Symptoms and treatment of rheumatoid arthritis. Classification of rheumatoid arthritis - joint damage Relief of pain and inflammation in the joints

Today, rheumatoid arthritis is considered to be an autoimmune disease that predominantly affects the small joints of the hands. Over time, this pathology leads to deformation of the bone tissue and dysfunction of the hand.
According to statistics, pathology occurs in 0.8% of the population, while it is much more often diagnosed in women. There is also an increase in the number of cases in the age category after 50 years.

What are the causes of this disease?

The exact causes of rheumatoid arthritis are still not known. A role in the development of the pathology of some infections is assumed: mycoplasma, Epstein-Barr virus, cytomegalovirus, rubella virus. The infection causes chronic damage to the synovium of the joint. Subsequently, this leads to the formation of new antigens on its inner surface, the so-called autoimmune inflammation develops.

The next stage in the development of the disease is the direct damage to the joints themselves with characteristic signs.

What is the clinic for rheumatoid arthritis?

The onset of the disease, as a rule, has no specific symptoms. The patient may experience general weakness, fatigue, subfebrile temperature, pain in small and large joints for several months. Very rarely, in 10% of cases, there is a rapid onset of the disease with high fever, swollen lymph nodes.

The next stage in the development of the disease is the direct damage to the joints themselves with characteristic signs:
1. Pain that gets worse with movement
2. Swelling and soreness of tissues around the joint
3. Stiffness in the joints, especially in the morning, for at least an hour
4. Local temperature increase, especially for large joints

What joints are affected in rheumatoid arthritis?

Basically, there is localization on the hands. Moreover, the lesion is always selective, the proximal interphalangeal and metacarpophalangeal joints are much more often involved. But the inflammatory process in the distal interphalangeal joints is observed much less frequently.
In addition, other joints of the upper extremities can be affected in parallel: wrist, elbow. On the lower extremities, these are most often the knee, ankle, and metatarsal joints.

The next stage in the development of rheumatoid arthritis is the appearance of deformities of the affected areas of the limbs. On the hands, they deviate to the radial side, and the fingers to the elbow, the so-called Z-shaped deformation. It is characterized by limited mobility of the thumb, which makes it impossible for the patient to grasp small objects.

Many patients also have extra-articular manifestations of the disease. These include: damage to the heart, lungs, pleura, the development of muscle atrophy, rheumatoid nodules. Rheumatoid nodules are small painless seals located around the affected joint and do not cause concern to the main patient.

Methods for diagnosing the disease

Today, the diagnostic method is the initial examination of the patient and the identification of characteristic clinical signs of the disease. Of the additional studies, the following have been used:
1. Radiography of the joints
2. MRI of the hands
3. Detection of elevated titers of rheumatoid factor during biochemical examination
4. Antibodies to cyclic citrullinated peptide, it is the most specific indicator of rheumatoid arthritis.

Treatment of rheumatoid arthritis

The first group of drugs used to treat rheumatoid arthritis are non-steroidal anti-inflammatory drugs (NSAIDs). They quickly eliminate inflammation in the joints, relieve pain, but, unfortunately, do not stop progressing diseases.

The second group is glucocorticoid hormones. They are used in small doses, fractionally. A positive point in their use is that they slow down the progression of the disease, in particular the formation of bone destruction. There are also methods for their intraarticular administration.

Drugs that affect the immune stages of inflammation in the joints are also used. These include immunosuppressants, cytostatics, gold preparations, sulfasalazine and others. You need to take them for a long time, many of them have a number of serious side effects.

Treatment of rheumatoid arthritis is aimed at minimizing symptoms: reducing inflammation and pain, restoring joint function, and preventing damage and deformity. Choosing how to treat diseases, the rheumatologist focuses on the degree of activity of the process, the location of the affected foci, the general state of health and the age of the patient. Treatment of rheumatic disease should prevent complications from the heart, eyes, blood vessels, skin, so it is important to see a doctor in time.

Of the recently proposed methods of treatment, methods of extracorporeal hemocorrection are used. These are technologies of autoplasma cryomodification and cell mass incubation with immunomodulators. Their essence is to take blood from a patient and extract autoimmune complexes from it. The processed blood plasma is then returned to the patient.

In each specific case of rheumatoid arthritis, a whole range of therapeutic measures is carried out. It depends on the severity of the disease, the stage of development, the presence of concomitant lesions of the internal organs. Only a specialist rheumatologist will be able to correctly prescribe a treatment regimen that can reduce the manifestations of the disease and its progression.

The whole truth about: rheumatoid arthritis of the joints and other interesting information about the treatment.

Rheumatoid arthritis is a systemic disease of unknown etiology with a widespread lesion of the connective tissue, mainly in the joints, with erosive changes in them, with a chronic, often relapsing and progressive course. The trigger mechanism can be an infectious focus, a cold, an injury.

The pathological process leads to the complete destruction of the articular tissues, to gross deformities and the development of ankylosis, which leads to loss of joint function and disability.

In severe cases, internal organs (heart, kidneys, lungs, blood vessels, muscles, etc.) can also be affected, which significantly worsens the prognosis for rheumatoid arthritis. Symptoms, diagnosis and methods of treatment of which we will analyze in detail in this article.

The prevalence of rheumatoid arthritis among the adult population of various climatic and geographical zones averages 0.6 - 1.3%. The annual incidence over the past decade remains at the level of 0.02%.

An increase in rheumatoid arthritis with age was noted, more women than men get sick. Among people younger than 35 years, the prevalence of the disease is 0.38%, at the age of 55 years and older - 1.4%. A high incidence of the disease was found in relatives of patients in the first degree of kinship (3.5%), especially in females (5.1%).

What is it: causes

Why does rheumatoid arthritis occur and what is it? Arthritis rheumatoid refers to autoimmune diseases, that is, diseases that occur when the normal functioning of the immune system is disrupted. As with most autoimmune pathologies, the exact cause of the disease has not been identified.

It is believed that provoking factors for the onset of the disease are:

1. Genetic predisposition - in close relatives of patients with rheumatoid arthritis, this disease develops much more often.
2. Infections - often arthritis occurs after measles, herpes infection, hepatitis B, mumps.
3. Adverse factors of the external and internal environment - hypothermia, exposure to toxic products, including occupational hazards, stress, as well as pregnancy, breastfeeding, menopause.

Under the influence of these factors, the cells of the immune system begin to attack the cells of the lining of the joint, which causes inflammation in them. As a result of this process, the joints become swollen, warm, and painful to the touch. Cells of the immune system also cause damage to blood vessels, which explains the so-called extra-articular symptoms of rheumatoid arthritis.

Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis (Still's disease) is an inflammatory disease of the joints, it is characterized by a progressive course with a fairly rapid involvement of internal organs in the process. For every 100,000 children, this disease occurs in 5-15 people.

There is an ailment in children under 16 years of age and can last for many years. The appearance of the disease can be the result of various influences - viral and bacterial effects, cooling, drugs, increased sensitivity to certain environmental factors, and many others.

First signs

Rheumatoid arthritis can begin acutely and subacutely, with the latter variant of the debut observed in most cases.

The first signs of RA:

• chronic fatigue;
• persistent muscle weakness;
• weight loss;
• the appearance of pain in the muscles for no apparent reason;
• sudden and causeless jumps in temperature to subfebrile level (37-38ºС);
• increased sweating.

As a rule, such manifestations of the disease are ignored, then articular syndrome and extra-articular manifestations of the disease develop.

Symptoms of rheumatoid arthritis: joint damage

In the case of rheumatoid arthritis, when studying the patient's complaints, special attention is paid to such symptoms:

1. Pain in the joints, their nature (aching, gnawing), intensity (strong, moderate, weak), duration (periodic, constant), connection with movement;
2. Morning stiffness in the joints, its duration;
3. The appearance of the joints (swelling, redness, deformities);
4. Persistent limitation of joint mobility.

In a patient with rheumatoid arthritis, other symptoms can also be noted:

1. Hyperemia of the skin over inflamed joints;
2. Atrophy of adjacent muscles;
3. With subluxations in the proximal interphalangeal joints, the hand looks like a “swan neck”, with subluxations in the metacarpophalangeal joints - “walrus flippers”.

On palpation, you can find: an increase in skin temperature above the surface of the joints; soreness of the affected joints; symptom of "lateral compression"; muscle atrophy and skin thickening; subcutaneous formations in the area of ​​\u200b\u200bthe joints, more often than the elbows, the so-called rheumatoid nodules; a symptom of balloting the patella to determine the presence of fluid in the knee joint.

Depending on clinical and laboratory data, there are 3 degrees of exacerbation of RA:

1. Low (pain in the joints is assessed by the patient no more than 3 points on a 10-point scale, morning stiffness lasts 30-60 minutes, ESR 15-30 mm/hour, CRP - 2 plus);
2. Average (pain - 4-6 points, stiffness in the joints up to 12 hours after sleep, ESR - 30-45 mm / h, CRP - 3 pluses);
3. High (pain - 6-10 points, stiffness is observed throughout the day, ESR - more than 45 mm / h, CRP - 4 plus).

With RA, peripheral joints are primarily affected, but we must not forget that this is a systemic disease, and any organs and tissues where connective tissue is present can be drawn into the pathological process.

Extra-articular symptoms in rheumatoid arthritis

The development of extra-articular (systemic) manifestations is more typical for the seropositive form of rheumatoid arthritis of severe long-term course.

1. Damage to the muscles is manifested by atrophy, a decrease in muscle strength and tone, and focal myositis.
2. Skin lesions are manifested by dryness, thinning of the skin, subcutaneous hemorrhages and small-focal necrosis.
3. Violation of the blood supply to the nail plates leads to their fragility, striation and degeneration.
4. The presence of rheumatoid nodules - subcutaneously located connective tissue nodules with a diameter of 0.5-2 cm. Characterized by a rounded shape, dense texture, mobility, painlessness, less often - immobility due to adhesion with aponeurosis.
   The presence of rheumatoid vasculitis, which occurs in 10-20% of cases.

The most severe course of rheumatoid arthritis is characterized by forms that occur with lymphadenopathy, lesions of the gastrointestinal tract (enetritis, colitis, amyloidosis of the rectal mucosa), nervous system (neuropathy, polyneuritis, functional autonomic disorders), involvement of the respiratory organs (pleurisy, diffuse fibrosis, pneumonitis, fibrosing alveolitis , bronchiolitis), kidneys (glomerulonephritis, amyloidosis), eyes.

On the part of the main vessels and the heart in rheumatoid arthritis, endocarditis, pericarditis, myocarditis, arteritis of the coronary vessels, granulomatous aortitis can occur.

Complications

• pathologies of the cardiovascular system;
• dysfunction of the nervous system;
• blood diseases;
• respiratory system damage;
• kidney disease;
• damage to the joints and the musculoskeletal system;
• skin lesions;
• eye diseases;
• dysfunction of the gastrointestinal tract;
• mental disorders;
• other pathologies.

How to distinguish RA from other diseases?

Unlike rheumatism, in rheumatoid arthritis inflammation is persistent - pain and swelling of the joints can last for years. This type of arthritis differs from arthrosis in that the pain does not increase with exertion, but, on the contrary, decreases after active movements.

Diagnostics

American Rheumatological Association Diagnosis Criteria for Rheumatoid Arthritis (1987). The presence of at least 4 of the following signs may indicate the presence of the disease:

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

A blood test shows the presence of inflammation in the body: the appearance of specific inflammatory proteins - seromucoid, fibrinogen, C-reactive protein, and rheumatoid factor.

The diagnosis of rheumatoid arthritis is possible only by assessing the totality of symptoms, radiological signs and laboratory diagnostic results. With a positive result, treatment is prescribed.

Treatment of rheumatoid arthritis

In the case of an accurate diagnosis of rheumatoid arthritis, systemic treatment involves the use of certain groups of drugs:

• non-steroidal anti-inflammatory substances;
• basic preparations;
• hormonal substances (glucocorticoids);
• biological agents.

At the present stage of development of medicine, the following goals are set for the treatment of rheumatoid arthritis:

• reduction and, if possible, elimination of the symptoms of the disease,
• prevention of destruction of joint tissues, disruption of its functions, development of deformities and adhesions (ankylosis),
• achieving a stable and long-term improvement in the condition of patients,
• increase in life span,
• improvement in the quality of life.

Treatment consists of a complex of methods of drug therapy, physiotherapy, clinical nutrition, surgical treatment, spa treatment and subsequent rehabilitation.

Non-steroidal anti-inflammatory drugs

This group of drugs is not included in the basic therapy of rheumatoid arthritis, since it does not affect the destructive process in the joints. However, drugs from this group are prescribed to reduce pain and eliminate stiffness.
in the joints.

Most often used:

• diclofenac;
• ibuprofen;
• nimesil;
• movalis;
• indomethacin;

They are prescribed during the period of exacerbation of pain and severe stiffness. With caution are prescribed to patients with gastritis.

