Autoimmune diseases affecting the joints

Arthritis is an inflammatory disease of the joints. With arthritis, a person experiences pain during active movements, flexion and extension, as well as when walking if the joints of the legs are inflamed. Sometimes the skin over the sore joint begins to turn red, and a local increase in temperature or general fever is observed.

Clinical picture

The disease is caused by metabolic disorders inside the joint, which results in an increase in the synovial membrane, leading to tissue proliferation and destruction of cartilage. Excess fluid in the joint leads to inflammation and pain and fever.

Signs of arthritis can appear gradually, starting with just a slight swelling and discomfort in the crook of the joint or phalanges of the fingers, followed by severe pain and other symptoms.

Kinds

Arthritis is divided according to localization:

• monoarthritis - arthritis of one joint;
• oligoarthritis (two or three affected areas);
• polyarthritis - arthritis of more than 3 joints.

Based on the nature of the changes that occur, arthritis is divided into:

• inflammatory, which is characterized by the presence of inflammation,
• degenerative, when first there is a malnutrition of the cartilage, dystrophy, a change in the appearance of the affected joint, followed by its deformation.

Arthritis can be acute or chronic:

• Acute arthritis develops rapidly, accompanied by severe pain and inflammation in the tissues, which disappear after 2-3 days.
• Chronic arthritis progresses gradually, slowly becoming a serious disease.

Due to the origin of the disease:

• Infectious or purulent arthritis. Manifests itself under the influence of a certain infection.
• Rheumatoid arthritis. It is formed due to the predominance of infectious and allergic diseases. This type is more dangerous than the first, as it often develops into chronic inflammation. If rheumatoid arthritis is left untreated, the patient may experience difficulty walking.
• Juvenile rheumatoid arthritis. This type predominantly occurs in children under 16 years of age. Unfortunately, the etiology of the disease is unknown to date, but has serious consequences: difficulty walking and disability in children.
• Reactive. Reactive arthritis manifests itself mainly due to changes in immunity in people who have a hereditary disposition to insufficient utilization of antigen complexes. Reactive arthritis sometimes occurs as a consequence of many infections. Most often it is a consequence of previous enterocolitis.
• Gouty arthritis. Usually one joint is affected, an attack of pain usually develops at night or in the early morning hours, if left untreated, attacks are repeated more often and last longer, and the level of uric acid in the blood is elevated.
• Osteoarthritis. Joints fail within a few years. A characteristic symptom is a crunching sound in the fingers or toes. It is dangerous because it can hit the spine. They may begin to swell and hurt.
• Traumatic. It appears in the presence of open and closed joint injuries and in the case of regularly occurring minor injuries.
• Rheumatism is a chronic connective tissue disease primarily affecting the heart and joints. Its etiology is also unclear, as are the causes of the development of rheumatoid arthritis;
• Arthrosis is a form of arthritis that affects only the joints and periarticular tissues, without affecting other organs.

Abstract on the topic: “Rheumatoid arthritis”

Abstract on the topic: rheumatoid arthritis

General information about the disease.

Rheumatic diseases have been known to medicine since the time of Hippocrates. But for many years, rheumatism was considered only as a disease of the joints, and many people still believe this.

Meanwhile, in modern medicine, a completely independent discipline has emerged - rheumatology, which studies diseases that affect connective tissue. Inflammation in rheumatism develops in those organs in which connective tissue plays a formative role - in the heart valves, articular membranes, ligaments of the joints, skin, blood vessels, bones. But the most pronounced, persistent and significant damage to health is determined precisely by damage to the heart and blood vessels.

Rheumatism is an infectious-allergic disease. The microbe whose infection is associated with the occurrence of rheumatism is β-hemolytic streptococcus of group A. Once in the body, streptococcus produces substances that have a toxic and destructive effect on the heart muscle. And streptococcal protein, when absorbed, causes an allergic mood in the body. In addition, the protein structure of this type of streptococcus is close to the tissues of the heart muscle and thymus gland (thymus), and the latter precisely affects the production and specialization of the main “immune cells” - lymphocytes.

In response to the introduction of an infectious agent, the immune response begins to operate: antibodies are produced aimed at destroying microbes. But due to the peculiarities of streptococcus, antibodies, firstly, do not destroy all microorganisms, and secondly, due to the similarity of the protein structure of streptococcus and the heart muscle, the body’s own tissues begin to be damaged, i.e. an autoimmune process starts.

Autoimmune is a condition in which the body perceives its own tissues as a foreign protein and begins to produce antibodies against them. This leads to the destruction of one’s own tissues and the development of an autoimmune disease.

Social factors play an important role in the development of rheumatism: unfavorable living conditions, imbalanced nutrition, etc.

Characteristics of the degrees of rheumatoid arthritis.

Clinically significant joint damage in rheumatoid arthritis may be preceded by nonspecific symptoms of rheumatoid arthritis - deterioration in general condition, a feeling of weakness, stiffness especially in the morning, arthralgia, weight loss, low-grade fever, lymphadenopathy. The main manifestation of the disease is persistent arthritis (usually polyarthritis) with early and preferential involvement of the wrist, metacarpophalangeal, proximal interphalangeal joints of the hands and metatarsophalangeal joints. Characterized by a feeling of morning stiffness, pain, swelling of the joints, hyperthermia of the tissues above them (in the absence of changes in skin color), symmetry of arthritis. Typically there is a gradual onset of the disease with wave-like changes in the severity of symptoms (sometimes even more or less long-term remissions are noted at the beginning of the disease), slow but steady progression of arthritis, and the involvement of more and more new joints. Sometimes rheumatoid arthritis begins with monoarthritis of the knee or shoulder joints, followed by involvement of the small joints of the hands and feet. There is also a known variant of the acute onset of the disease, in which, in addition to damage to the joints, 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 (according to X-ray data) arthritis. Typical deformities are the metacarpophalangeal (flexion contractures, subluxations), proximal interphalangeal (flexion contractures) and wrist joints - deviation of the hand to the outside (the so-called rheumatoid hand), as well as metatarsophalangeal joints (hammer fingers, their subluxations, flat feet, hallux valgus – rheumatoid foot). In some joints, inflammatory or fibroproliferative changes may predominate. More often, changes in joints are of a mixed nature.

