gives a striking effect already on the 3-5th day of treatment. The inflammatory process subsides, pain and swelling of the joints decreases. Subsequently, they switch to maintenance doses of the drug.

Method using cytostatics

Cyclophosphamide (cyclophosphamide) is administered once a month, 1000 mg for a year.
After a year, if remission (improvement of the condition) is observed, the order of administration is reduced to 1000 mg once every 3 months.
Admission is canceled after a year, after stable remission.

Biological therapy

With the help of new biomedical technologies, biologically active substances have been created that have shown good results in the treatment of autoimmune diseases.
Biological therapy is a relatively new method of treating rheumatoid arthritis, which is based on the uncoupling of the pathogenetic chain that develops inflammatory reactions. One of the main roles in the implementation of inflammatory reactions belongs to cytokines.
Cytokines are biologically active substances that are divided into several classes. They play a key role in the implementation of both physiological and pathological reactions.
TNFa (tumor necrosis factor) is a cytokine through which biological reactions in the body are carried out, including those of an inflammatory nature.
The mechanism of action of biological drugs is that they block the action of TNF-α, or the receptors with which it interacts.

Below are examples of some of the most commonly used drugs.

Inflikimab (remicade)
Adalimumab (humira)
Etanercept (enbrel)

The main disadvantages of biological drugs are their high cost and a significant decrease in immunity with long-term use.

Local treatment

Various ointments and creams are used as local treatment. They can consist of one drug or several. The main direction of action is on locally inflamed tissue around the affected joints. The most commonly used ointments are based on non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, indomethacin.

The combination of several drugs has become widespread. Below is an example of one of the combinations used:

• Diclofenac is an anti-inflammatory drug
• Dimexide - anti-inflammatory drug
• Heparin - an anticoagulant increases vascular permeability, thereby improving blood microcirculation and promoting deeper penetration of drugs
• Lidocaine is used as a local anesthetic. Reduces pain and irritation in tissues

The resulting solution is applied to a gauze pad and applied to the affected area as a compress for 1.5 hours before bedtime.
Physiotherapy for rheumatoid arthritis
Along with the use of medications, great importance in treatment of this disease play various physical procedures that are prescribed for the purpose of:

Reducing pain in joints and muscles
Reduced morning stiffness
Increasing patient activity

The following can be used as physiotherapeutic procedures:

Galvanic currents
Paraffin, ozokerite applications
Ultrasound
Irradiation with infrared rays

Despite the reduction in pain, significant improvement in the patient's condition, local treatment is of secondary importance and cannot be used as an independent method.

Drug treatment of rheumatoid arthritis during remission - cytostatic drugs, sulfasalazine, Wobenzym.
Treatment during this period consists of long-term use of cytostatic drugs.
Cytostatics are a group of drugs that inhibit the vital activity of all cells of the body, especially those that have the ability to divide intensively (cells of the gastrointestinal tract, gonads, hematopoietic system, tumor).
They have antitumor, immunosuppressive, anti-inflammatory effects. Given their high toxicity, cytostatics are used with extreme caution to avoid irreversible consequences after taking the drugs.

The most common drugs in this group are:

Methotrexate
Azathioprine
Leflunomide
Cyclophosphamide

The gold standard is a drug called methotrexate, which inhibits cell growth and development. The action appears slowly, the effect is observed after 3-4 months of treatment.

Maintenance therapy begins immediately after diagnosis. The recommended dose is 7.5-15 mg per week. 80% of patients experience a positive effect after 3-4 months of using the drug.
The important point is that you should take folic acid between doses of methotrexate. This will reduce the occurrence of unwanted side effects.

Hydroxychloroquine (Plaquenil)

An antimalarial drug with anti-inflammatory and weak immunosuppressive effects. Rarely used, mainly in combination therapy.

Sulfasalazine

The combined drug has a moderate anti-inflammatory and antimicrobial effect. Has the ability to accumulate in connective tissue. Just like hydroxychloroquine, it is used in combination therapy for intolerance to drugs of other groups.

Wobenzym

One of the representatives of systemic enzyme therapy. It is a drug with anti-inflammatory and immunomodulatory activity. Destroys immune complexes and stimulates the elimination of toxic metabolic products formed during inflammatory reactions. While taking Wobenzym, there was a significant improvement in clinical symptoms, as well as laboratory parameters characterizing the inflammatory process. It is recommended to take 5-10 tablets 3 times a day for 8-12 weeks.

High efficiency and absence of side effects allow the drug to be successfully used as monotherapy (one drug) and for maintenance therapy.

Considering the diversity existing groups drugs and methods of their use, you should not resort to independent selection of any of them. The material on the treatment of rheumatoid arthritis presented above is only the tip of the iceberg of all the information, so do not underestimate the disease itself and the attitude towards it, but seek qualified medical help as early as possible.