Basic preparations

In combination with hormones, they help reduce the activity of rheumatoid arthritis. The most common drugs for treatment currently are:

• preparations of gold;
• methotrexate;
• leflunomide;
• penicillamine;
• sulfasalazine.

There are also reserve drugs: cyclophosphamide, azathioprine, cyclosporine - they are used when the main drugs did not give the desired effect.

Biological agents

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

There are also studies suggesting the use of lymphocyte differentiation regulators as a treatment for rheumatoid arthritis. This will avoid damage to the synovial membranes by T-lymphocytes, which are incorrectly “directed” to the joints by the immune system.

Glucocorticoids

These are hormonal drugs:

• prednisolone;
• dexamethasone;
• methylprednisolone;
• triamcinolol;

They are prescribed both in the presence of systemic manifestations of the disease, and in their absence. Today, in the treatment of rheumatoid arthritis, treatment is practiced with both small and large doses of hormones (pulse therapy). Corticosteroids are great for pain relief.

methotrexate for rheumatoid arthritis

According to reviews, methotrexate for rheumatoid arthritis is actively prescribed in Russia and European countries. This is a drug that inhibits the cells of the immune system, prevents the occurrence of inflammatory processes in the joints and aggravation of the course of the disease. Now it is used very widely.

The drug has several side effects, therefore it is used under the close supervision of the attending physician, during the course of treatment the patient must regularly take blood tests. Despite this, methotrexate for rheumatoid arthritis is the most appropriate solution, in some cases it is simply irreplaceable.

The price of the drug varies depending on the form of release in the range from 200 to 1000 rubles.

Physiotherapy

Only after the acute form of the disease is removed, blood tests and temperature return to normal - you can apply massage and other methods of physiotherapy for rheumatoid arthritis. The fact is that physiotherapy has a stimulating effect and can enhance the inflammatory process.

These methods improve the blood supply to the joints, increase their mobility, and reduce deformity. Phonophoresis, diathermy, UHF, ozocerite and paraffin, infrared irradiation, therapeutic mud, balneotherapy in resorts are used. We will not dwell on these methods in detail.

Operation

Surgery can correct the health situation in the relatively early stages of the disease if one large joint (knee or wrist) is constantly inflamed. During this operation (synovectomy), the synovium of the joint is removed, resulting in long-term relief of symptoms.

Joint replacement surgery is performed for patients with more severe joint damage. The most successful are hip and knee surgeries.

Surgical intervention pursues the following goals:

• relieve pain
• correct deformities
• improve the functional state of the joints.

Rheumatoid arthritis is primarily a medical problem. Therefore, surgery is prescribed for those who are under the supervision of an experienced rheumatologist or doctor.

Food

The rules of the diet are as follows:

• including enough fruits and vegetables;
• reducing the load on the kidneys, liver and stomach;
• exclusion of products that cause allergies;
• replacing meat with dairy and vegetable products;
• consumption of foods high in calcium;
• refusal of food that causes excess weight.

Rheumatoid arthritis treatment with folk remedies

Treatment with folk remedies involves the use of medicinal plants with analgesic and anti-inflammatory properties.

1. To relieve pain in rheumatoid arthritis, you should take equally elder flowers, parsley root, stinging nettle leaf and willow bark. Grind everything, and then brew 1 tablespoon of the collection with 1 glass of boiling water, then boil for 5-7 minutes on low heat, then cool and strain. Take two glasses of decoction, morning and evening.
2. The flowers collected during the flowering of the chestnut are poured with high-quality vodka (for two parts of the flowers you need to take one part of vodka). The mixture is infused for two weeks in a dark place, filtered and after that the tincture is ready for use. You need to take tincture 5 drops three times a day one hour before meals.
3. In one hundred grams of alcohol, 50 grams of camphor oil are dissolved and 50 grams of mustard powder are added. Protein from two eggs is beaten separately and added to the mixture. The resulting ointment is rubbed into the affected joint and relieves pain symptoms well.
4. Burdock will help relieve joint pain. It can be used in the form of tinctures. We grind the leaves of the plant in a meat grinder and fill it with vodka (500 ml of vodka for 500 g of leaves). Shake the mixture and put in the refrigerator. At night, we apply gauze abundantly soaked in this solution to the sore spot. Pain after a few compresses passes. Treatment of rheumatoid arthritis with folk remedies can also be carried out using wraps at night with whole burdock leaves.

At home, you can make compresses, rub home-made ointments, and prepare decoctions. It is important to follow the right style of nutrition, which contributes to the restoration of metabolism in the body.

Prevention

Prevention of the disease and its exacerbations is aimed primarily at eliminating risk factors (stress, smoking, toxins), normalizing body weight and maintaining a balanced diet.

Compliance with these rules will help to avoid disability and prevent the rapid progression of RA.

Forecast

Rheumatoid arthritis reduces life expectancy by an average of 3 to 12 years. A 2005 study by the Mayo Clinic found that those with rheumatoid arthritis were twice as likely to have heart disease, independent of other risk factors such as diabetes, alcoholism, high cholesterol, and obesity.

The mechanism by which the risk of heart disease increases is unknown; the presence of chronic inflammation is considered a significant factor. Perhaps the use of new biological drugs can increase life expectancy and reduce risks for the cardiovascular system, as well as slow down the development of atherosclerosis.

Limited studies show a reduction in the risk of cardiovascular disease, while there is an increase in total cholesterol levels with an unchanged atherogenic index.

Joint disease is one of the most common health problems in people over the age of 50 today. Rheumatoid arthritis of the knee, the symptoms and treatment of which are known to doctors, is an autoimmune pathology that affects even children, unlike other joint disorders. With a disease, the body's immune system begins to perceive the joint cells as pathological and fights them, which is why inflammation occurs. The knee joints are affected in most cases symmetrically.

Provoking factors

Rheumatoid arthritis occurs in humans due to a malfunction of the immune system.

The following factors can give impetus to the development of pathology:

• severe allergic reaction - especially often causes a problem in children;
• serious metabolic disorders;
• severe infectious diseases;
• traumatic lesions of the joints, in which there was severe inflammation;
• severe form of psoriasis;
• severe purulent processes in the body;
• systemic autoimmune diseases.

Whatever causes the pathology, it has a chronic course, and all therapy is aimed only at eliminating the symptoms and reducing the rate of progression of the disease. According to statistics, pathology is more common in women than in men, and it first appears at a young age. The disease in women is especially difficult and leads to serious complications.

Symptoms of rheumatoid arthritis in women and men

Rheumatoid arthritis in women has more intense symptoms than in men. It is rather difficult to confuse a pathology with the symptoms of another disease, and therefore a doctor, even before conducting tests, can make a preliminary diagnosis quite easily. The disease tends to affect the joints symmetrically, and therefore, after the knee joint has begun to collapse on one side, the pathology develops in the second knee. It can also develop disorders in both knees at the same time.

The main signs of pathology:

• in the morning, stiffness is noted in the diseased joint, which completely disappears after 2-3 hours of activity;
• knee pain after strenuous exercise. With a strong destruction of the articular tissues, pain of pronounced intensity appears from the second half of the night and, reaching a peak in the morning, persists until lunch. By evening, the pain disappears;
• severe weakness in the diseased joint - disrupts its normal operation and prevents full movement;
• swelling of the lymph nodes - at first located as close as possible to the knee, and then regional ones;
• an increase in temperature to insignificant indicators at the time of an exacerbation of the disease and its complete normalization during periods of remission;
• deterioration in the quality of sleep due to pain;
• change in taste preferences.

As the disease progresses, the symptoms intensify, and in moments of exacerbation, the patient's condition seriously worsens. Gradually, other joints, as well as the cardiovascular system, are involved in the pathological process. This process is especially rapid if there is no therapy.

With the advanced form of the disease, all manifestations of the pathology are divided into local and general.

Direction of treatment

Therapy for the disease is aimed at four main goals, without which it is impossible to remove the exacerbation and start maintenance treatment.

1. Removal of inflammation. Until the condition is started, nonsteroidal drugs are used. If they are ineffective, then hormonal agents may be required to relieve inflammation.
2. Reduced stress on the joint. For this, knee pads are used, which additionally also fix the knee, preventing joint deformity against the background of pathological changes.
3. Removal of edema and restoration of mobility of the diseased joint. In addition to medicines and physiotherapy, physiotherapy exercises are used for this.
4. Restoration of damaged tissues and a decrease in the activity of a pathologically altered immune system.

Even if one of the stages of treatment is skipped, it is impossible to restore the normal state of the patient.

How is rheumatoid arthritis of the knee treated?

Treatment of the disease is complex. It is carried out constantly in order to maintain a satisfactory condition of the knee joint and prevent the progression of pathology.

The therapy includes the following elements:

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• wearing a special splint or other orthopedic devices that support the joint;
• physiotherapy exercises, the complex of which is selected individually;
• the use of physiotherapy procedures, including therapeutic baths;
• regular massage courses;
• taking medications.

What kind of therapeutic measures will be carried out, the attending physician determines, depending on how severe the damage to the joint occurs.

Modern medicines

In the treatment of the disease, 4 types of medicines are prescribed:

• non-steroidal anti-inflammatory drugs;
• painkillers;
• chondroprotectors - prescribe the latest generation of drugs that have a minimal burden on the stomach and are most effective in relation to diseased joints;
• glucocorticosteroid drugs.

If bacterial damage to the joints also joins the inflammation, a course of antibiotic treatment is carried out.

In severe cases, resort to surgical intervention. The decision on how the therapy will be carried out is made by the doctor, depending on the degree of damage. Each case is individual, and therefore the therapy of each patient takes place according to a special scheme.

The main drugs that are used to treat pathology are shown in the table.

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Specific drugs will be prescribed by the doctor depending on the general condition of the patient and whether there are other chronic diseases. Immunosuppressants can also be used - drugs to reduce the activity of immunity, which helps to reduce the intensity of the attack of leukocytes on joint cells. Such drugs are used very carefully so as not to cause a severe drop in immunity, which poses a serious threat to the body as a whole.

Massage during treatment

Massage for rheumatoid arthritis is necessary in order to improve blood circulation and tissue nutrition. The procedure also helps to normalize the outflow of lymph and relieve swelling. Initially, a massage course is carried out by a specialist after the removal of acute inflammation. Further, the patient is recommended to conduct regular self-massage with the use of ointments and creams for the joints. It should be done in a circular motion, starting from the lateral surfaces of the knee, then under it, and then along the outer part of the knee.

The leg during the procedure should be in a horizontal position so that there is no stagnation of blood and lymph. Massage should be done daily before going to bed, and if possible, then in the morning. Such treatment is contraindicated if there are open wounds in the knee area, the cartilage is seriously deformed, and the disease is in a state of exacerbation. Massage for rheumatoid arthritis gives results only if it is done in courses.

Exercises to treat rheumatoid arthritis of the knee

Therapeutic exercise helps to prevent deformity of the joints and the development in a short time of a serious deterioration in their mobility. Properly selected set of exercises prevents exacerbation of the disease. In addition to therapeutic exercises, swimming is useful, which has a beneficial effect on all metabolic processes in the body.

Gymnastics for rheumatoid arthritis of the knee joint is carried out strictly according to medical indications. Patients are prohibited from introducing new exercises at their own discretion without the consent of the doctor to prevent deterioration of the condition. It is also impossible to carry out exercise therapy if there are violations in the work of the cardiovascular system. A number of chronic pathologies of internal organs is also a contraindication to therapeutic exercises.

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When performing exercise therapy, a number of rules should be followed.

• The load is increased gradually. Initially, the exercises are carried out with minimal impact, which gradually increases.
• There should be no acute pain during exercise.
• Unpleasant sensations in a sore knee after gymnastics can last no more than 15 minutes. If they last longer, then this indicates an excessive load during classes or improperly selected exercises. This situation should be reported to the attending physician immediately.
• Exercise for rheumatoid arthritis should be done at the same time every day. You can skip gymnastics only for medical reasons, and for women - on the days of menstruation and premenstrual syndrome.

During the period of remission of the disease, the load during gymnastics with rheumatoid arthritis should be maximum.

Folk methods of treatment

Folk remedies can be used in parallel with the main treatment to relieve symptoms. As the main therapy for rheumatoid lesions of the knee joint, such agents cannot be used. They will not give the proper result and will not stop the development of the disease, but at the same time they will lubricate the symptoms for some period, due to which timely and correct treatment will be delayed. As a result, rheumatoid arthritis will continue to develop, and the cardiovascular system will be involved in the pathological process.

The following recipes are considered the best folk remedies.

