Rheumatoid arthritis: symptoms, diagnosis, criteria for diagnosis, treatment
If there is evidence of rheumatoid arthritis, then your doctor should be well aware of the symptoms, treatment and diagnosis of this pathology. Of all diseases are also important systemic diseases. They are dangerous because they can lead to disturbances of functions of vital organs and systems of man. Rheumatoid arthritis refers to such diseases. It cannot be cured completely, and in the absence of treatment the disease progresses and can cause disability. Most often the disease is diagnosed in adults. What is the etiology, clinic and treatment of this disease?
Rheumatoid arthritis: causes, symptoms
Rheumatoid arthritis is a medical condition in which mainly inflamed small joints of the human body. It is based on autoimmune shifts. According to official statistics, from this disease suffers from 1 to 2% of the population. Most often are persons of middle and old age. The peak incidence occurs in 40-50 year olds. More common in women.
The Main clinical manifestations are associated with destruction of cartilage of joints that may eventually lead to ankylosis. The latter is characterized by immobility of the joint. There is a theory that rheumatoid arthritis has an infectious nature. This is indicated by the following signs: hyperthermia of the body, the acute debut of the disease. Despite all of this, rheumatoid arthritis cannot be cured with antibacterial drugs. In addition, seasonality is not observed morbidity.
The causes of rheumatoid arthritis is not fully understood. There are 3 main risk factor for the development of this pathology:
- genetic susceptibility
- infection of the body by viruses;
- external factors.
Persons whose close relatives suffer from this disease, a greater risk of infection. Of great importance is due to a hereditary predisposition to autoimmune reactions. Often rheumatoid arthritis is formed after a viral illness. It may be measles, rubella, mumps, herpes zoster, cytomegalovirus infection. The most dangerous are: Epstein Barr, hepatitis B, retroviruses.
environmental Factors are also important. These include hypothermia, the influence on the organism of toxic substances, excessive sun exposure, stress, consumption of certain medications. In women with prolonged lactation the risk of developing disease is reduced.
The Disease occurs in several stages. At 1 stage there is swelling in the affected area. This contributes to the appearance of pain, increased temperature in the affected area and swelling. Already in the early stages you want to go to the doctor because the disease progresses steadily. In stage 2 changes the synovium of the joints. Signs of stage 3 include increased pain, the appearance of deformation and difficulty of movement. The symptoms appear suddenly, but the disease develops slowly. Arthritis most often occurs in the acute or subacute form. The disease develops a type of arthritis with simultaneous inflammation of 3 or more joints.
The Joints of the hands and feet become inflamed most often. It is often observed curvature of the fingers. Articular syndrome in rheumatoid arthritis has no specific features. It is characterized by:
- stiffness in the morning;
- swelling of the skin;
- the pain;
- dysfunction of the joint.
The diagnosis in the presence only of the articular syndrome complex. In this situation, differential diagnosis is with other forms of arthritis.
Aching pain can bother people constantly throughout the day, increasing in the second half. Pain disappears when the use of NSAIDs (non-steroidal anti-inflammatory drugs). An important feature of rheumatoid arthritis is the symmetry of defeat. Monoartrit is rare. Morning stiffness lasts differently, depending on the intensity of inflammation. When mild it lasts one hour, with heavy – can be permanent. Pain in rheumatoid arthritis in the early stages only occurs when moving. He then observed alone. The changes that occur in the joints, irreversible. Even after treatment, residual effects persist.
To Put the correct diagnosis the doctor can help other (extra-articular) symptoms. Sometimes before emergence of articular syndrome patients complain of fatigue, malaise, weight loss, pain in the muscles. Weight loss often occurs in the first weeks of the disease. For six months a person can lose 10-15 kgmass. Such patients are often concerned about periodic fever. Fever is a manifestation of inflammation in the joints. The temperature often rises in the evening and at night. Affects not only the joints but the muscles. Myalgia indicates acute inflammation. Muscle soreness can last for a very long time. They aching, appear during the movements. Specific sign of rheumatoid arthritis – nodules.
In the course of examination of the nodules visible to the naked eye. Their size is only 1-2 cm. They are Located under the skin, are detected near the affected joint. The nodes are painless and firm to the touch. This symptom reflects the severity of the disease. Sometimes rheumatoid arthritis is combined with osteoarthrosis. In severe cases, delayed therapy begin to suffer other vital organs (liver, heart, kidneys, lungs, eyes). Sometimes there are changes in the blood (anemia or thrombocytosis). In terms of cardio-vascular system often develops pericarditis, vasculitis and atherosclerosis. The kidneys may be affected by the type of nephritis or amyloidosis. Some patients develop keratopathy (pathology of the cornea), scleritis. In severe cases, suffers nervous system (neuropathy develops, monometric).
In pediatric practice is often diagnosed with the juvenile form. It develops in children under the age of 16 years. Children under 2 years of age rarely suffer from arthritis. The incidence of this disease is less than 1% of the total number of children. Girls get sick more often boys. Allocate 2 main clinical forms of the disease: systemic and articular. System in form in children may have fever, rash often appears, affects lymph nodes and internal organs (heart, lungs, kidneys). When the articular form affects the joints. While arthritis can affect not only the joints of the hands and feet, and cervical spine.
Children are more frequently inflamed large joints (knee, ankle, elbow, pelvis). In the absence of timely treatment of rheumatoid arthritis in children may lead to complications. The latter include myocarditis, cardiopulmonary failure, developmental delay and growth child. The later developed arthritis, the worse the prognosis for the health.
Diagnosis and treatment
Directly before treatment is required to put the correct diagnosis and exclude other pathology. To diagnosis of rheumatoid arthritis include:
- a medical history of disease;
- inspection of joints and skin;
- x-ray, MRI or CT scan
- laboratory investigation.
Diagnostic criteria of rheumatoid arthritis include:
- stiffness in the morning lasting more than 1 hour;
- the presence of polyarthritis (inflammation of more than 3 joints);
- inflammation of the joints on the right and left simultaneously
- the presence of rheumatoid nodes;
- identification of rheumafaktor in the blood;
- the presence of radiographic progression of the disease.
Not all of the above signs may be present. The wording of the diagnosis is made only after laboratory analysis and x-ray studies. During the laboratory diagnostics can reveal the presence of rheumatoid factor, acceleration of ESR (erythrocyte sedimentation rate), increased CRH, gamma globulin, anemia. With the help of x-ray examination can detect joint space narrowing, signs of osteoporosis and destruction of cartilage. It is very important to conduct a differential diagnosis. Children should be excluded juvenile spondylitis, Bechterew's disease, lupus, tumors of bone, acute leukemia and other types of arthritis. This has important implications for subsequent therapy.
Treatment should be comprehensive. Its main objectives are: prevention of complications, reduction of inflammation and elimination of the main symptoms.
Treatment involves medication (NSAIDs, anticancer drugs, cytostatics, immunosuppressants, corticosteroids), a diet, physiotherapy, blood detoxification (hemosorption, or plasmapheresis) and physiotherapy.
From immunosuppressive drugs the doctor may prescribe "Azathioprine". From the cytostatics used "Cyclophosphamide". Used ointments, gels. Important place in the treatment takes dietetics. You want to include in the diet foods fortified with calcium. We need to refuse from fatty meats, citrus. Thus, rheumatoid arthritis is a terrible disease. It can cause disability of both adults and children.