RHEUMATOID ARTHRITIS
DEFINITION
Rheumatoid arthritis (polyarthritis) is a chronic inflammatory disease of the joints of the extremities.
ETIOLOGY AND PATHOGENESIS
CLINICAL PICTURE
The disease presents with persistent arthritis (usually polyarthritis) with early and preferential involvement of the radiocarpal, metacarpophalangeal, proximal interphalangeal, and metatarsophalangeal joints. Any joint of the limbs may be affected. Characterized by a feeling of morning stiffness, pain, swelling of the joints, hyperthermia of the tissues above them (skin color does not change), symmetry inflammatory process. Typically, a gradual onset of the disease with undulating fluctuations in the severity of symptoms (sometimes even more or less long-term remissions are noted at the onset of the disease), a slow but steady progression of arthritis, involving more and more new joints. Sometimes rheumatoid arthritis begins and for a relatively long time can be manifested by monoarthritis of a large, often knee joint. A variant of the acute onset of the disease is also known, in which, in addition to joint damage, high fever and extra-articular manifestations (serositis, carditis, hepatolienal syndrome, lymphadenopathy, etc.) are noted.
The advanced stage of the disease is characterized by deforming, destructive (radiologically) arthritis. Typical deformations of the metacarpophalangeal (flexion contractures, subluxations), proximal interphalangeal (flexion contractures) and radiocarpal joints - deviation of the hand to the outside (the so-called rheumatoid hand) and metatarsophalangeal joints (hammer-shaped fingers, their subluxations, flat feet, hallux valgus, constituting the concept of rheumatoid feet In some joints, inflammatory or fibroproliferative changes may predominate.More often, changes in the joints are mixed.
Extra-articular (systemic) manifestations in rheumatoid arthritis are observed relatively infrequently, mainly with a seropositive (for rheumatoid factor) form of the disease, severe and generalized articular syndrome; their frequency increases as the disease progresses. These include subcutaneous (rheumatoid) nodules, which are more often located in the area of the elbow joint, serositis - usually moderately pronounced adhesive (adhesive) pleurisy and pericarditis; lymphadenopathy, peripheral neuropathy - an asymmetric lesion of the distal nerve trunks with sensory disorders, rarely movement disorders; cutaneous vasculitis, more often manifested by point necrosis of the skin in the area of the nail bed, etc.
Clinical signs of damage to internal organs (carditis pneumonitis, etc.) are rarely noted. In 10-15% of patients, amyloidosis develops with a predominant lesion of the kidneys, which is characterized by gradually increasing proteinuria, nephrotic syndrome, and later - renal failure. Rheumatoid arthritis, which, in addition to typical joint damage, is characterized by splenomegaly and leukopenia, is called Felty's syndrome.
DIAGNOSTICS
Indicators of laboratory research are not specific. In 70-80% of patients, rheumatoid factor is detected in the blood serum, this form of the disease is called seropositive. From the very beginning of the disease, as a rule, there is an increase in ESR, levels of fibrinogen, gamma globulins, C-reactive protein in the blood, as well as a decrease in hemoglobin.
Radiographically distinguish 4 stages of rheumatoid arthritis:
. Stage I (initial) - only periarticular osteoporosis;
. II stage - osteoporosis + narrowing of the joint space;
. Stage III - osteoporosis + narrowing of the joint space + bone erosion;
. Stage IV - a combination of signs of stage III and ankylase of the joint.
First of all, radiological changes in rheumatoid arthritis appear in the joints of the hands and metatarsophalangeal joints.
