Arthritic arthritis symptoms diagnosing and treatment

Causes of the disease on this 24-hour interval are unidentified. Collateral data, such as increasing the list of albumen roue jail cell consider and RBC deposit charge per unit (ESR) suggest the infective nature of the sue. It is believed that the disease develops as a effect of infection, which causes a compromised immune system in genetically susceptible individuals, with establishment of so-called. condition complexes (of the antibodies, viruses, etc..), which are deposited in tissues and pencil lead to junction hurt. Just the ineffectualness of antibacterial treatment of RA is probably to show the incorrectness of this assumption.
The disease is characterized by mellow impairment (70%), which comes pretty early. The main causes of destruction from the disease are unhealthiness complications and nephritic bankruptcy.
Treatment focuses principally on relieving pain, retardation disease advance and restore sullied by operation. Other spying of disease with the aid of mod tools behind significantly subdue the injury that privy be inflicted joints and other tissues.
For the foremost metre whitethorn take place afterward backbreaking strong-arm exertion, gushy shock, fatigue, hormonal changes during the period, the bear upon of untoward factors or transmission.
Epidemiology
Rheumatoid arthritis is distributed oecumenical and it affects completely ethnic groups. Prevalence of 0,5-1% (up 5% in the elderly) ratio M: F = 1:3 superlative of malady onrush - 30-35 years
Etiology
As with most autoimmune diseases, thither are 3 briny factors:
1. Ancestral susceptibility to autoimmunity.
2. Contagion factor out Conjectural triggers of rheumy diseases

Paramyxovirus - viruses, mumps, measles, metabolic process syncytial infection

Hepatitis B virus

Herpes virus - herpes simplex viruses, herpes virus zoster, cytomegalovirus , Epstein-Barr virus (a great deal higher in the synovial mobile of RA patients

Retroviruses - T-lymphotropic virus
3. Start-up divisor (hypothermia, insolation, intoxication, mutagenic drugs, endocrinopathy, stress, etc.). For women, continuance of breast-alimentation reduces the risk of RA. Breastfeeding for 24 months or more than reduces the take chances of underdeveloped RA by half.
The class of disease
Rheumatoid arthritis progresses in tierce stages. In the first base stage, the puffiness of the synovial bags causing pain, warmth and swelling some the joints. The second base arrange is the rapid cellular phone naval division that leads to compression of the synovial membrane. In the one-third stage, the reddened cells acquittance an enzyme that attacks the clappers and cartilage, which frequently leads to contortion of the stirred joints, increasing painful sensation and red ink of motive functions.
Typically, the disease progresses tardily at first, with the gradual deployment of clinical symptoms for various months or years, often less - subacute or discriminating. In around 2 / 3 of cases pyrexia occurs, and the roost - a mono-or oligoarticular form, and articular syndrome oft has no clinical specificity, which greatly complicates the differential diagnosing. Articular syndrome is characterized by morning time awkwardness for Sir Thomas More than 30 proceedings and exchangeable expressions in the instant half of the nighttime - symptoms of "stiff gloves", "corset"; on-going self-generated botheration in the joints, increasing during dynamic movements. The disappearing of the gracelessness depends on the activeness of the process: the Thomas More activity, the greater the continuance of simpleness. For the articulate syndrome in rheumatoid arthritis is characterized by monotony, the duration, saving of remainder effects afterwards discourse.
There May be prodromal clinical symptoms (balmy transitory pain, painful sensation human relationship with meteorologic conditions, autonomic dysfunction). Tell apart "joint damage" and "joints exception." Creaky arthritis is oftentimes conjunct with former spliff diseases - osteoarthritis, rheumatism, systemic connexion tissue paper diseases.
Allocate the followers options for the clinical flow of arthritic arthritis:

