With rheumatoid arthritis, how to treat it. What can cause rheumatoid arthritis
The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious physician. All drugs have contraindications. Need expert advice
Polymorphic rash
In juvenile arthritis, the rash appears at the height of the fever. Then it may periodically appear and disappear. However, it is not accompanied by itching or other unpleasant sensations. The nature of the rash can be very diverse.
Rash in juvenile rheumatoid arthritis is of the following types:
- patchy rash;
- rash in the form of urticaria;
- hemorrhagic rash;
- papular rash.
Kidney damage can be at the level of various structures, but amyloidosis most often develops. In amyloidosis, a mutated protein called amyloid accumulates in the kidney parenchyma. In a healthy body, this protein does not exist, but it is formed during long-term, chronic diseases. Renal amyloidosis proceeds very slowly, but it inevitably leads to kidney failure. Manifested by edema, protein in the urine, accumulation of metabolic products in the body ( e.g. urea).
Heart failure
In juvenile rheumatoid arthritis, both the heart muscle and the membranes that cover the heart can be affected. In the first case, the disease proceeds in the form of myocarditis. Myocarditis is accompanied by weakness and inferiority of cardiac activity. The heart, which normally functions as a pump in the body ( pumps blood throughout the body), in this case, is not able to provide oxygen to the entire body. Children complain of weakness, shortness of breath, fatigue.
Also, with rheumatoid arthritis, the pericardium can also be damaged with the development of pericarditis. Involvement in the pathological process of both the heart muscle and the pericardium is called myopericarditis.
Lung injury
Lung damage can occur in the form of sclerosing alveolitis or pleurisy. In the first case, the walls of the alveoli are replaced by connective tissue. As a result, the elasticity of the alveoli and the lung tissue itself decreases. In the case of pleurisy, effusion accumulates in the pleural cavity ( inflammatory fluid), which gradually compresses the lung. In both the first and second cases, the main symptom is shortness of breath.
Hepatolienal syndrome
Hepatolienal syndrome is characterized by an enlarged liver and spleen. More often, only the liver is enlarged ( hepatomegaly), which is manifested by dull aching pain in the right hypochondrium. If the spleen also enlarges ( splenomegaly), then the pain also appears on the left. However, in young children, any abdominal pain is localized around the navel. Therefore, it is possible to identify an enlarged liver and spleen only during a medical examination during palpation.
Lymphadenopathy
Lymphadenopathy is called enlarged lymph nodes. Those nodes that are localized near the inflamed joint increase. If the temporomandibular joints are affected, then the cervical and submandibular nodes increase; if the knee joint - then the popliteal nodes. Thus, lymphadenopathy is reactive, and not specific.
Juvenile rheumatoid arthritis can occur in several ways:
- oligoarticular variant- with damage to two - three, but not more than four joints;
- polyarticular variant- with damage to more than four joints;
- system variant- with damage to both internal organs and joints.
What are the first symptoms of rheumatoid arthritis?
The first symptoms of rheumatoid arthritis are very diverse. In about 60 percent of cases, the disease begins gradually, with the appearance of signs of general intoxication of the body and an increase in the main symptoms over several months. In 30 to 40 percent of patients, the initial symptoms of rheumatoid arthritis are limited to local signs of joint inflammation. All initial symptoms of rheumatoid arthritis can be divided into three main groups.
The first symptoms of rheumatoid arthritis are:
- symptoms of general intoxication of the body;
- symptoms of joint lesions;
- symptoms of extra-articular lesions.
Due to the prolonged inflammatory process in the body, protective barriers and systems are depleted. The body weakens, and there are signs of general intoxication with the decay products of inflammatory reactions.
Symptoms of general intoxication of the body in rheumatoid arthritis are:
- general fatigue;
- weakness in the whole body;
- weakness;
- aches in all joints and bones;
- aching pain in the muscles, which can persist for a long time;
- pallor of the skin of the face and limbs;
- cold hands and feet;
- sweating of the palms and feet;
- decreased or loss of appetite;
- weight loss;
- elevated body temperature up to 37.5 - 38 degrees;
- chills;
- enlargement of peripheral lymph nodes.
Symptoms of joint lesions
The main manifestations of rheumatoid arthritis are joint damage. In the initial stage of the disease, articular symptoms are caused by an active inflammatory process in the joints and the resulting periarticular ( periarticular) edema.
The first symptoms of articular lesions in rheumatoid arthritis are:
- morning stiffness;
- decrease in range of motion.
Arthritis is an inflammation of all the tissues that form and surround a joint.
The joints affected by rheumatoid arthritis vary in location and number.
Articular lesions in rheumatoid arthritis
| Criterion | Options | Brief explanation |
| Depending on the number of affected joints | monoarthritis | only one joint is affected. |
| oligoarthritis | two or three joints are affected. | |
| polyarthritis | more than four joints affected. | |
| By symmetry | symmetrical arthritis | the same joint on the right and left sides of the body is affected. |
| asymmetric arthritis | no damage to the opposite joint. | |
| Involved joints | large limb joints |
|
| small joints of the limbs |
|
In more than 65 percent of patients, the onset of the disease is manifested by polyarthritis. It is usually symmetrical and wraps around the small joints of the fingers and toes.
Arthritis is characterized by a number of local non-specific symptoms.
Nonspecific symptoms of joint inflammation in rheumatoid arthritis are:
- joint pain on palpation feeling);
- swelling of the joint and tendons attached to it;
- an increase in local temperature;
- sometimes slight redness of the skin around the joint.
Morning stiffness occurs in the first minutes after waking up and lasts up to 1 - 2 hours or more. After a long stay at rest, inflammatory fluid accumulates in the joints, due to which periarticular edema increases. The movements in the affected joints are limited and cause severe pain. Some sufferers liken morning stiffness to "feeling numb," "tight gloves," or "tight corset."
Joint pain
Joint pain in rheumatoid arthritis is constant, aching. A small physical load and even ordinary movements in the joints cause increased pain. After a warm-up or by the end of the working day, the pain tends to ease. Relief lasts no more than 3-4 hours, after which the pain intensifies again. To reduce pain, the patient involuntarily holds the affected joint in a bent position.
Decreased range of motion
Due to periarticular edema and pain in the inflamed joints, the range of motion decreases. This is especially noticeable with the defeat of the metacarpophalangeal and interphalangeal joints of the hands. Patients with rheumatoid arthritis have difficulty with fine motor skills of the hands. It becomes difficult for them to fasten buttons, thread a needle, and hold small objects.
Symptoms of extra-articular lesions
Usually, in rheumatoid arthritis, symptoms of extra-articular lesions appear in the later stages of the disease. However, some of them can be observed along with the first articular symptoms.
Symptoms of extra-articular lesions that may appear early in the disease are:
- subcutaneous nodules;
- muscle damage;
- vasculitis ( vascular inflammation) skin.
In rheumatoid arthritis, subcutaneous nodules are found in the affected joints. They are small rounded formations dense in consistency. Most often, nodules are located on the extensor surface of the elbow, hand, and on the Achilles tendon. They don't cause any pain.
Muscle damage
Muscle weakness is often one of the first symptoms of rheumatoid arthritis. Muscles near inflamed joints atrophy and decrease in size.
Skin vasculitis
Cutaneous vasculitis appears in the distal areas of the arms and legs. Many brown dots can be seen on the nails and fingertips.
Rheumatoid arthritis, which debuts with damage to the joints of the lower extremities, is sometimes accompanied by severe vasculitis in the form of skin ulcers on the legs.
What are the stages of rheumatoid arthritis?
There are several stages of rheumatoid arthritis. So, there are clinical stages and radiological stages of this disease. The clinical stages of rheumatoid arthritis are:
- first stage- manifested by swelling of the synovial bag of the joint, which causes pain, local temperature and swelling near the joint;
- second stage- cells of the synovial membrane under the influence of inflammatory enzymes begin to divide, which leads to compaction of the articular bag;
- third stage- deformity of the joint or joints) and loss of mobility.
- Early stage lasts the first six months. At this stage, there are no main symptoms of the disease, but it is manifested by periodic fever and lymphadenopathy.
- Expanded stage– lasts from six months to two years. It is characterized by extensive clinical manifestations - swelling and pain in the joints appear, changes in some internal organs are noted.
- late stage- two years or more after the onset of the disease. Complications begin to develop.
- Stage of early radiological changes- characterized by compaction of soft tissues and the development of periarticular osteoporosis. On x-ray film, this looks like increased transparency of the bone.
- Stage of moderate radiological changes- characterized by an increase in osteoporosis and the addition of cystic formations in the tubular bones. Also at this stage, the joint space begins to narrow.
- Stage of pronounced radiological changes- manifested by the presence of destructive changes. A feature of this stage is the appearance of deformities, dislocations and subluxations in the inflamed joints.
- Ankylosis stage- consists in the development of bone growths ( ankylosis) in the joints, usually in the joints of the wrists.
What are the types of rheumatoid arthritis?
