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Joints And Bones

Rheumatoid Arthritis: Symptoms, Diagnosis, Treatment

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Rheumatoid arthritis - an inflammatory disease characterized by symmetrical inflammation affecting the joints and internal organs.

Causes

The cause of rheumatoid arthritis is unknown. In the role of probable cause can serve a variety of viruses, bacteria, trauma, allergy, Heredity and other factors.

Incidence - 1% in the general population. The predominant age - 22-55 years. Predominant floor - female (3: 1).

Symptoms of rheumatoid arthritis

Common symptoms

  • fatiguability
  • A slight increase in body temperature
  • Adenopathy
  • Weight Loss.

joint disease

Symmetric joint damage - an important feature of rheumatoid arthritis (e.g., affected the right and left elbows or right and left knee joints)

  • Morning stiffness of the joints lasting more than 1 hour
  • Rheumatoid brush: the strain of "buttonhole" type "swan neck", "hand a lorgnette"
  • Rheumatoid Foot: deformation of the finger 1
  • Rheumatoid knee: Baker cyst, flexion deformation
  • Cervical spine: atlantoosevogo joint subluxations
  • Perstnecherpalovidny joint: deepening of voice, swallowing disorder.
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The defeat of the periarticular tissues

Tenosynovitis in the wrist and hand (inflammation of the tendon, characterized by swelling, pain and distinct creaking during movement).

bursitis, Especially in the elbow joint.

The defeat of the ligament apparatus to the development of increased mobility and deformations.

The defeat of the muscles: muscle atrophy, often drug (steroid, as well as in patients receiving penicillamine or aminohinolinovogo derivatives).

systemic manifestations

Rheumatoid nodules - dense subcutaneous education is typically localized in areas often suffer traumatic (e.g., in the olecranon on the extensor surfaces forearm). Very seldom is found in the internal organs (e.g., lung). It is observed in 20-50% of patients.

Anemia due to deceleration of iron metabolism in the body caused by impaired liver function; the amount of reduction platelet

Felty's Syndrome, including lowering blood neutrophil, Enlargement of the spleen,

Still's syndrome:

  • fever 39 ° C and above for one or more weeks;
  • joint pain 2 weeks or more;
  • blotchy rash salmon color that appears during fever.

Sjogren syndrome - dry mucous membranes of the eyes, mouth.

Also in rheumatoid arthritis may show signs of osteoporosis (This is the loss of bone tissue) amyloidosis.

Often, there are sores on the shins skin, inflammation of the arteries.

Diagnostics

In general, and biochemical analysis of blood:

  • anemia,
  • increased erythrocyte sedimentation rate,
  • elevated levels of C-reactive protein.

Articular cloudy liquid with low viscosity, increased number of leukocytes and neutrophils.

Rheumatoid factors (antibodies to immunoglobulins of class M) is positive in 70-90% of cases.

General urine analysis: albuminuria.

increase creatinineUrea serum (evaluation of renal function, a necessary step of selecting and monitoring treatment).

Criteria for diagnosis of rheumatoid arthritis by the American Rheumatism Association (1987). The presence of at least 4 of the following signs:

  • Morning stiffness of more than 1 chasa;
  • arthritis 3 or more joints;
  • Arthritis of hand joints;
  • symmetric arthritis;
  • rheumatoid nodules;
  • positive rheumatoid factor;
  • radiographic changes.

Treatment of rheumatoid arthritis

Drug therapy involves the use of three groups of drugs:

Nonsteroidal anti-inflammatory drugs

Representatives of nonsteroidal antiinflammatory drugs are

  • meloxicam,
  • nimesulide,
  • celecoxib.

These drugs have minimal side effects and retain high antiinflammatory and analgesic activity.

Meloxicam (movalis) at the beginning of treatment for inflammatory activity administered 15 mg / day., And subsequently transferred to 7.5 mg / day. as maintenance therapy.

Nimesulide administered in a dose of 100 mg twice a day.

Celecoxib (Celebrex) is administered 100-200 mg twice a day.

For older people the selection of the dosage of the drug is required. However, patients with a body weight lower than the average (50 kg) it is desirable to begin treatment with the lowest recommended dose.

Avoid combination of two or more non-steroidal anti-inflammatory drugs since their effectiveness remains unchanged, but the risk of side effects increases.

basic drugs

Basic drugs recommended immediately after diagnosis.