TREATMENT
In the presence of an infection or suspicion of it (tuberculosis, yersiniosis, etc.), therapy with an appropriate antibacterial drug is necessary. In the absence of striking extra-articular manifestations (for example, high fever, Felty's syndrome or polyneuropathy), the treatment of articular syndrome begins with the selection of non-steroidal anti-inflammatory drugs: indomethacin (75-150 mg / day), orthophene (75-150 mg / day), naproxen (500- 750 mg / day), less often ibuprofen (1-2 g / day); they are used for a long time (not courses), for years. At the same time, corticosteroid drugs (hydrocortisone, metipred, kenalog) are injected into the most inflamed joints. The immunocomplex nature of the disease makes it indicated to carry out courses of pasmopheresis, in most cases giving a pronounced effect. The instability of the results of this therapy is an indication for the addition of the so-called basic drugs: krizanol (34 mg of gold contained in 2 ml of a 5% solution or in 1 ml of a 10% solution of the drug once a week intramuscularly), 0-penicillamine (cuprenil, metalcaptase, 300-750 mg/day), delagil (0.25 g/day) or sulfasalazine (2 g/day). These drugs act slowly, so they should be used for at least 6 months, and with a clear positive effect, their treatment must be continued further (for years).
Oral corticosteroids in the absence of bright extra-articular manifestations are prescribed as rarely as possible, usually only for severe pain in the joints, non-steroidal anti-inflammatory drugs and intra-articular administration of corticosteroids in small doses (no more than 10 mg / day of prednisolone), for a short period and in combination with the main means , allowing you to subsequently reduce the dose of hormones and completely cancel them. Carticosteroids (oral prednisone 20-30 mg/day, sometimes up to 60 mg/day or as pulse therapy: intravenous metipred 1 g for 3 days) are absolutely indicated in the presence of high fever, generalized rheumatoid vasculitis. Immunosuppressants (chlorbutin - 6-8 mg / day, azathioprine - 100-150 mg / day, cyclophosphamide - 100-150 mg / day, methotrexate - 2.5-7.5 mg / day for one day of each week) are drugs of choice in the presence of bright extra-articular manifestations (polyneuropathy, generalized vasculitis, etc.), and in other cases they are used only if all previous therapy is ineffective. The use of basic drugs for the treatment of rheumatoid arthritis should be carried out under the constant supervision of a physician who knows all aspects of the action of these drugs. It is important in the treatment physiotherapy aimed at maintaining maximum joint mobility and maintaining muscle mass. Physiotherapeutic procedures (non-steroidal anti-inflammatory drug electrophoresis, hydrocortisone phonophoresis, dimexide applications) and spa treatment are of auxiliary importance and are used only with a slight severity of arthritis.
With persistent mono- and oligoarthritis, synovectomy is performed either by introducing gold isotopes and others into the joint, or surgically. With persistent deformities of the joints, reconstructive operations are performed.
A common complication of a viral infection of the body is arthritis with influenza. The complex of symptoms of such a disease includes myalgia - muscle pain and arthralgia - discomfort in the joints. Basically, the body's abnormal response to a pathogen causes reactive arthritis. It does not occur in everyone, but, as a complication, it can manifest itself in the form of inflammation of one or more joints already on the first day of the influenza infection.
Why does arthritis get worse?
This pathological condition is associated with the restructuring of immunity in response to a pathogenic agent - a virus. After the flu, peculiar immune complexes are formed, an allergic reaction occurs to the pathogen itself and to secondary bacterial infections, which, against the background of a weakening of the body's protective functions, join the underlying disease.
The mechanism of the development of arthritis in influenza is that on the articular surfaces covered with hyaline cartilage there are receptors akin to antibodies that have appeared in response to the pathogen. Therefore, not recognizing strangers and their own, the cells of the defense system attack the musculoskeletal system. Faster and stronger immune aggression is directed against joints that are well supplied with blood. With the blood comes a greater number of warring immune complexes that perceive cartilage as foreign. A similar mechanism has rheumatoid arthritis, which develops with streptococcal infection.
Flu arthritis symptoms
One of the symptoms of arthritis is joint inflammation. Manifested by pain, swelling and dysfunction. Even in the initial (prodromal) period of influenza, weakness, stiffness of movements in the limbs, small muscle spasms appear. At the end of the first day of illness, in some cases mono- or oligoarthritis occurs - an acute inflammation of one or a pair of joints. Arthritis is rare during a full-blown influenza pattern. After 1-2 weeks, immune complexes have time to form that affect the articular surfaces, as a result of which persistent inflammation occurs, which can become chronic.