Before prescribing treatment, the doctor must make a correct diagnosis, find out the stage of the disease, the course of the pathological process, and then, taking into account the individual characteristics of each organism and the person as a whole, select the appropriate treatment.

• Consultation with a rheumatologist once every 6 months
• Gymnastic exercises, therapeutic massage, spa treatment (balneotherapy).
• Lightweight recommended gymnastic exercises to maintain the required range of motion in the joints, to prevent the occurrence of osteoporosis (loss of bone tissue due to leaching of calcium salts).
• Muscle massage is necessary in case of ankylosis (complete immobility in the joints), to maintain their normal tone and mass.
• Balneotherapy is recommended for mild cases of the disease.

• Taking methotrexate 7.5-15 mg once a week (as prescribed by your doctor)
• Sanitation of chronic foci of infection (tonsillitis, chronic sinusitis, pneumonia, pyelonephritis, etc.)
• For instability in the joints and to prevent the development of further deformities, orthopedic splints and simple supporting devices are used.

What is seropositive rheumatoid arthritis

Seropositive rheumatoid arthritis means that rheumatoid factor is present in the blood of affected people. This subtype of rheumatoid arthritis has its own clinical and prognostic features. The presence of rheumatoid factor is assessed in favor of an unfavorable prognosis.

Rheumatoid factor is a type of antibody that is produced by the body itself against its own immunoglobulins class G. It is synthesized by the cells of the synovial membrane (the structure lining the inside of the articular surface) of the joint. Once in the blood, rheumatoid factor reacts with immunoglobulin G and forms an immune complex. Subsequently, this complex settles on the joints and vessels feeding this joint. Having settled, the immune complex triggers a cascade of inflammatory reactions that damage cartilage tissue and other elements of joints.

Rheumatoid factor is produced not only in rheumatoid arthritis, but also in a number of other diseases. For example, it may indicate a recent infection. Therefore, a certain amount of rheumatoid factor may be present normally. The difference between positive rheumatoid arthritis and recent infection will be the amount of this factor. Rheumatoid arthritis is considered positive if the amount of rheumatoid factor in the blood exceeds more than 25 IU (international units) per milliliter. If the analysis produces a value of less than 25 IU/ml, then the analysis for rheumatoid factor is considered negative.

It should be noted that the presence of a positive rheumatoid factor (even within the range of 50 – 100 IU/ml) is not an absolute indicator of rheumatoid arthritis. Its presence is only one of many criteria necessary to make a diagnosis.
What is seronegative rheumatoid arthritis?
Seronegative rheumatoid arthritis means that there is no rheumatoid factor in the blood of affected people. This form of the disease occurs in every fifth patient suffering from rheumatoid arthritis (that is, in 20 percent of patients). The absence of this laboratory indicator is a criterion for a favorable course of the disease. At the same time, the pathology is less treatable and responds to basic therapy. The onset of seronegative rheumatoid arthritis is usually acute and sudden, which distinguishes it from other forms.

Rheumatoid factor is a type of protein that acts as an antibody. These proteins are synthesized by the body against its own immunoglobulins G, which they perceive as antigens. Subsequently, complexes are formed consisting of rheumatoid factor and immunoglobulins. They circulate in the blood for a certain time, after which they settle on the surfaces of the joints. These compounds have immune properties that trigger a cascade of immunoinflammatory reactions. However, they settle not only in the joints, but also in other organs where there is connective tissue. This explains multiple lesions internal organs in rheumatoid arthritis.

The absence of this factor does not mean that the above mechanisms do not occur in seronegative rheumatoid arthritis. Damage to joints and internal organs is also characteristic of this form of arthritis. A negative test for rheumatoid factor only indicates that it is not present in elevated concentrations. A certain amount of this parameter is still present in the blood plasma. An amount of rheumatoid factor between 25 and 30 IU (international units) per milliliter of blood is considered a negative result. It should immediately be noted that each laboratory operates within its own limits.

Because there are often false positive and false negative results, the analysis is repeated several times. Even if several tests done in a row do not reveal the presence of this factor, this does not exclude rheumatoid arthritis. If there are other mandatory criteria for making a diagnosis, then it is made on their basis.

How does juvenile rheumatoid arthritis manifest?

Juvenile rheumatoid arthritis manifests itself with multiple articular and extra-articular symptoms. It is a form of rheumatoid arthritis that occurs in children and adolescents.

Manifestations of juvenile rheumatoid arthritis are:

Damage to large and medium joints;
elevated temperature;
polymorphic rash;
kidney damage;
heart damage;
lung damage;
hepatolienal syndrome;
lymphadenopathy.

