Rheumatoid arthritis
Description of the disease
Rheumatoid arthritis is a chronic autoimmune disorder whose cause is unknown. It is characterized by inflammation of joints, particularly small joints, leading to erosion and destruction. The disease can also affect internal organs, causing early disability and shortening the life expectancy of patients.
Rheumatoid arthritis refers to systemic connective tissue diseases that primarily affect small joints. The spine most commonly affected is the cervical spine and the shoulders, elbows, wrists, metacarpophalangeal, proximal interphalangeal, hips, knees, ankles, metatarsophalangeal, and tarsal joints. Less commonly, the sternoclavicular, acromioclavicular, temporomandibular, and cricoarytenoid joints are affected.
Signs and symptoms
The disease usually develops gradually, and its full clinical picture develops over years. Less commonly, it may be acute. Most often, it begins with monotone pain and a feeling of early morning stiffness in the small joints of the hands, which lasts more than 30 minutes (gloves tight). Stiffness usually subsides after active movements begin (called pacing). However, rheumatoid arthritis may debut with single major joint involvement, most often in the knee, or with general symptoms such as weakness, loss of appetite, malaise, weight loss, and fever. In such cases, joint syndrome may be less severe or absent at all.
As the disease continues to develop, new joints become involved, joint changes remain after exacerbations are treated, joint mobility is impaired, deformities occur (typically months after initial symptoms), and muscular dystrophy (decrease in muscle volume) joins the process. Eventually, internal organ and system damage occurs. Internal disorders are diverse and manifest as diseases of the lungs (pleuritis, pneumonia), heart, blood vessels (vasculitis), kidneys (infectious-toxic interstitial nephritis), eyes, and salivary glands.
The most important clinical signs of rheumatoid arthritis are symmetry of the small joints in the hands (if several interphalangeal joints hurt in one hand, the same joints hurt in the other), early-morning stiffness, and no clinical appearance of joint inflammation. In this disorder, joints are not swollen, enlarged, but gradually deformed and, because of decreased range of motion, dystrophic changes occur in the affected muscles.
Clinical forms of rheumatoid arthritis
Clinical classification of rheumatoid arthritis has been developed, including seropositive, seronegative and special clinical forms of the disease. The latter include Felty syndrome (hematologic arthritis) and Still disease of adults (a rare type of inflammatory arthritis that causes joint damage similar to rheumatoid arthritis).
Seropositive and seronegative rheumatoid arthritis are determined based on the presence of rheumatoid factor (RF) or antibodies from the anticitrullinated antibody family, such as anti-cyclic citrullinated peptide (anti-CCP) antibodies, anti-citrullinated vimentin antibody (anti-MCV), and anti-keratin antibodies.
Causes
The main cause is autoimmune inflammation. Under the influence of genetic factors and infection (presumably - viral), the body forms immune complexes that are deposited in the tissues and, above all, in the cartilage of the joints. In the places of deposit of these complexes, an inflammatory process develops.
Diagnostic methods
Diagnosis of rheumatoid is made by a rheumatologist on the basis of complaints, history, clinical examination, and the obligatory use of laboratory and instrumental methods of examination. Diagnosis aims to determine clinical illness, severity, and complications.
Diagnosis of rheumatoid arthritis is not particularly difficult when there is an extensive pattern with many joint deformities. But in the early stages it is quite difficult due to the variety of clinical manifestations of the disease. X-rays can confirm joint changes. There are no completely specific diagnostic signs in the early stages of the disease, so it is the combination of signs that is important for the diagnosis of rheumatoid arthritis. For example, the diagnosis of rheumatoid arthritis is highly likely if there is a combination of morning stiffness for more than 1 hour, arthritis in three or more joints, symmetric hand arthritis, and elevated rheumatoid factor.
Treatment
Treatment of rheumatoid arthritis is prescribed by a general practitioner and a rheumatologist. The goal of treatment is to achieve disease remission. Treatment of joint syndrome requires appropriate treatment with a nonsteroidal anti-inflammatory drug. Given the nature of the disease, these should be the drugs with the maximum anti-inflammatory and analgesic effect with minimal side effects. In parallel, corticosteroids are injected into the most inflamed joints (diprospan is now the drug of choice).
Because of the autoimmune nature of the disease, baseline therapy drugs that affect this mechanism of development (aminoquinoline derivatives, gold preparations) are used. Previously, the indication for prescribing this therapy for rheumatoid arthritis was the presence of organ involvement, but this approach has changed and there is a tendency to prescribe a baseline therapy immediately after diagnosis of a disease - to achieve sustained remission.
Corticosteroids are given systemically if other anti-inflammatory therapies are ineffective. When disease activity is high and internal organs are involved, pulse therapy—brief (three days) IV corticosteroids) in very high doses (sometimes combined with cytostatics)—is used to achieve remission. Extracorporeal techniques (plasma exchange) are beneficial but are usually short-lived, so these techniques are not widely used in rheumatoid arthritis.
Massage, physiotherapy techniques have an auxiliary value and are prescribed according to individual indications. It should be emphasized that the treatment of rheumatoid arthritis requires long-term or permanent use of drugs with serious side effects. Therefore, it requires continuous laboratory monitoring to assess the activity of the process, timely detection of adverse reactions. Long-term cooperation between the patient and his permanent treating physician is essential for success in the treatment of this disease.