The diagnosis is confirmed by laboratory data. With reactive influenza arthritis, the number of leukocytes, ESR, and C-reactive protein increase. Biochemical parameters indicate an increase in the concentration of seromucoid and sialic acids.
On x-ray with this pathology, there will be no changes. In rare cases, with a severe course of the process, a narrowing of the joint space is formed, the contours of the cartilage surfaces are deformed. Ultrasound shows a similar picture. Body temperature rises to 38 °C. Patients limp on the affected limbs, sparing them. When inflammation of the joint capsule is attached, the exudate accumulating in the cavity stretches the capsule, which aggravates the situation with an increase in pain.
How to treat arthritis?
The patient is advised to limit movement in the joints, to minimize the load on them. It is recommended to eat plant foods rich in vitamins and mineral complexes, reduce the amount of sweets, drink more fluids. Antiviral agents that reduce the viral load and suppress inflammation have an effective effect: Tamiflu, Amizon, Remantadin. To relieve pain and relieve inflammation, the groups of drugs presented in the table are prescribed:
Physiotherapy methods
Ozokerite treatment will help regulate peripheral circulation in the joints. Physiotherapy treatments include:
- Paraffin wraps. The method of long and uniform heat exposure.
- Ozokerite applications. Compresses from a substance that includes paraffin, mineral oils and resins.
- Ultrahigh frequency therapy (UHF). The method of treatment, which consists in influencing the body electric field ultra-high frequency (40 MHz), which is supplied to the patient with the help of capacitor plates-electrodes.
- Laser therapy. Physiotherapy method using infrared or red light radiation.
- Magnetotherapy. A type of treatment that consists in the effect of static magnetic fields on the joints at the molecular level.
- Phonophoresis. The technique of simultaneous exposure to ultrasound and drugs.
- Electrophoresis. Treatment with a combined effect on the body of a current of low strength and voltage (galvanization) and drugs.
Why is arthritis dangerous?
Complications that occur after inflammation of the joints are classified into early and late. The former include phlegmon and panarthritis -
Arthritis - it is an inflammation of the joint. In arthritis, pain is observed when moving or lifting weights, the joint loses mobility, swells, changes shape, the skin over the joint turns red.
The main symptoms of arthritis are:
Pain and swelling in the joints.
Morning stiffness in the joints of the hands.
Weakness, fatigue.
Increase in body temperature.
Weight loss.
Types of arthritis
There are two types of arthritis:
Inflammatory arthritis.
Degenerative arthritis.
Inflammatory arthritis is associated with inflammation of the membrane lining the joint from the inside:
Infectious (purulent) arthritis
Rheumatoid arthritis
Gout
Degenerative arthritis is associated with damage to the articular cartilage:
Osteoarthritis
Traumatic arthritis
Purulent arthritis occurs when pathogens of a pyogenic infection penetrate into the joint. Purulent arthritis are primary and secondary. Primary arthritis is seen in wounds. Secondary arthritis develops when an infection from neighboring tissues or blood enters the joint. There is damage and destruction of cartilage. Arthritis can lead to periarticular cellulitis. In this case, severe pain, high fever, chills are observed.
Rheumatoid arthritis- a systemic disease with damage to the joints by the type of polyarthritis.
The causes of rheumatoid arthritis have not yet been clarified. The role of streptococci, viruses and other microorganisms, as well as genetic factors, is most often indicated.
A special role in the development of rheumatoid arthritis is played by the defeat of one's own immune system. The presence or absence of rheumatoid factor in the blood defines two forms of rheumatoid arthritis.
The seropositive form of arthritis is more severe. The disease usually begins acutely, with morning stiffness and pain, fever. At first, one joint is often affected (monoarthritis), and after a few months, other joints are involved in the process.
Rheumatoid arthritis often affects the small joints of the hand. Rheumatoid arthritis is characterized by persistent pain that worsens with movement and lessens at night. Arthritis is accompanied by muscle atrophy and the formation of rheumatoid nodules in the skin.
Arthritis with flu
Most flu patients have sensations of damage to the muscles and joints. During the peak of the flu, the joints are affected less frequently. However, after 10-15 days, the likelihood of arthritis increases. Arthritis with influenza is usually allergic in nature and often becomes chronic.