Damage to large and medium joints

Unlike adults, where the small joints are affected, in children rheumatoid arthritis targets the large joints. The knees, ankles, elbows and temporomandibular joints. In this case, there is a symmetrical involvement of several joints, that is, polyarthritis. But there is also damage to two or three joints (which is less common) - oligoarthritis. The defeat of one single joint, or monoarthritis, is not typical for this disease. Juvenile arthritis is accompanied by local swelling, pain, and sometimes deformation of the joint. However, it should be noted that, in general, the course of arthritis in 80–90 percent of cases is relatively favorable. Only 20–10 percent experience severe destructive changes. This mainly occurs in the hip and temporomandibular joints.

Pain in the joints occurs both at rest and with movement. However, very often children cannot describe the nature of the pain. The skin over the affected joints is often changed, namely it becomes pale and dry. There are also muscle changes - the muscles attached to the affected joints quickly atrophy (become thin and lose their functions).

Those joints in which destructive changes occur quickly become deformed. The articular surfaces of the bones form a single bone fusion, as a result of which the joint becomes immobile. This phenomenon is called ankylosis.

Fever

The disease may debut with a rise in temperature if it is an acute or subacute form. In this case, it rises to 37.5 - 38 degrees. A rise in temperature is observed in the morning hours. By lunchtime or evening it can drop sharply to normal limits (36.6 degrees). Temperature rises are accompanied severe chills, and falls – increased sweating.

Polymorphous rash

At juvenile arthritis the rash appears at the height of the fever. Then it may periodically appear and disappear. However, it is not accompanied by itching or other unpleasant sensations. The nature of the rash can be very diverse.

Juvenile rheumatoid arthritis rashes are of the following types:

Spotted rash;
rash in the form of hives;
hemorrhagic rash;
papular rash.

Kidney damage

Kidney damage can occur at the level of various structures, but amyloidosis most often develops. In amyloidosis, a mutated protein called amyloid accumulates in the kidney parenchyma. IN healthy body this protein does not exist, but it is formed during long-term, chronic diseases. Renal amyloidosis progresses very slowly, but it inevitably leads to renal failure. Manifested by edema, protein in the urine, accumulation of metabolic products in the body (for example, urea).

Heart damage

Juvenile rheumatoid arthritis can affect both the heart muscle and the membranes that cover the heart. In the first case, the disease occurs in the form of myocarditis. Myocarditis is accompanied by weakness and inferiority of cardiac activity.

The heart, which normally functions as a pump in the body (pumps blood throughout the body), in this case is not able to provide oxygen to the entire body. Children complain of weakness, shortness of breath, and fatigue.

Also, with rheumatoid arthritis, the pericardium can also be damaged with the development of pericarditis. Involvement of both the heart muscle and the pericardium in the pathological process is called myopericarditis.

Lung damage

Lung damage can occur in the form of sclerosing alveolitis or pleurisy. In the first case, the walls of the alveoli are replaced connective tissue. As a result, the elasticity of the alveoli and the lung tissue itself decreases. In case of pleurisy, effusion accumulates in the pleural cavity ( inflammatory fluid), which gradually compresses the lung. In both the first and second cases, the main symptom is shortness of breath.

Hepatolienal syndrome

Hepatolienal syndrome is characterized by an enlarged liver and spleen. More often, only the liver enlarges (hepatomegaly), which is manifested by a dull aching pain in the right hypochondrium. If the spleen also enlarges (splenomegaly), then pain also appears on the left. However, in young children, any abdominal pain is localized around the navel. Therefore, it is possible to detect an enlarged liver and spleen only during a medical examination during palpation.

Lymphadenopathy

Lymphadenopathy is an enlargement of the lymph nodes. Those nodes that are localized near the inflamed joint become enlarged. If the temporomandibular joints are affected, then the cervical and submandibular nodes increase; if the knee joint, then the popliteal nodes. Thus, lymphadenopathy is reactive and not specific.

Juvenile rheumatoid arthritis can occur in several ways:

• oligoarticular variant - with damage to two to three, but not more than four joints;
• polyarticular variant - with damage to more than four joints;
• system option- with damage to both internal organs and joints.

The first option accounts for 50 percent of the cases, the second option accounts for 30 percent, and the third option accounts for 20 percent.

What are the first symptoms of rheumatoid arthritis?

The first symptoms of rheumatoid arthritis are very varied. In about 60 percent of cases, the disease begins gradually, with the appearance of signs of general intoxication of the body and an increase in the main symptoms over several months. In 30–40 percent of patients, the initial symptoms of rheumatoid arthritis are limited local signs joint inflammation.

All initial symptoms Rheumatoid arthritis can be divided into three main groups.

The first groups of symptoms of rheumatoid arthritis are:

Symptoms of general intoxication of the body;
symptoms of joint lesions;
symptoms of extra-articular lesions.

Symptoms of general intoxication of the body

Due to the prolonged inflammatory process in the body, protective barriers and systems are depleted. The body weakens, and signs of general intoxication with decay products of inflammatory reactions appear.

