Rheumatoid arthritis( RA) is a chronic, slow-progressive systemic disease of connective tissue of an infectious-allergic nature with a predominant lesion of peripheral joints. The pathological process leads to the complete destruction of the joint tissues, to gross deformities and the development of ankylosis, which leads to loss of joint function and disability. In severe cases, the internal organs( heart, kidneys, lungs, blood vessels, muscles, etc.) can be affected at a late stage of rheumatoid arthritis, which significantly worsens the prognosis of the disease.
Rheumatoid arthritis is classified as a group of autoimmune pathologies, that is, tissue damage is caused by a person's own immune system, which for some reason has failed, and she began to produce antibodies to her cells and tissues.
In women, the disease is diagnosed 3 times more often than in men. Pathology develops in people of any age and even in children( juvenile rheumatoid arthritis), but the peak falls on the age of 40-50 years. The prevalence of the disease is 5.2% for women and 2.5% for men. In the international classification of diseases 10 revision( ICD 10) this pathology is assigned code M05.
In RA, the immune system begins to destroy its own articular tissues instead of the foreign organisms
Causes and predisposing factors
The causes of this form of arthritis are not fully understood. Most often you can hear about the infectious hypothesis of the disease. Rheumatoid joint damage is associated with the Epstein-Barr virus, rubella, herpes, hepatitis B, etc.
In recent years, the role of genetic factors in the development of rheumatoid arthritis is increasingly being discussed. Certain variants of human genes can lead to violations of immunological processes and the inferiority of the immune response. To provoke the launch of a pathological cascade of immune reactions that will lead to the formation of autoantibodies, a large number of predisposing factors may include: infection, hypothermia, stress, hormonal failure, trauma, allergic reaction, surgery, etc.
Classification of rheumatoid arthritis
Rheumatoid arthritis is characterized by a largea variety of clinical manifestations and laboratory data, which creates serious obstacles in the recognition of the disease. To simplify this process, there is a classification of rheumatoid arthritis, which is used to diagnose, as well as drafting a treatment and prognosis program.
Clinical and immunological characteristics:
- Seropositive RA, when a specific rheumatoid factor is detected in the blood of patients( 80% of cases).Clinical variants of seropositive RA: polyarthritis, rheumatoid vasculitis, rheumatoid nodules, rheumatoid lung disease, Felty syndrome.
- Seronegative RA( 20% of cases) when there is no rheumatoid factor in the blood. Clinical variants of the disease: polyarthritis, adult's Still's syndrome.
The degree of activity of the pathological process of distinguishes remission in rheumatoid arthritis( there is no joint pain, morning stiffness, ESR up to 15 mm / h, CRP not more than 1 plus) and the phase of exacerbation. Depending on the clinical and laboratory data, there are 3 degrees of exacerbation of RA:
- is 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 /2 plus);
- average( pain - 4-6 points, joint stiffness up to 12 hours after sleep, ESR - 30-45 mm / h, SRB - 3 plus);
- high( pain - 6-10 points, stiffness is observed throughout the day, ESR - more than 45 mm / h, SRB - 4 plus).
X-ray stage of ( changes that are detected during X-ray examination in affected joints):
- First: osteoplastic osteoporosis is detected.
- The second: osteoporosis + narrowing of the joint space, there may be single usuricies( they look like "holes" in the intraarticular parts of the bones).
- Third: multiple usuras appear.
- Fourth: joint ankylosis develops, their deformity.
X-ray shows the 4th stage of the AS AS8686 Functional activity:
- All patient's vital manipulations are performed without difficulty, despite the disease.
- Self-service causes significant difficulties.
- The patient can not service himself without assistance.
Thus, a complete diagnosis of rheumatoid arthritis may be as follows: "Seropositive rheumatoid arthritis: polyarthritis, active phase, medium activity, X-ray stage 2, functional activity -1".
Disease Rheumatoid arthritis can begin acutely and subacute, and the last version of the debut is observed in most cases. Signs of pathology can be divided into joint and extra-articular manifestations. Some patients may notice nonspecific complaints even before the joints are affected, which are called a prodromal, or latent, period.
First signs of RA:
- chronic fatigue;
- permanent muscle weakness;
- weight reduction;
- the appearance of muscle pain for no apparent reason;
- sudden and causeless temperature jumps to a low-grade level( 37-38 ° C);
- increased sweating.
As a rule, such manifestations of the disease remain without attention, as they are explained by psychosomatics, life in conditions of chronic stress and overwork. Further, articular syndrome and extra-articular manifestations of the disease develop.
Joint damage in RA
In 70% of RA patients, polyartritic type occurs( simultaneous lesion of more than 3 joints), oligoarthritis( inflammation of 2-3 joints) and monoarthritis( joint damage) are much less frequent. A characteristic feature of RA is the inflammation of small joints of the hands and feet. Less often, the ankle, elbow, knee joints, wrist are drawn into the pathological process, the hip, shoulder and articulations of the spine are even more rarely inflamed.
Rheumatoid arthritis of the 1st stage, you can notice the swelling of the proximal interphalangeal joints
Joint pain has its own peculiarities:
- is characterized by a wave-like current: it intensifies towards evening, it subside slightly during the day;
- is reduced by non-steroidal anti-inflammatory drugs.
Other characteristics of articular syndrome in RA:
- sympathetic joint damage;
- there is morning stiffness in diseased joints;
- joints can swell, the skin above them becomes red, local temperature rises( signs of inflammation).
Later, the function of inflamed joints begins to suffer( for example, the patient can not squeeze his hand into a fist), their typical deformations gradually develop:
- "walrus fin"( ulnar deviation of the hand);
- "swan's neck";
- formation of spindle-shaped fingers;
- valgus or varus deformity of the knee joints,
- ankylosis articulations( complete immobility).