According to the number of joints involved in the pathological process and the presence of rheumatoid factor, several types of rheumatoid arthritis are distinguished. The types of rheumatoid arthritis are:
- polyarthritis- simultaneous damage to more than four joints;
- oligoarthritis- simultaneous inflammation of 2 - 3 joints, maximum - 4;
- monoarthritis- inflammation of one joint.
There are also specific forms of rheumatoid arthritis. These are Felty's syndrome and Still's disease.
Felty syndrome
Felty's syndrome is a special variant of rheumatoid arthritis, which is characterized by damage to both joints and internal organs. It is manifested by severe damage to the joints, enlargement of the liver and spleen, as well as inflammation of the vessels ( vasculitis). Felty's syndrome is especially severe due to the presence of such a symptom as neutropenia. With neutropenia, white blood cells decrease, which is why there is a constant risk of infectious complications.
Still's disease
In Still's disease, arthritis is accompanied by recurrent fever and rash. The temperature fluctuates between 37 - 37.2 degrees. At the same time, it periodically appears and disappears, that is, it recurs. The rash in Still's disease is large-spotted or papular. Rheumatoid factor is negative.
Another variant of rheumatoid arthritis is juvenile rheumatoid arthritis. This type of arthritis occurs in children and adolescents under 16 years of age. It is characterized by both articular and extra-articular manifestations. Of the extra-articular symptoms, keratoconjunctivitis, scleritis, rheumatoid nodules, pericarditis, and neuropathies are more common. Children with juvenile arthritis often lag behind in physical development.
What are the degrees of activity of rheumatoid arthritis?
There is low, moderate and high activity in rheumatoid arthritis. In order to determine it, various indexes and methods are used. To date, the most commonly used method is the European Antirheumatic League, which proposed the use of the DAS index. In order to calculate this index, certain parameters must be used. The components of the DAS index are:
- general well-being of the patient according to the visual analogue scale;
- the number of swollen joints;
- the number of painful joints according to the RICHIE index;
- ESR ( ).
There is the following interpretation of the DAS index:
- low activity at DAS less than 2.4;
- moderate activity at DAS from 2.4 to 3.7;
- high activity with DAS of 3.7 or more.
Rheumatoid arthritis activity can also be assessed by the Larsen method. This is an X-ray method that takes into account the presence and depth of destructive changes. Larsen identified six degrees of change - from 0 ( norm) until 6 ( the degree of pronounced destructive changes). Also relevant is the HAQ indicator, which takes into account the degree of functional changes.
In everyday practice, the doctor is more often guided by functional classes. Functional classes reflect both the degree of activity of the pathological process and its correlation with the daily activities of the patient.
There are the following functional classes of rheumatoid arthritis:
- 1 class- all movements in all joints are preserved without restriction;
- Grade 2– mobility is preserved when performing daily loads;
- 3rd grade– the ability to perform daily activities is limited;
- 4th grade- Unable to carry out daily activities.
What tests should be taken for rheumatoid arthritis?
With rheumatoid arthritis, it is necessary to take a number of tests that help to correctly diagnose the disease, determine at what stage it is, and also evaluate the effectiveness of treatment. Among the laboratory tests that are prescribed for rheumatoid arthritis, two main groups can be distinguished:
- standard analyses;
- specific blood tests.
There is a small list of standard tests that must be taken for rheumatoid arthritis. The results of these tests may indicate the development of inflammatory reactions in the body and the degree of their severity. Thanks to standard tests, the severity and stage of the disease can be determined.
The standard tests for rheumatoid arthritis are:
- hemoleukogram ( general blood analysis);
- ESR ( sedimentation rate of erythrocytes);
- blood test for C-reactive protein;
- detection of rheumatoid factor.
With rheumatoid arthritis in the hemoleukogram, an altered ratio and amount of cellular elements of the blood are found.
Pathological changes in the hemoleukogram in rheumatoid arthritis
| Cellular elements | Changes | |
| Leukocytes
(white blood cells) | the number increases (leukocytosis) | more than 9 thousand cells per milliliter of blood |
| Neutrophils
(a special type of white blood cell) | it is possible to reduce the number (neutropenia) | less than 48 percent of total white blood cells |
| platelets
(cells involved in blood clotting) | it is possible to reduce the number (thrombocytopenia). | more than 320 thousand cells per milliliter of blood |
| Hemoglobin
(main constituent of red blood cells) | concentration decreases (anemia) | less than 120 grams per liter of blood |
Typically, mild leukocytosis and mild anemia are seen in rheumatoid arthritis. The more acute and severe the course of rheumatoid arthritis, the greater the number of leukocytes in the blood.
In a particularly severe course of the disease, when the inflammatory process affects the spleen, neutropenia and thrombocytopenia are noted.
ESR
In rheumatoid arthritis, the rate of erythrocyte sedimentation to the bottom of the tube is examined. An active inflammatory process causes an increase in this rate of more than 15 millimeters per hour. With adequate treatment and regression of the disease, the erythrocyte sedimentation rate decreases.
Blood chemistry
A biochemical blood test is done to detect an increase in protein synthesis, which indicates the active phase of inflammation.
The main pathological changes in the biochemical blood test in rheumatoid arthritis
| Blood biochemicals | Changes | Numerical equivalent of changes |
| fibrinogen | rises | more than 4 grams per liter |
| Haptoglobin | rises | more than 3.03 grams per liter |
| Sialic acids | rising | more than 2.33 millimoles per liter |
| Gamma globulins | rising | more than 25% of the total number of globulins ( more than 16 grams per liter of blood) |
General urine analysis
In the initial stages of rheumatoid arthritis, a general urine test remains unchanged for a long time. In a severe course of the disease, the inflammatory process affects the renal tissue and disrupts the function of the kidneys as a whole. In the general analysis of urine, erythrocytes are found ( microhematuria), leukocytes ( leukocyturia) and epithelial cells of the kidneys. Also, up to 3 grams of proteins are detected in the urine ( squirrel) per litre. With the development of renal failure, a decrease in the total urine volume of less than 400 milliliters per day is recorded.
Blood test for C-reactive protein
In rheumatoid arthritis, a blood test is required to detect C-reactive protein. This protein is produced actively in the first 24-48 hours from the onset of the inflammation process. The amount of C-reactive protein in the blood indicates the severity of inflammation and the risk of disease progression. In rheumatoid arthritis, the amount of C-reactive protein is more than 5 milligrams per liter of blood.
Identification of rheumatoid factor.
More than 75 percent of patients with rheumatoid arthritis have a positive reaction to rheumatoid factor. In the midst of his illness, his credits ( levels) increase from 1:32.
Rheumatoid factor is a special immune complexes that are formed in the body during severe inflammatory reactions. During inflammation, lymphocytes are damaged ( immune blood cells) that continue to synthesize immune proteins. The body takes these proteins for foreign particles and produces rheumatoid factor against them.
Specific blood tests
Specific blood tests that are prescribed for rheumatoid arthritis indicate the presence of specific markers of the disease.
Specific blood tests are:
- detection of antibodies to cyclic citrulline peptide ( anti-SSR);
- detection of antibodies to modified citrullinated vimentin ( anti-MCV).
The detection of antibodies to cyclic citrulline peptide is a highly specific early test for the diagnosis of rheumatoid arthritis. The specificity of this assay is 97 to 98 percent.
Citrulline is a special protein substance that is formed during inflammatory reactions. Especially a lot of citrulline is synthesized in damaged cartilage cells. Proteins of damaged cells are perceived by the body's immune system as foreign. Specific antibodies are produced against them, called anti-CCP antibodies.
The higher the titer of antibodies to CCP, the higher the severity of cartilage damage.
Determination of antibodies to modified citrullinated vimentin
Antibodies to modified citrullinated vimentin are considered the most specific markers in the diagnosis and monitoring of rheumatoid arthritis.
Under the action of various inflammatory enzymes in damaged cells, in addition to citrulline, another special protein is synthesized - modified citrullinated vimentin. The highest concentration of this substance is found in the synovial ( articular) liquids. The immune system of the body produces a large number of antibodies to MVC, which can be found in the peripheral blood.
An anti-MCV test can diagnose rheumatoid arthritis with 99 to 100 percent accuracy.
What is systemic rheumatoid arthritis?
Systemic rheumatoid arthritis is a variant of rheumatoid arthritis that occurs with systemic ( or extra-articular) manifestations. With this pathology, extra-articular manifestations can dominate in the clinic of the disease and push the articular symptoms into the background. Any organ or organ system can be affected.
Systemic manifestations of rheumatoid arthritis are:
- from the cardiovascular system- myocarditis, pericarditis, myopericarditis, vasculitis, in rare cases, granulomatous valvular lesions;
- from the respiratory system- Kaplan's syndrome presence of rheumatoid nodules in the lungs), bronchiolitis, damage to the interstitium of the lungs;
- from the nervous system- neuropathy ( sensory or motor), mononeuritis, cervical myelitis;
- from the lymphatic system- lymphadenopathy;
- from the urinary system- kidney amyloidosis, nephritis;
- from the skin- rheumatoid nodules, livedo reticularis, thickening of the skin, multiple microinfarctions in the area of the nail bed;
- by the organs of vision- keratitis, conjunctivitis, episcleritis;
- from the blood system anemia, thrombocytosis, neutropenia.