Symptoms of general intoxication of the body with rheumatoid arthritis are:

General fatigue;
weakness throughout the body;
brokenness;
aches in all joints and bones;
aching pain in muscles, which can persist for a long time;
pallor of the skin of the face and limbs;
coldness of the palms and feet;
sweating of palms and feet;
decreased or loss of appetite;
weight loss;
increased body temperature up to 37.5 - 38 degrees;
chills;
enlargement of peripheral lymph nodes.

Intoxication symptoms appear with some frequency. The degree of their manifestation directly depends on the general condition of the patient’s body. With exacerbation of chronic diseases or decreased immunity, these symptoms intensify.

Symptoms of joint lesions

The main manifestations of rheumatoid arthritis are joint damage. In the initial stage of the disease, articular symptoms are caused by an active inflammatory process in the joints and the resulting periarticular (periarticular) edema.

The first symptoms of joint lesions in rheumatoid arthritis are:

Arthritis;
morning stiffness;
joint pain;
decrease in range of motion.

Arthritis

• Arthritis is an inflammation of all the tissues that form and surround a joint.
• The joints affected by rheumatoid arthritis vary in location and number.
• In more than 65 percent of patients, the onset of the disease is polyarthritis. It is usually symmetrical and wraps around the small joints of the fingers and toes.
• Arthritis is characterized by a number of local nonspecific symptoms.

Nonspecific symptoms of joint inflammation in rheumatoid arthritis are:

Pain in the joint upon palpation (feeling);
swelling of the joint and tendons attached to it;
increase in local temperature;
sometimes slight redness of the skin around the joint.

Morning stiffness occurs in the first minutes after waking up and lasts up to 1 – 2 hours or more. After a long stay at rest, inflammatory fluid accumulates in the joints, due to which periarticular edema increases. Movement in the affected joints is limited and causes severe pain. Some patients compare morning stiffness to a “stiff body feeling,” “tight gloves,” or “tight corset.”

Joint pain

Joint pain in rheumatoid arthritis is constant and aching. Light physical activity and even normal movements in the joints cause increased pain. After warming up or towards the end of the working day, the pain tends to ease. Relief lasts no more than 3–4 hours, after which the pain intensifies again. To reduce pain, the patient involuntarily holds the affected joint in a bent position.

Decreased range of motion

Due to periarticular swelling and pain in inflamed joints, the range of motion decreases. This is especially noticeable when the metacarpophalangeal and interphalangeal joints of the hands are affected. Patients with rheumatoid arthritis have difficulty with fine motor skills. It becomes difficult for them to fasten buttons, thread a needle, and hold small objects.

Symptoms of extra-articular lesions

Typically, in rheumatoid arthritis, symptoms of extra-articular lesions appear in the later stages of the disease. However, some of them can be observed together with the first joint symptoms.

Symptoms of extra-articular lesions that may appear early in the disease are:

Subcutaneous nodules;
muscle damage;
vasculitis (inflammation of blood vessels) of the skin.

Subcutaneous nodules

In rheumatoid arthritis, subcutaneous nodules are found in the area of ​​the affected joints. They are small round formations with a dense consistency. Most often, nodules are located on the extensor surface of the elbow, hand and Achilles tendon. They do not cause any pain.

Muscle damage

Often one of the first symptoms of rheumatoid arthritis is muscle weakness. The muscles near the inflamed joints atrophy and decrease in size.

Skin vasculitis

Cutaneous vasculitis appears in the distal areas of the arms and legs. Many brown dots can be seen on the nails and fingertips.
Rheumatoid arthritis, which begins with damage to the joints of the lower extremities, is sometimes accompanied by severe vasculitis in the form of skin ulcers on the legs.

What are the stages of rheumatoid arthritis?

There are several stages of rheumatoid arthritis. So, there are clinical stages and radiological stages of this disease.

The clinical stages of rheumatoid arthritis are:

• first stage - manifested by edema bursa a joint that causes pain, local temperature and swelling near the joint;
• the second stage - the cells of the synovial membrane, under the influence of inflammatory enzymes, begin to divide, which leads to compaction of the joint capsule;
• third stage – deformation of the joint (or joints) and loss of mobility occurs.

The following clinical stages of rheumatoid arthritis are distinguished by time:

• Early stage – lasts the first six months. At this stage there are no main symptoms of the disease, but it is manifested by periodic fever and lymphadenopathy.
• The advanced stage lasts from six months to two years. It is characterized by extensive clinical manifestations - swelling and pain in the joints appear, changes in some internal organs are noted.
• Late stage – two years or more from the onset of the disease. Complications begin to develop.