Lyme disease caused by spirochetes after a tick bite. Very often, in the first stage of the disease, stiffness of the neck appears, and after a few months the patient develops arthritis.
Infectious-allergic arthritis begins acutely, develops due to increased sensitivity of the body to an infectious agent (streptococcus, staphylococcus aureus).
Infectious-allergic polyarthritis is more common in young women. There is a connection between the onset of arthritis and an acute upper respiratory tract infection. 10-15 days after an acute infection, during the period of the greatest allergization of the body, acute inflammation of the joints occurs. But if patients with acute respiratory diseases take anti-inflammatory drugs, the process in the joints proceeds sluggishly.
Polyarthritis
Non-infectious polyarthritis develops with systemic diseases - allergies, connective tissue diseases (lupus erythematosus, scleroderma), blood diseases and hemorrhagic diathesis, malignant tumors, diseases with profound metabolic disorders (uremia, gout), injuries.
Inflammation of the periarticular tissues in arthritis
With periarthritis, bursitis, tendonitis and some other arthritis, joint capsules, tendons, ligaments become inflamed. The causes of these diseases are mechanical overload with flat feet, professional and sports overloads, curvature of the spine, and injuries. Often periarthritis affects the shoulder and hip joints.
Arthritis treatment
The duration of arthritis is 1-2 months. However, in some patients it persists for a longer period.
Recurrence of arthritis is possible after repeated acute infection or hypothermia. Under the influence of anti-inflammatory therapy, the shape and size of the joints are normalized, and function is restored.
Therapy is carried out with non-hormonal anti-inflammatory drugs: brufen, flugalin, naproxen, butadione, indomethacin, voltaren.
Desensitizing therapy - suprastin, diphenhydramine. Additionally, ultraviolet irradiation, vitamins, low-carbohydrate foods are recommended. The disappearance of arthritis must be confirmed clinically and radiologically. Usually, long-term treatment is required, and then observation by a rheumatologist, regular laboratory (2-4 times a year) and radiological (1-2 times a year) monitoring of inflammation activity for many years.
Several groups of anti-inflammatory drugs have been developed and successfully used to combat arthritis. In acute cases, they can be administered by injection directly into the site of inflammation. Restoration of joint mobility and muscle elasticity is achieved using special techniques of gymnastics and massage. A course treatment is performed with chondroprotectors that stimulate the restoration of cartilage of the joints.
Non-pharmacological treatments for arthritis include:
Reducing the load on the joints: weight loss; selection orthopedic shoes with a soft sole and a fixed heel, the use of arch supports, knee pads, walking sticks.
Therapeutic exercises, which should be carried out in a sitting position, lying down or in the water (i.e. without static loads) and should not cause increased pain in the joints. Exercises on bent knees and squats are completely excluded. Swimming lessons are recommended.
Physiotherapy treatment: thermal procedures, ultrasound, magnetotherapy, laser therapy, acupuncture, hydrotherapy, massage, electrical impulse muscle stimulation. Any physiotherapy procedures are carried out in the absence of contraindications.
Getting rid of bad habits: to give up smoking, overuse coffee drinks.
Pharmacological treatments for arthritis:
Local therapy: the use of non-steroidal anti-inflammatory creams, ointments or gels; intraarticular or periarticular administration of glucocorticosteroids.
For moderate pain in the joints, simple painkillers (paracetamol) are used, and if their effect is insufficient, non-steroidal anti-inflammatory drugs are prescribed.
Currently, much attention in the treatment of arthritis is paid to drugs that can eliminate not only pain, but also prevent, slow down or reverse the pathological processes that occur in the joints with arthritis. Such drugs are called chondroprotectors, i.e. cartilage-protecting drugs. They are able to stimulate the synthesis of the basic substance of cartilage and at the same time inhibit the production of an enzyme that destroys cartilage. Thus, chondroprotectors enhance regenerative and suppress destructive processes in cartilage. With their appointment, pain is often significantly reduced, the range of motion increases, and the function of the joints is restored. Chondroprotectors are well tolerated and very rarely cause side effects.