1. Raw potato compress for pain relief. Such a remedy helps with an exacerbation of the disease, for a number of patients completely replacing analgesics. For procedure 2, large potatoes are washed off the ground and grated. Further, having placed in a colander, the mass is dipped in boiling water for 3 seconds and then, after letting it drain a little, spread it on gauze folded 4 times. Potatoes are covered with a layer of gauze and applied to the knee. From above it is covered with polyethylene and insulated with a woolen scarf. It is necessary to do such a compress all night for at least 7 days in a row.
2. Compresses with 9% vinegar. This measure allows you to relieve pain and reduce swelling of the joint. For treatment, a tablespoon of vinegar is dissolved in 2 cups of boiling water and, after wetting a cloth in the solution, apply it to the sore spot. Next, the knee is wrapped according to all the rules of the compress. You can leave such a vinegar lotion for 6-8 hours.
3. Burdock leaves. This tool allows you to remove swelling and reduce pain. If there is no burdock at hand, then for the same purpose you can use the leaves of coltsfoot or cabbage. For treatment, the leaves are slightly crumpled in the hands or pierced in several places with a pin. After that, they are applied to the knee and fixed with a bandage. Next, the leg is wrapped in woolen cloth. It is necessary to change the leaves attached to the knee once every 6 hours.
4. Honey compresses. This remedy helps fight inflammation. For treatment before going to bed, it is necessary to lubricate the sore knee with honey in a thin layer. After the knee must be wrapped with cling film and insulated. Treatment is carried out for at least 15 days in a row.

If rheumatoid arthritis occurs, the patient must undergo a full course of therapy, which includes various methods, including exercise therapy. In the future, continuous maintenance therapy is required. Without it, it is impossible to prevent the further development of pathology in a short time. Even with treatment, the disease will gradually develop and eventually lead to disability. Knees in autoimmune joint diseases are often affected, and therefore supportive therapy is well developed.

Rheumatoid arthritis is an autoimmune disease that affects the connective tissue and includes systemic complications. First of all, the joints are affected - the disease is characterized by symmetrical polyarthritis of small joints. Extra-articular symptoms include damage to the muscles, heart, lungs, liver, gastrointestinal tract, etc. Rheumatoid arthritis is severe and causes disability in 70% of patients.

Causes and conditions of the disease

The exact cause of rheumatoid arthritis has not been established. Modern scientists are inclined to two main hypotheses for the development of the disease:

1. genetic predisposition- if rheumatoid arthritis was diagnosed in parents, then the likelihood of its occurrence in children increases. The rule of genetic predisposition is pronounced in monozygotic twins. Recent studies have identified certain histocompatibility antigens that code for malfunctions in the body's immune responses. In patients with rheumatoid arthritis, these antigens are present and can be inherited.
2. Viral pathogen- according to clinicians, the vast majority of patients have high titers of antibodies to the Epstein-Barr virus in the blood. It is important to note the similarity between certain fragments of the virus and a portion of the histocompatibility antigen chain. It is also assumed that the disease can be caused by herpes, rubella, papilloma B19, etc. viruses.
3. Bacterial agents- Recent studies have shown that the entry of bacteria into the body is accompanied by an immune response to the so-called "stress" proteins synthesized by microbes. It is assumed that these components are able to trigger a complex pathogenetic mechanism leading to the formation of rheumatoid factor.
4. Trigger components of the disease- these are conditions that contribute to the launch of a pathological reaction. In healthy people, triggers do not cause disease, but if a person is predisposed, they trigger pathogenesis. These include:
   • frequent hypothermia;
   • smoking and alcohol;
   • joint injuries;
   • hormonal changes;
   • stress;
   • harmful ecology.

According to statistics, the disease develops:

• in women more often than in men;
• over the age of 45;
• with frequent diseases of the respiratory system, arthritis, anomalies in the development of the musculoskeletal system;
• with burdened heredity;
• in the presence of the above antigens.

The onset and course of the disease

The pathogenesis of rheumatoid arthritis is a very complex autoimmune process. In our article, we will analyze only the key points that allow the ordinary reader to understand the mechanism for the development of pathology. The disease is based on a pathological reaction of the immune system, which attacks healthy cells of the connective tissue, mistakenly recognizing them as foreign. This autoimmune process goes through several stages:

1. Synoviocytes located in the connective tissue produce a large amount of inflammatory substances (cytokines) and activate special cells of the immune system - T-helpers of the first type.
2. T-helpers secrete gamma-interferon, which activates another immune cells - macrophages and monocytes. The latter also produce specialized inflammatory substances:
   • tumor necrosis factor - promotes the release of the liquid part of the blood into the area of ​​​​inflammation, forming edema and inflammation.
   • IL-1 - contributes to the development of osteoporosis in the joint area and an increase in body temperature.
   • IL-6 - activates liver cells that produce a large amount of C-reactive protein, and also contributes to the conversion of B-lymphocytes into plasma cells.
   • IL-8 - increases the concentration of neutrophils in the joint fluid.
3. Plasma cells produce modified immunoglobulins M and G, which attack the connective tissue, and when interacting with unchanged immunoglobulins G, damage the microvasculature of the joint.
4. The release of endothelial growth factor leads to additional formation of capillaries in the connective tissue, as well as a specialized tissue called pannus. This tissue has signs of a tumor and is able to grow in the joint cavity, causing its deformation.

Classification of rheumatoid arthritis

To formulate the correct diagnosis, the doctor must know the classification of the disease. Clinicians use the International Classification of Diseases of the 10th revision (ICD-10), which is more convenient for a competent diagnosis. For a patient, this classification is too complicated, so we will analyze the varieties of rheumatoid arthritis according to the following criteria:

1. According to the articular syndrome:
   • monoarthritis- one joint is involved;
   • oligoarthritis- inflammation of two joints;
   • polyarthritis- Involvement of 3 or more joints.
2. According to radiological stages:
   • first- thickening of the cartilage and the walls of the articular bag, small areas of osteoporosis;
   • second– formation of foci of erosion on cartilage, narrowing of the joint space, development of an extensive zone of osteoporosis;
   • third- deformation and periodic dislocations in the affected joints;
   • fourth- complete disappearance of the joint space, there may be signs of bone fusion.
3. According to the clinical picture:
   • low activity- morning stiffness in the joints up to 30 minutes, during the day slight pain, moderate swelling of the joints, erythrocyte sedimentation rate (ESR) up to 30 mm / h, analysis for C-reactive protein (CRP) +;
   • average activity- stiffness in the first half of the day, moderate pain (possible without load), severe swelling over the affected area. ESR up to 40 mm/hour, CRP ++, elevated levels of inflammatory blood enzymes;
   • high activity- stiffness in the joints lasts all day, complications such as damage to internal organs, ESR more than 40 mm / h CRP +++, a pronounced predominance of inflammatory enzymes join.
4. According to the progression of the disease:
   • very early stage- pathology develops within six months;
   • early stage- the clinic of rheumatoid arthritis is characterized by a duration of symptoms from 6 to 12 months;
   • extended stage- the disease proceeds for more than 12 months without pronounced destruction of the joints;
   • late stage- pathological processes last more than 2 years with severe deformity of the joints.
5. By limiting physical activity:
   • first degree– maintaining working capacity and habitual way of life;
   • second degree- periodic loss from the usual way of life;
   • third degree- inability to work.
   • fourth degree- Lack of self-service, disability.
6. According to laboratory tests for rheumatoid factor:
   • seropositive- according to the results of the analyzes, the rheumatoid factor is detected;
   • seronegative- No rheumatoid factor.

It is important to mention several options from ICD-10:

1. Juvenile (juvenile)- is a chronic rheumatoid arthritis that occurs in children with a predominant joint lesion.
2. Rheumatoid bursitis- inflammation of the joint capsules. The shoulder joints are predominantly affected.
3. Felty syndrome- a complication in which an enlarged spleen and a decrease in granulocytes in the blood join the clinical picture.

Symptoms of rheumatoid arthritis

The course and development of the disease is expressed by articular and extra-articular manifestations. The articular lesion develops first and represents an inflammatory polyarthritis. Extra-articular signs, or complications of the underlying disease, are involved in the pathology later, characterized by multiple lesions (skin, muscles, internal organs, fundus, lymph nodes).

Which joints are affected in rheumatoid arthritis?

Arthritis is characterized by lesions of the same type of joints on the right and left sides - for example, arthritis of the knee joints on the right and left. It is important to note that small-caliber joints are predominantly affected.

The onset of the disease is usually preceded by:

• sharp changes in climate - spring or autumn;
• transferred ARVI, pneumonia, etc.;
• stress or psycho-emotional overstrain;
• trauma;
• hormonal changes in the body - puberty, pregnancy or menopause.

When questioned by the doctor of the patient, the so-called prodromal period or the period of precursors is often revealed, which appears several weeks before the onset of the disease. This period corresponds to:

• general weakness, loss of strength;
• periodic lack of appetite, weight loss;
• small rises in temperature and sweating;
• slight joint pain and morning stiffness.

The pain symptom in the joints occurs due to the concentration of inflammatory substances in the connective tissue.

The onset of development is usually subacute or latent, in which the symptoms are mild, and the disease progresses gradually - complaints of pain in the joints do not appear immediately. Gradually, the pain increases, forcing a person to see a doctor. Sometimes the disease begins acutely, accompanied by severe joint pain, morning stiffness, and fever.

Above the affected joint, you can find:

• swelling and redness;
• pain reaction when touched;
• an increase in local temperature.

There is also stiffness in the joint. Later, mobility decreases, which eventually leads to a complete lack of mobility with subsequent deformity of the joint. The most common targets for rheumatoid attack are the joints of the hands and feet, elbows, knees and shoulders. Less commonly involved in the pathology of the hip, sacroiliac and ankle. The exclusion joints in rheumatoid arthritis are the distal interphalangeal (located just above the nail plate), the proximal interphalangeal joint of the little finger, and the metacarpophalangeal joint of the thumb (located at its base).

Rheumatoid lesion of the joints of the hand

The purpose of rheumatoid lesions are:

• metacarpophalangeal joints 2 to 5 are joints near the base of the fingers;
• proximal interphalangeal joints from 1 to 4 fingers;
• all joints of the wrist and carpometacarpal joints - a series of small joints in the area of ​​\u200b\u200bthe palm itself.

As a rule, the small joints listed above are the first to be affected. Soreness leads to the fact that the patient is unable to clench the hand into a fist, and the fingers swell greatly. After a few months, the intermetacarpal muscles begin to atrophy, which leads to retraction of the skin on the palm and back of the hand. There are deformations and subluxations of the metacarpophalangeal joints, as a result of which the fingers are bent with a deviation towards the little finger. The little finger itself curves less than the other fingers. Clinicians refer to this deformity as a "major's fin". Then there is a curvature of the fingers according to the “swan neck” principle - the proximal interphalangeal joints of the fingers are bent, and the distal ones are excessively unbent.

Sometimes deformations occur with flexion of the metacarpophalangeal and extension of the lower interphalangeal joints (button loop). All of these changes greatly disrupt the functions of the brush.

Ultimately, pathological changes in the hand can lead to:

• to shortening of the fingers, fusion of the phalanges with each other and complete loss of mobility;
• tenosiviitis - inflammation of the flexor tendons of the fingers, as well as their synovial canals.

The result of tenosivitis is swelling of the finger and severe pain. With compression of the branches of the median nerve, which pass near the affected joints, loss of sensitivity from fingers 1 to 3 is possible. With prolonged compression, pain can spread to the entire forearm up to the elbow.

Damage to other joints of the upper limb

Later, the disease attacks the wrist, elbow and shoulder joints.

Deformation of these joints in rheumatoid arthritis manifests itself after the development of inflammation and is irreversible.

1. Radiocarpal rheumatoid arthritis leads to soreness, swelling of the affected area, limited flexion and abduction of the hand. Wrist arthritis is often complicated by synovitis and median nerve neuralgia.
2. The elbow joint is formed by the joints of three bones - the ulna and radius of the forearm, as well as the humerus. Therefore, arthritis can affect all three joints that form the complex elbow joint. Local arthritis is accompanied by severe pain during flexion and extension - contracture may develop in an intermediate position. With severe inflammation, it is impossible to carry out rotational movements (supination and pronation).
3. Arthritis of the shoulder joint is characterized by the spread of inflammation to the tendon synovial bags, collarbone, muscle frame. Swelling, soreness and limited movement develop gradually.
4. Inflammation can go to the axillary lymph nodes. Due to the fact that the shoulder joint has only one ligament and is strengthened due to muscle tone, myalgia, turning into atrophy, leads to habitual shoulder subluxations.

Damage to the joints of the foot

The second target for rheumatoid arthritis after damage to the hand is the foot. Most often, inflammation develops in the metatarsophalangeal joints of 2-4 fingers and is accompanied by pain when walking, standing on tiptoe, and jumping. Edema of the dorsal surface of the foot, hammertoe deformity of the fingers, subluxations of the listed joints, valgus deformity of the big toe are visually noted.

Later, inflammation of the synovial bags and synovitis join the arthritis, leading to compression of the plantar nerves. Injured effects on the nerves lead to loss of sensation in the foot, pain that can rise up to the knee joint.

Other arthritis of the lower limb

1. Rheumatoid arthritis of the knee is characterized by pain and swelling in the knees. The pain is aggravated by flexion movements, during squats, when climbing stairs. Often, with severe edema, fluid balloting is noted when touching the anterolateral region of the knee. Severe pain can lead to the development of contracture in the semi-flexion position, as well as to the protrusion of the joint capsule in the posterior sections (Baker's cyst). Prolonged arthralgia of the knee joint forms an atrophy of the anterior group of thigh muscles.