The following radiological stages of rheumatoid arthritis are distinguished:

• The stage of early radiological changes is characterized by hardening of soft tissues and the development of periarticular osteoporosis. On x-ray film this appears as increased bone transparency.
• The stage of moderate radiological changes is characterized by an increase in osteoporosis and the addition of cystic formations in the tubular bones. Also at this stage, the joint space begins to narrow.
• The stage of pronounced radiological changes is manifested by the presence of destructive changes. A feature of this stage is the appearance of deformities, dislocations and subluxations in the inflamed joints.
• Ankylosis stage - consists of the development of bone fusions (ankylosis) in the joints, usually in the wrist joints.

Especially for: - http://site Rheumatoid arthritis characterized by symmetrical inflammation of peripheral joints. This is a chronic disease. The cause of the appearance is unknown, but there is evidence of a strong genetic predisposition. Rheumatoid arthritis is more common among women. The main symptoms are: a feeling of “stiffness” in the joints in the morning, swelling, pain in the inflamed joints. Although there is no cure for this disease universal medicine, new methods of therapy allow, if not to treat, then to completely control the patient’s condition.

Definition

Rheumatoid arthritis is a condition that is characterized by inflammation of the peripheral joints of the hands, wrists, elbows, shoulders, hips and feet. The disease affects both sides of the body and, as it progresses, leads to joint destruction. The process is characterized by persistent inflammation of the synovium of the joints, the surface of the cartilage, which leads to deformation and erosion of the bone. Usually only the joints are affected, but cases of the inflammatory process spreading to the lungs, heart and nervous system have been described.

Reason for development

Although the cause of the disease has not yet been clearly elucidated, modern research suggests an autoimmune process, during which the own tissues of the synovial membrane of the joint are affected.

Who is at risk?

About 1% of the world's population suffers from rheumatoid arthritis. Women are affected approximately two to three times more often than men. With age, the incidence increases in people of all genders and nations, all over the world. The disease can begin at any age, with peak incidence occurring in the fourth and fifth decades of life ( up to 80% of patients complain of the onset of symptoms at this age).

Symptoms and signs

Rheumatoid arthritis is characterized by chronic polyarthritis, meaning that it affects many joints. The onset of the disease is characterized by fatigue in the joints, lethargy in the muscles; as a rule, patients do not consult a doctor until signs of inflammation of the joints become obvious. This may continue for several weeks or months.

About 10% of people have atypical signs of rheumatoid arthritis: fever, general malaise, inflammation of only one joint. The main symptoms are stiffness, pain and weakness in the affected joints. Stiffness and stiffness usually worsen after a period of inactivity. Common symptom- morning stiffness ( lasts more than one hour). The duration of this symptom can determine the degree of development of the disease.

Inflammation of the synovial membrane causes swelling, limitation, and painful movements in the joint. The joint is warm to the touch. Multiple swelling of the joints leads to the accumulation of fluid in the synovial space, thickening of the joint capsule and synovial membrane. The patient is forced to keep the joint in a semi-flexed state, as this reduces pain. Subsequently, chronic inflammation leads to bone deformation. There are also many non-articular manifestations of rheumatoid arthritis.

Diagnostics

The most important aspect of assessing the problem is the clinical examination. In 85% of patients, the so-called rheumatoid factor is detected in the blood serum. The effectiveness of this test is subject to error; a more accurate result in diagnosing rheumatoid arthritis is provided by a new test for anti-CCP antibodies. Rheumatoid arthritis is often accompanied by anemia. Here, tests for inflammatory markers: erythrocyte sedimentation rate (ESR) and C-reactive protein are used to assess the progress of the disease.

X-ray examination is not always effective in the early stages of the disease, when there are no visible changes in the structure of the bone and joint. However, it is good at assessing the degree of bone erosion, narrowing of the joint space and changes in the articular surfaces. Also, the x-ray method allows you to evaluate the patient’s body’s response to therapy.

Prevention

There is no single effective prevention method. According to some studies, smoking increases the risk of disease.

Treatment

It is important to understand that rheumatoid arthritis is a treatable condition that requires urgent intervention as soon as possible. A rheumatologist will help you deal with this problem. Although some homeopathic remedies can temporarily relieve swelling and pain in the affected joint, there is no evidence that they can in any way change the course of the disease. Disease-modifying antirheumatic drugs ( DMARDs) are the cornerstone of all therapy for rheumatoid arthritis and should be prescribed as soon as possible to achieve remission. Remission is defined as the absence of weakness and swelling in the joints, as well as the return of laboratory indicators of inflammation to normal.

Main goals of therapy for rheumatoid arthritis

• Reducing pain.
• Reduce inflammation.
• Control of the disease process, with the possibility of early remission.
• Maintaining ability to work.

Exercise and physiotherapy

Physical exercises are selected individually and can greatly improve the patient’s condition. The basic principle of this therapy: “ if the joint is swollen, it should be left alone, if not, move it" Inflamed joints can be immobilized with splints, which helps reduce swelling.