Surgical treatment (joint arthroplasty), which is used only for the most advanced forms of arthritis.
Treatment of rheumatoid arthritis
There is no cure for rheumatoid arthritis. Current treatments aim to reduce inflammation, improve joint function, and prevent disability in patients. Earlier initiation of treatment improves the prognosis. Optimal treatment includes not only drug therapy, but also exercise therapy, lifestyle changes, and other interventions. Two types of drugs are used in the treatment of rheumatoid arthritis: first-line anti-inflammatory or fast-acting drugs and slow-acting second-line drugs (also called disease-modifying or disease-modifying drugs). The first group of drugs include aspirin and hormones (corticosteroids), which relieve inflammation and reduce pain. Basic drugs (eg, methotrexate) cause remission and prevent or slow down joint destruction, but are not anti-inflammatory drugs. Surgical treatment is used to correct severe joint deformities.
Treatment of reactive arthritis
General hygiene measures for the prevention of intestinal infections, the use of condoms to reduce the risk of infection with urogenital chlamydia and other sexually transmitted diseases.
Treatment of infectious arthritis
Infectious arthritis usually requires several days of hospital treatment, followed by medication and physical therapy sessions over several weeks or months.
Treatment of arthrosis
Gymnastics 2-3 times a week for 15 minutes.
Periodic preventive treatment of arthrosis 1-2 times a year (chondroprotectors, physiotherapy, manual therapy, massage).
Gentle exercise regimen and rational nutrition.
Treatment of infectious-allergic arthritis
Antimicrobial, anti-inflammatory and desensitizing medications. Before prescribing antibiotics to a patient with arthritis, their tolerance is clarified. It is desirable to carry out balneological treatment after the treatment of arthritis (sea, hydrogen sulfide, radon baths).
Treatment of periarthritis
The treatment of periarthritis, bursitis, tendinitis takes 1-3 months. Pain can be relieved within a week. If periarthritis is advanced (6 months or more without proper treatment), a 10-20% limitation of joint mobility often persists. After removing the acute symptoms of periarthritis, preventive courses are needed 1-2 times a year (chondroprotectors, physiotherapy, massage).
Treatment of arthritis complications
Sepsis is a common complication of arthritis. Late complications include fistulas, ankylosis, dislocations, arthrosis, limb deformities. Treatment of complications of arthritis depends on the duration of the disease. Purulent arthritis should be treated promptly. With purulent arthritis, the inflammatory fluid is sucked off and the joint is washed with an isotonic solution of sodium chloride, antibiotics are prescribed. The limb must be immobilized.
Non-traditional arthritis treatments:
In a 200-gram bottle put a piece of camphor the size of 1/4 piece of refined sugar. Pour 1/3 of the bottle with turpentine, 1/3 - sunflower oil, 1/3 - wine alcohol. Let it brew for 3 days. Rub dry into the affected joint at night and tie in the form of a compress.
Lubricate the affected joints with celandine juice, after a few days the pain decreases. The more juice is applied to the joints, the more actively the treatment takes place.
1 tsp celandine pour 1 cup boiling water, leave for 1 hour. Drink 50 g 3 times a day 15 minutes before meals for 1-2 months.
1 st. l. herbs of wood lice (medium stellate) pour 1 cup boiling water. Insist, wrapped, 4 hours, strain. Take 1/4 cup 4 times a day before meals.
1 st. l. fresh purslane herb pour 1 cup cold water. Boil 10 minutes after boiling. Insist, wrapped, 2 hours, strain. Take 1-2 tbsp. l. 3-4 times a day.
20 g of horse chestnut flowers insist 2 weeks in 0.5 liters of alcohol or vodka. Apply the tincture as a rub.
Take 50 g of mullein flowers (bear's ear) and insist 2 weeks in 0.5 liters of vodka or 70% alcohol. Use this tincture for rubbing as an anesthetic.
3 tsp rhizomes and roots of yellow gentian boil for 20 minutes, bay, 3 glasses of water. Insist, wrapped, 2 hours, strain. Take 1/2 cup 3-4 times a day before meals for arthritis of various origins.