Extra-articular (systemic) manifestations of rheumatoid arthritis are observed relatively infrequently, mainly in the seropositive (for rheumatoid factor) form of the disease, severe and generalized articular syndrome; their frequency increases as the disease progresses. Systemic manifestations include subcutaneous (rheumatoid) nodules, which are often located in the elbow joint, serositis (usually moderate adhesive pleurisy and pericarditis), lymphadenopathy, peripheral neuropathy (asymmetric damage to the distal nerve trunks with sensitivity disorders, rarely motor disorders), cutaneous vasculitis, more often manifested by point necrosis of the skin in the nail bed area, etc.

Clinical signs of damage to internal organs are rarely found, usually in patients with severe seropositive rheumatoid arthritis. Possible damage to the respiratory system (pleurisy, interstitial pulmonary fibrosis, bronchiolitis obliterans, rheumatoid nodules in the lung, pulmonary vasculitis), heart (vasculitis, nodule formation, myaloidosis, serositis, valvulitis and fibrosis). Patients with rheumatoid arthritis are prone to early development of atherosclerotic vascular lesions. With long-term active rheumatoid arthritis, amyloidosis sometimes develops with predominant kidney damage, gradually increasing proteinuria, nephrotic syndrome, and later renal failure.

Clinically pronounced systemic rheumatoid vasculitis develops in less than 1% of patients; male gender, high titers of rheumatoid factor, and severe course of the disease predispose to its development. Almost all patients exhibit severe nonspecific symptoms, such as fever, weight loss, etc.; believe that a sudden rapid decrease in body weight in patients with rheumatoid arthritis allows one to suspect the development of rheumatoid vasculitis. Classic clinical manifestations of rheumatoid vasculitis are peripheral gangrene and neuropathy (multiple mononeuritis, distal symmetric sensory or sensory-motor neuropathy), as well as scleritis, pericarditis and pulmonary lesions, infarctions of the periungual bed (digital arteritis), skin rash, chronic leg ulcers, rheumatoid nodules . Damage to the heart, lungs, and eyes in the form of scleritis and episcleritis is often detected.

Rheumatoid arthritis, which, in addition to typical joint damage, is characterized by splenomegaly and leukopenia, is called Felty's syndrome. These patients have a significantly increased risk of developing non-Hodgkin's lymphoma.

Laboratory test results are non-specific. In 70–80% of patients, rheumatoid factor (RF) is detected in the blood serum; this form of the disease is called seropositive. From the very beginning of the disease, as a rule, ESR and the level of C-reactive protein in the blood increase, and the level of hemoglobin decreases.

Radiologically, there are 4 stages of rheumatoid arthritis:

• in stage I (initial) only periarticular osteoporosis is detected;
• in II – osteoporosis and narrowing of the joint space;
• in III – osteoporosis, narrowing of the joint space and bone erosion;
• Stage IV is characterized by a combination of stage III symptoms and joint ankylosis.

The earliest radiographic changes in rheumatoid arthritis appear in the joints of the hands and metatarsophalangeal joints.

Prevention of disease. Exercise therapy.

The causes of rheumatoid arthritis have not yet been precisely established. Many patients associate its onset with hypothermia, stress, a viral infection, heavy physical activity, etc. Experts believe that a hereditary factor is of some importance, since rheumatoid arthritis often occurs in relatives. The disease is insidious in that it affects people mainly at a young age - from 20 to 40 years. If a person has developed this disease, then he needs to realize that it will accompany him for many years, since it is not yet possible to completely recover from rheumatoid arthritis. No special cure has been created for this disease. You cannot find pills for rheumatoid arthritis in any pharmacy; treatment must be comprehensive and long-term. On the other hand, the latest methods of treating this disease using effective medications can significantly alleviate the condition of patients in the acute period and increase the duration of remission.

If we talk about the prevention of this disease, then the prevention of rheumatoid arthritis consists in reducing the risk of unfavorable factors that could provoke it, and when the disease has already manifested itself, in timely initiation of therapy.

If a person suddenly begins to experience pain in the small joints of the fingers and wrists, and the damage to the joints is symmetrical (for example, a joint hurts on the right hand and the same on the left), it is necessary to consult a doctor as soon as possible. Correct diagnosis and timely treatment of rheumatoid arthritis quickly yield positive results.

Typically, steroids and non-steroidal anti-inflammatory drugs are used in the acute period of the disease. In order to prevent destruction of the joints affected by the disease, basic therapy is also prescribed. Moreover, the drugs included in its composition act slowly, so sometimes they have to be used for years. In the non-acute period of the disease, physical therapy, massage, physiotherapy are prescribed, and spa treatment is indicated. Only such an integrated approach provides effective treatment for rheumatoid arthritis. But sometimes conservative methods are not enough, and surgery has to be resorted to to eliminate inflammation and preserve joint function.

Rheumatoid arthritis is a serious disease that leads to deformation and destruction of bones (joints) and, as a result, to disability of the patient. Therefore, the prevention and treatment of rheumatoid arthritis, the search for its causes and the most effective medications are pressing problems of modern medicine and pharmacology.

General recommendations: Exercise therapy should be performed in a ventilated, warm room 2-3 times a day: 1. When waking up, without getting out of bed, a lightweight complex with a small number of repetitions. 2. At 11-12 noon the entire complex is of medium intensity. 3. At 14-15 hours of the day, repeat the daily complex.

Movements should not cause significant pain. Exercises are performed within the available range of motion. More complex movements are missed during an exacerbation. You can increase the intensity of the load very slowly, reducing it during periods of exacerbation. The set of exercises can be expanded if necessary (on the advice of a doctor). After performing gymnastics, slight fatigue is allowed, but no more. Gymnastics for rheumatoid arthritis is not intense and usually does not require heart rate monitoring before and after exercise. However, with concomitant cardiovascular pathology, such control will not hurt. The difference in heart rate before and after exercise should be no more than 16-20 beats per minute and recover within 10-15 minutes.

So, let's get started.

