ICD 10. Rheumatoid arthritis: symptoms and treatment

According to the ICD 10, rheumatoid arthritis belongs to class M: inflammatory polyarthropathies. In addition to it, this includes JRA( juvenile, or juvenile rheumatoid arthritis), gout and others. The causes of this disease have not yet been fully clarified. There are several theories about its development, but unanimity has not yet been formed. It is suggested that infection causes disturbances in the regulation of the immune system in people who are predisposed to it. As a result, molecules are formed that destroy the tissues of the joints. Against this theory is the fact that rheumatoid arthritis( the ICD code is 10 M05) is poorly treated with antibacterial drugs.

History of the disease

Rheumatoid arthritis is an ancient disease. The first cases of it were found in the study of skeletons of Indians, whose age was about four and a half thousand years. In the literature, the description of RA occurs from the year 123 AD.People with characteristic symptoms of the disease were imprinted on the canvases of Rubens.

As a nosological unit, rheumatoid arthritis was first described by the doctor Landreu-Bove in the early nineteenth century and called her "asthenic gout."Its present name was given to the disease after half a century, in 1859, during the mention in a treatise on the nature and treatment of rheumatic gout. For every one hundred thousand people, fifty people are diagnosed, most of them women. By 2010, more than forty-nine thousand people died in the world from the RA.

The etiology and pathogenesis of

RA is so common that it has been given a separate chapter in the ICD 10. Rheumatoid arthritis, like other joint pathologies, causes the following factors:

1. Heredity:

is a predisposition to autoimmune diseases in the family;

- the presence of a specific class of antibodies of histocompatibility.

2. Infections:

- measles, mumps( mumps), respiratory syncytial infection;

- hepatitis B;

- the whole family of herpes viruses, CMV( cytomegalovirus), Epstein-Barr;

- retroviruses.

3. Trigger factor:

- supercooling;

- intoxication;

- stress, taking medications, hormonal failures.

The pathogenesis of the disease lies in the abnormal response of the cells of the immune system to the presence of antigens. Lymphocytes produce immunoglobulins against body tissues, instead of destroying bacteria or viruses.

Clinic

According to ICD 10, rheumatoid arthritis develops in three stages. In the first stage, the swelling of the articular bags is observed, which causes pain, the temperature rises and the shape of the joints changes. In the second stage of the tissue cell, which covers the joint from the inside, begin to quickly divide. Therefore, the synovial membrane becomes dense and rigid. In the third stage, inflammatory cells release enzymes that destroy the joint tissues. This causes difficulties with arbitrary movements and leads to physical defects.

Rheumatoid arthritis( ICD 10 - M05) has a gradual onset. Symptoms appear gradually, it can take months. In extremely rare cases, the process can begin acutely or subacute. The fact that articular syndrome( pain, defoguration and local fever) is not a pathognomonic symptom, it significantly complicates the diagnosis of the disease. As a rule, the morning stiffness( inability to make movements in the joints) lasts about half an hour, and it intensifies when trying to actively move. Harbinger of the disease is pain in joints with changing weather and general meteosensitivity.

Variants of the clinical course of

There are several variants of the course of the disease, which the physician should orient in the clinic.

1. Classic , when joint damage occurs symmetrically, the disease progresses slowly and there are all its harbingers.

2. Oligoarthritis with lesion of exceptionally large joints, usually knee joints. It begins acutely, and all manifestations are reversible within a month and a half from the onset of the disease. At the same time pains in the joints are volatile, there are no pathological changes on the roentgenogram, and treatment with NVS( non-steroidal anti-inflammatory drugs) gives a positive effect.

3. Felti syndrome is diagnosed if an enlarged spleen with a characteristic pattern of blood changes joins the joint disease.

4. Juvenile rheumatoid arthritis ( code on the ICD 10 - M08).A characteristic feature is that they are sick children under 16 years old. There are two forms of this disease:

- with allergoseptic syndrome;

is an articular-visceral form that includes vasculitis( inflammation of the joints), damage to the valves of the heart, kidneys and digestive tract, as well as damage to the nervous system.

Classification of

As with other nosological units reflected in ICD 10, rheumatoid arthritis has several classifications.

1. On clinical manifestations:

- very early, when symptoms last up to six months;

- early if the disease lasts for up to a year;

- deployed - up to 24 months;

- late - with a disease duration of more than two years.

2. X-ray stages:

- The first. There is thickening and consolidation of the soft tissues of the joint, single foci of osteoporosis.

- Second. The process of osteoporosis captures the entire epiphysis of the bone, the joint gap narrows, erosions appear on the cartilages;

- Third. Deformation of the epiphyses of bones, habitual dislocations and subluxations;

- Fourth. Ankylosis( complete absence of joint space).

3. Immunological characteristics:

On rheumatoid factor:

- seropositive rheumatoid arthritis( ICD 10 - M05.0).This means that the patient's rheumatoid factor is detected in the blood.

- seronegative rheumatoid arthritis.

For antibodies to the cyclic citrulline peptide( Anti-CCP):

- seropositive rheumatoid arthritis;

- seronegative rheumatoid arthritis( ICD 10 - M06).

4. Functional class:

• First - all activities are stored.
• The second - the professional activity is disrupted.
• The third - retains the ability to self-service.
• Fourth - all activities are violated.

Rheumatoid arthritis in children

Juvenile rheumatoid arthritis ICD-10 singles out in a separate category - as an autoimmune disease of young children. Most often, children become ill after a serious infection, vaccination or joint trauma. In the synovial membrane develops aseptic inflammation, which leads to excessive accumulation of fluid in the joint cavity, pain, and ultimately - thickening the wall of the joint capsule and sticking it to the cartilage. After a while the cartilage is destroyed, and the child becomes disabled.

The clinic distinguishes mono -, oligo - and polyarthritis. When only one joint is affected, it is, accordingly, monoarthritis. If pathological changes are susceptible to up to four joints simultaneously, then this is oligoarthritis. Polyarthritis is diagnosed when almost all joints are affected. There is also systemic rheumatoid arthritis, when other organs are affected besides the skeleton.

Diagnosis

In order to diagnose, it is necessary to correctly and fully collect anamnesis, conduct biochemical blood tests, make radiographs of joints, and also serodiagnostics.

In the analysis of blood, the doctor pays attention to the rate of erythrocyte sedimentation, the rheumatoid factor, the number of blood elements. The most progressive at the moment is the detection of anti-CCP, which was released in 2005.This is a highly specific indicator, which is almost always present in the blood of patients, in contrast to rheumatoid factor.

Treatment of

If the patient has had an infection or is in high gear, then he is shown specific antibacterial therapy. When selecting medicines pay attention to the severity of the joint syndrome. As a rule, they start with nonsteroidal anti-inflammatory drugs and at the same time insert corticosteroids into the joint. In addition, since RA is an autoimmune disease, the patient needs a plasmapheresis to eliminate all immune complexes from the body.

Treatment, as a rule, is long and can be delayed for years. This is due to the fact that drugs must accumulate in the tissues. One of the key points of therapy is the treatment of osteoporosis. For this, the patient is asked to follow a special diet with a high calcium content( dairy products, almonds, walnuts, hazelnuts), and also take calcium and vitamin D.