Essential drugs basic therapy of rheumatoid arthritis are:

  • methotrexate,
  • sulfasalazine,
  • D-penicillamine,
  • aminohinolinovogo drugs
  • cyclophosphamide,
  • azathioprine,
  • Cyclosporin A (Sandimmune)
  • Remicade (infliximab),
  • Enbrel (etanercept),
  • systemic enzyme therapy drugs (Wobenzym, Phlogenzym)
  • leflunomide (Arava), and others.

Inefficient over 1.5-3 months basic drugs must be replaced or used in combination with hormones at low doses, thus reducing the activity of rheumatoid arthritis.

Six months - a critical time, not later than that effective basic therapy should be selected.

In the course of treatment is monitored carefully DMARDs disease activity and side effects.

The use of high doses of hormones (pulse therapy), in combination with a slow-acting agents to improve the efficiency of the latter.

The use of systemic enzyme therapy, Wobenzym drug often.

The drug has anti-inflammatory, immunomodulatory and secondary analgesic effect. This allows its wide use in rheumatoid arthritis in combination with non-steroidal anti-inflammatory agents, DMARDs, hormones.

Assign to 7-10 pills 3 times a day 30 minutes before meals; tablets washed down with a glass of water without chewing. Supportive therapy - 3-5 tablets 3 times a day.

Glucocorticoids (hormones)

With a high degree of inflammation activity of the hormones used, and in cases of systemic manifestations of rheumatoid arthritis - a pulse therapy (only hormones or in combination with cytostatic - cyclophosphamide) without systemic manifestations - a localizer treatment.

Hormones are also used as maintenance therapy after failure of other drugs.

In some cases, hormones are used as a topical treatment. The drug of choice is diprospan, providing extended operation.

Ointments, creams, gels based on non-steroidal anti-inflammatory drugs (ibuprofen, piroxicam, ketoprofen, diclofenac) is used in the form of applications on inflamed joints.

To enhance the anti-inflammatory effect of the above applications of ointment formulations which combine with applications dimethylsulfoxide solution at a dilution of 1: 2-1: 4.

Moderate disease activity in low efficiency of other treatments required by the destination hormones in small maintenance doses (5-7.5 mg prednisone equivalent) in combination with other drugs, particularly with drugs of systemic enzyme therapy (3-5 tablets vobenzim 3 times / day).

Adjunctive therapy

If no response to standard drug therapy in patients with rheumatoid arthritis high activity is used plasmapheresis, Limfotsitaferez.

An important aspect in the treatment of rheumatoid arthritis is the prevention of osteoporosis - recovery disorders of calcium balance in the direction of increasing its absorption in the gut and reduce excretion of body.

For this purpose diet with a high content of calcium.

sources of calcium are dairy products (especially hard cheeses and cream cheese; less cheese, milk, cream), almonds, walnuts and wood and so on., as well as the calcium supplement in combination with vitamin D or its active metabolites.

A drug that can be attributed to basic antiosteoporeticheskim means is Miakaltsik. It is available for intramuscular administration of 100 ME and a nasal spray; assigned according to the scheme in conjunction with calcium supplementation (calcitonin) and derivatives of vitamin D.

In the treatment of rheumatoid arthritis is also used laser treatment. Particularly under severe exacerbations of rheumatoid arthritis in recent years it has been widely used vnekorporalnye therapies (primarily hemosorbtion and plasmapheresis).

Laser therapy is particularly indicated in the early stage of the process. The course is no more than 15 procedures.

In order to reduce pain and eliminate the spasm of periarticular tissues used cryotherapy (cold therapy), a course of 10-20 procedures.

In order effects on allergic processes, nutrition and removal of tissue inflammation apply and other physical therapies.

In the early stages of rheumatoid arthritis recommended ultraviolet irradiation of the affected joints, electrophoresis dimethylsulfoxide, calcium salicylates.

When a persistent changes in the joints and in the absence of high activity signs designate phonophoresis hydrocortisone, magnetic, pulsed currents.

Physical therapy and massage are assigned to all patients in order to relieve muscle spasm, rapid restoration of joint function.

All patients with rheumatoid arthritis should be systematically observed and examined by a rheumatologist.

Patients with slowly progressive course without hitting the internal organs to appear at the rheumatologist 1 time in 3 months. If there is internal organ involvement, patients are examined by a rheumatologist 1 every 2-4 weeks.

Spa treatment of patients with rheumatoid arthritis, it is recommended to carry out an annual non-acute.

In benign course of the process without significant changes of the joints shown in the use of radioactive baths and Tshaltubo Belokuriha; in a typical progressive process - hydrogen sulfide treatment baths Sochi, Sernovodsk, Pyatigorsk Ķemeri; with marked deformities and contractures - mud applications treatment in Evpatoria, Saki, Pyatigorsk, Odessa.

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