Other manifestations of systemic rheumatoid arthritis are:
- arthritis of the knee joints with subsequent hallux valgus;
- arthritis of the foot joints with deformity of the big toe and subluxation of the metatarsophalangeal joints;
- arthritis of the cervical spine with subluxation in the atlantoaxial joint ( joint of the first and second cervical vertebrae) and compression of the vertebral artery;
- damage to the ligamentous apparatus - with the development of bursitis and tendosynovitis, as well as the formation of synovial cysts ( for example, a Baker's cyst on the back of the knee);
- the appearance of rheumatoid nodules around the affected joints;
- recurrent subfebrile ( 37 - 37.2 degrees) temperature;
- morning stiffness in the joints;
- soreness of the affected joints;
- decreased strength in the limbs;
- polymorphic rash, in adults - rarely, in children - more often;
How is rheumatoid arthritis treated?
Rheumatoid arthritis is treated with a combination of different therapeutic methods. The goal of therapy is to relieve pain, eliminate inflammation and maintain joint mobility. Therapeutic approaches for rheumatoid arthritis are:
- drug therapy;
- physiotherapy;
- Spa treatment;
- maintaining a certain lifestyle.
Methods of drug therapy depend on the clinical picture of the disease and the individual characteristics of the patient. When treating with drugs, an important task is to prevent the development of side effects. Therefore, it is necessary to take drugs under the supervision of a doctor who periodically prescribes blood tests to monitor the patient's condition. Depending on the goals pursued in drug therapy, several approaches are used. Each of them is carried out using different groups of drugs.
The types of drug treatment are:
- anti-inflammatory therapy;
- basic therapy;
- local therapy.
The goal of this type of treatment is to eliminate the symptoms of an active inflammatory process. This type of therapy is not the main one in the treatment of rheumatoid arthritis, but it helps to alleviate the patient's condition due to the reduction of pain. In most cases, non-steroidal anti-inflammatory drugs and corticosteroids are used to relieve inflammation.
Basic therapy
The drugs on the basis of which basic therapy is carried out are the main ones in the treatment of polyarthritis. These medicines act on the main cause of the disease. Such treatment does not give a quick result and the onset of a positive effect is possible not earlier than in a month. With properly selected drugs, basic therapy allows achieving stable remission in most patients.
Local therapy
Topical treatment is an adjunct to the main therapy for rheumatoid arthritis.
Types of local treatment are:
- Applications based on drugs- contribute to the reduction of inflammatory processes and have an analgesic effect.
- Rubbing ointments and gels- rubbed into the area of the affected joint, helping to smooth out the symptoms of the inflammatory process. Such treatment is effective in the initial stages of the disease.
- The introduction of drugs by the intraarticular method- allows you to influence directly the affected joints. Various drugs, biologically and chemically active substances are used for treatment.
The goal of physiotherapeutic procedures is to normalize blood circulation in the affected joints and improve their mobility. Also, physiotherapy can eliminate muscle spasms.
The types of physiotherapy are:
- electrophoresis- the introduction of drugs through the skin using an electric current;
- phonophoresis- injection of drugs through the skin with ultrasound;
- ultraviolet irradiation- impact on the affected areas with ultraviolet waves of different waves;
- darsonvalization– the procedure is based on the application of pulsed current;
- diathermy- heating the diseased joint with electric current;
- ozokerite– thermal compresses based on a natural resource;
- cryotherapy- general or local exposure to cold;
- laser therapy- the use of light energy for medicinal purposes.
Surgery
Surgical treatments are used to preserve, restore or improve joint function. At an early stage of the disease, preventive treatment is carried out, during which the shell of the affected joints is excised. In the presence of persistent deformities in the joints, the patient is shown reconstructive surgery. In the course of such manipulations, along with excision of the membrane, the altered sections of the articular tissue are removed. Modeling of new articular surfaces, replacement of individual parts of the joint with implants, and restriction of joint mobility can also be carried out.
Spa treatment
Sanatorium-and-spa treatment is indicated when the patient's condition improves in order to fix the achieved results in the course of treatment. The most effective resorts, where the emphasis is on mineral baths.
- salt;
- radon;
- hydrogen sulfide;
- iodine-bromine.
A big role in the treatment of rheumatoid arthritis is the patient's adherence to a certain lifestyle. Following the rules makes therapy more effective and allows you to increase the duration of remission achieved during treatment.
- dieting;
- overweight prevention;
- restriction of tobacco and alcohol-containing products;
- timely rest;
- prevention of infectious diseases;
- practicing permitted sports swimming, aerobics, walking).
What medicines are used in the treatment of rheumatoid arthritis?
In the treatment of rheumatoid arthritis, drugs with different mechanisms of action are used. Basically, the goal of drug treatment is to eliminate pain, stop the destructive process and prevent the development of complications. In the treatment of rheumatoid arthritis, the following groups of drugs are used:
- non-steroidal anti-inflammatory drugs ( NSAIDs);
- glucocorticoids ( GC);
- immunosuppressants;
- antimetabolites.
Drugs used in the treatment of rheumatoid arthritis
| Drug group | Representatives | effects | When appointed |
| Non-steroidal anti-inflammatory drugs |
| This group of drugs is not included in the basic therapy of rheumatoid arthritis, since it does not affect the destructive process in the joints. However, drugs from this group are prescribed to reduce pain and eliminate stiffness in the joints. | They are prescribed during the period of exacerbation of pain and severe stiffness. With caution are prescribed to patients with gastritis. |
| Glucocorticoids |
| Unlike NSAIDs, they not only relieve swelling and eliminate pain, but also slow down the process of destruction in the joints. They have a fast and dose-dependent effect. The drugs of this group are prescribed both systemically and locally ( intra-articular injections). Their long-term use is complicated by the development of numerous side effects ( osteoporosis, stomach ulcers). | In low doses, they are prescribed orally for a long period. High doses are administered intravenously ( pulse therapy) in cases of systemic rheumatoid arthritis. |
| Antimetabolites |
| The drugs of this group are included in the basic therapy of rheumatoid arthritis, as they slow down the destructive processes in the joints. They are the drugs of choice. To date, methotrexate is the "gold standard" especially in the treatment of seropositive rheumatoid arthritis. Methotrexate is prescribed in conjunction with folic acid preparations. | Treatment is carried out under the periodic control of a blood test. Preparations from this group are prescribed once a week, the duration of treatment is determined individually. The effect is evaluated after a month from the start of treatment. |
| Immunosuppressants |
| Also included in the basic therapy of rheumatoid arthritis. As a rule, they are prescribed in combinations with antimetabolites, namely with methotrexate. The most common combinations are methotrexate + cyclosporine, methotrexate + leflunomide. | They are used in combination therapy with antimetabolites, as well as in cases where there is no effect from methotrexate. |
Treatment with basic drugs
The basic drugs of treatment include drugs from the group of immunosuppressants and antimetabolites. Treatment should be carried out in all patients with rheumatoid arthritis without exception. Numerous studies have shown that these drugs not only reduce the intensity of pain, but also slow down the processes of tissue destruction and improve functional activity. The duration of therapy with these drugs is unlimited and depends on the characteristics of the course of the disease.
Combination therapy with basic drugs includes 2 or 3 drugs from this group. Women of childbearing age are recommended to use various methods of contraception, because it has been proven teratogenic ( disfiguring) the effect of these drugs on the fetus.
After 20 years from the onset of the disease, 50 to 80 percent of patients lose their ability to work.
The main principles of treatment of rheumatoid arthritis are as follows:
- the main goal of treatment is to achieve remission, complete or partial;
- treatment is carried out under the strict supervision of a rheumatologist and a family therapist;
- intravenous injections, droppers with basic treatment drugs are carried out only in a hospital under the supervision of a doctor;
- Monotherapy is preferred single drug treatment), and only in case of inefficiency they switch to combination therapy;
- in parallel, prevention of complications is carried out ( infectious, cardiovascular complications, anemia);
- NSAID therapy is carried out simultaneously with basic treatment;
- treatment with basic drugs is prescribed as early as possible; basic therapy is recommended to start within three months from the onset of the first symptoms;
- the effectiveness of the undertaken treatment method is assessed according to international standards.
With rheumatoid arthritis, a special diet is recommended, which will reduce inflammation and correct metabolic disorders. Diet rules for rheumatoid arthritis are:
- exclusion of products that cause allergies;
- replacing meat with dairy and vegetable products;
- including enough fruits and vegetables;
- reducing the burden on the kidneys, liver and stomach;
- eating foods high in calcium;
- refusal of food that causes excess weight.