Temporomandibular joint injury

The temporomandibular joint is combined - its functionality is accompanied by synchronous movements in both capsules. Arthritis is always accompanied only by bilateral soreness. Morning stiffness causes particular discomfort to the patient - due to the difficulty of opening the mouth and pain during chewing, eating is much more difficult. This leads to weight loss, nervousness. In severe cases, neighboring anatomical structures may be involved in the inflammatory process:

• chewing and temporal muscles;
• neighboring cellular spaces;
• parotid salivary gland;
• branches of the trigeminal and facial nerves.

Damage to the joints of the spinal column

Vertebral joints are extremely rarely involved in the clinical picture of rheumatoid arthritis. Arthritis usually develops in the junction of the head with the first cervical vertebrae (atlanto-occipital joint), the junctions of the first and second cervical vertebrae (median and lateral atlanto-axial joints). Clinically, inflammation is manifested by pain in the upper neck, characterized by the inability to painlessly turn the head to the side.

Extra-articular manifestations of rheumatoid arthritis (complications)

These lesions occur over a long course of the disease, predominantly in seropositive patients. Clinicians attribute these pathologies to complications of rheumatoid arthritis, since they develop with a systemic effect on the body.

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Muscle damage

Myopathy in rheumatoid arthritis begins with the defeat of three groups of muscles of the hand:

• elevation of the thumb;
• elevation of the little finger;
• intermediate muscles.

Later, the myopathy rises and captures the back muscle group of the forearm. On the lower limb, the disease attacks the anterior muscles of the thigh and gluteal region. Myopathy is characterized by pain during muscle contraction, which aggravates movement processes.

Skin changes

With a long course of rheumatoid arthritis, the skin becomes dry and thinner, numerous hemorrhages appear on the skin all over the body. The nail plates become more brittle, with transverse striation. Under the nails or near them, small zones of soft tissue death are noted.

Rheumatoid nodules

These are small dense formations located under the skin. Usually they are mobile and painless, loosely connected to the surrounding tissues. They are usually located on the back surface of the elbow joint, the extensor side of the forearm and the back of the head. Sometimes they are found in the myocardium, heart valves, between the membranes of the brain or spinal cord, in the lung tissue. They usually form during periods of exacerbations, and during remission they can disappear completely or decrease significantly. There is such a serious complication as rheumatoid nodulosis - the presence of nodules scattered throughout the body with multiple swelling of the joints, the presence of cysts and an elevated level of rheumatoid factor in the blood.

Damage to the lymph nodes

Such a complication is detected during an exacerbation and is characterized by an increase in a number of lymph nodes, usually near the affected joints:

• with arthritis of the joints of the upper limb, an increase in the elbow, axillary and cervical nodes is noted;
• temporomandibular arthritis is accompanied by an increase in the submandibular and cervical lymph nodes;
• arthritis of the joints of the lower limb leads to temporary hypertrophy of the inguinal lymph nodes.

Often, lymphadenopathy is accompanied by an enlarged spleen.

Damage to the stomach, intestines and liver

1. The defeat of the stomach is characterized by suppression of the synthesis of gastric juice, the formation of numerous erosions and ulcers. The result of such complications are dull pulling pains in the epigastrium, the formation of plaque on the mucous membrane of the tongue, and a decrease in appetite.
2. Rheumatoid arthritis can be complicated by inflammation of the small and large intestines - enteritis and colitis. Intestinal damage leads to acute and chronic pain, bloating, stool disorders, nausea and vomiting.
3. Sometimes the liver increases, its borders expand.

Pulmonary complications

The defeat of the lungs in rheumatoid arthritis usually occurs in parallel with the defeat of their membrane - the pleura. The defeat of the pleura is characterized by inflammatory changes - pleurisy.

Pleurisy may be dry or exudative. In the first case, the friction of dry, inflamed pleura during breathing causes severe discomfort to the patient. Exudative pleurisy is characterized by effusion of the liquid part of the blood into the pleural cavity, followed by compression of the lung, which leads to shortness of breath, a feeling of heaviness on the affected side. The defeat of the lungs is manifested by the development of pneumonitis and fibrosing alveolitis. A characteristic feature of complications of the lungs and pleura is the weak effectiveness of antibiotics and the rapid effect of the use of anti-inflammatory drugs.

Cardiac Complications

Heart damage in rheumatoid arthritis manifests itself in the form of the following diseases:

1. Inflammation of the muscle membrane - myocarditis.
2. The defeat of the outer shell in the form of pericarditis.
3. The formation of acquired malformations of the heart in case of damage to the inner lining of the heart - endocarditis.
4. The defeat of the pericardial vessels - the aorta (aortitis) and the coronary arteries (coronary arteritis).

Inflammatory changes in the heart and blood vessels are manifested by complaints of shortness of breath and chest pain. A more accurate diagnosis is made by a cardiologist after passing the appropriate examination.

Renal complications

Kidney damage in rheumatoid arthritis is carried out with the involvement of the glomerular apparatus in the inflammatory process, resulting in the development of rheumatoid glomerulonephritis, renal amyloidosis. As a result of renal complications, anemia can develop in rheumatoid arthritis, which is formed when the disease becomes chronic.

Damage to the organ of vision

Eye damage in rheumatoid arthritis is very rare and is manifested by inflammation of the outer shell of the eyeball - the sclera. Inflammatory changes are characterized by severe pain, capillary dilation, and sometimes the formation of small rheumatoid nodules. With combined pathologies, the development of dry conjunctivitis is possible, in which the closure of the eyelid is accompanied by a strong pain sensation.

Complications from the nervous system

Damage to the nervous system is characterized by the following symptoms:

1. Frequent headaches and dizziness indicate a violation of the blood supply to the brain and encephalopathy.
2. A reaction to a change in temperature, increased sweating and a change in diuresis indicate damage to the autonomic nervous system.
3. Weakness in the affected limbs, difficulty in movement speak in favor of ischemic neuropathy.
4. Stitching pains in the extremities and parasthesias occur when the corresponding nerves are pinched and in neuralgia.

Other complications

If rheumatoid arthritis develops for a long time, there may be associated complications - such as inflammation of the pleura and pericardium, multiple hemorrhages on the internal organs.

Establishing diagnosis

Articular lesions occur in the later stages of the disease. Since at the beginning of the disease the articular syndrome does not manifest itself, the diagnosis of rheumatoid arthritis in the early stages is very difficult.

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There are certain criteria for the diagnosis of rheumatoid arthritis:

• morning stiffness of the joints for at least an hour;
• arthritis of three or more joints;
• damage to the joints on the hand;
• symmetrical involvement of the joints in the clinical picture;
• the presence of rheumatoid nodules;
• the presence of rheumatoid factor;
• articular x-ray picture.

Diagnosis of rheumatoid arthritis is positive when four of the above symptoms are detected. It is important to note that the first four symptoms should persist for one to two months. Indisputable evidence of rheumatoid arthritis is synchronous minor polyarthritis. To identify the criteria described above, as well as additional diagnostic parameters, laboratory and instrumental research methods are used.

Laboratory methods

1. Complete blood count - with a high activity of the process, anemia may develop (a drop in hemoglobin, leukocytes). An increase in ESR in rheumatoid arthritis is an indirect sign of the development of the disease.
2. A biochemical blood test is informative for determining the degree of inflammation activity and identifying complications. First of all, attention is drawn to an increase in C-reactive protein, fibrinogen, seromucoid, sialic acids, haptoglobin, globulins and a decrease in albumin levels.
3. Immunological analysis of blood is one of the informative methods. In favor of rheumatoid arthritis is evidenced by the presence of rheumatoid factor, cryoglobulins. Often, antikeratin antibodies, LE cells, and circulating immune complexes are found in the blood.

Instrumental research methods

Instrumental diagnostics involves the use of methods that allow you to visually determine arthritis. The most common methods include: x-ray examination, magnetic resonance imaging, examination of synovial fluid followed by a biopsy.

X-ray examination

This type of study is the most informative, because it allows you to identify inflammation and deformity in the joints. The main radiographic features of rheumatoid arthritis are:

• disseminated or focal osteoporosis;
• reduction of the joint space;
• the appearance of erosion on the articular surfaces.

Radiological stages of rheumatoid arthritis are set by the doctor depending on the listed criteria.

Magnetic resonance imaging (MRI)

MRI for rheumatoid arthritis is an alternative to x-ray examination. MRI is based on the use of magnetic waves. If the X-ray examination shows bone structures in detail, then soft tissues are perfectly visualized with MRI.

Synovial fluid examination and biopsy

Synovial fluid - produced by the cells of the joint capsule to reduce friction during movement. Thanks to the synovial fluid, the coefficient of friction in the joints is 0.01. Joint fluid reflects all pathological changes in the joint, so taking it for analysis significantly complements the diagnostic criteria. A biopsy of the joint capsule with the presence of fibrin and inflammatory elements will leave the diagnosis of rheumatoid arthritis beyond doubt.

Main characteristics of synovial fluid

Differential Diagnosis

Differential diagnosis is a thorough analysis of the results of the examination in order to screen out inappropriate diagnoses with similar symptoms. Differential diagnosis of rheumatoid arthritis is carried out with reactive arthritis and osteoarthritis.

1. Reactive arthritis- this is a lesion of the joints after suffering diseases of infectious etiology.
2. Osteoarthritis- a set of diseases of various etiologies with damage to the joints with their subsequent deformation.

The main differences between these three types of diseases are shown in the table below.

Differential differences between rheumatoid arthritis, reactive arthritis and osteoarthritis:

Treatment

The treatment of rheumatoid arthritis is a complex complex process that requires a responsible approach from both the attending physician and the patient. According to modern research, it is impossible to cure the disease, therapy is aimed only at relieving symptoms and slowing the progression of joint damage. Treatment includes drug therapy and physical therapy. Prevention of the disease includes physical therapy and spa treatment. As an addition, treatment with folk remedies is possible, but only under the supervision of the attending physician.

Drug therapy

Drug therapy includes symptomatic treatment - necessary to relieve pain and basic therapy - the purpose of which is to maintain the integrity of the musculoskeletal system and prevent complications.

Relieve pain and inflammation in the joints

The drugs of choice are non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal painkillers - glucocorticoids. Symptomatic therapy greatly alleviates the suffering of the patient, but does not cure the underlying disease; when it is canceled, the symptoms gradually recur.
NSAIDs for rheumatoid arthritis are prescribed in the following sequence:

• selective NSAIDs- have a minimum of side effects and act for a long time. These drugs are allowed to be taken for a long time - from several months to several years. From this group, the most popular drugs are: Meloxicam, Movalis, Celebrex, Nimesil, Nise, Nimid, Revmoksib.
• non-selective NSAIDs- are appointed when the selective group is ineffective. These drugs have a quick effect, but have pronounced side effects - especially from the gastrointestinal tract. As efficiency and toxic effects increase, they are divided into the first and second stages. The first stage drugs are Diclofenac, Ibuprofen, Ketoprofen. The second stage is represented by Indomethacin, Ketorolac and Piroxicam. Symptomatic therapy

Attention! If there is no positive effect for a maximum of a week, you should contact your doctor to replace the drug.

Glucocorticoids in rheumatoid arthritis, they have a strong analgesic effect. They are hormonal drugs, so their overdose can cause the following side effects:

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• hormonal disruptions;
• hyperfunction of the adrenal cortex;
• pancreatitis, diabetes mellitus;
• decreased immunity, frequent SARS;
• thrombosis and bleeding;
• the appearance of edema;
• disorders of the gastrointestinal tract;
• other disorders: itching on the mucous membranes of the respiratory tract, diseases of the sense organs.

The drugs of choice are: medrol, diprospan, prednisolone, methylprednisolone, triamcinolol, dexamethasone, betamethasone.

Basic therapy

The basic therapy of rheumatoid arthritis includes a group of drugs with a long-term effect, which significantly slow down the destructive changes in the connective tissue.

Cytostatics- these drugs are used mainly in oncology, but are the best means of basic therapy for rheumatoid arthritis. The mechanism of their action is aimed at inhibiting the growth of pannus and slowing down the destruction in the joints.

The most popular cytostatics:

• Methotrexate;
• Arava;
• Remicade.

Biologicals– their action is aimed at binding the tumor necrosis factor, which plays a key role in the pathogenesis of rheumatoid arthritis. An important point is that these drugs are prescribed separately from each other due to the high likelihood of severe side effects.

Drugs of choice include:

• Anakinra;
• Actemra;
• Rituximab;
• etanercept;
• Humira;
• Orence.

Chondroprotectors- is prescribed to restore cartilage tissue and increase its resistance to autoimmune attacks of rheumatoid arthritis.

These include:

• Teraflex;
• Artra;
• Alflutop;
• Hyaluron.

