Rheumatoid arthritis: symptoms, diagnosis, treatment with drugs in children and adults
Chronic inflammation of the connective tissue in which the joints are affected is called rheumatoid arthritis. Symptoms, diagnosis, treatment of this disease will be considered in the materials of this article.
What is rheumatoid arthritis?
This is quite a serious disease, which in just a few years can turn an absolutely healthy person into a weak invalid. It is known that rheumatoid arthritis is classified as an autoimmune disease. It develops according to a simple scheme. Different types of leukocytes due to the influence of certain factors begin to rapidly destroy the tissues of their own joints. They swell, and after a while there are erosions. To a lesser extent, tendons and ligaments suffer. The cartilage itself is completely destroyed.
Pathology is characterized by chronic progressive inflammation of the synovial membrane of the joint. In most cases, this process extends to the feet, knees, joints of the hips and hands. As the disease progresses, the cartilaginous bone is affected, and the joints are deformed. In severe course, systemic manifestations with simultaneous damage to blood vessels, skin, muscles and heart are possible.
Disease rheumatoid arthritis has been known since ancient times. Rheuma translated from Greek means "flow".There are several versions of the reasons for using this term. Some researchers are sure that the ailment was associated with the expiration of mucus, which gradually accumulated in the brain. Others explain his interpretation of the nature of the pain that occurs every time during an attack. Over time it became clear that nothing and nowhere with arthritis does not flow, but the name decided to keep.
This disease affects the most conserved parts of the human body - bones. During the archaeological excavations of settlements, scientists found deformations characteristic of rheumatoid arthritis on the remains of skeletons. In medical reference books, several names of this disease can be found: chronic infectious rheumatism, deforming arthritis, disfiguring ailment, but this name has settled down.
For the first time the term "rheumatoid arthritis" was proposed by A. Garro in 1858.However, a detailed description of the disease was described in the 1800s by Augustine Bove. He considered her to be one of the types of gout. In 1892 Garro presented a clear distinction between these two concepts.
Causes of rheumatoid arthritis
If you know why rheumatoid arthritis develops, diagnosis, treatment and prevention usually do not cause particular difficulties. In addition, this information allows you to with some probability to prevent further development of the disease. Its prevention, as a rule, is based on the elimination of the effect of provoking factors.
The etiology of the disease is not fully understood. Experts have identified a number of factors that together can trigger the development of ailment. The main role belongs to the hereditary predisposition. Normally, leukocytes must kill foreign elements. These include bacteria, viruses, cancer cells. If the body has a defect in the immune system at the genetic level, the leukocytes gradually lose the ability to recognize "good" and "bad" elements. On the other hand, changing genes that are responsible for the operation of certain types of leukocytes leads to a disruption in the ratio of cells. As a result, the inflammatory process starts, which does not stop in a timely manner and takes on a chronic form. Thus, rheumatoid arthritis gradually develops. Symptoms, diagnosis, treatment - these are several questions that every person who is at risk of this ailment should know.
In close relatives, the transmission is not the disease itself, but the predisposition of the immune system to the above violation. It can be realized as a disease. The likelihood of rheumatoid arthritis depends on the degree of kinship, as well as the impact of certain factors throughout life. The latter include:
- Smoking .The connection between this addiction and arthritis scientists noticed in the 70's of last century. Smoking more than 25 cigarettes a day for a long period of time( more than 20 years) increases the risk of the disease. The components of tobacco smoke affect the cells of the immune system, as a result of which the latter begin to produce autoantibodies.
- Gender and age. It is proved that the fair sex is more susceptible to rheumatoid arthritis. The disease can manifest itself at any age, but most often it occurs about 40-50 years.
- Infections. A patient with rheumatoid arthritis may notice an exacerbation of a pathology after a recent acute respiratory viral infection.
- . Disorders of the hormonal background. Scientists have proven that taking oral contraceptives significantly reduces the incidence of rheumatoid arthritis. Pregnancy in women with this diagnosis often causes remission, and childbirth, on the contrary, contribute to exacerbation.
Under the action of the described factors, the cells of the immune system begin to attack the elements of the joints of the joint, which provokes their inflammation. Skin covers in the affected area become hot and painful. The negative action of cells of the immune system also extends to the blood vessels, which explains the extraarticular manifestations of the disease.
Clinical picture of
It is impossible to confuse classic rheumatoid arthritis with other pathologies of similar nature. The first symptoms begin to appear within a few weeks until the inflammation becomes apparent. Initially, the disease affects the index and middle fingers of the hand. This causes inflammation and a slight swelling in the area of metacarpophalangeal joints. They are at the base of the fingers. A characteristic symptom of the disease is the simultaneous damage to the joints on the other arm. Pain syndrome can be observed from several months to one year. Such discomfort usually appears in the morning and lasts until noon, then goes to a decline. After physical activity or work, the pain syndrome passes.
Parallel to the pathological process are attached small joints of the feet, which are located at the base of the fingers. Patients note the soreness under the pads when pressed. As the disease progresses, larger joints become inflamed( ankle, shoulder and knee).