Immediately after waking up: Starting position lying on your back with straightened legs: 1. Without lifting your head from the pillow, slowly turn your head to the right and left, while you should feel a slight tension in the neck muscles at the extreme points of movement. Repeat 3-5 times (there should be no pain). 2. Raise your hands slowly up and behind your head as you inhale and slowly lower them as you exhale. Repeat 3-5 times. 3. Slowly squeeze your hands and bend your toes to a state of slight tension. Hold in this position for several seconds and unclench/unbend. Repeat 3-5 times. 4. Alternately slowly bend your legs at the knee joints, while your heels slide along the bed. Repeat 3-5 times. Starting position lying on your back, legs bent at the knees, feet touching the bed: 5. Tilt your knees to the right and left within the available range of motion. If possible, the feet and pelvis do not leave the bed. Repeat 3-5 times. 6. Alternately slowly raise the right and left legs, straightening them at the knee joints. Repeat 3-5 times. Starting position lying on your side: 7. Lying on your left side (if possible), we abduct your right leg. Repeat 3-5 times. 8. Also on the right side Starting position sitting on a chair. 9. Arms bent at the elbows, hands touching the shoulder joints. We perform rotational movements in the shoulder joints. In this case, the elbows describe circles/arcs of the maximum possible amplitude, but without pain. The movements are made first clockwise, then counterclockwise. 10. Arms are lowered along the body, relaxed, slowly raise your arms up as you inhale and also slowly lower them down as you exhale.

Probably enough for morning exercises. I repeat, the movements are performed within the limits of possible amplitude and should not cause significant pain. Definitely slow. It is advisable to repeat this complex during the day, but the number of exercises can be increased.

Bibliography:

"People's newspaper"

www.medicinform.net

www.mediki-online.ru

Complete medical encyclopedia

Causes

The clear and exact cause of arthritis has not yet been determined, but doctors have identified some factors that can trigger the development of arthritis. Let's look at them:

• infections caused by bacteria, fungi, viruses;
• allergies;
• metabolic disease;
• injury;
• lack of vitamins (vitaminosis);
• insufficient intake of nutrients into the body
• diseases of the nervous system;
• disturbances in the functioning of the immune system;
• excessive stress on joints;
• poor nutrition, incl. consumption of alcoholic beverages;
• overweight;
• disturbances in the functioning of the endocrine gland;
• genetic predisposition;
• insect bites, such as wasps, bees, etc.;
• hypothermia (hypothermia);
• some diseases: tuberculosis, brucellosis, gout, dysentery, gonorrhea.

Arthritis symptoms

The leading symptom of arthritis is pain in one or more joints. At first they are weak and have practically no effect on a person’s ordinary life. Over time, the pain syndrome increases: the pain becomes wave-like, intensifying with movement, at night and closer to the morning. The intensity of pain varies from mild to very strong, severely complicating any movement.

Secondary symptoms:

• morning stiffness,
• swelling,
• skin redness,
• increase in local temperature in the area of ​​inflammation,
• deterioration of the patient's motor activity,
• restriction of his mobility,
• formation of persistent joint deformities.

It is important to remember that the first signs of arthritis are pain. At the initial stages they are weakly expressed, in the acute period they are especially pronounced, and in chronic arthritis they can change (weakly expressed to strongly expressed and vice versa). As mentioned above, signs may vary for different types of disease.

Rheumatoid arthritis

Rheumatoid arthritis (rheumatoid polyarthritis) is an autoimmune disease in which the synovium is attacked and destroyed by cells of the immune system, causing inflammation.

The pathology affects a large number of joints. The metacarpophalangeal and medial joints of the fingers, wrists, and metatarsophalangeal joints on both sides of the body are often affected.

Women are three times more likely to have this disease than men. The disease can occur at any age, but most often begins after 50 years in women and 10 years later in men. The disease in children is called juvenile rheumatoid arthritis.

Causes

Most often, the causes of this condition are genetic factors. Viruses or bacteria are also suspected. However, there is no convincing scientific evidence. In any case, in addition to hereditary factors, environmental influences also play a very important role. Studies have shown that smokers have an increased risk of developing pathology and severe symptoms. More is known about the inflammatory process in the joint. The immune system plays a major role in this. In rheumatoid arthritis, immune system cells attack the body's own tissues. This causes inflammation of the joints. Doctors call such an attack on one’s own body an autoimmune reaction.

Symptoms

Nonspecific symptoms appear at the initial stage of the disease:

• fatigue,
• states of exhaustion,
• lack of appetite,
• weight loss,
• fever, temperature rise up to 38.

Musculoskeletal symptoms

Typical symptoms in the musculoskeletal system of varying intensity:

• Morning stiffness and joint pain. Fingers are usually affected. Symptoms may persist for up to several hours, after which improvement occurs.
• Inflammation of the joints - swelling, overheating, severe pain in the second half of the night. The pain intensifies from pressure on the joint and with maximum flexion and extension of the joint. Typically, the metatarsophalangeal and median joints of the fingers, wrists and metatarsophalangeal joints of the toes are affected on both sides of the body, and later the inflammation also spreads to other large and small joints (polyarthritis). A noticeable deformation of the joints appears and their mobility decreases.
• Symptoms of tendinitis (tenosynovitis) appear - swelling and pain in the hand and ankle. Damage to nearby nerves can cause carpal tunnel syndrome, which causes numbness in one of the fingers;
• Decreased grip strength: This is often noticed early by patients and leads to increased difficulty in daily activities such as screwing on jam jars.
• Rheumatoid nodules: On the extensor sides of the joints, especially the elbows and hands, but also on the Achilles tendon and the front of the leg, benign, hard and partially mobile nodules appear that develop under the skin or directly on the tendons.

As the disease progresses, typical joint deformities develop, and in rare cases, rheumatoid arthritis can also affect other organ systems. Rheumatoid arthritis increases the likelihood of certain other diseases. These additional ailments can burden patients in their daily lives and, in certain circumstances, even shorten their life expectancy. These include:

• atherosclerosis (“vascular calcification”);
• osteoporosis (bone loss);
• chronic generalized pain syndromes;
• infections;
• depression and anxiety disorders;
• lymphoma (malignant diseases of certain immune cells).