Point-by-point treatment

• Relieve symptoms and reduce inflammation. Simple analgesics and non-steroidal anti-inflammatory drugs are used to reduce pain and stiffness. If there are no contraindications from the cardiovascular system, coxibs are used, these include drugs Celebrex And Prexige.
• Basic anti-inflammatory drugs. An important treatment option is early intensive treatment with DMARDs. These drugs reduce the deterioration of the joint and neutralize the potential harm from x-rays. The drugs used are methotrexate, chloroquine, sulfasalazine. A treatment method with TNF antagonists is also being developed ( tumor necrosis factors). IN this moment This therapy is very expensive and is used infrequently.
• Cortisone. Low doses of cortisone drugs have a beneficial effect on the inflammatory process, especially in the period before the prescription of DMARDs. However, the side effects of the drug preclude its long-term use. Injections intramuscularly or directly into a joint can “extinguish” local inflammation, and large doses of cortisone can be life-saving in extreme cases, such as the development of systemic disease and involvement of other organs.

Surgery

The goal of surgical treatment of rheumatoid arthritis is to restore the function of the organ, since the indication for surgery is precisely the severe limitation of the flexion ability of the joint. Synovectomy ( excision of the synovium of the joint) can relieve the patient of unpleasant symptoms for a long time, and in case of destruction and deformation of the joint, endoprosthetics can be used. Doctors are especially successful in replacing knee and hip joints.

Conclusion

It is difficult to predict the outcome of rheumatoid arthritis, a disease that has many variations and complications. But, as a rule, if remission occurs within 3 to 6 months, then the prognosis for the next few years is most often favorable. It is also of great importance early start treatment. Most people with rheumatoid arthritis experience periods of worsening and bettering of the condition, with variable joint deformity. The disease develops most strongly within 2 to 6 years, but effective remission can be achieved if treatment is started in the first year of the disease.

The average life expectancy of people with rheumatoid arthritis decreases slightly, and with a properly selected course of medication, the quality of life is no different from the quality of life of a healthy person.

You should consult a doctor if:

• You experience constant fatigue and poor appetite, and there is a family history of rheumatoid arthritis.
• You already have rheumatoid arthritis and are experiencing worsening symptoms ( pain, joint swelling, limitation of movement).
• You are being treated with basic anti-inflammatory drugs and feel pain in the stomach, there have been cases of black stools and vomiting blood.
• You are taking medications to treat rheumatoid arthritis, but you still have pain, limited movement, and swelling in your joints.

• Don't be afraid to get a specialist's opinion.
• Find out more about the medications you may need to take.
• Remember, the diagnosis is made in the clinic, and not in the laboratory or x-ray room.
• The most important specialist for you is a rheumatologist, not a surgeon.
• Remission of the disease is the goal of treatment - don't settle for less.
• A positive psychological attitude is no less important than a properly selected treatment program.

What is rheumatoid arthritis? It is a disease that causes inflammation and pain in the joints, leading to disruption of their normal mobility. As the disease progresses, the synovial membrane that lines the joint capsule, then the process moves to the intra-articular tissues, resulting in ankylosis (complete immobility of the joint). On initial stages pathology, the symptoms of rheumatoid arthritis may resemble polyarthritis, but in its etiology the disease differs from other diseases of the skeletal system that have similar symptoms. The fact that this is an independent disease is confirmed by the presence of a separate code for rheumatoid arthritis according to ICD 10. Rheumatoid arthritis of the joints affects both children and adults, but is four times more common in women than in men. There were no significant differences in the symptoms and course of the disease by gender - in both cases the disease develops in the same way, and the same can be said about the methods of treatment.

Causes and symptoms

Rheumatoid arthritis is a chronic articular pathology that causes erosive and destructive processes in the connective and intra-articular tissues of the bone apparatus, which is irreversible. According to ICD 10 (tenth version of the International Classification of Diseases) there are the following types pathologies:

• M05 is a seropositive form in which rheumatoid factor is present in the patient’s blood. The development of the disease occurs gradually;
• M06 is a seronegative type, occurring in approximately 20% of cases, when the presence of rheumatoid factor is not observed, and the disease develops quite quickly;
• M08 – so-called juvenile or juvenile rheumatoid arthritis.

Rheumatoid arthritis of the joints is diagnosed in approximately two percent of the population of European countries, including Russia. Most often, the disease affects the small joints of the fingers and toes, and the large ones - the wrist, elbow, shoulder, ankle and knee. Damage to the hip joints and spine in rheumatoid arthritis occurs much less frequently - this usually characterizes the last stage of the disease.

The main cause of rheumatoid arthritis is a malfunction of the immune system. The body fights its own cells as if they were foreign. Therefore, chronic rheumatoid arthritis belongs to a group of autoimmune diseases in which the immune system destroys tissue instead of protecting it. In this case, joints are no exception.

The impetus for the development of rheumatoid arthritis can be:

• Allergic reaction;
• Past infectious disease - rubella, herpes, various types of hepatitis and other pathologies;
• Surgical intervention.