The course of rheumatoid arthritis is exacerbated by the use of allergen products. Therefore, it is necessary to limit or completely exclude them from the diet. You can identify foods that contribute to allergies with the help of an elimination diet. To do this, for a period of 7 - 15 days, it is necessary to exclude a certain product from the diet. Next, you should enter this product on the menu for a day and observe the symptoms for 3 days. For accuracy, this procedure must be carried out several times. It is necessary to start an elimination diet with foods that most often cause an exacerbation of this disease.
Allergenic foods include:
- citrus ( oranges, grapefruits, lemons, tangerines);
- whole milk ( cow, goat);
- cereals ( rye, wheat, oats, corn);
- nightshade crops ( tomatoes, potatoes, peppers, eggplant).
Replacing meat with dairy and plant products
According to medical statistics, about 40 percent of patients with rheumatoid arthritis report an improvement in their condition when they refuse meat. Therefore, especially during an exacerbation of the disease, it is necessary to completely exclude or limit as much as possible the use of dishes that include the meat of any wild or domestic animals.
Compensate for the lack of meat in the diet is necessary products, which include a large amount of protein. In the absence of allergies, dairy products can become a source of protein. You should also consume a sufficient amount of fatty fish.
- legumes ( beans, chickpeas, lentils, soy);
- eggs ( chicken, quail);
- nuts ( almond, peanut, hazelnut, walnut);
- vegetable oils ( olive, linseed, corn);
- fish ( mackerel, tuna, sardine, herring).
Vegetables and fruits contain a large number of substances that help reduce the symptoms of rheumatoid arthritis. Therefore, such patients need to consume at least 200 grams of fruits and 300 grams of vegetables daily. It should be borne in mind that not all fruits and vegetables are recommended for this disease.
Herbal products that are useful for consumption are:
- broccoli;
- Brussels sprouts;
- carrot;
- pumpkin;
- zucchini;
- leaf salad;
- avocado;
- apples;
- pears;
- strawberries.
A diet for rheumatoid arthritis should help the body more easily tolerate drug therapy. Therefore, patients need to give up products that negatively affect the functionality of the kidneys, liver and gastrointestinal tract.
Foods to be excluded are:
- hot spices, flavor enhancers, food additives;
- canned factory products;
- rich broths;
- butter, margarine, lard;
- cocoa, chocolate;
- strongly brewed coffee and tea;
- carbonated drinks.
Eating foods high in calcium
Drugs taken during treatment for rheumatoid arthritis lead to calcium deficiency, which can cause osteoporosis ( fragility and decreased bone density). Therefore, the diet of patients should include foods that are rich in this element.
Sources of calcium are:
- dairy;
- soy products;
- legumes ( beans);
- nuts ( almond, Brazil nut);
- seeds ( poppy, sesame);
- leafy greens ( parsley, lettuce, arugula).
Refusal of foods that cause excess weight
Patients with rheumatoid arthritis limit their physical activity, resulting in excess weight. Excess body weight puts stress on inflamed joints. Therefore, the diet of such people should contain a reduced amount of calories. To do this, it is necessary to reduce the amount of refined carbohydrates consumed, which are found in sugar, flour and refined vegetable oil. You should also limit your intake of high-fat foods.
High calorie foods are:
- pizza, hamburgers, hot dogs;
- muffins, cakes, pastries;
- powdered and carbonated drinks;
- chips, crackers, french fries;
- marmalade, jam, jams.
What are the complications of rheumatoid arthritis?
Rheumatoid arthritis is accompanied by changes not only in the joints, but also in almost all other body systems. Complications of rheumatoid arthritis are:
- damage to the joints and the musculoskeletal system;
- skin lesions;
- eye diseases;
- pathologies of the cardiovascular system;
- dysfunction of the nervous system;
- respiratory system damage;
- dysfunction of the gastrointestinal tract;
- mental disorders;
- other pathologies.
Progressing, rheumatoid arthritis affects the elbow, wrist, hip and other joints. Often the cervical spine and temporomandibular joints are involved in the process. Inflammatory processes entail the loss of functionality and mobility of the joints. This causes the patient's lack of independence, as it becomes difficult for him to satisfy his needs.
Musculoskeletal disorders are:
- pathological changes in muscle tissue due to malnutrition;
- bursitis ( inflammation of the joint capsules);
- tendinitis ( inflammation of the tendons);
- synovitis ( inflammation of the lining of the joints);
- damage to the joints located in the larynx ( causes shortness of breath, bronchitis, voice change).
Among patients with rheumatoid arthritis, 20 percent have lupus ( skin tuberculosis) or rheumatoid nodules, which are localized in the areas of the elbows, fingers, forearms. Inflammation of the blood vessels in some patients causes ulcerative skin lesions, rashes, or other pathological changes.
Other skin problems with this disease are:
- thickening or depletion of the skin;
- digital arteritis ( small necrosis in the nail bed);
- mesh livedo ( highly translucent blood vessels due to thinning of the skin);
- cyanotic color of the skin of the fingers and feet;
- gangrene of the fingers.
Lesions of the visual organs in rheumatoid arthritis manifest themselves in various ways. The most common is inflammation of the episclera ( the sclera of the eye, which contains the blood vessels). Another dangerous complication that can cause vision loss is scleritis ( inflammation of the eyeball). Rheumatoid arthritis may be accompanied by dysfunction of the lacrimal glands, resulting in the development of conjunctivitis.
Pathologies of the cardiovascular system
In rheumatoid arthritis in many patients between the pericardium ( shell of the heart) and fluid accumulates in the heart, leading to pericarditis ( inflammation of the pericardium). In some cases, an inflammatory process may develop in the middle membrane of the heart ( myocarditis). Rheumatoid arthritis increases the likelihood of diseases such as heart attack and stroke. Another dangerous complication of this type of arthritis is inflammation of the small blood vessels.
Nervous system dysfunction
As a result of compression of the nerve trunks in the joints, patients develop pain in the lower and upper extremities, which intensify at night.
Other disorders of the nervous system are:
- paresthesia ( sensory disturbance);
- burning, chilliness of hands and feet;
- movement disorders;
- muscle atrophy;
- cervical myelitis ( inflammation of the cervical spine).
The vast majority of patients with active rheumatoid arthritis develop anemia ( insufficient number of red blood cells). This leads to general weakness, sleep disturbances, heart palpitations. Against the background of this disease, hair begins to fall out, nails break badly, the skin loses elasticity and becomes dry. Another complication is neutropenia ( a decrease in the number of a certain group of leukocytes in the blood), which significantly increases the risk of developing infectious diseases. The active inflammatory process in rheumatoid arthritis can trigger the production of excessive platelet counts ( thrombocytosis), which increases the risk of vascular occlusion.
Respiratory system lesions
The inflammatory process in rheumatoid arthritis can cause pleurisy ( inflammation of the lining surrounding the lungs). In some cases, rheumatoid nodules may develop in the lungs. These growths sometimes lead to lung infections, coughing up blood, and accumulation of fluid between the chest and the lining of the lungs. This form of arthritis can also cause pulmonary hypertension and interstitial lung disease (gastric or duodenal ulcer. Periodically, complications such as gastrointestinal bleeding can occur.
Mental disorders
One of the complications of rheumatoid arthritis that manifests itself on a mental level is depression. The need for the systematic use of potent drugs, restrictions and the inability to lead a normal life cause negative changes in the patient's emotional background. According to statistics, 11 percent of patients have signs of depression in moderate or severe form.
Other pathologies
Diseases that provoke rheumatoid arthritis are:
- splenomegaly ( enlargement of the spleen);
- peripheral lymphadenopathy ( enlargement of peripheral lymph nodes);
- autoimmune thyroiditis ( autoimmune thyroid disease).
What is the prognosis for rheumatoid arthritis?
The prognosis for rheumatoid arthritis depends on the clinical picture of the disease. For many years, this disease was classified as a pathology with an unfavorable prognosis. People who had this form of arthritis were considered doomed to disability. Today, subject to a number of conditions, the prognosis of this disease can be favorable. It should be borne in mind that a favorable prognosis does not imply the absence of relapses ( repeated exacerbations) rheumatoid arthritis, and the patient should be under medical supervision for a long time. The main factor that contributes to a favorable prognosis is the timely detection of the disease and immediately started therapy. With adequate treatment, remission can occur within the first year. The most significant progress is achieved in the period from 2 to 6 years of illness, after which the process stops. Causes of an unfavorable prognosis
The reasons that adversely affect the prognosis include:
- the female gender of the patient;
- young age;
- exacerbation lasting at least 6 months;
- inflammation of more than 20 joints;
- seropositive test for rheumatoid factor at the onset of the disease;
- increased erythrocyte sedimentation rate;
- high concentration of C-reactive protein ( substance that is an indicator of inflammation) in blood serum;
- a large amount of haptoglobin ( a protein formed in the acute phase of inflammation) in plasma;
- carriage of HLA-DR4 ( antigen indicating a predisposition to a severe course of the disease and low susceptibility to basic drugs).
Every year, from the total number of patients with this disease, from 5 to 10 percent of patients become disabled. After 15-20 years from the onset of the disease, the vast majority of patients are diagnosed with a severe stage of rheumatoid arthritis, which is accompanied by immobility of individual joints.