Indications for visiting a rheumatologist

To effectively treat rheumatoid arthritis, prompt diagnosis is important. Only early therapy—within three months from the onset of the first signs of the disease—can prevent irreversible damage and secondary diseases.

The doctor makes a diagnosis based on a medical history, including symptoms (location and duration of joint pain and joint swelling in the family) and the results of a physical examination. Indications for early rheumatoid arthritis include:

• Swelling in more than two joints for six weeks or longer
• Symmetrical arrangement of the affected joints, that is, both halves of the body are affected
• 60 minutes or longer of persistent morning stiffness

Diagnostics

Physical examination includes all joints (not just the affected ones) for swelling, tenderness, functional impairment, rheumatoid nodes, as well as signs of organ damage and associated diseases.

Blood analysis

Based on measurable elevated levels of inflammation in the blood (erythrocyte sedimentation rate (ESR), C-reactive protein, it is possible to estimate how actively the disease is developing. However, these values ​​are often normal at the onset of the disease and, on the other hand, are also increased in other chronic and acute inflammation or infections.

About 85 percent of patients have rheumatoid factors and/or anti-citrullinated protein/peptide antibodies (ACPA) in their blood. These are autoantibodies, that is, antibodies directed against certain endogenous substances. Rheumatoid factors are considered to be relatively nonspecific since they also occur in the normal healthy population during adulthood. On the contrary, antibodies are very specific. With a certain level of antibodies, there is a high probability that rheumatoid arthritis is already present or will develop in the next few years.

Hardware Research

X-rays of the affected joints, hands, and feet are usually taken to visualize the joint changes characteristic of this disease. Typical changes are bone defects on the outer edge of the articular surfaces, a lack of calcium salts in the bone near the joint (osteoporosis) and joint displacements.

With the help of ultrasound, inflammatory changes in the joints, optic nerve sheaths and bursa can be well assessed. Ultrasound can provide additional information about the joints, such as the occurrence of joint effusions (increased fluid accumulation in the joint), the extent of rheumatic tissue that has formed, and joint destruction.

Rheumatoid arthritis treatment

Therapeutic approaches are numerous and range from purely symptomatic painkillers and anti-inflammatory drugs to basic therapy that slows the progression of the disease, from physical therapy to surgery on the affected joints. An appropriate diet may also help reduce symptoms.

Treatment options for rheumatoid arthritis have expanded significantly over the past few years. The goal of therapy is to completely suppress symptoms or stop the disease if possible. The rheumatologist designs a therapy tailored to the patient's individual case.

Drug therapy

The most important thing in therapy is that the patient tolerates well the so-called basic drugs, which affect the immune system and slow down the destruction of joints, and in the best case, completely suppress it. The effect of the medications does not appear immediately, but only after a few weeks. If the disease begins with a large number of inflamed joints, glucocorticoids are used. They very quickly fight inflammation, and with it pain and swelling of the joints.

Non-drug therapy

• Physiotherapy - helps strengthen muscles, prevent joint stiffness and thus ensure joint flexibility. Orthotic devices such as insoles, crutches or splints can also make daily life easier for patients.
• A healthy diet can also influence the course of the disease. A healthy diet is small amounts of red meat, lots of fish, vegetables and fruits.
• Patients with rheumatoid arthritis should make lifestyle changes. This involves doing as much physical movement as possible to keep your joints mobile.
• Overweight people should aim for a normal body weight, and smokers should quit smoking.

Degrees of the disease

The symptoms of arthritis differ in stages by the manifestations of pain and the aggravation of pathological processes. So, if the disease develops into a complicated form, then the symptoms will be more noticeable. Let's look at all four stages of arthritis:

1st degree

The disease does not manifest itself clinically, but X-rays of the joints show the first signs of inflammation. Sometimes there is a slight stiffness of movement and periodic pain during physical activity.

2nd degree arthritis

The progressive inflammatory process leads to thinning of the tissues of the articular structures and erosion of the heads of the bones. Swelling appears in the area of ​​the affected joints; A local increase in temperature and redness of the skin are often observed, movements are accompanied by crunching.

3rd degree

The third degree of the disease is characterized by the following symptoms:

• X-ray examination shows severe deformity;
• Often a person at this stage is assigned a disability;
• Mobility is limited, it is difficult for the patient to move if the lower part of the body is damaged;
• Hand movements are performed with great difficulty. It becomes difficult for the patient to perform even basic self-care actions. The hands are affected symmetrically;
• Pain haunts a person even when he is at rest;
• Due to muscle spasm caused by pain, the limbs are fixed in the wrong position. This ultimately leads to even greater deformation of the joints.

Arthritis 4 degrees

Leads to almost complete immobility of damaged joints, with severe round-the-clock pain. It is impossible to move independently. Negative changes in the bones are already becoming irreversible. When the knees are affected, muscle contractures form.

Complications

Ignoring the symptoms of arthritis can lead to serious complications that provoke other diseases:

• Diseases of internal organs.
• Heart failure.
• Damage to soft tissues.
• Tendon ruptures.
• Dislocation of the spine.
• Numbness of arms and legs.

Although arthritis is a common condition that most people experience, its treatment should be taken seriously. Timely diagnosis and treatment will help maintain flexibility and mobility of the joints, which will make it possible to lead an active lifestyle even in old age.

Diagnosis of arthritis includes:

• general and biochemical blood test;
• Analysis of urine;
• X-rays can determine the condition of the bones and identify changes caused by arthritis;
• computed tomography to assess the condition of soft tissues;
• magnetic resonance imaging helps to more clearly examine the condition of bone structures, as well as soft tissues;
• isotope scanning of the skeleton;
• Ultrasound helps determine the extent of damage to large joints;
• analysis of synovial fluid helps to identify features of infectious arthritis of inflammatory agents and choose an adequate method of treatment;
• arthroscopy is an endoscopic method that involves inserting a special sensor into the joint cavity to study their condition;
• arthrography determines the condition of the cartilage and soft tissues that surround the joint;
• myelography evaluates the condition of the spinal cord, spine and its roots, and is used in conjunction with a computed tomograph.