1 glass of walnut partitions pour 0.5 liters of vodka, leave for 18 days. Take 2-3 times a day for a month.
Rheumatoid arthritis affects people most different ages, but most often those who are over 30. There are about 5 times more women among those who are ill than men. In general, according to researchers, rheumatoid arthritis affects 1-2% of the world's population.
To date, the causes of the disease are not fully understood. However, it was found that there is a hereditary predisposition to this disease: members of the patient's family are more likely to get this disease than others. But this does not mean that the relatives of the patient will get sick with a 100% probability. The disease will arise only if there are favorable factors for it.
Risk factors
Infection
In almost half of the patients, the onset of rheumatoid arthritis was preceded by an acute respiratory disease (ARI), influenza, tonsillitis, or exacerbation of chronic infectious diseases. Quite often, the disease develops as a continuation of reactive or infectious arthritis.
Stress, severe hypothermia - these factors lead to a decrease in immune forces and the occurrence of allergic reactions. As a result, reactivity can be impaired in such a way that the body begins to produce antibodies that attack its own joints and tissues. This process is called autoallergy, so rheumatoid arthritis is now classified as an autoimmune disease.
In rheumatoid arthritis, the synovial membrane of the joints (the membrane lining the surface of the joints) is primarily affected, in which inflammation processes occur. At the same time, synovial cells actively multiply, forming an aggressive tissue - pannus, which, in the process of growth, destroys bone, cartilage tissues and ligaments, which leads to destruction and deformities of the joints.
Clinical manifestations of rheumatoid arthritis
The onset of rheumatoid arthritis is usually either subacute 20% or gradual 70% with pain syndrome, swelling and stiffness of the joints in the morning. By the middle of the day, the pain subsides, the movements become more consolidated. The number of affected joints increases over several weeks or months. Only in 10% of patients the onset of rheumatoid arthritis is acute. For the early stage of the disease, damage to the small joints of the hands and feet is especially characteristic. Large joints are usually involved in the process later.
Usually, in rheumatoid arthritis, in addition to joint damage, other manifestations of the disease are also observed; in the blood serum, an increased level of rheumatoid factor, a protein that is produced before inflammation, is found. Often, patients have a feeling of weakness, deterioration in appetite and sleep, fever up to 37.2-38 ° C, chills. Patients lose weight, sometimes significantly.
In 20-35% of patients who usually have rheumatoid factor in the blood serum, with a severe course of the disease, rheumatoid nodules (subcutaneous nodules) occur. Typical localization of the nodules is the elbow joint and the extensor surface of the forearm. Nodules often appear during an exacerbation of the disease and disappear as the general condition improves.
The course of the disease is undulating: periods of deterioration in the patient's well-being are replaced by periods of spontaneous improvements. After stress, a cold or hypothermia, the patient's condition, as a rule, worsens, the so-called active phase of the disease develops. Over time, various disorders of the activity of internal organs are added to the damage to the joints. Not only continuous treatment will help to avoid exacerbations, but also precautionary measures. Dampness, cold, drafts, sudden changes in weather and climate change provoke the disease. Do not engage in heavy physical labor. Therefore, if you are a country holiday lover, you should be careful!
Treatment of rheumatoid arthritis
If there is an infection or if it is suspected (tuberculosis, yersiniosis, etc.), therapy with an appropriate antibacterial drug is necessary. In the absence of striking extra-articular manifestations, for example, no fever or polyneuropathy is observed, the treatment of articular syndrome begins with the selection of non-steroidal anti-inflammatory drugs - indamethacin, orthophene, naproxen, less often - ibuprofen. They are used for a long time (not courses), for years.
At the same time, corticosteroid drugs are injected into the most inflamed joints - hydrocortisone, metipred, kenalog. The immunocomplex nature of the disease indicates the effectiveness of plasmapheresis courses ( modern methods purification of blood plasma), in most cases giving a pronounced effect.