The classic variation of the (symmetric vote out both diminished and big joints

Mono-or oligoarthritis, primarily touching the big joints, nigh much the human knee. Stark disease onrush and reversibility of entirely manifestations during 1-1,5 months (arthralgias are migratory in nature, radiographic changes are absent, anti-rabble-rousing drugs bid relatively incontrovertible event in the latter on that point are entirely the symptoms of rheumy arthritis).
Diagnosis
Diagnosis of creaky arthritis (RA) - For a long sentence thither was no taxonomic category try that would unequivocally sustain the front of the disease . Currently, diagnosis of disease based on biochemical depth psychology of blood, changes in the joints are seeable on x-rays, and the use of BASIC clinical markers, simply besides in junction with the ecumenical clinical manifestations - fever, malaise, and weight loss
In the psychoanalysis of blood line examined ESR, arthritic factor, blood platelet count, etc. The to the highest degree advance analysis is the titre of antibodies to cyclic citrulline-containing peptides - ACCP, anti-CCP, anti-CCP. The specificity of this indicant is 90%, patch it is salute in 79% of sera from patients with RA.
Diagnostically authoritative clinical features are the want of discolouration of the shin complete the reddened joints, the ontogeny of tendonous synovitis flexors or extensors of the fingers and the organization of amyotrophy, distinctive strains of brushes, so-called "rheumatoid wrist.
The criteria for poor prognosis are:

Early damage of large joints and the appearance of rheumatoid nodules

swollen lymph nodes

involvement of new joints in the subsequent exacerbation;

systemic disease;

persistent disease activity with no remission for over a year;

persistent increase in the ESR;

early appearance (within the first year) and high titers of rheumatoid factor

early (up to four months), radiographic changes in the affected joints - a rapid progression of destructive changes;

Detection of antinuclear antibodies and LE-cells

Carrier antigens HLA-DR4
Symptoms
Rheumatoid arthritis can begin at any joint, but most often starts from small joints in the fingers, hands and wrists. Typically, joint damage is symmetric, for example if the sore joint on his right hand, then ill be the same joint on the left. The more joints afflicted the more advanced stages of disease.

Other common symptoms include:

Fatigue

Morning stiffness. Generally, the longer the constraint, the disease activity.

Weakness

Flu-like symptoms, including low heat.

Pain during prolonged sitting

Outbreaks of disease activity are accompanied by remission.

Muscle pain

Loss of appetite, depression, weight loss, anemia, cold and / or sweaty palms and feet