Autoimmune diseases affecting the joints

1. General characteristics of autoimmune diseases affecting the joints
2. Rheumatoid arthritis
3. Acute rheumatic fever
4. Ankylosing spondylitis (Bechterew's disease)
5. Joint damage in systemic lupus erythematosus
6. Joint damage due to systemic sclerosis
7. Psoriatic arthritis
8. Arthritis in ulcerative colitis and Crohn's disease
9. Reactive arthritis
10. Symptoms of allergic diseases in autoimmune joint diseases
11. Literature

Autoimmune diseases often affect vital organs such as the heart, lungs, and other
General characteristics of autoimmune diseases affecting the joints

Most autoimmune diseases affecting the joints are diffuse connective tissue diseases (systemic rheumatic diseases). This is a large group of diseases, each of which has a complex classification, complex diagnostic algorithms and rules for formulating a diagnosis, as well as multicomponent treatment regimens.

Since the connective tissue that is affected in these diseases is present in many organs, these diseases are characterized by a variety of clinical manifestations. Often vital organs (heart, lungs, kidneys, liver) are involved in the pathological process - this determines the prognosis of life for the patient.

In systemic rheumatic diseases, the joints are affected along with other organs and systems. Depending on the nosology, this may determine the clinical picture of the disease and its prognosis (for example, with rheumatoid arthritis) or perhaps less significant against the background of damage to other organs, as with systemic scleroderma [1].

In other autoimmune diseases and diseases with a pathogenesis that is not fully understood, joint damage is an additional symptom and is not observed in all patients. For example, arthritis in autoimmune inflammatory bowel diseases.

In other cases, joint lesions may be involved in the process only in severe cases of the disease (for example, psoriasis) [4, 6]. The degree of joint damage can be pronounced and determine the severity of the disease, the prognosis of the patient’s ability to work and his quality of life. Or, conversely, the degree of damage may cause only completely reversible inflammatory changes. In this case, the prognosis of the disease may be associated with damage to other organs and systems (for example, in acute rheumatic fever) [1].

The cause of most diseases in this group is not fully understood [1]. Many of them are characterized by a hereditary predisposition, which can be determined by certain genes encoding antigens of the so-called major histocompatibility complex (referred to as HLA or MHC antigens). These genes are contained on the surface of all nucleated cells of the body (HLA CI class antigens) or on the surface of the so-called antigen-presenting cells:

An acute infection can provoke the onset of many autoimmune diseases

• B-lymphocytes,
• tissue macrophages,
• dendritic cells (HLA class II antigens).

The name of these genes is associated with the phenomenon of organ transplant rejection, but in the physiology of the immune system they are responsible for the presentation of antigen to T lymphocytes and for the initiation of the development of an immune response to the pathogen. Their connection with a predisposition to the development of systemic autoimmune diseases is currently not fully understood.

As one of the mechanisms, the phenomenon of so-called “antigenic mimicry” has been proposed, in which the antigens of common pathogens of infectious diseases (viruses that cause ARVI, Escherichia coli, streptococcus, etc.) have a similar structure to the proteins of a person who is a carrier of certain genes of the major histocompatibility complex and causes cross-immune reactivity.

The infection suffered by such a patient leads to an ongoing immune response to antigens of the body’s own tissues and the development of an autoimmune disease. Therefore, for many autoimmune diseases, the factor that provokes the onset of the disease is an acute infection.

As the name of this group of diseases suggests, the leading mechanism of their development is the aggression of the immune system towards its own connective tissue antigens.

Of the main types of pathological reactions of the immune system (see “Types of allergic reactions”) in systemic autoimmune connective tissue diseases, type III is most often realized (immune complex type - in rheumatoid arthritis and systemic lupus erythematosus). Less commonly occurs type II (cytotoxic type - in acute rheumatic fever) or IV (delayed hypersensitivity - in rheumatoid arthritis).

Often, different mechanisms of immunopathological reactions play a role in the pathogenesis of one disease [1, 3]. The main pathological process in these diseases is inflammation, which leads to the appearance of the main clinical signs of the disease - local and general symptoms (fever, malaise, weight loss, etc.), its result often being irreversible changes in the affected organs. The clinical picture of the disease has its own characteristics for each nosology, some of which will be described below.

Since the incidence of systemic autoimmune diseases is low and many of them do not have specific symptoms that are not observed in other diseases, only a doctor can suspect the presence of a disease from this group in a patient based on a combination of characteristic clinical signs, the so-called diagnostic criteria for the disease, approved in international guidelines for its diagnosis and treatment.

Reasons for examination to exclude systemic rheumatic diseases

• the patient develops joint symptoms at a relatively young age,
• lack of connection between symptoms and increased load on the affected joints,
• suffered joint injuries,
• signs of metabolic disorders (obesity and metabolic syndrome, which may be accompanied by gout),
• burdened hereditary history.

The diagnosis of systemic connective tissue disease is established by a rheumatologist.

It is confirmed by specific tests for a specific nosology or laboratory tests identifying markers that may be common to the entire group of systemic rheumatic diseases. For example, C-reactive protein, rheumatoid factor.

Laboratory diagnostics is based on the identification of specific antibodies to one’s own organs and tissues, immune complexes formed during the development of the disease, antigens of the major histocompatibility complex, characteristic of certain diseases of this group and identified using monoclonal antibodies, genes encoding these antigens, identified by determining specific DNA sequences.

Instrumental diagnostic methods make it possible to determine the degree of damage to the affected organs and their functionality. To assess changes in the joints, radiography, magnetic resonance imaging, and ultrasound examination of the joint are used. In addition, joint puncture is used to take samples for synovial fluid analysis and arthroscopy [7].

All of the above examinations are necessary to identify the disease and clarify the degree of its severity.

To avoid disability and death, constant medical supervision and therapy that meets the standards is necessary

Certain key changes in the necessary laboratory and instrumental examinations are included in the diagnosis. For example, for rheumatoid arthritis - the presence or absence of rheumatoid factor in the blood, the stage of radiological changes. This is important in determining the scope of therapy.

Making a diagnosis for a rheumatologist when identifying signs of autoimmune damage to organs and systems is often difficult: the symptoms identified in a patient and examination data can combine signs of several diseases of this group [1].

Treatment of systemic connective tissue diseases includes the prescription of immunosuppressive and cytostatic drugs, drugs that slow down the pathological formation of connective tissue, and other special chemotherapy agents.