Death in rheumatoid arthritis
Death in rheumatoid arthritis ends in about 15 - 20 percent of cases. Death occurs due to infectious processes ( pneumonia, pyelonephritis), pathologies of the gastrointestinal tract ( bleeding, perforation), cardiovascular accidents ( heart attack, stroke). Agranulocytosis is a common cause of death in rheumatoid arthritis ( a condition in which the level of white blood cells in the blood decreases) against which strong septic and purulent processes develop.
Syndrome of chronic pelvic pain. Causes, symptoms, mechanisms of development, diagnosis, principles of treatment of the disease.
The main goals of treatment are to control inflammation and prevent development. How to treat rheumatoid arthritis? Therapy usually includes medication, physical therapy, and regular exercise. Early treatment is the key to good results.
Medical treatment for rheumatoid arthritis
There is no cure for rheumatoid arthritis. Non-drug treatments include controlled exercise, nutritional counseling to prevent overweight and control cholesterol levels.
How to treat rheumatoid arthritis? Medical therapy is the main method of treatment. Drug therapy is aimed at reducing inflammation and preventing deformities. There are four different classes of drugs that are used depending on the severity of the disease.
Class 1: non-steroidal anti-inflammatory drugs (NSAIDs). First of all, the doctor prescribes treatment without hormones. Medications relieve the symptoms of arthritis. The most commonly used are Ibuprofen and Naproxen. They are taken for 2-4 weeks to achieve maximum effect.
Class 2: basic antirheumatic drugs. They are able to reduce not only inflammation, but also prevent the progression of the disease. The main drugs in this group are:
- Leflunomide is initially taken at 100 mg once a day. The course of this reception lasts 3 days. Then a maintenance dose of 20 mg per day is prescribed.
- Methotrexate is taken at 7.5 mg once a week for 1-2 months. Then the dosage is increased to 10 mg, taking 1 time per week.
- Penicillamine: The initial dosage is 125 or 250 mg as a single dose. The dose is increased, if necessary, by 125-250 mg per day. Treatment lasts 2-3 months.
- Sulfasalazine - 1 g of the drug to be taken 2-3 times a day. the duration of treatment is 1-2 months.
- Azathioprine - 100-150 mg daily for 2-3 months, then a maintenance dose of 50 mg daily.
- Cyclophosphamide is taken at 100-200 mg/day. Then the doctor prescribes a maintenance dose - 50 mg of the substance daily.
- azathioprine;
- Cyclosporine is taken at 2.53 mg/kg daily.
Many of these immunosuppressive drugs must be used under strict medical supervision. The effects of the drugs are felt after a few weeks of use.
Class 3: biologics for treatment. When methotrexate or other basic drugs do not relieve the symptoms of rheumatoid arthritis of the fingers, knee or shoulder joint, doctors recommend biologics. Biological products are genetically modified proteins. They block certain parts of the immune system that play a key role in inflammation. Medicines can slow or stop the disease.
There are various biological products that target different parts of the immune system. Most effective:
- Abatacept, Adalimumab;
- Anakinroy, Certolizumab;
- etanercept, etanercept;
- Golimumab, Infliximab;
- infliximab, rituximab;
- Tocilizumab.
Because biologics suppress the immune system, they increase the risk of infection.
Attention! In no case do not self-medicate by increasing the dosage or duration of taking biologics.
Cases have been reported in which the patient had rheumatoid arthritis of the knee joint, and along with it there was a severe infectious disease incompatible with life.
Class 4: combination therapy and corticosteroids. Rheumatoid arthritis of the hands and large joints (knee, shoulder, elbow) is not always treatable. Especially when the patient went to the hospital late. in such cases, combination therapy may help. There is no guarantee of recovery, but before resorting to surgical treatment, the doctor must try all available methods of therapy.
Schemes for combining drugs in the first stages of development:
- Methotrexate + Hydroxychloroquine sulfate.
- Methotrexate + Sulfasalazine.
- Gold salts + Hydroxychloroquine sulfate.
- Methotrexate + Hydroxychloroquine sulfate + Sulfasalazine.
A doctor treating end-stage joint disease may recommend steroids. They relieve pain and stiffness of affected joints if previous remedies have proven useless. In most cases, they are used temporarily. But, some people need to take steroids for a long time to control pain and inflammation.
Potential side effects of long-term steroid use include high blood pressure, osteoporosis, and diabetes. But with proper use of drugs, the patient quickly recovers.
The second scheme is anti-inflammatory therapy with corticosteroids:
- The first day - intravenously 1 g of Methylprednisolone and 1 g of Cyclophosphamide.
- The second and third days - the introduction of 1 g of Methylprednisolone.
Patients with severe disease and organ involvement are given more aggressive treatment with corticosteroids.
Folk remedies
Inflammatory diseases of the joints are difficult and long to treat. To speed up recovery, in addition to drug therapy, use folk remedies.
Juices
People with rheumatoid arthritis should include juices containing anti-inflammatory nutrients in their daily diet. These nutrients include beta-carotene (found in parsley, broccoli, and spinach) and iron (found in carrots, apples, and ginger).
- Black cherry juice is good for arthritis. Drink 2 glasses of this drink twice a day. You can stop treatment after the pain subsides.
- Pineapple is a source of the enzyme bromelain, which has strong anti-inflammatory properties. Drink 250 ml of pineapple juice 2-3 times a day.
At home, prepare cocktails by combining the following products:
- Carrots, celery and cabbage juice, parsley.
- Potato juice (if you are not allergic).
- Carrot, beetroot and cucumber.
- Radish, garlic.
Attention! Some juices may cause adverse reactions. Avoid citrus fruits, and be wary of vegetables in the nightshade family, including potatoes, tomatoes, peppers, and eggplant.
Recipes from traditional medicine
Treatment in a folk way has always been welcomed among doctors and the population. It is inexpensive and effective. Recommended recipes for the treatment of rheumatoid arthritis:
- Dilute 5 drops of ginger essential oil with 20 drops of olive oil and almond oil. Rub into painful areas.
- On an empty stomach, take 3-4 walnuts or one fresh coconut.
- Boswellia has a unique anti-inflammatory effect, like conventional non-steroidal anti-inflammatory drugs (NSAIDs). Rub Boswellia extract on the affected joints.
- Feverfew has been used for centuries to treat arthritis. It is a powerful natural aspirin. Brew the herb according to the recipe on the package. take 2 times a day.
Ginseng contains components called ginsenosides, which have various pharmacological actions. It is an adaptogen - it increases the body's ability to cope with various stresses. Pour three tablespoons of ginseng into 1 liter of vodka. Let the mixture sit for 5-6 weeks in a cool, dark place, shaking the tincture frequently. Strain, take 1 tbsp. l. fluids after dinner or before bed every night. The course of treatment lasts 3 months. Then, take a break for 2 weeks before starting treatment again.
Important! Use American ginseng, not Asian. Asian ginseng may aggravate pain.
At home, you can make tea from common hops, licorice, oregano, or make evening compresses from red pepper, nettle and essential oils.
Rheumatoid arthritis belongs to a group of diseases called collagenoses. The peculiarity of this type of arthritis is that there are no established specific causes of its occurrence and it is completely impossible to cure it.
The result of such a reaction is that the immune system destroys the connective tissue of the joints and other systems of the human body.
It is the complex of these changes that is called rheumatoid arthritis.
The main stages of rheumatoid arthritis
Naturally, the question of how to treat rheumatoid arthritis occupies every person with this diagnosis. The main condition for successful disposal of the disease is the correctness and timeliness of treatment.
Rheumatoid arthritis has a rather complex symptomatology, so it is extremely important not to delay treatment and think over methods that will not allow pronounced consequences for the body.
The question of how to treat rheumatoid arthritis implies an answer consisting of two indispensable conditions:
- it is necessary to eliminate pathological manifestations in the tissues adjacent to the joints,
- you need to completely restore the damaged area.
As you know, rheumatoid arthritis has complex and noticeable manifestations for a person, for example, swelling and pain in the affected area, as well as damage to internal organs, bleeding and heart failure.
To partially cure rheumatoid arthritis, modern doctors offer the following treatment methods:
- medications,
- sets of therapeutic exercises,
- therapeutic massage and physiotherapy procedures,
- proper diet,
- traditional medicine,
- surgical intervention.
Despite the complexity of treatment, it is almost impossible to completely cure rheumatoid arthritis. Once manifested, this disease can make itself felt with some frequency.
But if a person responds to the symptoms in a timely manner and correctly uses remedies against the disease, it will not affect life expectancy.
Clinical manifestations of rheumatoid arthritis
Timely therapy will not only significantly help in the fight against this arthritis, but will also prevent the appearance of various complications.
It is important to remember: the treatment of rheumatoid arthritis takes place only under the supervision of a doctor, the treatment course consists of serious medical remedies that require careful attention. How to get rid of arthritis will be prompted by a doctor who needs to be contacted without delay.