Also risk factors are severe physical labor and severe hypothermia. The immune system is forced to sharply intensify its activity, and as a result of hard work, the immune system ceases to distinguish its own from someone else's.

With age, the immune status decreases and begins to malfunction, which is caused by natural causes, therefore, rheumatoid arthritis in adults, or rather, in older people, appears much more often than in children and youth.

It is important to distinguish rheumatoid arthritis from other joint diseases as early as possible, since the main danger of pathology in the absence of timely treatment is the development severe complications and damage to internal organs (heart and kidneys). Experts include the first symptoms of rheumatoid arthritis, which allow one to suspect the development of this particular pathology:

• The development of the pathological process usually begins with small joints on the toes. The pain intensifies when pressing on the fingertips. Subsequently, inflammation spreads to large joints. One of the characteristic signs of pathology is the symmetry of the lesion, i.e. paired joints hurt at the same time: both knees or both ankles;
• In the morning hours, there is severe stiffness in movements: before getting out of bed, it takes considerable time to develop the joints;
• Patient complaints about pain symptoms, the severity of which depends on the stage of rheumatoid arthritis and the individual characteristics of the patient’s body - the threshold of sensitivity to pain is different for all people. The nature of the pain is aching, attacks are of moderate strength, but of significant duration, and exhaust the patient with their constancy. The pain reaches its peak at night and in the morning. In the afternoon it may subside until it disappears completely, but returns in the evening;
• An itchy rash appears on the surface of the skin in the area of ​​diseased joints, rolling nodules form under the skin - round painless compactions from 2-3 mm to 2-3 cm in diameter, which can disappear and reappear;
• A febrile state occurs periodically and relatively slight increase body temperature not due to any external reasons;

All these symptoms can be attributed to systemic manifestations rheumatoid arthritis. Also, the early stage is characterized by signs of general intoxication of the body: weight loss, weakness, lethargy, sweating, muscle pain, which is why patients often confuse the disease with pathologies of an infectious nature.

Having discovered one or more signs of rheumatoid arthritis, a person needs to consult a specialist as soon as possible and undergo a detailed examination. The sooner a patient begins systematic treatment of rheumatoid arthritis of the joints, the higher his chances of achieving, if not recovery (as already mentioned, degenerative processes are irreversible), then long-term stable remission, allowing to avoid the development of complications and normal image life.

Diagnosis and classification

A complete diagnosis of rheumatoid arthritis is only possible using a set of diagnostic techniques. Put primary diagnosis rheumatoid arthritis, the doctor is helped by an external examination and questioning of the patient, studying the anamnesis (previous diseases) of the patient himself and his immediate relatives, since the disease is quite often hereditary, affecting representatives of the same family.

To clarify the diagnosis, the following studies are carried out:

• General and biochemical blood tests;
• X-ray.

Blood tests for rheumatoid arthritis show a decrease in hemoglobin levels, a decrease in the number of red blood cells and platelets, and an increase in the erythrocyte sedimentation rate (ESR). The concentration of so-called C-reactive protein and gammaglobulin in the blood increases. All these signs indicate the presence of an inflammatory process in the body.

The fact that it was caused by rheumatoid arthritis of the joints is clearly confirmed by the presence of rheumatoid factor in the blood, which is a special substance that promotes the destruction of joint tissue. It is produced by the body in response to a request from the immune system, which mistakenly perceives joint cells as foreign. The degree of concentration of this substance indicates the stage of development of the disease: the deeper pathological processes, the higher the level of this indicator.

But with a seronegative type of rheumatoid arthritis, rheumatoid factor may be absent in the blood. Therefore, the decisive word in establishing a diagnosis belongs to fluoroscopy, which gives the doctor the opportunity to obtain a visual representation of the processes occurring in the affected joints. The classification of rheumatoid arthritis by stage is also based on X-ray data.

The first stage can be diagnosed by:

• Bone thinning;
• Thickening and compaction of soft tissues;
• Signs of periarticular osteoporosis;
• Cysts that appear on the image as clearing of bone tissue.

A characteristic feature of the first stage is the degree of activity of rheumatoid arthritis. The disease may progress slowly, starting in adolescence or even childhood(the so-called juvenile rheumatoid arthritis), but develops to its full extent only in adulthood. But another option is also possible, in which the disease takes off rapidly immediately after its occurrence.

In the second stage, bone erosion begins to develop. At first it is localized near the cartilaginous layer, gradually capturing deeper layers. Deformation of the cartilage itself is not visible at this stage, but changes in soft tissues and First stage atrophy of the muscles attached to the affected parts of the bone apparatus, which can be attributed to extra-articular manifestations of rheumatoid arthritis. Swelling appears in the area of ​​the synovial bursa, the joints swell, and patients complain of pain and aches.