Non-steroidal anti-inflammatory drugs are used as symptomatic therapy, and even glucocorticosteroids for these diseases cannot always be used as a means of basic treatment. Medical observation and prescription of therapy in accordance with standards is a prerequisite for preventing the development of serious complications, including disability and death.

A new direction of treatment is the use of biological therapy drugs - monoclonal antibodies to key molecules involved in immunological and inflammatory reactions in these diseases. This group of drugs is highly effective and has no side effects of chemotherapy. In complex treatment for joint damage, surgical interventions are used, physical therapy and physiotherapy are prescribed [1].

Rheumatoid arthritis

Rheumatoid arthritis is the most common systemic autoimmune disease in humans [1].

The disease is based on the production of autoantibodies to immunoglobulin G with the development of an inflammatory process in the lining of the joint and gradual destruction of the joints.

Clinical picture

• gradual onset
• presence of constant pain in the joints,
• morning stiffness in the joints: stiffness and stiffness in the muscles surrounding the joint after waking up or a long rest with the gradual development of arthritis of the small peripheral joints of the hands and feet.

Less commonly, large joints are involved in the process - knees, elbows, ankles. It is necessary to involve five or more joints in the process; symmetry of joint damage is characteristic.

A typical sign of the disease is deviation of the first and fourth fingers to the ulnar (inner) side (the so-called ulnar deviation) and other deformities associated with the involvement of not only the joint itself, but also the adjacent tendons, as well as the presence of subcutaneous “rheumatoid nodules.”

Damage to joints in rheumatoid arthritis is irreversible and limits their function.

Extra-articular lesions in rheumatoid arthritis include the above-mentioned “rheumatoid nodules”, muscle damage in the form of atrophy and muscle weakness, rheumatoid pleurisy (damage to the pleura of the lung) and rheumatoid pneumonitis (damage to the alveoli of the lung with the development of pulmonary fibrosis and respiratory failure).

On the part of the heart, functional changes are possible - the presence of inflammatory processes (pericarditis, myocarditis, pathology of the heart valves and coronary arteries) is rare. The sclera and conjunctiva of the eye may be involved in the process, and concomitant vasculitis is possible.

A specific laboratory marker of rheumatoid arthritis is rheumatoid factor (RF) - IgM class antibodies to one's own immunoglobulin G. Depending on their presence, RF-positive and RF-negative rheumatoid arthritis are distinguished. In the latter case, the development of the disease is associated with antibodies to IgG of other classes, the laboratory determination of which is unreliable, and the diagnosis is established on the basis of other criteria.

It should be noted that rheumatoid factor is not specific for rheumatoid arthritis. It can occur in other autoimmune connective tissue diseases and should be assessed by a doctor in conjunction with the clinical picture of the disease.

Specific laboratory markers of rheumatoid arthritis

• antibodies to cyclic citrulline-containing peptide (anti-CCP)
• antibodies to citrullinated vimentin (anti-MCV), which are specific markers of this disease,
• antinuclear antibodies, which can occur in other systemic rheumatoid diseases.

Treatment of rheumatoid arthritis

Treatment of the disease includes the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids to relieve pain and stop inflammation in the initial stages and the use of basic drugs aimed at suppressing the immunological mechanisms of disease development and joint destruction. The slow onset of a lasting effect of these drugs necessitates their use in combination with anti-inflammatory drugs.

Modern approaches to drug therapy are the use of monoclonal antibodies to tumor necrosis factor and other molecules that play a key role in the pathogenesis of the disease - biological therapy. These drugs are free of the side effects of cytostatics, but due to their high cost and the presence of their own side effects (the appearance of antinuclear antibodies in the blood, the risk of lupus-like syndrome, exacerbation of chronic infections, including tuberculosis), they limit their use. They are recommended for use in the absence of sufficient effect from cytostatics [1, 7].

Acute rheumatic fever

Acute rheumatic fever ( a disease that in the past was called “rheumatism”) is a post-infectious complication of tonsillitis (tonsillitis) or pharyngitis caused by group A hemolytic streptococcus.

This disease manifests itself as a systemic inflammatory disease of connective tissue with primary damage to the following organs:

• cardiovascular system (carditis),
• joints (migratory polyarthritis),
• brain (chorea is a syndrome characterized by erratic, jerky, irregular movements, similar to normal facial movements and gestures, but more elaborate, often reminiscent of dance),
• skin (ring-shaped erythema, rheumatic nodules).

Acute rheumatic fever develops in predisposed individuals - more often in children and young people (7-15 years). Fever is associated with the body's autoimmune response due to cross-reactivity between streptococcal antigens and the affected human tissues (the phenomenon of molecular mimicry).

A characteristic complication of the disease that determines its severity is chronic rheumatic heart disease - marginal fibrosis of the heart valves or heart defects.

Arthritis (or arthralgia) of several large joints is one of the leading symptoms of the disease in 60-100% of patients with the first attack of acute rheumatic fever. The knee, ankle, wrist and elbow joints are most often affected. In addition, there is pain in the joints, which are often so severe that they lead to a significant limitation of their mobility, swelling of the joints, and sometimes redness of the skin over the joints.

The characteristic features of rheumatoid arthritis are its migratory nature (signs of damage to some joints almost completely disappear within 1-5 days and are replaced by equally pronounced damage to other joints) and rapid complete reverse development under the influence of modern anti-inflammatory therapy.

Laboratory confirmation of the diagnosis is the detection of antistreptolysin O and antibodies to DNA-ase, identification of hemolytic streptococcus A during bacteriological examination of a throat smear.

Antibiotics of the penicillin group, glucocorticosteroids and NSAIDs are used for treatment [5].

Ankylosing spondylitis (Bechterew's disease)

Ankylosing spondylitis (ankylosing spondylitis) is a chronic inflammatory disease of the joints, mainly affecting the joints of the axial skeleton (intervertebral joints, sacroiliac joint) in adults, and causing chronic back pain and limited mobility (rigidity) of the spine. The disease can also affect peripheral joints and tendons, eyes and intestines.