Hand deformation of the type of ulnar deviation
Suffer and muscles with ligaments. Develops atrophy of muscle mass of the hands, tenosynovitis, carpal tunnel syndrome, Baker's cyst, muscle contractures and other symptoms.
Extra-articular manifestations of
disease In RA, first of all, peripheral joints suffer, but one should not forget that this is a systemic disease, and any organs and tissues with connective tissue can be involved in the pathological process. As a rule, extra-articular symptoms appear in the late stages of the disease, significantly aggravate its course and worsen the prognosis. That is why rheumatoid arthritis is considered dangerous not only for health, but also for the life of a sick person.
The most common extraarticular signs of RA:
- skin and subcutaneous tissue damage( thinning and dryness of skin, skin rash, brittle nails, pinpoint hemorrhages);
- appearance of rheumatoid nodules - dense subcutaneous formations up to 2 cm in diameter, they are painless, mobile, appear near the affected joints, in places of increased pressure;
- muscle damage: there are myalgias, muscle strength decreases, their atrophy develops, which further aggravates deformity of the limbs;
- lungs and pleura: develops dry or exudative pleurisy, "rheumatoid lung"( fibrosing alveolitis, interstitial pneumonia), which can cause respiratory failure and death of the patient;
- GI disease: development of autoimmune hepatitis, pancreatitis, gastritis, enteritis;
- cardiovascular damage: pericarditis, myocarditis and endocarditis may develop, stenosis or heart valve failure may occur;
- kidney: developing glomerulonephritis, renal amyloidosis, chronic renal failure;
- develops vasculitis;
- Felty Syndrome: anemia, a decrease in platelet blood( risk of bleeding), an increase in the spleen, peripheral lymph nodes, rheumatoid polyarthritis, a decrease in the number of leukocytes in the blood.
Autoantibodies in RA can affect all organs where connective tissue is present.
Diagnosis in rheumatoid arthritis
It is very difficult to diagnose rheumatoid arthritis, as there is no specific marker of the disease. Therefore, the diagnosis should be comprehensive and must take into account the possibility of other similar diseases.
Diagnostic criteria RA:
- Morning stiffness in joints.
- Arthritis of 3 joint zones and more.
- Arthritis of the joints of the hands.
- Symmetric defeat of articulations.
- Rheumatoid nodules.
- Rheumatoid factor in the blood.
- Characteristic radiographic signs.
The diagnosis can be considered reliable if there are 4 of the 7 criteria described, with clauses 1-4 being present for a minimum of 6 weeks.
As it was said, there are no specific methods that can accurately confirm RA, but there are some laboratory tests and instrumental examinations that will help the doctor understand the diagnosis and exclude similar diseases.
Analyzes for rheumatoid arthritis can be divided into 2 categories:
- General laboratory tests that indicate the presence of an inflammatory process in the body: a general blood test, acute inflammatory phase proteins, ESR, CRP, biochemical tests that also allow an evaluation of the function of internal organs.
- Specific tests that indicate RA: detection of rheumatoid factor in the blood, anti-cytrulin antibodies( ATSP), antinuclear antibodies( ANA), synovial fluid cytology and identification of changes characteristic of autoimmune inflammation( rheumatoid factor, ragocytes, discoloration and transparency, an increase in the number of leukocytes).
Mechanism of formation of rheumatoid factor
Instrumental diagnostic methods:
- MRI, CT;
- biopsy of the damaged joint;
- ultrasound of joints and internal organs.
Differential diagnosis of rheumatoid arthritis is an indispensable component of setting the right diagnosis. Most often it is necessary to look for differences from arthritis of reactive, osteoarthritis, psoriatic arthropathy, rheumatic arthritis, Bechterew's disease, Sjogren's syndrome.
Differential diagnosis of RA
Consequences and complications of rheumatoid arthritis
The consequences of rheumatoid arthritis depend on the timeliness of the diagnosis and the purpose of specific therapy, on the degree of activity of the process and the course of its course, on the presence of internal injuries and compliance with all medical recommendations.
Very often because of gross deformations of the joints, patients become disabled, their quality of life is significantly reduced. If extraarticular lesions are attached, cardiac, pulmonary, and renal failure may develop, which leads to death. Significantly increases the risk of fatal cardiovascular events( heart attack, stroke).
Because of the need to constantly take hormonal drugs, non-steroidal anti-inflammatory and cytotoxic drugs, severe side effects of drug therapy develop.
Modern methods of treatment of
The main therapy for RA is medicines. Other methods( physical therapy, massage, physiotherapy) are used only during remission as a general restorative therapy. It is important to remember that gymnastics is prohibited in the active phase of the disease.
Treatment can be divided into 2 stages:
- relief of inflammation exacerbation;
- basic therapy for rheumatoid arthritis.
Methotrexate is the main drug for basic therapy of AS
. Drugs that eliminate the symptoms of pathology include
- non-steroidal anti-inflammatory drugs,
- glucocorticoid hormones.
There are several schemes for the use of these drugs. In each case, the doctor selects the right medicine and its doses on an individual basis.
Basic medications are used not only during an exacerbation, but also at remission. They are able both to eliminate the symptoms of the disease, and to influence its course, prolonging the period of remission. These include:
- cyclosporin A,
- preparations of gold,
- preparations of biological therapy.
Treatment of rheumatoid arthritis is a very difficult task, which is beyond the power of every specialist. But you need to remember that by joint efforts you can take the disease under control and prevent its disabling effects. The main thing is not to give up, follow all medical recommendations and believe in success.
- Causes and predisposing factors
- Classification of rheumatoid arthritis
- Symptoms of the disease
- Diagnosis in rheumatoid arthritis
- Consequences and complications of rheumatoid arthritis
- Modern therapies