Other drugs of basic therapy - various groups of drugs that are aimed at strengthening the immune system:

• Sulfasalazine;
• Bicilin-3;
• Penicillamine;
• Cycloferon;
• Delagil.

Physiotherapy

Physiotherapy is a set of methods based on the therapeutic effect on the human body of natural and artificially created factors. The most popular methods of physical therapy for rheumatoid arthritis are massage, electrophoresis, acupuncture and cryotherapy.

Massage

Massage for rheumatoid arthritis is used only during periods of remission, during which pain is significantly reduced, swelling subsides, and the patient's general well-being is normalized. Massage is performed by a specialist on the affected joints and surrounding soft tissues.

Useful properties of massage:

• improves blood circulation and tissue trophism;
• promotes the absorption of exudate into the circulatory system and reduces swelling;
• prevents local atrophic changes in the muscles;
• prevents the deposition of calcium salts in the joints;
• normalizes movement in the joint, reduces stiffness in the morning;
• prevents joint deformity.

electrophoresis

This is a technique based on the use of drugs and the combined effects of galvanization. Electrophoresis in rheumatoid arthritis has a strong analgesic effect, as it is used in combination with glucocorticoids. The advantage of the method compared to the usual medication is that side effects are minimized, and the effectiveness is significantly prolonged.

Acupuncture and cryotherapy

Acupuncture is a physiotherapeutic procedure based on the reflex effect of needles on certain areas located near large nerves. Cryotherapy is based on exposure to the affected area with cold air, about -180 degrees Celsius. Acupuncture and cryotherapy for rheumatoid arthritis are distracting procedures and are used as an addition to the main methods, in order to relieve pain symptoms.

Traditional medicine and rheumatoid arthritis

Salt baths, tinctures and decoctions based on leaves and medicinal herbs are used as folk methods of treatment. For salt baths in rheumatoid arthritis, sea or table salt, magnesium sulfate, potassium bromide are used. Taking salt baths helps to normalize blood circulation, improves local metabolism, and reduces swelling of surrounding tissues.

Also often used for treatment:

1. Bay leaf for rheumatoid arthritis - 1 teaspoon of leaf powder is brewed with boiling water and boiled for 10 minutes. Take 3 times a day for a third of a glass before meals.
2. Mumiyo for rheumatoid arthritis is used together with honey - stir 50 g of mumiyo and 100 g of honey and take 1 teaspoon 30 minutes before breakfast.
3. Gelatin, ginger and tomatoes also have useful properties for rheumatoid arthritis. The presence of these products in the diet has a general strengthening effect on the body and on cartilage tissue in particular.

Prevention

Prevention of rheumatoid arthritis is divided into primary and secondary. Primary prevention involves preventing the onset of the disease in a healthy person, and secondary prevention is aimed at preventing the development of relapses and complications in people suffering from rheumatoid arthritis.

Primary prevention includes:

• diagnosis and treatment of infectious diseases;
• detection of chronic infection in the body;
• strengthening immunity and maintaining a healthy lifestyle.

Secondary prevention implies:

• strict adherence to the doctor's recommendations for taking medicines, attending physiotherapy procedures and dieting;
• spa treatment during periods of remission;
• constant exercise therapy.

Video footage

What is rheumatoid arthritis is a disease that causes inflammation and pain in the joints, leading to a violation of their normal mobility. In the course of the development of the disease, the synovial membrane that lines the joint capsule is destroyed, then the process passes to the intra-articular tissues, resulting in ankylosis (complete immobility of the joint). In the initial stages of the pathology, the symptoms of rheumatoid arthritis may resemble polyarthritis, but in its etiology the disease differs from other diseases of the bone apparatus that have similar symptoms. The fact that this is an independent disease is also 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 it occurs four times more often in women than in men. There were no significant differences in the symptoms and course of the disease by gender - both in those and in others the disease develops in the same way, the same can be said about the methods of treatment.

What does rheumatoid arthritis look like?

Causes and signs of rheumatoid arthritis

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

• 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 species, occurring in about 20% of cases when the presence of rheumatoid factor is not observed, and the disease develops quite quickly;
• M08 - the 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 fingers and toes from small joints, the wrist, elbow, shoulder, ankle and knee from large ones. 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 tissues instead of protecting them. In this case, the joints are no exception.

The impetus for the development of rheumatoid arthritis can be:

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

Also risk factors are hard physical work 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 between self and someone else.

Causes of rheumatoid arthritis

The immune status decreases and begins to falter in old age, which is caused by natural causes. This can also be one of the causes of rheumatoid arthritis. Therefore, rheumatoid arthritis in adults, or rather, the elderly, manifests itself much more often than in children and young people. It is important to distinguish rheumatoid arthritis from other joint diseases as early as possible, since the main thing that rheumatoid arthritis is dangerous in the absence of timely treatment is the development of severe complications and damage to internal organs (heart and kidneys). The first symptoms of rheumatoid arthritis, which make it possible to suspect the development of this particular pathology, experts include:

• The development of the pathological process usually begins with small joints on the toes. The pain is aggravated by pressing on the fingertips. In the future, 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, there is a strong stiffness in movements: before getting out of bed, it takes a lot of time to develop the joints;
• Complaints of patients 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, the attacks are of moderate strength, but of considerable duration, and exhaust the patient with their constancy. The pain peaks 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 seals from 2-3 mm to 2-3 cm in diameter, which can disappear and reappear;
• Periodically there is a feverish state and a relatively small increase in body temperature, not due to any external causes;

Symptoms of rheumatoid arthritis

All these symptoms can be attributed to systemic manifestations of rheumatoid arthritis. Also, the early stage of rheumatoid arthritis 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 found one or more signs of rheumatoid arthritis, a person needs to contact a specialist as soon as possible and undergo a detailed examination. The sooner the patient begins the 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 a long-term stable remission, which allows to avoid the development of complications and lead a normal life.

Diagnosis and classification

A complete diagnosis of rheumatoid arthritis is possible only when using a complex of diagnostic techniques. To make a primary diagnosis of rheumatoid arthritis, the doctor helps the external examination and questioning of the patient, the study of the anamnesis (past diseases) of the patient himself and his immediate family, since the disease is quite often hereditary, affecting representatives of the same genus.

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 in the blood of the so-called C-reactive protein and gamma globulin increases. All these signs indicate the presence of an inflammatory process in the body.

Methods for diagnosing rheumatoid arthritis

The fact that rheumatoid arthritis of the joints became its cause unequivocally confirms the presence of rheumatoid factor in the blood, which is a special substance that contributes to the destruction of joint tissues. 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 the pathological processes, the higher the level of this indicator.

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

Diagnosis of the first stage of rheumatoid arthritis allows:

• thinning of the bone;
• Thickening and compaction of soft tissues;
• Signs of periarticular osteoporosis;
• Cysts that look like a clearing of the bone tissue in the picture.

A characteristic feature of the first stage is the degree of activity of rheumatoid arthritis. The disease can progress slowly, starting in adolescence or even childhood (the so-called juvenile rheumatoid arthritis), but develop in full force only in adulthood. But another option is also possible, in which the disease takes a rapid start immediately after the onset.

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

The progression of bone erosion signals the approach of the third stage, in which the joint deformity becomes clearly visible on the picture, the synovial tissues become denser, which leads to limited mobility. Muscular atrophy progresses. Accelerated calcification begins - the deposition of salts on the surface of the joint. Calcifications have a different density in different parts 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 gaps, bone deformity, multiple erosion and cysts. In this form, the curvature of the bones is clearly visible not only in the x-ray, but also in the usual photo of rheumatoid arthritis.

Attention!

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

Therapeutic methods for rheumatoid arthritis

Starting the treatment of rheumatoid arthritis of the joints, modern medicine involves the use for this purpose 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:

• Salts of gold;
• Immunosuppressants;
• Antimalarial;
• Sulfonamides;
• D-penicillamine.

Conventional therapy for rheumatoid arthritis

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

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

Immunosuppressants, or cytostatics, reduce the level of immune response, helping to reduce its destructive power in the fight against its own body. Many patients are afraid of the word “immunosuppressant”, fearing to be completely without immune protection, as happens in oncology. But the doses of drugs for rheumatoid arthritis are incomparable to those used in anticancer therapy, so they 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 most of the modern pharmacological drugs against this disease were not in the arsenal of medicine. Now they are used much less frequently, and only with sluggish forms, when there is still no need for intensive care.

Sulfonamides do not act as quickly as immunosuppressants, which occupy the first place in the “hit parade” of antirheumatoid drugs. Good tolerability, a minimum of side effects and a low price speak in their favor.

D-penicillamine has undesirable side effects in half of cases of seropositive rheumatoid arthritis and up to one third in seronegative rheumatoid arthritis. But if the doctor has no choice. he uses this drug as a last resort for rheumatoid arthritis when none of the others have worked.

Folk remedies

Many patients, along with pharmacological, use the treatment of rheumatoid arthritis with folk remedies. Herbal healers recommend the following recipes:

Wraps of diseased joints with fresh leaves of burdock, coltsfoot or cabbage alleviate joint pain and reduce 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. It is better to lubricate the joints with it in the 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 an incomplete glass of honey (add the ingredients in turn, mixing thoroughly). Add a tablespoon of table salt to the resulting mixture and also mix until completely dissolved. The product must be stored in the refrigerator, pouring in small portions as necessary and heated in a water bath. After rubbing the balm into the joints, they must be warmly covered.

Folk remedies are used as a supplement 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 - scuffs, abrasions, scratches.

Traditional treatments for rheumatoid arthritis

Prevention of rheumatoid arthritis experts divide 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 rehabilitation of foci of chronic inflammation and infection (caries, sinusitis, etc.), strengthening immunity, hardening, a healthy lifestyle, good nutrition. rejection of bad habits. To prevent exacerbations, one should also avoid infectious diseases, limit physical activity, prevent hypothermia, follow a diet by reducing the consumption of foods such as pasta and white bread, sweets, and coffee.

It is important to carefully follow the prescriptions of doctors regarding sleep, work and rest, and also not to violate the schedule for taking the medicines prescribed by them. Under such conditions, the chances of a long-term remission, which allows the patient to maintain working capacity and habitual lifestyle, are quite high.

- a systemic disease that affects mainly the joints. Syndromes characteristic of rheumatoid arthritis appear at any age.

Often, severe pain, crunching in the joints cause a persistent decline in the quality of life in people, forcing them to look for effective methods of treatment. If medications, like metipred, are ineffective, patients often try to treat pain, crunch with traditional medicine - onion peel, badger fat. Someone goes to the sea, takes air baths. Current laser treatment.

Often people go to see a doctor for answers to questions - why there was pain, a crunch in the joints, what drugs to take, what side effects can be expected when switching to metipred, how long to continue treatment for rheumatoid arthritis. Many are concerned about the question of whether it is possible to cure the pain, crunching trip to the Dead Sea.

Articular syndrome is caused by a violation of the body's immune system. The defeat of the joints by rheumatoid arthritis manifests itself in the form of an increasing destructive-erosive process that captures a group of joints.

Specific immunoglobulins are formed to the body's own tissues. Antibodies are obtained - rheumatoid factor. Antibodies to own tissues come into contact with proteins, form immune conglomerates. Penetrating into the synovial cavity, conglomerates are captured by leukocytes, disintegrate in the process of phagocytosis. This leads to increased formation of inflammatory mediators in the joint cavity. These biologically active substances have anaphylactic, cytotoxic properties. Lymphocytes accumulate in the synovial membrane, damaging the cartilage tissue, leading to the formation of rheumatoid nodules. The patient is worried about crunching in the limbs, pain syndrome. It is a separate unit.

A dangerous consequence of rheumatoid arthritis is amyloidosis. This complication develops after many years of a protracted course of the disease. Exceptions have been recorded when amyloidosis affects the youthful organism in the first years of the development of rheumatoid arthritis.

The classic version of the flow

The clinic of joint damage grows slowly. The first symptoms are pain, the intensity of which increases over time. Swelling joins, a crunch appears, stiffness in the morning, making it difficult to move. Small groups of joints are affected. The pain is moderate, appears when walking. At this stage, folk recipes have a good effect. Chopped onion peel, infused with alcohol, brewed with water. Castor oil is added to the infusion, applied topically to the affected joints.

Badger fat is an effective remedy for easing articular syndrome. An effective measure during this period can be a trip to a resort on the warm sea.

Doctors refer to recurrent arthritis as a rare variant of the course. The disease debuts acutely, subacutely, begins with the defeat of one large joint, less often the disease affects groups of joints. After a short period of time, the clinic is reduced, even if you do not take medication. Rheumatoid attacks are repeated for a number of years, until they lead to the development of a classic clinical picture, patients are forced to consult a rheumatologist.

Serious consequences of rheumatoid arthritis are vascular damage, kidney amyloidosis.

In severe cases, folk remedies, treatment at sea will not give the desired effect.

Articular syndrome

Different joints, soft tissues that are adjacent to them are involved in the painful process. Joint damage by rheumatoid arthritis may be the leading manifestation in the clinical picture.