Treatment of arthritis with drugs
Often, for the treatment of rheumatoid arthritis, medications from different pharmaceutical groups are used. All of these groups are equally important for treatment.
The first group is non-steroidal anti-inflammatory drugs. These medicines are necessary for the destruction of inflammatory processes in the body. With the help of drugs, swelling and pain are reduced, the work of the damaged joint is normalized.
The second group of drugs against rheumatoid arthritis includes steroid hormones or corticosteroids.
In the third group of drugs are basic drugs. Modern complex basic preparations are simply necessary, as they effectively stop the development of the disease.
It is worth noting that all of the above drugs have a negative impact on the functioning of the internal organs of the patient. Along with such treatment, you need to take drugs aimed at normalizing the functioning of internal organs.
The doctor prescribes drugs from three pharmaceutical groups based on diagnostic procedures, since you need to know the degree of damage to each of the organs and systems.
Physiotherapy and massage for arthritis
Physiotherapeutic procedures and therapeutic massage in the treatment of rheumatoid arthritis give stable positive results and are needed to enhance the effect of drug treatment. Due to the use of these methods, the patient has the following changes:
- strengthening muscle tissue
- improvement of blood circulation,
- accelerated elimination of the inflammatory process.
The following procedures are recognized as particularly effective:
- amplipulse,
- phonophoresis,
- ozocerite and several others.
If rheumatoid arthritis is in an acute form, then any physiotherapy procedures are strictly contraindicated. At this time, the best treatment option is regular exercise therapy.
The regularity of performing physiotherapeutic procedures and massage is the basis of their effectiveness. It is extremely important that all procedures are controlled by a doctor, since at the initial stage of treatment it is necessary to develop the skill of proper breathing.
For patients with an active stage in the development of this disease, therapeutic exercises consist only in a calm lying position.
Proper Diet
Balanced and proper nutrition is important for a person with any disease. With rheumatoid arthritis, it is necessary to minimize the consumption of high-calorie and fatty foods.
This is due to the fact that the patient needs to lose weight, as this will reduce the load on diseased joints.
You need to exclude from your diet:
- potato,
- muffin,
- White bread,
- pasta.
In addition, doctors advise reducing the consumption of foods that cause allergic reactions. These foods include honey, citrus fruits, and eggs.
Spicy, salty and fried foods should also not be consumed in the treatment of rheumatoid arthritis. It is important to completely eliminate alcohol. For people with rheumatoid arthritis, cereals, fruits, vegetables and bran bread are useful.
Animal products can be consumed by patients with rheumatoid arthritis, for example, fish and lean meats are allowed.
It is best to cook these products for a couple. It is very important that during the treatment process, the patient eats at least five times a day. Products should be fresh and portions should be small.
Traditional treatments for rheumatoid arthritis
Traditional methods of treatment have always been considered quite effective for any disease. Traditional medicine is also used in the treatment of rheumatoid arthritis.
The advantages of folk remedies are that they can be easily prepared independently at home, in addition, if the recipe is selected taking into account the individual condition of the patient, then it is absolutely harmless to the body.
For rheumatoid arthritis, traditional methods of treatment such as rubbing and compresses are used. Recipes may include:
- paraffin,
- birch and nettle leaves,
- violet herbs,
- Red clover.
In order for folk remedies to bring tangible benefits, it is important to consult a doctor before any use. In addition, it is necessary to take into account the physiological characteristics of the patient, since a strong allergic reaction may begin on the individual components of the remedy.
Be sure to remember that folk methods of getting rid of rheumatoid arthritis can only be used as adjuvant therapy.
Thus, none of the traditional medicine can replace qualified medical treatment. Traditional medicine can only enhance the effect of professional treatment.
Applying alternative methods of treating this type of arthritis, one cannot refuse the main course of treatment, which is prescribed by the attending physician.
In order to avoid the occurrence of rheumatoid arthritis with a high degree of probability, it is necessary to adhere to a healthy lifestyle and a balanced diet, this attitude will allow rheumatoid arthritis to be cured faster, even if it appears at an early stage.
What is rheumatoid arthritis, causes and symptoms of the disease. Its diagnosis and treatment with folk remedies, medicines, physiotherapy.
Description and causes of rheumatoid arthritis
Rheumatoid arthritis is characterized by damage mainly to small joints and, in the case of neglect of the disease, also internal organs. It covers connective tissue and cartilage. It is studied and treated by rheumatologists.
Translated from ancient Greek, this name means "a state of inflammation." It is characterized by a high level of disability - up to 65%, which occurs during the first 2-3 years. It is associated with numerous complications, among which renal failure is the most common. Blood vessels, heart, nervous system, liver, eyes also suffer.
Presumably, the disease develops as a result of a violation of the human immune system, which leads to any infection. Often, patients have chronic tonsillitis or ARVI is often fixed. Most of all, those who have a similar problem in their family are prone to it, since this type of arthritis is almost always inherited.
But not all people with poor genetics suffer from this disease, the following factors contribute to its development:
- Smoking. Tobacco smoke negatively affects the immune system, as a result of which it begins to destroy healthy cells.
- Bad hormonal background. The risk of getting sick increases in girls taking contraceptives. It has also been proven that the situation often worsens during pregnancy and with polycystic ovaries.
- Abuse of caffeine. It destroys healthy cells, slows down their renewal and weakens the body's defense against infectious diseases. This negatively affects the joints, which are affected by various bacteria.
- Avitaminosis. With a lack of vitamins C, A, E, B, the level of immunity decreases and the body remains defenseless against various infections. Once in it, they penetrate into tissues, joints and internal organs, significantly increasing the risk of developing arthritis.
Main symptoms of rheumatoid arthritis
The clinical picture is severe pain and a feeling of aching in the fingers, hands, ankle joints, inflammation and redness of the skin in these areas, their poor mobility. Often, cysts form here and severe itching bothers.
In the initial stages, the symptoms are not pronounced, discomfort in the elbows, knees, and hips occurs only from time to time. Gradually, it begins to grow, preventing sleep and leading a normal life. After 1-2 years, in the absence of treatment, “holes” appear in the cartilage, it becomes more difficult for a person to maintain stability and move on foot.
Signs of rheumatoid arthritis include:
- Pain of intense intensity. Usually they are observed in the morning and subside in the evening. With the development of the disease, they suffer for days on end, it comes to the point that even painkillers do not help.
- Stiffness when moving. It becomes more difficult for the patient to get out of bed, climb stairs, walk. By this time, sports activities have basically ceased - cycling, running, power loads in the gym are no longer within the power of a person.
- Weakness. The patient feels bad: he often feels dizzy, apathy worries, he doesn’t want to do anything and he has to literally force himself to get out of bed. In addition to this, performance decreases and mood worsens.
- Anemia. Due to the suppression of the immune system, the body is deficient in healthy cells and with great difficulty resists the attacks of viruses. It is caused by a lack of iron, ascorbic and folic acids in the blood.
- Enlarged lymph nodes. This symptom occurs if the cause of the disease is any infection or tonsillitis, SARS, pharyngitis. As a result, they are quickly palpable and are characterized by increased soreness. A person encounters this at about 2-3 months of illness.
- . They become uneven and do not fully bend, reminiscent of the “swan neck”. Often the phalanges of the little finger are curved outward. This symptom accompanies usually advanced arthritis.
- Curvature of the legs. The knees tend to the sides, and the feet, on the contrary, to each other, as a result, a kind of wheel is formed that prevents normal walking. Unfortunately, these processes are already irreversible.
- Amyotrophy. As a result, a person is not able to lift weights, play sports, move a lot. Any tension in the arms and legs causes him pain and requires great effort.
Diagnosis of rheumatoid arthritis
The examination begins with an examination of the patient and the collection of anamnesis. Without fail, knees, elbows, hands are felt. It is recommended to make an X-ray, ultrasound and MRI of all joints, which allow you to identify inflammation of the connective tissue and determine the degree of their destruction.
To confirm the diagnosis, you need to pass a general and biochemical blood test. The basis for its formulation may be the detection of rheumatoid factor here, which is present in 60% of all cases of the disease, the detection of elevated levels of leukocytes, C-reactive protein, anticitrulline and antinuclear antibodies.
Quite informative is the ultrasound of the pelvis, abdomen, heart and kidneys, since these organs are most often affected by arthritis.
No less useful is the study of the composition of synovial fluid taken by puncture from the joint cavity. It is examined for bacteria - the causative agents of the disease. This procedure is called arthroscopy.
It also shows the performance of scintigraphy, this is the most effective research method to date.
Important! You can talk about the disease with poor results of more than 3-4 different studies.
How to treat rheumatoid arthritis
It must be said right away that it is impossible to get rid of this disease completely, since it is chronic. Only in the initial stages is it possible to improve well-being and prevent complications. In any case, the treatment of rheumatoid arthritis depends on the symptoms shown, and it should be comprehensive - include the right diet, taking anti-inflammatory and immunostimulating drugs, collagen injections and other means. Folk remedies will not be superfluous, but various physiotherapy procedures still form the basis of success.