Difficulties in differential diagnosis of pain in the spine in ankylosing spondylitis with osteochondrosis, in which these symptoms are caused by purely mechanical reasons, can lead to a delay in diagnosis and prescription of the necessary treatment up to 8 years from the moment the first symptoms appear. The latter, in turn, worsens the prognosis of the disease and increases the likelihood of disability.

Signs of difference from osteochondrosis:

• features of the daily rhythm of pain - they are stronger in the second half of the night and in the morning, and not in the evening, as with osteochondrosis,
• young age of onset of the disease,
• presence of signs of general malaise,
• involvement of other joints, eyes and intestines in the process,
• the presence of an increased erythrocyte sedimentation rate (ESR) in repeated general blood tests,
• the patient has a burdened hereditary history.

There are no specific laboratory markers of the disease: predisposition to its development can be established by identifying the major histocompatibility complex antigen HLA - B27.

For treatment, NSAIDs, glucocorticosteroids and cytostatic drugs, and biological therapy are used. To slow the progression of the disease, therapeutic exercises and physiotherapy play an important role as part of complex treatment [9].

Joint damage in systemic lupus erythematosus

The causes of systemic lupus erythematosus are still not understood

In a number of autoimmune diseases, joint damage may occur, but is not a characteristic sign of the disease that determines its prognosis. An example of such diseases is systemic lupus erythematosus - a chronic systemic autoimmune disease of unknown etiology, in which an immunoinflammatory process develops in various organs and tissues (serous membranes: peritoneum, pleura, pericardium; kidneys, lungs, heart, skin, nervous system, etc.), leading as the disease progresses to the formation of multiple organ failure.

The causes of systemic lupus erythematosus remain unknown: the influence of hereditary factors and viral infection is assumed to be the trigger for the development of the disease; the unfavorable influence of certain hormones (primarily estrogens) on the course of the disease has been established, which explains the high prevalence of the disease among women.

Clinical signs of the disease are: erythematous rashes on the skin of the face in the form of a “butterfly” and discoid rash, the presence of photosensitivity, ulcers in the oral cavity, inflammation of the serous membranes, kidney damage with the appearance of protein and leukocytes in the urine, changes in the general blood test - anemia, decreased number of leukocytes and lymphocytes, platelets.

Joint involvement is the most common manifestation of systemic lupus erythematosus. Joint pain may precede the onset of multisystem involvement and immunological manifestations of the disease by many months and years.

Arthralgia occurs in almost 100% of patients at various stages of the disease. The pain may occur in one or more joints and may be short-lived.

With high activity of the disease, the pain may be more persistent, and a picture of arthritis later develops with pain during movement, pain in the joints, swelling, inflammation of the membranes of the joint, redness, increased skin temperature over the joint and disruption of its function.

Arthritis can be migratory in nature without residual effects, as in acute rheumatic fever, but more often they occur in the small joints of the hands. Arthritis is usually symmetrical. Articular syndrome in systemic lupus erythematosus may be accompanied by inflammation of the skeletal muscles.

Serious complications of the disease from the musculoskeletal system are aseptic necrosis of bones - the head of the femur, humerus, and less commonly the bones of the wrist, knee joint, elbow joint, and foot.

Markers identified during laboratory diagnosis of the disease are antibodies to DNA, anti-Sm antibodies, detection of antinuclear antibodies not associated with taking medications that can cause their formation, identification of so-called LE - cells - neutrophil leukocytes containing phagocytosed fragments of the nuclei of other cells.

For treatment, glucocorticosteroids, cytostatic drugs, as well as group 4 chemotherapy drugs - aminoquinoline derivatives, which are also used in the treatment of malaria, are used. Hemosorption and plasmapheresis are also used [1].

Joint damage due to systemic sclerosis

The severity of the disease and life expectancy in systemic scleroderma depend on the deposition of connective tissue macromolecules in vital organs

Systemic scleroderma is an autoimmune disease of unknown origin, characterized by progressive deposition of collagen and other connective tissue macromolecules in the skin and other organs and systems, damage to the capillary bed and multiple immunological disorders. The most pronounced clinical signs of the disease are skin lesions - thinning and coarsening of the skin of the fingers with the appearance of paroxysmal spasms of the blood vessels of the fingers, the so-called Raynaud's syndrome, areas of thinning and coarsening, dense swelling and atrophy of the facial skin, and the appearance of foci of hyperpigmentation on the face. In severe cases of the disease, similar skin changes are diffuse.

The deposition of connective tissue macromolecules in vital organs (lungs, heart and great vessels, esophagus, intestines, etc.) in systemic scleroderma determines the severity of the disease and the patient’s life expectancy.

Clinical manifestations of joint damage in this disease are pain in the joints, limited mobility, the appearance of the so-called “tendon friction noise”, detected during a medical examination and associated with the involvement of tendons and fascia in the process, pain in the muscles surrounding the joint and muscle weakness.

Complications are possible in the form of necrosis of the distal and middle phalanges of the fingers due to disruption of their blood supply.

Markers for laboratory diagnosis of the disease are anticentromere antibodies, antibodies to topoisomerase I (Scl-70), antinuclear antibodies, antiRNA antibodies, antibodies to ribonucleoproteins.

In the treatment of the disease, in addition to immunosuppressive glucocorticosteroid and cytostatic drugs, a key role is also played by drugs that slow down fibrosis [1, 10].

Psoriatic arthritis

Psoriatic arthritis is a syndrome of joint damage that develops in a small number (less than 5%) of patients suffering from psoriasis (for a description of the disease, see the corresponding section of the article “Health: non-allergic skin diseases”).

In most patients with psoriatic arthritis, clinical signs of psoriasis precede the development of the disease. However, in 15-20% of patients, signs of arthritis develop before the appearance of typical skin manifestations.

The joints of the fingers are predominantly affected, with the development of joint pain and swelling of the fingers. Characteristic deformities of the nail plates on fingers affected by arthritis. Other joints may also be involved: intervertebral and sacroiliac.

If arthritis appears before the development of skin manifestations of psoriasis or if there are foci of skin lesions only in places inaccessible for examination (perineum, scalp, etc.), the doctor may have difficulties in differential diagnosis with other autoimmune diseases of the joints.