A typical syndrome of joint damage in rheumatoid arthritis is deformity, crunching of the hands, phalanges of the fingers. The bones take the form of a spindle, the hand is significantly deformed. Early tests for the presence of joint damage, according to the das scale, note a decrease in muscle mass on the back of the hand, accompanied by a drop in their functional abilities. The defeat of the articular heads leads to persistent deformation of the bone, mobility is impaired, contractures develop. They resort to surgical treatment, laser correction.

How to assess the severity of the condition

Doctors have developed tests called the DAS index, which allow you to combine individual symptoms into a single index that helps to evaluate.

The components of the DAS index are indicators:

1. Articular index SIR.
2. Number of swollen joints.
3. Blood test, erythrocyte sedimentation rate test.
4. Tests for the general clinical condition of the body.

A variation of the das scale is an index called DAS 28

1. SIR assesses the state of the joints, their pain during palpation on a scale of three points. A group of at least 53 joints is evaluated. The highest value in the DAS 28 test is 78 points.
2. The number of swollen joints evaluates the condition of 44 of them. The maximum score is 44 points.
3. To assess the general condition of the patient, tests are carried out on a special scale.

The patient is offered to answer the question, what deterioration in the condition seriously affects the quality of life, why he thinks so. The most severe complication is renal amyloidosis.

DAS28 tests are similar in most parameters to the DAS index, covering a smaller number of joints - 28.

Instead of ESR, when calculating the DAS28 scale, a test for C-reactive protein is used.

Technically, the DAS28 count consists of a clinical examination, swollen aching joints count, blood sampling for clinical analysis.

A special laboratory is needed that allows you to take blood, study ESR, a computer with a special program for counting.

The DAS28 index is calculated using special formulas.

No uniform standards have been developed for the assessment, it was carried out taking into account the opinion of an experienced doctor about the patient's condition.

To compare the results according to the DAS28 index, an assessment of the patient's condition by a doctor was used, about 12 methods that allow an objective characterization of the joints.

The described scales are used when it is necessary to control the methods of treatment. Whatever the effectiveness, the test does not replace the examination, history taking.

Features of arthritis in children, adolescents

Juvenile, pauciarticular arthritis has been classified as an independent nosological entity.

There are two types of flow - predominantly affecting the joints, predominantly systemic, affecting the connective tissue.

Juvenile arthritis affects large joints, there is damage to the bones of the spine. Rheumatoid factor is rare in adolescents.

The main symptoms that characterize the lesion in this form of arthritis are pain, stiffness in the morning after waking up, swelling in the joints. Juvenile rheumatoid arthritis is different in that the pain syndrome is less pronounced than in adults, the crunch in the joints is less common. Often adolescents do not complain of pain, stiffness. Often the symptoms of inflammation are noted in the knee, hip joints, wrist, ankles. In a third of patients, juvenile arthritis involves the spine in the pathological process.

A characteristic cider in juvenile rheumatoid arthritis is a lag in physical growth as a whole, a lag in a separate part of the body where the cartilage is affected. It is important to consider which joints are affected.

In most patients, after a number of years, with a chronic course, lack of adequate treatment, a serious complication develops - kidney amyloidosis.

Amyloidosis

The long course of rheumatoid arthritis leads to a serious complication - amyloidosis.

Secondary amyloidosis occurs in patients with rheumatoid arthritis with a high degree of activity of the pathological process, uncontrolled even by such methods of treatment as metipred.

The syndrome is a lesion of the glomerular system of the kidneys with the development of proteinuria. Often secondary amyloidosis leads to the development of renal failure.

In a number of adolescents with juvenile arthritis with multiple progressive lesions of bones, articular cavities, systemic extraosseous manifestations, several years after the onset of the disease, secondary amyloidosis often manifests itself, affecting the glomeruli of the kidneys.

Principles of treatment

In the acute stage, drug therapy is carried out with hormonal drugs such as Metipred, and non-steroidal anti-inflammatory drugs are taken.

In a state without exacerbation, resort treatment at sea is resorted to.

A trip to the Dead Sea will be effective in a therapeutic sense.

From home remedies in not severe cases, it is worth using badger fat in the form of compresses, in the form of a pharmacy ointment. Relieve pain, crunch, inflammation home remedy containing vegetable oil, onion peel.

In severe cases, surgical, laser treatment is indicated.

Medical therapy

Treatment of chronic rheumatoid arthritis should be comprehensive. In the acute period, you should keep calm, stick to a diet. Food should be rich in plant foods, contain calcium in sufficient quantities.

Medical treatment for rheumatoid arthritis consists of prescribing anti-inflammatory drugs. It is carried out by two types of drugs - non-steroidal anti-inflammatory drugs, the hormonal drug metipred.

The mechanism of the pharmacological action of Metipred is to suppress the production of antibodies that support inflammation, pain in the joints. In addition, Metipred has an immunosuppressive effect, leading to the suppression of autoaggression of the immune system.

The comfortable use of the drug Metipred is due to the fact that it is produced in various forms - tablets, powder for preparing a solution for injection. Treatment of rheumatoid arthritis with Metipred is carried out according to a stepwise scheme, after a course of injections, the patient is transferred to a tablet form.

The main active ingredient of Metipred is the synthetic hormone methylprednisolone. The prices of the drug vary depending on the manufacturer.

A serious side effect of hormonal drugs is that calcium is washed out of bone tissue. It should be taken into account when prescribing a diet.

Local therapy

For topical use, balms for the treatment of bone and cartilage containing badger fat are suitable. Traditional medicine has long used badger fat in the treatment of arthritis. Due to its anti-inflammatory action.

The pharmacological industry has included badger fat in the composition of ointments, gels used in the treatment of joints. Stimulate microcirculation in the joints, accelerate the regeneration of cartilage tissue, relieve inflammation, nourish the tissue of the joints. Fir oil, which is part of the balms, is a strong immunomodulator.

Widely known gel for topical application containing badger fat, aromatic oil of pine, fir - Sustamed.

An alternative is homemade balm, which includes onion peel, castor oil.

Apply badger fat in its pure form for setting compresses, rubbing into the affected joints.

Badger fat has side effects - individual intolerance. Badger fat is contraindicated in diseases of the liver, pancreas, in children under 7 years of age.

In order to enhance the effect of taking drugs, correct the immune system, laser treatment is used. In addition to the local anti-inflammatory effect, laser treatment increases the overall immune status of the body, reduces the number of complications from hormones.

Folk remedies

Onion peel is considered a popular remedy in the treatment of joints. You can prepare alcohol tincture, decoction, oil.

1. To prepare a tincture for alcohol, the onion peel is crushed, placed in a container, poured with alcohol, infused for several days. Infused onion peel is stored in a dark place, used as lotions, compresses. The remedy eliminates pain, inflammatory syndrome.
2. To prepare an aqueous infusion, onion peel is taken in the amount of 2 tablespoons, poured with two glasses of boiling water. The resulting infusion is boiled in a water bath, cooled, filtered.

For greater efficiency, a stronger infusion is prepared, onion peel is poured with less water.

Prepare at home medicinal oil for the joints. Onion peel, castor oil are used. You can add a small amount of natural badger fat.

Spa therapy

Outside the acute stage, spa treatment is effective, especially at the Dead Sea. It should be remembered that with complications such as amyloidosis, resort treatment should be approached with caution.

Rheumatoid arthritis is an autoimmune disease that affects the connective tissue and includes systemic complications. First of all, the joints are affected - the disease is characterized by symmetrical polyarthritis of small joints. Extra-articular symptoms include damage to the muscles, heart, lungs, liver, gastrointestinal tract, etc. Rheumatoid arthritis is severe and causes disability in 70% of patients.

The exact cause of rheumatoid arthritis has not been established. Modern scientists are inclined to two main hypotheses for the development of the disease:

1. genetic predisposition- if rheumatoid arthritis was diagnosed in parents, then the likelihood of its occurrence in children increases. The rule of genetic predisposition is pronounced in monozygotic twins. Recent studies have identified certain histocompatibility antigens that code for malfunctions in the body's immune responses. In patients with rheumatoid arthritis, these antigens are present and can be inherited.
2. Viral pathogen- according to clinicians, the vast majority of patients have high titers of antibodies to the Epstein-Barr virus in the blood. It is important to note the similarity between certain fragments of the virus and a portion of the histocompatibility antigen chain. It is also assumed that the herpes, rubella, papilloma B 19, etc. viruses can cause the disease.
3. Bacterial agents- Recent studies have shown that the entry of bacteria into the body is accompanied by an immune response to the so-called "stress" proteins synthesized by microbes. It is assumed that these components are able to trigger a complex pathogenetic mechanism leading to the formation of rheumatoid factor.
4. Trigger components of the disease- these are conditions that contribute to the launch of a pathological reaction. In healthy people, triggers do not cause disease, but if a person is predisposed, they trigger pathogenesis. These include:
   • frequent hypothermia;
   • smoking and alcohol;
   • joint injuries;
   • hormonal changes;
   • stress;
   • harmful ecology.

According to statistics, the disease develops:

• more often than in men;
• over the age of 45;
• with frequent diseases of the respiratory system, arthritis, anomalies in the development of the musculoskeletal system;
• with burdened heredity;
• in the presence of the above antigens.

The onset and course of the disease

The pathogenesis of rheumatoid arthritis is a very complex autoimmune process. In our article, we will analyze only the key points that allow the ordinary reader to understand the mechanism for the development of pathology. The disease is based on a pathological reaction of the immune system, which attacks healthy cells of the connective tissue, mistakenly recognizing them as foreign. This autoimmune process goes through several stages:

1. Synoviocytes located in the connective tissue produce a large amount of inflammatory substances (cytokines) and activate special cells of the immune system - T-helpers of the first type.
2. T-helpers secrete gamma-interferon, which activates another immune cells - macrophages and monocytes. The latter also produce specialized inflammatory substances:
   • tumor necrosis factor - promotes the release of the liquid part of the blood into the area of ​​​​inflammation, forming edema and inflammation.
   • IL-1 - contributes to the development of osteoporosis in the joint area and an increase in body temperature.
   • IL-6 - activates liver cells that produce a large amount of C-reactive protein, and also contributes to the conversion of B-lymphocytes into plasma cells.
   • IL-8 - increases the concentration of neutrophils in the joint fluid.
3. Plasma cells produce modified immunoglobulins M and G, which attack the connective tissue, and when interacting with unchanged immunoglobulins G, damage the microvasculature of the joint.
4. The release of endothelial growth factor leads to additional formation of capillaries in the connective tissue, as well as a specialized tissue called pannus. This tissue has signs of a tumor and is able to grow in the joint cavity, causing its deformation.

Classification of rheumatoid arthritis

To formulate the correct diagnosis, the doctor must know the classification of the disease. Clinicians use the International Classification of Diseases of the 10th revision (ICD-10), which is more convenient for a competent diagnosis. For a patient, this classification is too complicated, so we will analyze the varieties of rheumatoid arthritis according to the following criteria:

1. According to the articular syndrome:
   • monoarthritis- one joint is involved;
   • oligoarthritis- inflammation of two joints;
   • polyarthritis- Involvement of 3 or more joints.
2. According to radiological stages:
   • first- thickening of the cartilage and the walls of the articular bag, small areas of osteoporosis;
   • second– formation of foci of erosion on cartilage, narrowing of the joint space, development of an extensive zone of osteoporosis;
   • third- deformation and periodic dislocations in the affected joints;
   • fourth- complete disappearance of the joint space, there may be signs of bone fusion.
3. According to the clinical picture:
   • low activity- morning stiffness in the joints up to 30 minutes, during the day slight pain, moderate swelling of the joints, erythrocyte sedimentation rate (ESR) up to 30 mm / h, analysis for C-reactive protein (CRP) +;
   • average activity- stiffness in the first half of the day, moderate pain (possible without load), severe swelling over the affected area. ESR up to 40 mm/hour, CRP ++, elevated levels of inflammatory blood enzymes;
   • high activity- stiffness in the joints lasts all day, complications such as damage to internal organs, ESR more than 40 mm / h CRP +++, a pronounced predominance of inflammatory enzymes join.
4. According to the progression of the disease:
   • very early stage- pathology develops within six months;
   • early stage- the clinic of rheumatoid arthritis is characterized by a duration of symptoms from 6 to 12 months;
   • extended stage- the disease proceeds for more than 12 months without pronounced destruction of the joints;
   • late stage- pathological processes last more than 2 years with severe deformity of the joints.
5. By limiting physical activity:
   • first degree– maintaining working capacity and habitual way of life;
   • second degree- periodic loss from the usual way of life;
   • third degree- inability to work.
   • fourth degree- Lack of self-service, disability.
6. According to laboratory tests for rheumatoid factor:
   • - according to the results, the rheumatoid factor is detected;
   • - No rheumatoid factor.

It is important to mention several options from ICD-10:

1. - is a chronic rheumatoid arthritis that occurs in children with a predominant joint lesion.
2. - inflammation of the joint capsules. The shoulder joints are predominantly affected.
3. - a complication in which an enlarged spleen and a decrease in granulocytes in the blood join the clinical picture.

