Rheumatoid arthritis. Treatment, symptoms, medicines, folk remedies, clinical guidelines

Rheumatoid arthritis - a chronic, autoimmune disease, characterized by inflammation of the joints of the shell. Timely treatment will help prevent further complications.

types of diseases

Rheumatoid arthritis has several species from which depends treatment pathology:

Type of disease	Description
juvenile	Juvenile rheumatoid arthritis develops in children and adolescents up to 16 years. Over time, symptoms may fade away, but the disease can not be cured completely - a period of remission, which can be very lengthy.
antibody-positive	When in the form of seropositive blood diseases rheumatoid factor is present.
antibody-negative	In this form of rheumatoid factor is absent, but the disease is still progressing.
systematic	The most severe form of rheumatoid arthritis, which affects not only the joints, but also the heart, kidneys, lungs and other organs. System arthritis is not common, but can develop in the absence of treatment.
Felty's syndrome	Sustained increase in the size of spleen, complications of internal organs, neutropenia.
Still's disease	Prolonged fever, skin rash.

Separately isolated undifferentiated arthritis, in which there is a pronounced inflammation of the joints, but the disease is not applicable to any form of classification of rheumatoid arthritis.

Also highlight the classification of degrees of activity:

1. 1 degree - in the structure of the joints there is little change, motion activity joint capsules stored.
2. 2 degree - joint function partly preserved; the patient can engage in daily activities.
3. Grade 3 - the patient is almost not able to perform everyday activities.
4. Grade 4 - the patient is not fully able to do everyday chores.

According to the number of joints involved allocate: monoartrit (amazed 1 joint), oligoarthritis (2-3 amazed joint, no more), polyarthritis (inflammation localized in 4 or more joints).

Stage and grade

Rheumatoid arthritis, the treatment of which depends not only on the species but extent progresses in three stages:

1. First stage. The symptoms in the early stages often absent or mild. Changes become visible only on X-ray image.
2. Second phase. Manifested typical symptoms of disease, the patient begins to notice irregularities in the joints. Inflammation becomes visually noticeable.
3. The third stage. Is deformed joints and almost complete loss of mobility. Painful sensations are very strong and almost nagging. Due to the progression of the disease, the patient may experience complications of the cardiovascular, nervous, digestive and other organ systems.

symptoms

Rheumatoid arthritis in the early progression shown in the form of swelling joint capsules and a small stiffness in the morning. Later, the patient begins to disturb the joint pain, aggravated by the commission of the movements and probing fingers, seals are formed in the joint capsules, which are called rheumatoid knots.

This - the main symptoms of the disease, which may be accompanied by:

• local temperature increases (the affected joints are hot to the touch), and changes in skin color;
• weakness and constant fatigue;
• decreased appetite.

In rheumatoid arthritis, the joints are usually affected symmetrically on both sides of the body. Most often, inflammation occurs in the small joints of the hands (in the fingers). Less commonly affects the toes, foot joints and large joints (the elbow, knee, ankle).

Causes of

It is believed that rheumatoid arthritis has an autoimmune origin when human immune cells instead of having to fight off viruses, bacteria and fungi start to attack its own cells body.

Scientists believe that it is promoted by a genetic predisposition and infection by viral infection - Then in the body form immune complexes that are deposited in the tissues of the joints and cause inflammation.

Also, the development of the disease may contribute to:

1. Heavy physical work, and some of the load on the joints. At risk are people whose daily work is related to the load on the joints, especially Finger: porters, construction workers, office workers working at the computer or by writing often hands.
2. Infectious diseases. Rheumatoid arthritis may develop on the background of the recently suffering a severe joint disease (acute bursitis or synovitis). Also contribute to the occurrence of frequent hypothermia joints, acute respiratory infections and colds.
3. Joint injuries. In case of injury, particularly open, in the joint capsule can get a foreign agent that causes inflammation. Against this background, further develop the joint disease, including rheumatoid arthritis.
4. Prolonged stress, nervous stress.

Diagnostics

Diagnosis and treatment of rheumatoid arthritis engaged several experts: rheumatologist, doctor arthrology. If large joints are involved, you may need to consult a podiatrist.

First specialist conducts a visual inspection of the affected joints (in the presence of swelling, stiffness) and collects history - whether a family history of rheumatoid arthritis (and other disorders of the musculoskeletal system) rheumatism. Also, the doctor should inquire about the availability of recent injuries of the joints, the transferred infectious diseases and the presence of any autoimmune disease.