The progression of bone erosion signals the approach of the third stage, at which the deformation of the joint becomes clearly visible on the image, the synovial tissues become denser, which leads to limited mobility. Muscle atrophy progresses. Accelerated calcification begins - the deposition of salts on the surface of the joint. Calcifications have different densities in different areas of the bone.

The fourth, or advanced stage of rheumatoid arthritis is characterized by severe osteoporosis. Articular syndrome in rheumatoid arthritis in the fourth stage leads to narrowing/fusion of interarticular spaces, bone deformation, multiple erosions and cysts. In this form, the curvature of the bones is clearly visible not only on an x-ray, but also on a regular photo of rheumatoid arthritis (see above).

Attention!

Spontaneous remission of rheumatoid arthritis without the use of medications is possible. But the vast majority of patients do not have to seriously count on self-healing - the disease requires persistent systematic treatment.

Therapeutic techniques

When starting treatment for rheumatoid arthritis of the joints, modern medicine For this purpose, it involves the use of drugs from the so-called basic group, which act on the main causes of the disease.

Traditional therapy

Basic therapy includes drugs of five groups:

• Gold salts;
• Immunosuppressants;
• Antimalarial;
• Sulfonamides;
• D-penicillamine.

Aurotherapy (gold therapy) is most effective for acute rheumatoid arthritis. If used at an early stage, they can significantly slow down the development of the disease, therefore they are often used in the treatment of children and adolescents. Gold salts also have a positive effect on related ailments: they suppress the development of fungal microflora and Helicobacter - the culprits in the development of gastritis and stomach ulcers. They can be used in the treatment of patients with cancer.

A complication of aurotherapy is golden dermatitis - skin rashes in the form of spots and blisters, the appearance of which is accompanied by severe itching. In most cases, they disappear quickly after stopping the drug, but sometimes they do not go away for months. Therefore, when taking gold preparations, you need to carefully monitor the condition of the body.

Immunosuppressants, or cytostatics, reduce the level of immune response, helping to reduce its destructive power in the fight against one’s own body. Many patients are afraid of the word “immunosuppressant”, fearing to be left without immune protection altogether, as happens in oncology. But the doses of drugs for rheumatoid arthritis are incomparable with those used in anticancer therapy, and therefore cannot lead to a similar effect.

Antimalarial drugs were actively used in the treatment of rheumatoid arthritis in the middle of the last century, when the arsenal of medicine did not have most of the modern pharmacological drugs against this disease. Now they are used much less frequently, and only for indolent forms, when there is no need for intensive care.

Sulfonamides do not act as quickly as immunosuppressants, which occupy first place in the “hit parade” of antirheumatoid drugs. They are favored by good tolerability, minimal side effects and low price.

D-penicillamine causes unwanted side effects in half of cases of seropositive rheumatoid arthritis and up to one third of cases of seronegative rheumatoid arthritis. But if the doctor has no choice. he uses this drug as last resort fighting rheumatoid arthritis when none of the others gave the expected effect.

Folk remedies

Many patients, along with pharmacological ones, use folk remedies to treat rheumatoid arthritis. Herbal healers recommend the following recipes:

Wrapping sore joints with fresh leaves of burdock, coltsfoot or cabbage softens joint pain and reduces inflammation;

Liquid ointment has the same properties, which can be prepared from the yolk of a raw chicken egg (preferably homemade), adding to it a teaspoon of turpentine and apple cider vinegar and mixing thoroughly. Lubricate your joints with it better evening before going to bed;

Another recipe for a healing balm includes two glasses of freshly squeezed black radish juice, half a glass of vodka and half a glass of honey (add the ingredients one at a time, mixing thoroughly). Add a tablespoon of table salt to the resulting mixture and stir until completely dissolved. The product must be stored in the refrigerator, poured in small portions as needed and heated in a water bath. After rubbing the balm into the joints, they must be covered warmly.

Folk remedies are used as a complement to traditional drug therapy, but do not replace it. They can be applied to the surface of the skin only if there are no microtraumas on it - abrasions, abrasions, scratches.

Experts divide prevention of rheumatoid arthritis into:

• Primary – helping to prevent the development of the disease;
• Secondary – helping to avoid its exacerbations.

Primary prevention involves minimizing the threat of infectious colds, timely sanitation of foci of chronic inflammation and infection (caries, sinusitis, etc.), strengthening the immune system, hardening, a healthy lifestyle, good nutrition. refusal bad habits. To prevent exacerbations, you should also avoid infectious diseases, limit physical activity, avoid hypothermia, follow a diet, reducing the consumption of foods such as pasta and white bread, sweets, coffee.

It is important to carefully follow the instructions of doctors regarding sleep, work and rest, and also not to violate the schedule of taking the medications they prescribe. Under such conditions, the chances of long-term remission, allowing the patient to maintain working capacity and familiar image life is quite high.