Violation of glands near the eyes and mouth, causing insufficient production of tears and saliva.
Treatment
In the presence of infection need the appropriate antibacterial therapy. In the absence of bright extraarticular manifestations (eg, high fevers, Felty's syndrome or polynervopathy) treatment of joint syndrome begin with the selection of non-steroidal anti-inflammatory drugs (NSAIDs). At the same time in the most inflamed joints injected corticosteroids. An important point in the treatment of rheumatoid arthritis is the prevention of osteoporosis - restoration of the calcium balance in the direction of increasing its absorption in the intestine and reducedthe excretion. Sources of calcium are dairy products (especially cheese, which contains from 600 to 1000 mg of calcium per 100 g of the product, as well as cheese, to a lesser degree of cottage cheese, milk, sour cream), almonds, hazelnuts and walnuts, etc., and calcium supplements in combination with vitamin D or its active metabolite.
Importance in the treatment is therapeutic exercise, aimed at maintaining maximum joint mobility and maintaining muscle mass.
Physiotherapy (electrophoresis of nonsteroidal anti-inflammatory drugs, hydrocortisone phonophoresis) and spa treatment. With persistent mono-and oligoarthritis includes introduction of isotopes of gold, yttrium, etc., With persistent strains of joints is carried out reconstructive surgery.
Modern Therapy
Systemic drug therapy involves the use of four classes of drugs:
1. nonsteroidal anti-inflammatory drugs (NSAIDs),
2. basic drugs
3. glucocorticosteroids (GCS)
4. biological agents.
Non-steroidal anti-inflammatory drugs NSAIDs remain the first line of therapeutic agents that are directed primarily to the relief of acute manifestations of the disease, as well as ensuring stable clinical and laboratory remission.
In the acute phase of illness use of NSAIDs, corticosteroids, pulse therapy with corticosteroids or in combination with cytotoxic immunosuppressive agents.
Current NSAIDs have a marked anti-inflammatory effect which is caused by inhibition of the activity of cyclooxygenase (COX) - a key enzyme of arachidonic acid metabolism. Of particular interest is the discovery of two isoforms of COX, which are identified as COX-1 and COX-2 and play different roles in regulating the synthesis of prostaglandins (PG). Proved that NSAIDs inhibit the activity of COX isoforms, but their anti-inflammatory activity is due to inhibition of COX-2.
Most of the known NSAIDs inhibit primarily COX-1 activity, which explains the appearance of complications such as gastropathy, renal failure, encephalopathy, hepatotoxicity.
Thus, depending on the nature of blocking COX, NSAIDs are divided into selective and nonselective COX-2 inhibitors.
Representatives of the selective COX-2 inhibitors are meloxicam, nimesulide, celecoxib. These drugs have minimal side effects and retain high anti-inflammatory and analgesic activity. COX-2 inhibitors can be used in all programs of the treatment of rheumatoid arthritis, which require the use of NSAIDs. Meloxicam (Movalis) in the early treatment of inflammatory activity assigned to 15 mg / day and subsequently transferred to 7.5 mg / day as maintenance therapy. Nimesulide is assigned a dose of 100 mg twice a day.
Celecoxib (Celebrex) - a specific inhibitor of COX-2 - is assigned to 100-200 mg twice a day. Selection for the elderly dosage of the drug is not required. However, patients with body weight below the median (50 kg) it is desirable to begin treatment with the lowest recommended dose.
You should avoid combining two or more NSAIDs, because of their effectiveness remain unchanged, and the risk of side effects increases.
Basic Preparations Basic drugs continue to play a pivotal role in the treatment of rheumatoid arthritis, but now there has been a new approach to their destination. In contrast to the well-known tactic of gradual treatment of rheumatoid arthritis ("precept of the pyramid"), is now advocated early aggressive treatment of basic drugs immediately after diagnosis, the purpose of which - changed the flow of rheumatoid arthritis and remission maintenance. The reason for this are the lack of early rheumatoid arthritis deformities, osteopenia, and severe complications, formed by autoimmune mechanisms, the high likelihood of remission.
The main drugs of basic therapy of rheumatoid arthritis include: methotrexate, sulfasalazine, gold preparations, D-penicillamine,. By means of the reserve include cyclophosphamide, azathioprine, cyclosporine A . The new group consisted of the following drugs: Remicade.
Ineffective for 1.5-3 months of basic drugs should be replaced or used in combination with corticosteroids in low doses, thus reducing the activity of rheumatoid arthritis before the start of the first. Six months - a critical period, no later than that should be adjusted effective basic therapy.
The best preparation for the start of basic therapy in severe rheumatoid arthritis and RF-positivity, presence of extraarticular manifestations of methotrexate is considered - cytotoxic immunosuppressive agent, which is well tolerated for prolonged use and has fewer side effects than other drugs of this group .
In the treatment of basic drugs carefully monitored the activity of the disease and side effects.
Corticosteroids A new approach is the use of high doses of corticosteroids (pulse therapy) in combination with slow acting tools that can improve the efficiency of the latter; combinations of methotrexate with salts of gold, sulfasalazine, as well as a selective immunosuppressive agent cyclosporin A.
With a high degree of inflammatory activity are used corticosteroids, and in cases of systemic manifestations of rheumatoid arthritis a form of pulse therapy is used. Corticosteroids only or in combination with cytostatic drugs - cyclophosphamide. SCS is also used as supporting anti-inflammatory therapy after failure of other medicines.
In some cases, corticosteroids are used as local therapy. The indications for their use are: mostly mono-or oligoarthritis of large joints,
Biological agents
In rheumatoid arthritis the synovial membrane , for unclear reasons, secrete a large amount of the enzyme glucose-6-phosphate dehydrogenase that also destroys the disulfide bonds in the cell membrane. In this case, there is "leakage" of proteolytic enzymes from the cell lysosomes, which cause damage to surrounding bones and cartilage. The body responds to this by making cytokines , among which also has a tumor necrosis factor -the A TNF . Cascade of these reactions in cells are triggered by cytokines, further aggravating the symptoms of the disease. Chronic rheumatoid inflammation associated with TNF-α, often causing damage to the cartilage and joints, leading to physical disability.
The treatment uses a monoclonal antibody to the cytokine TNF-the A , which is effective with high affinity in binding to TNF, both in its soluble and transmembrane forms resulting in neutralizing activity of TNF .
During the progression of rheumatoid arthritis, Joint damage in patients with rheumatoid arthritis is observed as a narrowing of the joint space between bones and erosion of bone in the articular space. Clinical trials of monoclonal antibody showed its use as a slow erosion and narrowing of the space between the bones.

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