Next, it assigns a complex of diagnostic measures:

General blood analysis	Watch leukocyte count and erythrocyte sedimentation rate - if they are raised, the body has an inflammatory process.
The test for rheumatoid factor	It helps to identify rheumatoid factor and its amount in the blood; presence revmo factor in some cases, is not the cause of diagnosis "rheumatoid arthritis", and indicates a more severe pathologies.
Anttsitrullinovyh test for the presence of antibodies (anti-CCP)	Citrulline - an amino acid that is formed during the inflammatory process in the body. The immune system begins to create antibodies to kill cells with citrulline. The test for anti-CCP by venous blood is the most sensitive, since the antibodies are found in approximately 80-90% of patients with rheumatoid arthritis.
Analysis of the synovial fluid (shell) joint	The change in color, clarity and density of the liquid. Also, looking at the type and number of cells in the synovium - if there are cellular in appearance cells (called ragotsitami), it is possible to judge the existence of rheumatoid arthritis.
radiography	It helps to identify the destruction of the cartilage of the joint structures, the presence of erosions and narrowing interarticular slots.
scintigraphy joints	The inflamed joints accumulates radioactive material - technetium. Scintigraphy is a sensitive method for the determination of technetium in the joints and allows you to diagnose in the early stages.
soft tissue around the joint US	Using ultrasonic studies reveal abnormalities in the structure of soft tissue around the joints; also using ultrasound can detect inflammation in the surrounding muscles.
Arthroscopy	The articular cavity through a small incision administered arthroscope (a type endoscope) through which the treated joint inside. During this procedure can take a small amount of the inflamed tissue site for subsequent biopsy.
CT or MRI	These methods make it possible to accurately determine the changes in the structure of the joints, muscles and bones nearby.

The doctor optionally assigns all the described methods of diagnosis. Determine the disease process can be based on the results of laboratory blood tests and X-rays.

Other types of research may be appointed in the case of shortness of diagnosis. The high level of sedimentation rate and white blood cells, the presence of anti-CCP, high revmo factor in the blood and visible erosion on X-ray image are the reason for the diagnosis.

When to see a doctor

Rheumatoid arthritis, which is necessary to begin treatment as soon as possible, has a pronounced initial symptoms: swelling and joint stiffness, and pain when making movements.

If these signs are present, you will need as soon as possible to see a specialist. Irregularities in the joints can also be signs of other diseases, timely diagnosis and help prevent their progression.

prevention

Most often, rheumatoid arthritis is manifested by the autoimmune disorders, and to prevent it can not develop. The only thing you can do - is to avoid hypothermia and treated in time, and viral inflammatory and infectious diseases (including SARS and the usual angina, complications which can lead to rheumatoid arthritis). Also, do not strongly burden the joints.

Patients with rheumatoid arthritis in remission should observe the following recommendations for the prevention of recurrence of inflammation:

• pass a comprehensive examination by a rheumatologist 1-2 times a year;
• reduce the load on the joints;
• diet;
• avoid hypothermia joints;
• not sunbathe (including, in the solarium);
• perform light physical activity (on the testimony of the doctor);
• time to cure viral and inflammatory and infectious diseases;
• held annually spa treatment;
• on the testimony of a doctor taking methotrexate 1 time per week.
• in lesions of large joints wear special orthopedic devices to prevent deformation;
• no smoking.

therapies

Rheumatoid arthritis (treatment of complex and long-term illness) can not be cured completely, but using drugs and other techniques can significantly reduce the severity and frequency of symptoms manifestations. Treatment has two directions - the relief of acute stage of the disease and further maintenance therapy.

Medications

When rheumatoid arthritis is prescribed the following drugs:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs). Cropped inflammation and inhibit the synthesis of the enzyme COX-1, provokes inflammation, eliminate painful sensations. May be administered in the form of tablets, suspensions, ointments and gels, injections. For NSAIDs include: "Ibuprofen", "Nise", "diclofenac", "Nimesulide" and their analogues.
2. Selective COX-2 inhibitors. Also have pronounced anti-inflammatory and analgesic effect, using the ineffectiveness of NSAID. For COX-2 inhibitors include: "Meloxicam", "piroxicam".
3. glucocorticosteroids( "Dexamethasone", "Prednisolone"). Hormonal agents, produced in the form of ointments or injection and are used in severe pain. Also have a pronounced anti-inflammatory effect.
4. Cytostatics. Since rheumatoid arthritis - autoimmune diseases, drugs, cytostatic needed to suppress the immune system. The most effective drug groups is given "MTX", which is assigned in the form of tablets or injection.
5. Biologicals. Treatment of rheumatoid arthritis biologicals is the destruction of pathogenic circuit causing inflammation. The drugs block the action of TNF-alpha - a cytokine responsible for inflammation. Thus, the patient is a significant improvement and a long period of remission.
6. Chondroprotectors. Prevent and stop the destruction of cartilage, help to restore already damaged cartilage structures, improves motor activity of the joints. Are assigned in the form of tablets, gels and ointments, local injection.

Therapy is chosen individually by the attending physician. Additionally, local applications can be allocated to Dimexidum or lidocaine to reduce painful sensations, and various mineral complexes for toning the body.

Traditional methods

Traditional methods are not effective in the fight against autoimmune rheumatoid arthritis. However, they have a pronounced anti-inflammatory effect and help eliminate stiffness and swelling of joints.

infusion cinquefoil

Potentilla marsh - a medicinal plant, which has a pronounced anti-inflammatory and analgesic effect, improves joint mobility.