Other symptoms of the disease are rheumatoid nodules and morning stiffness syndrome. Patients note that after a dream there is a feeling of discomfort. So-called rheumatoid nodules form in the area just below the elbow, on the feet and hands. In the section, they are represented by the accumulation of immune cells that surround the area of necrotic tissue.
In some patients, the clinical picture is supplemented by a deterioration in general condition. The temperature rises, sleep and appetite disappear. Rheumatoid arthritis of the fingers of the fingers at an extended stage is characterized by deformation of the hands. This condition is accompanied by a so-called ulnar deviation, and the mobility of the joints gradually decreases. When vertebral articulations join the inflammatory process, severe pain arises in the neck and occiput.
Stages of development of the disease
There are several criteria that make it possible to accurately classify the stages of rheumatoid arthritis. The most informative are those that are based on the results of the roentgenogram.
They are divided into four categories:
- At the initial stage, the first signs of a decrease in bone density are discernible. This is the only manifestation of the disease, which can be determined from the radiograph. Soft tissue gradually thickens. Sometimes on the bone you can distinguish light areas. These are the so-called cysts. If the articular fissures are narrow, we can talk about the rapid development of the disease and its imminent transition to the next stage. A distinctive feature of this stage of the disease is a prolonged course without obvious clinical signs. The patient may not notice any health problems, so do not rush to see a doctor.
- The second stage is characterized by the further development of the pathological process and the involvement of bones in it. First of all, hands in the zone of elbows and wrists suffer. If erosion is localized next to the cartilage, in this area the mobility is limited. In this case, the cartilage itself can remain intact, but the muscles are already beginning to atrophy. Synovial bags swell and slightly inflamed. Patients during an exacerbation usually complain of an ache and strong pains.
- In rheumatoid arthritis of the third stage, the image shows muscle atrophy and joint deformity. If the deposition of salts is observed even at the initial stage of the development of the disease, then calcification is clearly discernible on the x-ray.
- At the fourth stage, bone disorders become noticeable. On the X-ray, osteoporosis, multiple erosions and cysts are clearly visible. The joint is completely deformed, and the muscles around it are atrophied.
The determination of the stage of rheumatoid arthritis makes it possible to select the most effective therapy, and also to prevent possible complications.
Rheumatoid arthritis is classified as a chronic disease of unknown etiology, so its detection is often difficult. In 1997, the American College of Rheumatology proposed several criteria for the diagnosis of this pathology, which remain relevant to this day. In the presence of four of the seven items from the list of symptoms, the diagnosis can be considered reliable.
- Morning stiffness. Rheumatoid nodules.
- Defeat more than three joints.
- Positive rheumatoid factor.
- Lesion of wrist joints.
- Radiographic changes.
- Symmetrical joint damage.
Unfortunately, the above signs can be found only in the late stages of the development of the disease. That is why when there is morning stiffness and soreness in the joints, it is necessary to go to the hospital. If rheumatoid arthritis is detected, the symptoms, diagnosis, treatment and prevention measures of this disease should be known to every physician.
To confirm the final diagnosis, the patient is required to take an x-ray of the hands and feet, a blood test to identify the rheumatoid factor and evaluate the ESR.After the examination, the doctor selects the appropriate treatment. Usually it is complex and consists of several stages. About each specific variant we will tell hardly more low.
To eliminate the "basis of the disease" the basic treatment of rheumatoid arthritis is used. Drugs prescribed by a doctor do not eliminate pain and other symptoms of the disease. They are designed to interrupt the further development of the disease. The positive effect of the use of medicines becomes noticeable only after a month of treatment.
Gold preparations for fighting this disease have been used for about a hundred years. Their effect is especially effective at the initial stages of the disease with severe joint pain and rheumatoid nodules. Among the possible side effects can be attributed to the appearance of "golden" dermatitis and inflammation of the mucous membranes.
Immunosuppressants are also actively used in therapy( Methotrexate, Azathioprine).These drugs with rheumatoid arthritis are aimed at artificial inhibition of the body's defenses. Due to the fact that they are borrowed from oncology, many are afraid to use them. However, this is a false fear. To treat arthritis, smaller doses are used, so side effects are extremely rare.
In some cases, patients are prescribed sulfonamides. These are antibacterial drugs that suppress the growth of pathogenic microflora. The likelihood of side effects is extremely small. Their effectiveness is slightly lower in comparison with immunosuppressants and gold preparations. Positive therapeutic dynamics in patients with a diagnosis of "rheumatoid arthritis of the fingers" is observed only after six months of such treatment.
Non-steroidal anti-inflammatory drugs( NSAIDs) have analgesic and antipyretic effects( "Meloxicam", "Diclofenac").They are prescribed for acute pain in the joints. These medicines significantly improve the patient's condition. It is only necessary to stop receiving them, as soon as the ailment returns. NSAIDs are not able to completely overcome the disease, they only eliminate unpleasant symptoms. Virtually all medicines have contraindications, so before starting a course of therapy, it is recommended to consult a doctor.