Diet for rheumatoid arthritis
With such a problem, doctors prescribe to stick to table No. 10P. It is necessary to ensure that the body receives no more than 100 g of proteins, 70 g of fats, 250 g of complex carbohydrates per day, simple ones should be completely excluded. The optimal caloric content per day is up to 2600 kcal, with obesity it is reduced by 50%. The amount of water drunk is reduced to 1 liter, the amount of table salt is reduced, which is allowed no more than 6 g. The emphasis is on foods rich in calcium, phosphorus, magnesium, potassium and iron.
Regardless of the stage of arthritis, you can eat:
- Fruit. Of these, emphasis should be placed on apples, pears, oranges, bananas, kiwi, which contain a lot of iron, magnesium, potassium, ascorbic acid. All this can be eaten both raw and thermally processed - to cook compotes, fruit drinks, uzvar.
- Berries. Particular attention should be paid to blueberries, currants, raspberries and strawberries. They increase the level of immunity, promote weight loss and eliminate various infections.
- Vegetables. It is necessary to include more beets, white and cauliflower, carrots in the menu. Potatoes should be limited as much as possible due to the high percentage of starch in it.
- Cereals. Preference should be given to buckwheat and oatmeal, with which you can cook both first and second courses. In small quantities, unpolished rice and semolina are allowed.
- nuts. Walnuts, Brazilian, almonds, peanuts, pistachios - all this can be consumed as a source of unsaturated fats and complex carbohydrates that provide energy.
- Oils. The most useful of them is olive, because it contains a lot of unsaturated fatty acids that normalize the work of the heart, which often suffers from arthritis.
- Dairy. They should have a minimum percentage of fat, so it’s better to buy store-bought rather than homemade cottage cheese, sour cream, cream, cheese, etc.
- Fish. You should choose not very fatty varieties - hake, pollock, notothenia. Sometimes you can afford a little salted salmon or mackerel.
- Meat. White chicken fillet, veal, turkey are ideal, which are recommended to be baked, steamed or stewed.
The amount of sugar consumed per day should not exceed 30 g, it is best to choose an unrefined, brown product. Do not get carried away and sweets based on it, especially chocolate.
It is necessary to completely exclude coffee, strong tea, fresh white bread, hot spices, mayonnaise and sauces. Too strong mushroom, fish and meat broths will not work either, you will also have to forget about alcohol.
Important! The optimal number of meals on the "table number 10" diet is 5-6 times a day. And between them there should not be long breaks, more than 3-4 hours.
Medical treatment for rheumatoid arthritis
The main task of the doctor is to stimulate the immune system, eliminate pain, activate the regeneration of cartilage and connective tissue, suppress the activity of the detected infection, which is the culprit of the disease. Vitamin-mineral complexes based on calcium, magnesium, potassium and ascorbic acid deserve special attention. In the initial stages, intra-articular injections of hormonal drugs are effective.
Here's what it's all about:
- Injections. The patient is given corticosteroids to control inflammation. The most powerful of this group are "Flosteron" and "Celeston". In addition, with the active process of cartilage destruction, chondroprotectors are used, among which Alflutop is the most popular. To avoid joint injuries, the risk of which increases dramatically with arthritis, hyaluronic acid is prescribed. Pain is relieved by gas injections. In rare cases, the introduction of the patient's own blood plasma into the tissues is required, it accelerates the recovery of the joints. Regardless of the type of drug, the course of treatment is 3 months, at least 3-5 injections should be made with a break of 10-20 days. The effect of them persists for 3-5 months, after which the course is repeated.
- Tablets and capsules. If rheumatism is caused, for example, by streptococcus, then drugs are initially selected to suppress its activity, most often Amoxicillin or Cefadroxil is prescribed. In order to restore cartilage and relieve inflammation, take Dicloran or Voltaren. To increase immunity, Immunoplus and Imudon are suitable, who drink 1-2 tablets. a day before meals. The drugs "Pumpan" and "Taurine" help protect the heart. Pain is eliminated by taking Ibuprofen and No-shpa.
- Ointments. Excellent in the treatment of rheumatoid arthritis means "Dolgit", "Indomethacin", "Piroxicam-Verte". They slow down the production of prostaglandins, which cause inflammation, which leads to pain. As a result of their use, swelling decreases, joint mobility improves, and tissue itching disappears. Apply ointments 2-3 times a day in the morning and evening, they are applied to the problem area, rubbed into the skin and left until completely absorbed. Treatment continues for 2-3 weeks, after which you need to take a break for 2-3 months.
Treatment of rheumatoid arthritis with folk remedies
Various compresses and lotions, infusions, tinctures and decoctions help well. Relieve pain and relieve inflammation of turmeric, propolis, aconite roots. Excellent for treatment and potatoes, garlic, juniper, but all this should be used only in addition to taking basic medications.
Apply folk remedies for about a week. You should not resort to them during pregnancy and lactation, ideally, you should consult your doctor before doing this.
- with potatoes. Heat it, clean and rub it, fold it into a piece of gauze, which must be applied to the sore joint for 20 minutes. Put on tights or gloves from above, depending on what exactly worries you - legs or arms.
- with garlic. Squeeze juice out of it (5 slices), mix it with vodka (1 tablespoon), let the composition stand for 5 days and drink 1 teaspoon once a day. This should be done on an empty stomach, after which you can not eat for 1-2 hours.
- With lemon. Twist it (1 pc.) In a meat grinder, mix with chopped horseradish root (1 tsp) and boiled water (3 tbsp.). Let the mixture stand for a day, then use it 1 tbsp. l. one hour before meals. After a week, treatment must be interrupted, it can be resumed after a month. Do not use this remedy for stomach and intestinal ulcers, during exacerbation of gastritis and colitis. By the way, if the mass is too bitter, you can add a little honey (2 tablespoons) to it.
- With milk. Heat it (300 ml) and mix with grated garlic (10 cloves). Add a little honey here (2 tablespoons). Eat 1 tbsp. l. weight per day for a week. It should be eaten warm one hour before the main meal. This tool increases the level of immunity, eliminates various infections and restores cartilage.
- With birch buds. They (200 g) must be poured with boiling water (2 l) and insisted for a day. Next, the composition should, after filtering, add 2 cups to the bath before bathing. Take it for 30 minutes 2-3 times a week. It is very important that the affected knee or elbow be completely submerged in water.
- With lilacs and chestnuts. In the first case, you need plant branches (300 g), which should be cut into smaller pieces, and in the second, the fruits themselves, they will need 200 g. Mix the two components, pour boiling water over them (5 l) and leave for three days in a glass jar under a lid. Keep it in a warm place, out of direct sunlight. The finished composition should be filtered, a piece of gauze should be moistened in it and applied to sore joints.
- With juniper needles. Grind it (250 g) in a meat grinder and mix with butter (300 g), preferably homemade. The finished mixture must be rubbed into problem areas and then insulated by putting on warm trousers or tights. This is an excellent sedative, anti-inflammatory and analgesic, you need to use it for 2-4 weeks.
Important! The more a person sweats with rheumatoid arthritis, the faster the immune system strengthens and the body is cleared of toxins that exacerbate the situation with such a disease.
Therapeutic procedures for rheumatoid arthritis of the joints
Both at the initial and at the last stages, ultraphonophoresis is shown, for example, with Karipain cream. It is applied to the problem area, after which it is exposed to ultraviolet radiation. One session lasts about 20 minutes, but in total they need to go through 8-12, depending on the activity of the process.
In addition, high-intensity pulsed magnetic therapy is recommended. With its help, you can improve metabolic processes in tissues, eliminate swelling and normalize blood circulation. To notice any effect, you will need to take a course of 10 procedures.
Quite effective in the fight against rheumatoid arthritis and phototherapy, for this special lamps "Bioptron" and "General Secretary" are used. Visible light penetrates the tissues to a depth of 1-2 cm, starting the process of their regeneration. This method is relevant only in the subacute stage, the course of treatment includes 12 sessions.
No less useful will be electrophoresis with lidase. This solution is applied to the skin in problem areas, after which it penetrates deep into the tissues using electrolytic dissociation. One procedure takes about 20 minutes, it is performed with a frequency of 1 time in 3 days. Their maximum number should not exceed fifteen approaches.
Also, patients are recommended sessions of general and local cryotherapy, which is the use of cold. During its implementation, a special mixture is applied to the problem joint, the temperature of which is usually below -100°C. To get a more or less decent result, you need to visit a doctor 20 times.
The previous technique is very effective in combination with naftalanotherapy. It involves lubricating the skin with special oil or taking a bath filled with it. The procedure is carried out every 2-3 days, after each of them the patient is wrapped in a warm blanket. For one course, the doctor needs to visit about 15 times.
Without fail, those suffering from arthritis are recommended treatment in special balneological sanatoriums. It is very useful to take mineral water and bathe in it, radon, sodium chloride, sulfide, nitrogen-silicon baths are especially effective. You need to take them daily for 10-20 days for 30 minutes. Applications with therapeutic mud, primarily from the Dead Sea, also help a lot.