The infusion of cinquefoil can be bought at a pharmacy or make your own:

1. 100 g of dry raw materials (it is possible to use the roots, leaves and stems) to grind and put into a jar made of dark glass.
2. Pour raw material quality 0.5 L of vodka or ethyl alcohol.
3. Leave to infuse for 3 weeks, shaking regularly.
4. After 3 weeks of the infusion and store in a dark place.

The infusion of cinquefoil can be used inside as follows: 1 tbsp. l. 3 times a day before meals. The course of treatment - 1 month.

Also, a means is used to rastirok (small amount tinctures neat rubbing movements in the joint and then wrapped) and compresses - a piece of gauze soaked in liqueur, wrapped her joint top impose cotton cloth and warm scarf. Compress hold at least 3-4 hours.

Packs of potatoes

It is necessary to rub 1 medium potato on a coarse grater, and shift the resultant slurry in a small bag made of cotton or linen. Then place the bag for a few seconds in hot water, and without pressing, to shift to the affected joint. The procedure must be done before going to bed, twisting the joint film that no liquid dripping. The course of treatment - 7 days.

Broth cranberries

Cranberry broth helps to relieve swelling and inflammation, and also contributes to the removal of salts from the joints.

To prepare the drink you need to:

1. 2 tbsp. l. dry crushed leaves of bilberry pour 1 cup of water and put on fire.
2. Bring to the boil and boiled for 15 min.
3. Broth to cool and strain.
4. Drink 3-4 times a day before meals.

Every day you need to prepare a fresh broth. The course of treatment - 2 weeks.

Physiotherapy

Physical therapy procedures used to:

• reduction of pain;
• increase vascular permeability and to improve circulation in the joints;
• improvement of motor activity of the joints.

Physical therapy is prescribed acute phase, as otherwise it can cause complications.

In most cases for the treatment of rheumatoid arthritis used:

• electrophoresis with administration of anesthetic drugs;
• irradiation of infrared rays;
• ultrasonic treatment;
• galvanic currents;
• laser irradiation;
• magnetic therapy.

May further designate paraffin or ozokerite applications which enhance the effectiveness of physiotherapy.

Physiotherapy

Physiotherapy or physical therapy is an important part of the treatment of joint disease - it helps to improve function joints, eliminate stiffness and slow the progression of the degenerative processes in the joints and muscles structures. Exercises can be done only in remission.

Physiotherapy exercises is chosen individually, depending on the age, type and stage of the disease, localization (in which there is inflammation of the joints) and individual characteristics of the organism patient.

Gymnastics can be practiced in a hospital under the supervision of an instructor of exercise therapy or at home - but not before the need for mandatory consultation of an instructor who will give advice on occupations.

acupuncture

This method is effective in convulsions and spasms caused by abnormalities of the musculoskeletal system. Acupuncture also helps to reduce pain, increase the sensitivity and permeability of the skin and blood vessels for better penetration of the local therapeutic drugs into the body.

The method consists in the conduct of special needles into the reflex points of the body. Depth of insertion, the needle thickness and the dwell time in the body depend on the patient's age and disease. For the best effect requires a course of 5-15 treatments.

Diet

Rheumatoid arthritis, treatment is aimed at relief of inflammation and pain can not be cured by diet. However, excluded from the diet some foods that can cause inflammation, can reduce the risk of disease recurrence.

It should be possible to exclude or limit the use of:

• Meat and fish oil-rich;
• fried and spicy dishes;
• salted food;
• starchy foods, sweets (including sugary carbonated water) and fresh white bread;
• citrus;
• Some cereals (corn, oats and wheat);
• canned and pickled products, spices;
• cow's milk;
• tomatoes;
• coffee and black tea (it is better to replace them with herbal teas or decoctions);
• alcohol.

Surgery

By resorting surgery if conservative treatments do not help, or if the joint has completely lost its function.

Depending on the stage of the disease may hold:

• excision and removal of damaged tissues;
• the reconstruction of the destroyed or deformed joint;
• joint replacement.

If a purulent arthritis (suppurative complications often develop in the absence of treatment), then articular synovial fluid cavity is evacuated together with pus, then poured antibacterial solution and sutured incision. After surgery, the patient undergoes lengthy rehabilitation, including the use of medication, exercise, physiotherapy.

Spa treatment

Patients with rheumatoid arthritis and other types of chronic arthritis is recommended annually spa treatment. In a specialized institution, patients are constantly under the supervision of a physician and are integrated with medication and treatment therapy. After resort can achieve long-term remission of rheumatoid arthritis.

possible complications

If untreated rheumatoid arthritis progresses and leads to serious complications:

1. For several years, strongly deformed joints, completely lose their function (formed ankylosis); person becomes disabled.
2. Begin to affect other joints, usually large.
3. Disease becomes systemic form, with the result that the internal organs are affected. Particularly dangerous rheumatoid arthritis, the cardiovascular, respiratory and visual systems.

Rheumatoid arthritis - a dangerous disease that can not be cured until the end. But with the help of long-term therapy can achieve a significant improvement in joint function and quality of life.

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