The instability of the results of the above therapy is an indication for the addition of the so-called basic funds. They act on the soil that gives rise to the disease, its basis. These drugs are used with an eye to the future, based on their ability to influence the causes of the disease and interrupt its development. But it should be remembered that, unlike hormones and non-steroidal anti-inflammatory drugs, basic drugs do not give a momentary positive effect, that is, they do not eliminate the symptoms of the disease in the first days and weeks of drug use. As a rule, basic preparations begin to act after a month. This is considered to be their major shortcoming.
The use of basic drugs for the treatment of rheumatoid arthritis should be carried out under the constant supervision of a physician who knows all aspects of the action of these drugs. Basic drugs act slowly, so they should be used for at least 6 months in a row, and with a clear positive effect, the intake continues for many years.
Currently, five groups of drugs are used as basic therapy: gold salts (krizanol, auranofin); D-penicillamine (cuprenil); the antimicrobial drug sulfasalazine; immunosuppressants - methotrexant, azathioprine, cyclophosphamide, chlorbutine, leukeran; antimalarial drugs - dalagil, plaquenil.
In rheumatoid arthritis, far from harmless drugs are prescribed. Especially seriously it is necessary to concern hormonal agents. Any unauthorized change in dose or drug withdrawal will inevitably lead to an exacerbation of the disease. Keep in mind that hormones cause complications: diabetes, stomach ulcers, disproportionate obesity. Yes, and other drugs - salicylates, cytostatics, D-penicillamine - can cause stomach pain, diarrhea, allergies, changes in blood composition.
It is difficult to say what the digestive organs suffer from more - from rheumatoid or from the drugs that treat it. If you experience abdominal pain, nausea and vomiting, do a gastroscopy - a stomach ulcer is possible. And drugs such as almagel will help protect the stomach from the corrosive effect of drugs.
But don't take it side effect drugs as something inevitable. There are a lot of drugs, so the doctor will always find a replacement.
Of great importance in reducing the onslaught of rheumatoid arthritis is physiotherapy exercises, which maintain maximum joint mobility and maintain muscle mass.
If the doctor has already diagnosed you (do not rush to diagnose yourself without a doctor - you can ruin your health with the wrong treatment!), Then the main task is to slow down the development of arthritis and not become a helpless invalid. First of all, get registered with a specialist in diseases of the joints. Not every polyclinic has a rheumatologist, but it is a must in the district one. Don't waste time looking for a super doctor (and even a super healer - all the more so, it is dangerous for your health). It is already known from centuries of practice that chronic disease it is better to be treated by one doctor who, over the years, will thoroughly study all the subtleties of your illness and immediately notice any changes for the worse. Visit your doctor at least once a month. Since rheumatoid arthritis occurs with exacerbations, which doctors call active phases you need to learn to recognize the visible signs of rheumatoid arthritis activity. This is easy to do.
- Accustom yourself to measure the temperature twice a day - in the morning and in the evening. An increase in temperature and associated weakness and malaise indicate the activity of the process.
- Look and feel the joints. Since the temperature can rise with any inflammatory disease, swelling and pain in the joints indicate the activity of rheumatoid arthritis. Feeling the joint, you can see that the skin over it is hot. Do not forget that not only previously affected joints can hurt, but also new ones.
- At the first signs of inflammation, consult a doctor. If the tests confirm the activity of the disease, then be sure to agree to treatment in a hospital. At home, exacerbation cannot be coped with. It will take not only a complete examination, but also the selection of drugs, and the adjustment of their dose, and a complex of medical procedures. All this is possible only in the hospital.
- After the elimination of the exacerbation, it is useful to conduct a course of sanatorium treatment. It is better to recover in the sanatoriums of Evpatoria, Matsesta, Odessa and Pyatigorsk. You can get a free or discounted voucher, and at the same time get a spa card from your rheumatologist.
If inflammation of the joints cannot be overlooked, then changes in internal organs do not make themselves felt for a long time: very often they occur under the guise of other diseases. Often there is rheumatoid damage to the lungs, heart, liver, kidneys, blood vessels and intestines. Such complications not only can seriously worsen the patient's condition, but pose a threat to his life.