Selective drugs for rheumatoid arthritis are used not so long ago. This is a new word in modern medical practice. These drugs are designed to significantly reduce the number of side effects, since they act solely at the site of inflammation and do not affect other organ systems. Selective drugs selectively block the production of inflammatory substances in the cartilaginous tissue of the joint. Medications are convenient to use. Of the possible disadvantages, it should be noted the effect on increased coagulability of the blood. This, in turn, can cause a heart attack or stroke.
Also used to combat rheumatoid arthritis are corticosteroids( Prednisolone, Dexamethasone).These are hormonal drugs designed to reduce pain and morning stiffness in the joints. The attitude of doctors to the question of the use of corticosteroids is ambiguous. Some tend to use hormones for the treatment of diseases, others - against it. The latter explain their opinion by the variety of side effects. Hormones, in addition to the general effect on the body, can increase blood sugar, lower immunity, cause hypertension. That is why before the appointment of treatment the doctor weighs all the pros and cons.
Topical treatment for rheumatoid arthritis
The drugs described above are not suitable for all patients. Some have individual intolerance of the constituent components, others do not observe a positive therapeutic effect. Therefore, in some cases, doctors resort to local treatment.
In the chronic course of the disease, laser irradiation is used. This therapy gives a mild anti-inflammatory effect. Approximately 80% of patients report an improvement in general condition.
Another option is cryotherapy. During the procedure, the specialist works by deep cooling to the affected joints. Cryotherapy is absolutely harmless and has no contraindications.
The use of ointments and various creams gives only temporary relief. The thing is that the skin covers only 7% of the active substances. This is not enough to obtain a stable therapeutic effect. Despite a wide range of benefits of treatment with ointments, they are resorted to in exceptional cases.
After removing the acute form of the disease, you can apply massage, as well as other methods of physiotherapy. The thing is that such treatment has a stimulating effect and helps to reduce local inflammation. These methods of therapy improve blood supply to affected joints and simultaneously increase their mobility. In medical practice, paraffin, UHF, phonophoresis, and also infrared irradiation are actively used today.
Compliance with a strict diet is indicated in patients with a diagnosis of rheumatoid arthritis. Symptoms, diagnosis and course of this disease can determine its cause. However, regardless of these factors, the adjustment of the diet is offered to all patients.
Doctors believe that some products contribute to the development of inflammatory processes in the tissues. These include pork, all citrus, wheat and rye, dairy products, as well as corn. Doctors recommend eating more fish, pearl barley and buckwheat porridge, chicken eggs. A special place in the diet should belong to fruits and vegetables, rich in vitamins. It is recommended to exclude fatty and fried foods for the entire course of therapy. Food should be steamed, and often eat in small portions. Together with drug therapy, a change in the habitual diet has a positive effect on the dynamics of recovery.
Juvenile rheumatoid arthritis
Symptoms, treatment, diagnosis in children of this disease practically do not differ from the course and therapy in adult patients. Rheumatoid arthritis of the juvenile type is characterized by rapid development. For every 100,000 children this ailment occurs in every 15 patients.
The disease occurs mainly up to 16 years and can last for several years. Its development is usually the result of various influences, ranging from viral infections and ending with increased sensitivity to certain environmental factors.
The main symptom of rheumatoid arthritis in children is a pain syndrome in one or at the same time several joints. On examination, their deformation is observed, which initially manifests itself in the form of a swelling. Gradually, the functionality of the joints is reduced. In some cases, in small patients lymph nodes increase, the temperature rises.
Therapy includes the use of NSAIDs( "Orthofen", "Brufen") in combination with gold salts and immunosuppressants. In the inactive stage of the disease, sanatorium treatment is recommended for children, where with the help of various recreational activities it is possible to normalize the motor activity.
Juvenile rheumatoid arthritis should not be overlooked. Symptoms, treatment, diagnosis of this disease in young patients require a qualified approach. If all necessary therapeutic measures are taken in time to eliminate this ailment, serious complications can be avoided. In addition, quality treatment at the initial stages does not affect the future life of a small patient.
Many patients are interested in how to cure rheumatoid arthritis. The diagnosis sounds awesome, but you should not be afraid of it. Unfortunately, there is no panacea for this disease. This is a chronic process that often requires lifelong therapy. The most important thing is to start it immediately.
Today, specialists from all over the world are constantly searching for new therapeutic methods that are not accompanied by side effects. This issue is especially important for women in a situation suffering from rheumatoid arthritis. After all, in this case, taking many medications is prohibited.
Many will agree that the best treatment for any ailment is its timely prevention. To ensure the protection of joints, doctors recommend a healthy lifestyle. It means the elimination of all bad habits, balanced nutrition, sufficient physical activity. Not the last role belongs to the strengthening of immunity and the fight against excess body weight.
Now you know what signs are accompanied by rheumatoid arthritis. Symptoms, diagnosis, treatment of the disease are several interrelated issues that require an exceptionally qualified approach. Rheumatoid arthritis is classified as a disease with an unfavorable prognosis. If all measures are taken in a timely manner to eliminate the inflammatory process, to follow the recommendations of the doctor clearly, it is possible to translate the pathology into a chronic form.