Symptoms of rheumatoid arthritis

The course and development of the disease is expressed by articular and extra-articular manifestations. The articular lesion develops first and represents an inflammatory polyarthritis. Extra-articular signs, or complications of the underlying disease, are involved in the pathology later, characterized by multiple lesions (skin, muscles, internal organs, fundus, lymph nodes).

Which joints are affected in rheumatoid arthritis?

Arthritis is characterized by lesions of the same type of joints on the right and left sides - for example, arthritis of the knee joints on the right and left. It is important to note that small-caliber joints are predominantly affected.

The onset of the disease is usually preceded by:

• sharp changes in climate - spring or autumn;
• transferred ARVI, pneumonia, etc.;
• stress or psycho-emotional overstrain;
• trauma;
• hormonal changes in the body - puberty, or menopause.

When questioned by the doctor of the patient, the so-called prodromal period or the period of precursors is often revealed, which appears several weeks before the onset of the disease. This period corresponds to:

• general weakness, loss of strength;
• periodic lack of appetite, weight loss;
• small rises in temperature and sweating;
• slight joint pain and morning stiffness.

The pain symptom in the joints occurs due to the concentration of inflammatory substances in the connective tissue.

The onset of development is usually subacute or latent, in which the symptoms are mild, and the disease progresses gradually - complaints of pain in the joints do not appear immediately. Gradually, the pain increases, forcing a person to see a doctor. Sometimes the disease begins acutely, accompanied by severe joint pain, morning stiffness, and fever.

Above the affected joint, you can find:

• swelling and redness;
• pain reaction when touched;
• an increase in local temperature.

There is also stiffness in the joint. Later, mobility decreases, which eventually leads to a complete lack of mobility with subsequent deformity of the joint. The most common targets for rheumatoid attack are the joints of the hands and feet, elbows, knees and shoulders. Less commonly involved in the pathology of the hip, sacroiliac and ankle. The exclusion joints in rheumatoid arthritis are the distal interphalangeal (located just above the nail plate), the proximal interphalangeal joint of the little finger, and the metacarpophalangeal joint of the thumb (located at its base).

Rheumatoid lesion of the joints of the hand

The purpose of rheumatoid lesions are:

• metacarpophalangeal joints 2 to 5 are joints near the base of the fingers;
• proximal interphalangeal joints from 1 to 4 fingers;
• all joints of the wrist and carpometacarpal joints - a series of small joints in the area of ​​\u200b\u200bthe palm itself.

As a rule, the small joints listed above are the first to be affected. Soreness leads to the fact that the patient is unable to clench the hand into a fist, and the fingers swell greatly. After a few months, the intermetacarpal muscles begin to atrophy, which leads to retraction of the skin on the palm and back of the hand. There are deformations and subluxations of the metacarpophalangeal joints, as a result of which the fingers are bent with a deviation towards the little finger. The little finger itself curves less than the other fingers. Clinicians refer to this deformity as a "major's fin". Then there is a curvature of the fingers according to the “swan neck” principle - the proximal interphalangeal joints of the fingers are bent, and the distal ones are excessively unbent.

Sometimes deformations occur with flexion of the metacarpophalangeal and extension of the lower interphalangeal joints (button loop). All of these changes greatly disrupt the functions of the brush.

Ultimately, pathological changes in the hand can lead to:

• to shortening of the fingers, fusion of the phalanges with each other and complete loss of mobility;
• tenosiviitis - inflammation of the flexor tendons of the fingers, as well as their synovial canals.

The result of tenosivitis is swelling of the finger and severe pain. With compression of the branches of the median nerve, which pass near the affected joints, loss of sensitivity from fingers 1 to 3 is possible. With prolonged compression, pain can spread to the entire forearm up to the elbow.

Later, the disease attacks the wrist, elbow and shoulder joints.

Deformation of these joints in rheumatoid arthritis manifests itself after the development of inflammation and is irreversible.

1. Radiocarpal rheumatoid arthritis leads to soreness, swelling of the affected area, limited flexion and abduction of the hand. Wrist arthritis is often complicated by synovitis and median nerve neuralgia.
2. The elbow joint is formed by the joints of three bones - the ulna and radius of the forearm, as well as the humerus. Therefore, arthritis can affect all three joints that form the complex elbow joint. Local arthritis is accompanied by severe pain during flexion and extension - contracture may develop in an intermediate position. With severe inflammation, it is impossible to carry out rotational movements (supination and pronation).
3. Arthritis of the shoulder joint is characterized by the spread of inflammation to the tendon synovial bags, collarbone, muscle frame. Swelling, soreness and limited movement develop gradually.
4. Inflammation can go to the axillary lymph nodes. Due to the fact that the shoulder joint has only one ligament and is strengthened due to muscle tone, myalgia, turning into atrophy, leads to habitual shoulder subluxations.

The second target for rheumatoid arthritis after damage to the hand is the foot. Most often, inflammation develops in the metatarsophalangeal joints of 2-4 fingers and is accompanied by pain when walking, standing on tiptoe, and jumping. Edema of the dorsal surface of the foot, hammertoe deformity of the fingers, subluxations of the listed joints, valgus deformity of the big toe are visually noted.

Later, inflammation of the synovial bags and synovitis join the arthritis, leading to compression of the plantar nerves. Injured effects on the nerves lead to loss of sensation in the foot, pain that can rise up to the knee joint.

1. characterized by pain, swelling in the knees. The pain is aggravated by flexion movements, during squats, when climbing stairs. Often, with severe edema, fluid balloting is noted when touching the anterolateral region of the knee. Severe pain can lead to the development of contracture in the semi-flexion position, as well as to the protrusion of the joint capsule in the posterior sections (Baker's cyst). Prolonged arthralgia of the knee joint forms an atrophy of the anterior group of thigh muscles.

Temporomandibular joint injury

The temporomandibular joint is combined - its functionality is accompanied by synchronous movements in both capsules. Arthritis is always accompanied only by bilateral soreness. Morning stiffness causes particular discomfort to the patient - due to the difficulty of opening the mouth and pain during chewing, eating is much more difficult. This leads to weight loss, nervousness. In severe cases, neighboring anatomical structures may be involved in the inflammatory process:

• chewing and temporal muscles;
• neighboring cellular spaces;
• parotid salivary gland;
• branches of the trigeminal and facial nerves.

Damage to the joints of the spinal column

Vertebral joints are extremely rarely involved in the clinical picture of rheumatoid arthritis. Arthritis usually develops in the junction of the head with the first cervical vertebrae (atlanto-occipital joint), the junctions of the first and second cervical vertebrae (median and lateral atlanto-axial joints). Clinically, inflammation is manifested by pain in the upper neck, characterized by the inability to painlessly turn the head to the side.

Extra-articular manifestations of rheumatoid arthritis (complications)

These lesions occur over a long course of the disease, predominantly in seropositive patients. Clinicians attribute these pathologies to complications of rheumatoid arthritis, since they develop with a systemic effect on the body.

Muscle damage

Myopathy in rheumatoid arthritis begins with the defeat of three groups of muscles of the hand:

• elevation of the thumb;
• elevation of the little finger;
• intermediate muscles.

Later, the myopathy rises and captures the back muscle group of the forearm. On the lower limb, the disease attacks the anterior muscles of the thigh and gluteal region. Myopathy is characterized by pain during muscle contraction, which aggravates movement processes.

Skin changes

With a long course of rheumatoid arthritis, the skin becomes dry and thinner, numerous hemorrhages appear on the skin all over the body. The nail plates become more brittle, with transverse striation. Under the nails or near them, small zones of soft tissue death are noted.

These are small dense formations located under the skin. Usually they are mobile and painless, loosely connected to the surrounding tissues. They are usually located on the back surface of the elbow joint, the extensor side of the forearm and the back of the head. Sometimes they are found in the myocardium, heart valves, between the membranes of the brain or spinal cord, in the lung tissue. They usually form during periods of exacerbations, and during remission they can disappear completely or decrease significantly. There is such a serious complication as rheumatoid nodulosis - the presence of nodules scattered throughout the body with multiple swelling of the joints, the presence of cysts and an elevated level of rheumatoid factor in the blood.

Damage to the lymph nodes

Such a complication is detected during an exacerbation and is characterized by an increase in a number of lymph nodes, usually near the affected joints:

• with arthritis of the joints of the upper limb, an increase in the elbow, axillary and cervical nodes is noted;
• temporomandibular arthritis is accompanied by an increase in the submandibular and cervical lymph nodes;
• arthritis of the joints of the lower limb leads to temporary hypertrophy of the inguinal lymph nodes.

Often, lymphadenopathy is accompanied by an enlarged spleen.

Damage to the stomach, intestines and liver

1. The defeat of the stomach is characterized by suppression of the synthesis of gastric juice, the formation of numerous erosions and ulcers. The result of such complications are dull pulling pains in the epigastrium, the formation of plaque on the mucous membrane of the tongue, and a decrease in appetite.
2. Rheumatoid arthritis can be complicated by inflammation of the small and large intestines - enteritis and colitis. Intestinal damage leads to acute and chronic pain, bloating, stool disorders, nausea and vomiting.
3. Sometimes the liver increases, its borders expand.

Pulmonary complications

The defeat of the lungs in rheumatoid arthritis usually occurs in parallel with the defeat of their membrane - the pleura. The defeat of the pleura is characterized by inflammatory changes - pleurisy.

Pleurisy may be dry or exudative. In the first case, the friction of dry, inflamed pleura during breathing causes severe discomfort to the patient. Exudative pleurisy is characterized by effusion of the liquid part of the blood into the pleural cavity, followed by compression of the lung, which leads to shortness of breath, a feeling of heaviness on the affected side. The defeat of the lungs is manifested by the development of pneumonitis and fibrosing alveolitis. A characteristic feature of complications of the lungs and pleura is the weak effectiveness of antibiotics and the rapid effect of the use of anti-inflammatory drugs.

Heart damage in rheumatoid arthritis manifests itself in the form of the following diseases:

1. Inflammation of the muscle membrane - myocarditis.
2. The defeat of the outer shell in the form of pericarditis.
3. The formation of acquired malformations of the heart in case of damage to the inner lining of the heart - endocarditis.
4. The defeat of the pericardial vessels - the aorta (aortitis) and the coronary arteries (coronary arteritis).

Inflammatory changes in the heart and blood vessels are manifested by complaints of shortness of breath and chest pain. A more accurate diagnosis is made by a cardiologist after passing the appropriate examination.

Renal complications

Kidney damage in rheumatoid arthritis is carried out with the involvement of the glomerular apparatus in the inflammatory process, resulting in the development of rheumatoid glomerulonephritis, renal amyloidosis. As a result of renal complications, anemia can develop in rheumatoid arthritis, which is formed when the disease becomes chronic.

Damage to the organ of vision

Eye damage in rheumatoid arthritis is very rare and is manifested by inflammation of the outer shell of the eyeball - the sclera. Inflammatory changes are characterized by severe pain, capillary dilation, and sometimes the formation of small rheumatoid nodules. With combined pathologies, the development of dry conjunctivitis is possible, in which the closure of the eyelid is accompanied by a strong pain sensation.

Complications from the nervous system

Damage to the nervous system is characterized by the following symptoms:

1. Frequent headaches and dizziness indicate a violation of the blood supply to the brain and encephalopathy.
2. A reaction to a change in temperature, increased sweating and a change in diuresis indicate damage to the autonomic nervous system.
3. Weakness in the affected limbs, difficulty in movement speak in favor of ischemic neuropathy.
4. Stitching pains in the extremities and parasthesias occur when the corresponding nerves are pinched and in neuralgia.

Other complications

If rheumatoid arthritis develops for a long time, there may be associated complications - such as inflammation of the pleura and pericardium, multiple hemorrhages on the internal organs.

Establishing diagnosis

Articular lesions occur in the later stages of the disease. Since at the beginning of the disease the articular syndrome does not manifest itself, the diagnosis of rheumatoid arthritis in the early stages is very difficult.

There are certain criteria for the diagnosis of rheumatoid arthritis:

• morning stiffness of the joints for at least an hour;
• arthritis of three or more joints;
• damage to the joints on the hand;
• symmetrical involvement of the joints in the clinical picture;
• the presence of rheumatoid nodules;
• the presence of rheumatoid factor;
• articular x-ray picture.

Diagnosis of rheumatoid arthritis is positive when four of the above symptoms are detected. It is important to note that the first four symptoms should persist for one to two months. Indisputable evidence of rheumatoid arthritis is synchronous minor polyarthritis. To identify the criteria described above, as well as additional diagnostic parameters, laboratory and instrumental research methods are used.