Rheumatoid arthritis does not bypass the most important organ - the heart. Over time, a defect may even form. To "catch" rheumatoid carditis at the very beginning, conduct self-examination: count the pulse, note not only the number of beats, but also their uniformity, measure pressure daily. Watch how you endure physical fatigue, whether there are pains in the heart and shortness of breath. It makes sense to do an ECG more often, and if there are warning signs, ask the doctor to refer you to echocardiography.
Almost half of patients with rheumatoid arthritis affect the lungs. The "first swallows" are cough and shortness of breath, appearing simultaneously with inflammation of the joints. It is important to pay attention to them in time and visit a doctor. X-rays should be taken to detect advanced lung changes.
Almost always, with rheumatoid arthritis, the level of hemoglobin in the blood decreases. Therefore, watch the skin - its pallor indicates anemia. And weakness and dizziness say that anemia is pronounced. But the true level of hemoglobin can only be determined with the help of tests. Feel free to take a referral for a blood test and do it at least once every two months. Always keep the previous result so that the doctor can draw conclusions based on the comparison.
The disease takes on a severe character with kidney damage. Collect urine in a transparent jar and examine the contents in the light. Cloudy urine may indicate the presence of protein in it, and red urine may indicate blood. Both are bad. But even if the urine looks normal, periodically take it for analysis - most of the changes are not visible to the eye. And watch out for swelling: bags appearing in the morning under the eyes indicate a violation of the kidneys. This is also indicated by a persistent increase in blood pressure.
The disease also affects the eyes, skin, blood vessels and nerves. Do not neglect dispensary examinations, regularly consult with specialists, do not wait for the appearance of obvious signs of rheumatoid arthritis.
The causes of RA are not yet fully understood, but research is ongoing in this area. Scientists know that RA is an autoimmune disease. The normal role of the body's immune system is to fight and protect people from infections. However, when a person has an autoimmune disease, their own immune system destroys their own, healthy body tissues, and not foreign substances, like an infection.
In the case of RA, the immune system targets the lining of the joints, called the synovial membrane, causing inflammation and damage to the joints.
The characteristic swelling occurs when the joint creates too much lubricating (synovial) fluid in response to inflammation. Sometimes other parts of the body, such as the lungs and eyes, may also be affected.
Some people may be more at risk of developing RA due to hereditary factors. What exactly causes the body's immune system to attack the joints remains unknown.
The inflammation causes the joints to become painful, hot, and swollen, and movement is restricted. Inflammation caused by RA can lead to joint damage, especially if left untreated. RA can occur at any age, but usually occurs between 35 and 64 years of age. It is the second most common form of arthritis in the world. An estimated 57% of people with RA are women.
The most common symptoms of RA are:
- Swelling, pain and warmth in the joints. Usually, smaller joints are affected, such as those in the arms or legs.
- Persistent fatigue.
- Difficulty sleeping due to pain.
- Weak muscles.
- Feeling of thirst and sweating.
The course and severity of RA varies from person to person, and no two cases are the same. Symptoms can change every day. There may be times when the disease is active and progressing, and at other times the disease is inactive.
Joint pain can be removed or minimized, significantly alleviating the painful condition. Menovazin is one of the best medicines that can have a strong analgesic effect. It is time-tested and just recommended in the treatment of RA.
Other medicines used to treat people with RA may increase the risk of infections. Vaccination can help prevent some of these infections.
An autoimmune disease, RA occurs when a person's immune system mistakenly attacks its own tissue. While RA primarily affects the tissue lining of the joints, it can also affect the lungs, heart, kidneys, and eyes.
Rheumatoid arthritis drugs work by suppressing the patient's immune system. However, unwanted side effect this suppression is an increased risk of infection, especially in the lungs.
Vaccination can significantly reduce the risk of infection. But, if the patient has a weakened immune system, vaccines that contain live viruses should be avoided. These types of vaccinations can cause infection in people with suppressed immune systems.
The nasal spray version contains a live virus and is therefore not recommended for people who have weakened immune systems.
You should talk to your healthcare provider about what vaccinations might be helpful and when during your treatment would be the best time to get them.