Swimming 2-3 times a week for at least half an hour, outdoor walks, a special exercise therapy complex and professional massage have a positive effect on the patient's health.
How to treat rheumatoid arthritis - look at the video:
It is very important to detect the symptoms of rheumatoid arthritis in time and diagnose the body. The earlier the disease is detected, the higher the percentage of successful treatment. But it is still impossible to completely get rid of it, the goal of doctors is to achieve the longest possible remission and prevent further destruction of the joints.
Rheumatoid arthritis is an autoimmune rheumatic disease of unknown etiology, characterized by chronic erosive arthritis (synovitis) and systemic damage to internal organs. The essence of the disease is reduced to the occurrence of severe irreversible changes in the joints.
Internal organs may also be involved in the process. It is diagnosed in patients of any age. It develops due to an inadequate response of the immune system to certain stimuli, which results in the destruction of connective tissue and other components of the joints. According to statistics, women suffer from rheumatoid arthritis more often, but they are characterized by a somewhat milder course of the disease than men.
As with other diseases, it all starts with the study of the patient's complaints and his visual examination.
Further, the patient receives a referral for blood tests, the results of which reveal a rheumatoid factor, and also undergoes x-rays. If necessary, the specialist will recommend additional diagnostic methods to obtain a more accurate and complete picture of the course of the disease.
One of the main dangers of rheumatoid arthritis is the fact that many months can pass from the onset of its course to the diagnosis - often patients attribute adverse changes in their health to age, which is wrong.
Any alarming symptoms should be a reason to go to the doctor, because the earlier the disease is detected, the higher the chances remain for its successful and quick elimination.
General information about the treatment of the disease
It is impossible to completely get rid of rheumatoid arthritis as such. Existing therapeutic techniques, first of all, help to reduce the severity of inflammatory processes and pain, restore joint function and reduce the likelihood of complications.
To combat pain and inflammation, special anti-inflammatory drugs are used. Additionally, basic therapy is prescribed, based on cytostatic agents and immunosuppressants, due to which the rate of progression of the disease decreases and the patient goes into remission.
In the presence of severe deformities, surgical intervention may be indicated. The decision regarding this issue is made by the attending physician.
Important note! Any joint disease requires an integrated therapeutic approach. Rheumatoid arthritis is no exception - various physiotherapy techniques, gymnastics, diets and other methods of influence are used to combat it. Today we will dwell in more detail specifically on drug therapy.
Remember: any information is provided for informational purposes only. The presented names and descriptions of drugs are not a medical prescription and should not be used by patients to draw up an uncontrolled self-treatment program.
Drug treatment should be strictly according to the doctor's prescription.
Medicines for rheumatoid arthritis
Drug therapy for rheumatoid arthritis includes drugs from several different groups. About them further.
Non-steroidal anti-inflammatory drugs
They help fight painful symptoms and help eliminate the manifestations of inflammatory processes. Along with this, they do not give a clinical effect on the direct causes of the disease and do not improve the condition of the joints.
The drugs are selected individually for the patient and are taken in strictly prescribed dosages by the doctor. If necessary (lack of effect, occurrence of side effects, etc.), the doctor will review the composition of therapy.
Important! Doctors almost never prescribe the simultaneous use of two or more non-steroidal anti-inflammatory drugs - drugs in this group do not combine with each other.
It must be remembered that such drugs are not intended for long-term use - the risk of side effects is high. After eliminating inflammation and pain, the patient is prescribed other, non-drug methods of treatment.
Basic preparations
This category includes drugs that affect the course of the disease, helping to significantly reduce the severity of inflammatory processes, reduce the intensity of joint damage or completely prevent them, restore the functional and structural integrity of the affected areas, i.e. do everything so that the patient can return to normal life.
Information on the most commonly used basic therapy preparations is given in the table.
Table. Preparations of basic therapy
| Groups of medicines | Names |
|---|---|
| The most widely distributed drug under the trade name Plaquenil is on sale. |
| Rheumatrex can be cited as the most recognizable. |
| They are sold, for example, under the trade names Solganal, Ridaura, etc. |
| Kuprenil |
| For example, Azulfidine. |
| Most often found under the trade name Imuran. |
| For example, Arava. |
| Widely known as Neoral, Sandimmun, etc. |
Let's clarify the information presented in the table: the "gold standard" for the treatment of rheumatoid arthritis is methotrexate. If the patient is intolerant to its constituent substances, the doctor prescribes leflunomide or sulfasalazine. The drugs are taken in courses - you should not count on an instant effect. For example, methotrexate relieves the patient's condition in 1-1.5 months, while hydroxychloroquine - in 2-3 months. To achieve significant results of treatment, in most cases, the patient takes the drugs longer than the specified period. If methotrexate monotherapy or combination therapy (methotrexate + other anti-inflammatory drugs used at the required dosage for 3 or more months) gives an insufficient effect, then the doctor adjusts the treatment by prescribing TNF-a inhibitors that have similar toxicity with the same effect: this is infliximab - INF , adalimumab - ADA, etanercept - ETC, certolizumab pegol - CTZ, golimumab - GLM), anti-B cell drug - rituximab (RTM), T-lymphocyte co-stimulation blocker - abatacept (ABC) and interleukin 6 receptor blocker - tocilizumab ( TCZ).
In some cases (mainly in the initial, non-advanced stages of the disease), this antibacterial drug can become an objective replacement for sulfasalazine and hydroxychloroquine.
Biological response modifiers
Designed to reduce the severity of inflammatory processes and prevent their occurrence. Unlike the previously studied basic drugs, they begin to act relatively quickly - positive changes are noted already after 2-4 weeks.
Preparations of the biological group are designed for both single and complex use. They are characterized by a rather high cost, therefore they are used mainly in the absence of the necessary effectiveness of taking basic drugs or if the patient is found to be intolerant to them in the dosages necessary for treatment.
Preparations of this group are intended for administration by subcutaneous or intravenous injection.
Important! Biological drugs suppress the immune system, which is why they are forbidden to be prescribed to patients with dangerous infectious diseases, tuberculosis, lymphoma (both current and in history) and a number of other diseases - this moment requires an individual clarification from the treating specialist.
They have a strong anti-inflammatory effect. Among the most prominent representatives of the category, prednisone, as well as prednisone, should be noted. There are modifications for oral, intravenous and intraarticular use. Relatively quickly suppress the symptoms of the disease in the form of stiffness, pain, swelling, etc.
Most often used in the presence of severe forms of the pathological process, accompanied by a pronounced limitation of mobility and, in general, a significant deterioration in the quality of life. In the case of such patients, the use of glucocorticoids suppresses symptoms and restores performance until the time is right to start the use of other drugs prescribed in courses and characterized by a slower action.
The problem is that the use of glucocorticosteroids can provoke a number of side effects, for example, weight gain, cataracts, osteoporosis, a decrease in the body's resistance to infections, etc. That is why they are used only in extreme cases.
Reduce pain. Some are also characterized by anti-inflammatory action. The most commonly used drugs are analgin and acetylsalicylic acid. For topical use, capsaicin-based ointments, such as Zostrix, may be recommended.
Narcotic analgesics can only be used as an emergency and in exceptional situations. The use of these in the case of rheumatoid arthritis, characterized by a long course, can provoke dependence.
Along with this, in the presence of severe complications of rheumatoid arthritis and the lack of the possibility of effective and safe use of surgical treatment methods, narcotic analgesics may be the only salvation for the patient. In this case, they should be used under the strict supervision of a professional rheumatologist and / or a qualified specialist in anesthesia with this group of drugs.
Paracetamol (lat. Paracetamolum) or acetaminophen is a drug, analgesic and antipyretic from the anilide group
Preparations for the elimination of sudden exacerbations
The course of the disease in question may be accompanied by sudden "outbreaks", i.e. temporary exacerbations. Patients treated with oral glucocorticoids or methotrexate often benefit from higher doses of the same drugs.
Also, manifestations of severe inflammation can be eliminated with injections of corticosteroids. During periods of exacerbation, patients are recommended bed rest or at least the maximum possible state of rest. In some cases, hospitalization is carried out.
Hospitalization may be required for exacerbations of rheumatoid arthritis
To minimize the risk of complications in the future, patients with rheumatoid arthritis should adhere to several important recommendations.
First, patients should give up any bad habits and minimize coffee consumption.
Secondly, you need follow a special diet. So, fatty meats, citrus fruits, potatoes, some cereals, etc. are not recommended for consumption. At the same time, the content of natural fermented milk products, carrots, cilantro and other products with carotenoids in the diet should be increased. More detailed recommendations regarding the correct diet will be provided by the appropriate specialist, having comprehensively assessed the patient's condition and the individual characteristics of the course of his illness.
Thirdly, it should be So, overweight patients need to get rid of it. To strengthen the body, special gymnastics is prescribed, various physiotherapeutic methods are used, etc.
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