Laboratory methods

1. Complete blood count - with a high activity of the process, anemia may develop (a drop in hemoglobin, leukocytes). An increase in ESR in rheumatoid arthritis is an indirect sign of the development of the disease.
2. A biochemical blood test is informative for determining the degree of inflammation activity and identifying complications. First of all, attention is drawn to an increase in C-reactive protein, fibrinogen, seromucoid, sialic acids, haptoglobin, globulins and a decrease in albumin levels.
3. Immunological analysis of blood is one of the informative methods. In favor of rheumatoid arthritis is evidenced by the presence of rheumatoid factor, cryoglobulins. Often, antikeratin antibodies, LE cells, and circulating immune complexes are found in the blood.

Instrumental research methods

Instrumental diagnostics involves the use of methods that allow you to visually determine arthritis. The most common methods include: x-ray examination, magnetic resonance imaging, examination of synovial fluid followed by a biopsy.

X-ray examination

This type of study is the most informative, because it allows you to identify inflammation and deformity in the joints. The main radiographic features of rheumatoid arthritis are:

• disseminated or focal osteoporosis;
• reduction of the joint space;
• the appearance of erosion on the articular surfaces.

Radiological stages of rheumatoid arthritis are set by the doctor depending on the listed criteria.

Synovial fluid examination and biopsy

Synovial fluid - produced by the cells of the joint capsule to reduce friction during movement. Thanks to the synovial fluid, the coefficient of friction in the joints is 0.01. Joint fluid reflects all pathological changes in the joint, so taking it for analysis significantly complements the diagnostic criteria. A biopsy of the joint capsule with the presence of fibrin and inflammatory elements will leave the diagnosis of rheumatoid arthritis beyond doubt.

Main characteristics of synovial fluid

Differential Diagnosis

Differential diagnosis is a thorough analysis of the results of the examination in order to screen out inappropriate diagnoses with similar symptoms. Differential diagnosis of rheumatoid arthritis is carried out with reactive arthritis and osteoarthritis.

1. Reactive arthritis- this is a lesion of the joints after suffering diseases of infectious etiology.
2. Osteoarthritis- a set of diseases of various etiologies with damage to the joints with their subsequent deformation.

The main differences between these three types of diseases are shown in the table below.

Differential differences between rheumatoid arthritis, reactive arthritis and osteoarthritis:

Treatment

The treatment of rheumatoid arthritis is a complex complex process that requires a responsible approach from both the attending physician and the patient. According to modern research, it is impossible to cure the disease, therapy is aimed only at relieving symptoms and slowing the progression of joint damage. Treatment includes drug therapy and. Prevention of the disease includes physical therapy and spa treatment. As an addition, treatment with folk remedies is possible, but only under the supervision of the attending physician.

Drug therapy

Drug therapy includes symptomatic treatment - necessary to relieve pain and basic therapy - the purpose of which is to maintain the integrity of the musculoskeletal system and prevent complications.

Relieve pain and inflammation in the joints

The drugs of choice are hormonal painkillers - glucocorticoids. Symptomatic therapy greatly alleviates the suffering of the patient, but does not cure the underlying disease; when it is canceled, the symptoms gradually recur.
NSAIDs for rheumatoid arthritis are prescribed in the following sequence:

• selective NSAIDs- have a minimum of side effects and act for a long time. These drugs are allowed to be taken for a long time - from several months to several years. From this group, the most popular drugs are: Meloxicam, Movalis, Celebrex, Nimesil, Nise, Nimid, Revmoksib.
• non-selective NSAIDs- are appointed when the selective group is ineffective. These drugs have a quick effect, but have pronounced side effects - especially from the gastrointestinal tract. As efficiency and toxic effects increase, they are divided into the first and second stages. The first stage drugs are Diclofenac, Ibuprofen, Ketoprofen. The second stage is represented by Indomethacin, Ketorolac and Piroxicam. Symptomatic therapy

Attention! If there is no positive effect for a maximum of a week, you should contact your doctor to replace the drug.

Glucocorticoids in rheumatoid arthritis, they have a strong analgesic effect. They are hormonal drugs, so their overdose can cause the following side effects:

• hormonal disruptions;
• hyperfunction of the adrenal cortex;
• pancreatitis, diabetes mellitus;
• decreased immunity, frequent SARS;
• thrombosis and bleeding;
• the appearance of edema;
• disorders of the gastrointestinal tract;
• other disorders: itching on the mucous membranes of the respiratory tract, diseases of the sense organs.

The drugs of choice are: medrol, diprospan, methylprednisolone, triamcinolol, dexamethasone, betamethasone.

Basic therapy

The basic therapy of rheumatoid arthritis includes a group of drugs with a long-term effect, which significantly slow down the destructive changes in the connective tissue.

Cytostatics- these drugs are used mainly in oncology, but are the best means of basic therapy for rheumatoid arthritis. The mechanism of their action is aimed at inhibiting the growth of pannus and slowing down the destruction in the joints.

The most popular cytostatics:

• Arava;
• Remicade.

Biologicals– their action is aimed at binding the tumor necrosis factor, which plays a key role in the pathogenesis of rheumatoid arthritis. An important point is that these drugs are prescribed separately from each other due to the high likelihood of severe side effects.

Drugs of choice include:

• Anakinra;
• Actemra;
• Rituximab;
• etanercept;
• Humira;
• Orence.

Chondroprotectors- is prescribed to restore cartilage tissue and increase its resistance to autoimmune attacks of rheumatoid arthritis.

These include:

• Teraflex;
• Artra;
• Alflutop;
• Hyaluron.

Other drugs of basic therapy - various groups of drugs that are aimed at strengthening the immune system:

• Bicilin-3;
• Penicillamine;
• Cycloferon;
• Delagil.

Physiotherapy

Physiotherapy is a set of methods based on the therapeutic effect on the human body of natural and artificially created factors. The most popular methods of physical therapy for rheumatoid arthritis are massage, electrophoresis, acupuncture and cryotherapy.

Massage for rheumatoid arthritis is used only during periods of remission, during which pain is significantly reduced, swelling subsides, and the patient's general well-being is normalized. Massage is performed by a specialist on the affected joints and surrounding soft tissues.

Useful properties of massage:

• improves blood circulation and tissue trophism;
• promotes the absorption of exudate into the circulatory system and reduces swelling;
• prevents local atrophic changes in the muscles;
• prevents the deposition of calcium salts in the joints;
• normalizes movement in the joint, reduces stiffness in the morning;
• prevents joint deformity.

electrophoresis

This is a technique based on the use of drugs and the combined effects of galvanization. Electrophoresis in rheumatoid arthritis has a strong analgesic effect, as it is used in combination with glucocorticoids. The advantage of the method compared to the usual medication is that side effects are minimized, and the effectiveness is significantly prolonged.

Acupuncture and cryotherapy

Acupuncture is a physiotherapeutic procedure based on the reflex effect of needles on certain areas located near large nerves. Cryotherapy is based on exposure to the affected area with cold air, about -180 degrees Celsius. Acupuncture and cryotherapy for rheumatoid arthritis are distracting procedures and are used as an addition to the main methods, in order to relieve pain symptoms.

Traditional medicine and rheumatoid arthritis

Salt baths, tinctures and decoctions based on leaves and medicinal herbs are used as folk methods of treatment. For salt baths in rheumatoid arthritis, sea or table salt, magnesium sulfate, potassium bromide are used. Taking salt baths helps to normalize blood circulation, improves local metabolism, and reduces swelling of surrounding tissues.

Prevention

Prevention of rheumatoid arthritis is divided into primary and secondary. Primary prevention involves preventing the onset of the disease in a healthy person, and secondary prevention is aimed at preventing the development of relapses and complications in people suffering from rheumatoid arthritis.

Primary prevention includes:

• diagnosis and treatment of infectious diseases;
• detection of chronic infection in the body;
• strengthening immunity and maintaining a healthy lifestyle.

Secondary prevention implies:

• strict adherence to the doctor's recommendations for taking medicines, attending physiotherapy procedures and;
• spa treatment during periods of remission;
• constant exercise therapy.

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Classification of rheumatoid arthritis.

Currently, in practical work, the International Statistical Classification of Diseases of the 10th revision (ICD-10) is used, as well as the working classification of rheumatoid arthritis proposed by the Russian Association of Rheumatologists in 2003.

Clinical picture of rheumatoid arthritis.

In the debut, rheumatoid arthritis manifests itself as an articular syndrome. Patients complain of pain in the small joints of the hands and feet, the most intense in the morning and decreasing in the evening. The formation of arthritis is sometimes preceded by muscle pain, moderate arthralgia, bursitis and tendovaginitis. It should be noted that the symptoms of the initial period of the disease (“early” RA) are not always pathognomonic, which creates certain difficulties in making a diagnosis.

Joint damage in the initial stage of rheumatoid arthritis may be unstable. Sometimes patients develop spontaneous remission with the disappearance of the articular syndrome. However, after some time, the pathological process resumes again with damage to a large number of joints, the pain becomes more severe, requiring the appointment of NSAIDs or glucocorticoids.

Typical for rheumatoid arthritis is a symmetrical lesion of the metacarpophalangeal, proximal interphalangeal and II-V metatarsophalangeal joints. In the future, the wrist, knee, shoulder, hip, elbow, ankle joints, tarsal joints, cervical spine, and temporomandibular joints are involved in the pathological process. In the initial stage of the disease, pain occurs only during movements, but as it progresses, they disturb patients at rest. Swelling and redness of the skin develops "over the affected joints, stiffness of movements and, as a result, dysfunction of the joints. As a rule, tendons, articular bags, muscles and bones are involved in the process. Muscle atrophy develops on the dorsal surface of the hands.

Morning stiffness is one of the most important symptoms of rheumatoid arthritis and is diagnostically significant if its duration is more than one hour. One of the reasons for the development of morning stiffness is a violation of the normal rhythm of the production of adrenal hormones with a shift in the peak of their production to a later period of the day, as well as the accumulation of cytokines in the edematous fluid of inflamed joints during sleep.

In patients with rheumatoid arthritis, there is a limitation of active and passive movements in the affected joints as a manifestation of a protective reaction due to pain, as well as as a result of developing muscle contractures. A progressive inflammatory process in the joints leads to a significant limitation of their mobility, the development of articular deviations, deformities and ankylosis.

Articular deviations result from the formation of an angle between two adjacent bones. This is due to the development of subluxations and prolonged contracture of individual muscle groups, which eventually become irreversible. In patients with rheumatoid arthritis, ulnar deviation is often detected - the deviation of the fingers towards the ulna ("walrus fin").

Articular deformities appear as a result of the spread of the inflammatory process to the articular cartilage and bone segments, as well as the development of contractures of nearby muscles. Due to the stretching of the joint capsule and ligaments, subluxations of the joints develop.

Ankylosis is formed as a result of the destruction of cartilage and the formation of connective tissue between the subchondral bone structures of both epiphyses (fibrous ankylosis), and then bone elements that finally fix the joint. Developing ankylosis significantly limits the patient's mobility and leads to the development of severe functional insufficiency of the joints.

Some typical deformities are characteristic of the advanced stage of rheumatoid arthritis.:

• deformity of the "swan neck" fingers - hyperextension of the proximal interphalangeal joint and flexion contracture of the distal interphalangeal joint;
• "spider" hand - the patient cannot touch the surface of the table with his palm due to the inability to straighten his fingers;
• boutonniere deformity - flexion contracture of the proximal interphalangeal joint with simultaneous hyperextension of the distal interphalangeal joint;
• valgus (varus) deformity of the knee joints.

Developing changes in the joints of the hand lead to a significant violation of its function. Patients cannot perform the usual actions - lift the kettle, hold the cup, open the door with a key, dress themselves, etc. This is also facilitated by the development of tenosynovitis of the extensor of the fingers on the back of the hand and the long extensor of the thumb. In addition, rheumatoid nodules can form on the tendons, causing severe pain when the fingers are bent. Tenosynovitis of the hand may be accompanied by carpal tunnel syndrome with signs of compression neuropathy. Violates the function of the hand and the emerging contracture of the thumb.

Inflammatory lesion of the elbow joint leads to restriction of movements with subsequent formation of contracture in the position of half-flexion and half-pronation, possibly infringement of the ulnar nerve with the development of paresthesia of the innervation zone.

For damage to the shoulder joint, its swelling, pain on palpation, active and passive movements, impaired mobility with the subsequent development of muscle atrophy are characteristic. The inflammatory process involves not only the synovial membrane of the joint, but also the distal third of the clavicle with the development of bursitis, synovial sheaths and muscles of the shoulder girdle, neck and chest. Sometimes there is anterior subluxation of the humerus due to developing weakness of the articular bag.

The hip joint in rheumatoid arthritis is relatively rarely involved in the pathological process. Its lesion is manifested by pain syndrome with irradiation to the inguinal or lower parts of the gluteal region and limitation of internal rotation of the limb. There is a tendency to fix the hip in the position of semi-flexion. Aseptic necrosis of the femoral head, which develops in some cases, followed by protrusion of the acetabulum, sharply restricts movement in the hip joint and requires arthroplasty.

Rheumatoid arthritis. X-ray of the right hip joint. Joint space narrowing

Rheumatoid arthritis. Sharp narrowing of the joint spaces of the knee joints