Cytostatic drugs are used for treatment; the modern direction of therapy is preparations of antibodies to tumor necrosis factor alpha [6].

Arthritis in ulcerative colitis and Crohn's disease

Joint lesions can also be observed in some patients with chronic inflammatory bowel diseases: Crohn's disease and ulcerative colitis, in which joint lesions can also precede the intestinal symptoms characteristic of these diseases.

Crohn's disease is an inflammatory disease involving all layers of the intestinal wall. It is characterized by diarrhea mixed with mucus and blood, abdominal pain (often in the right iliac region), weight loss, and fever.

Nonspecific ulcerative colitis is an ulcerative-destructive lesion of the colon mucosa, which is localized mainly in its distal parts.

Clinical picture

• bleeding from the rectum,
• frequent bowel movements,
• tenesmus - false painful urge to defecate;
• abdominal pain is less intense than with Crohn's disease and is most often localized in the left iliac region.

Joint lesions in these diseases occur in 20–40% of cases and occur in the form of arthritis (peripheral arthropathy), sacroiliitis (inflammation in the sacroiliac joint) and/or ankylosing spondylitis (as in ankylosing spondylitis).

Characterized by asymmetric, migrating damage to the joints, most often the lower extremities: knee and ankle joints, less often the elbow, hip, interphalangeal and metatarsophalangeal joints. The number of affected joints usually does not exceed five.

Articular syndrome occurs with alternating periods of exacerbations, the duration of which does not exceed 3–4 months, and remissions. However, patients often complain only of pain in the joints and, upon objective examination, no changes are detected. Over time, exacerbations of arthritis become less frequent. In most patients, arthritis does not lead to joint deformation or destruction.

The severity of symptoms and the frequency of relapses decrease when the underlying disease is treated [4].

Reactive arthritis

Reactive arthritis, described in the corresponding section of the article “Infections caused by Yersinia and their effect on allergic diseases,” can develop in individuals with a hereditary tendency to autoimmune pathology.

This pathology is possible after an infection (not only Yersinia, but also other intestinal infections). For example, Shigella - the causative agent of dysentery, salmonella, campollobacter.

Also, reactive arthritis can appear due to pathogens of urogenital infections, primarily Chlamydia trachomatis.

Clinical picture

1. acute onset with signs of general malaise and fever,
2. non-infectious urethritis, conjunctivitis and arthritis affecting the toes, ankles or sacroiliac joints.

As a rule, one joint on one limb is affected (asymmetric monoarthritis).

The diagnosis of the disease is confirmed by the detection of antibodies to suspected infectious pathogens and the detection of the HLA-B27 antigen.

Treatment includes antibacterial therapy and drugs aimed at treating arthritis: NSAIDs, glucocorticosteroids, cytostatics.

The effectiveness and safety of biological therapy drugs are currently being studied [8].

Symptoms of allergic diseases in autoimmune joint diseases

For a number of autoimmune diseases that affect the joints, symptoms characteristic of allergy pathology may occur. They can often precede a detailed clinical picture of the disease. For example, recurrent urticaria may be the first manifestation of a disease such as urticarial vasculitis, which may also involve damage to joints of various locations in the form of transient joint pain or severe arthritis.

Often, urticarial vasculitis can be associated with systemic lupus erythematosus, for which joint damage is characteristic.

Also, with systemic lupus erythematosus, the development in some patients of severe acquired angioedema associated with a C1 esterase inhibitor against the background of the disease has been described [2].

Thus, autoimmune diseases of the joints by their nature are more severe diseases compared to the pathology that develops against the background of their mechanical overload (osteoarthrosis, osteochondrosis). These diseases are a manifestation of systemic diseases that affect internal organs and have a poor prognosis. They require systematic medical supervision and adherence to drug treatment regimens.

Literature

1. Ya.A.Sigidin, N.G. Guseva, M.M. Ivanova “Diffuse connective tissue diseases (systemic rheumatic diseases) Moscow “Medicine” 2004 ISBN 5-225-04281.3 638 pp.
2. P.V. Kolhir Urticaria and angioedema. "Practical Medicine" Moscow 2012 UDC 616-514+616-009.863 BBK 55.8 K61 pp. 11-115, 215, 286-294
3. R.M. Khaitov, G.A. Ignatieva, I.G. Sidorovich “Immunology” Moscow “Medicine” 2002 UDC 616-092:612.017 (075.8) BBK 52.5 X19 pp. 162-176, 372-378
4. A. V. Meleshkina, S. N. Chebysheva, E. S. Zholobova, M. N. Nikolaeva “Articular syndrome in chronic inflammatory bowel diseases: the view of a rheumatologist” Medical scientific and practical journal #01/14
5. Internal diseases in 2 volumes: textbook / Ed. ON THE. Mukhina, V.S. Moiseeva, A.I. Martynova - 2010. - 1264 p.
6. Anwar Al Hammadi, MD, FRCPC; Chief Editor: Herbert S Diamond, MD "Psoriatic Arthritis" Medscape Diseases/Conditions Updated: Jan 21, 2016
7. Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD "Rheumatoid Arthritis" Medscape Diseases/Conditions Updated: Jul 19, 2016
8. Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD "Reactive Arthritis" Medscape Medical News Rheumatology Updated: Oct 31, 2015
9. Raj Sengupta, MD; Millicent A Stone, MD "The Assessment of Ankylosing Spondylitis in Clinical Practice" CME Released: 8/23/2007; Valid for credit through 8/23/2008
10. Sergio A Jimenez, MD; Chief Editor: Herbert S Diamond, MD "Scleroderma" Medscape Drugs and Diseases Updated: Oct 26, 2015

To articles »

Arthritis treatment

The sooner you worry about treatment, the greater the benefit will be. The first stages of arthritis already affect the joints, and with proper treatment it is quite possible to slow down the process. Special exercise therapy exercises have been developed and are prescribed during the period of improvement so that the muscles develop flexibility. Effective medications are also prescribed.

Treatment for arthritis depends on the stage and form of the disease. Therefore, at the first signs, be sure to contact a specialist and do not self-medicate.

How to treat arthritis without drugs?

Reducing stress on diseased joints:

• selection of orthopedic shoes with comfortable soles;
• weight loss;
• use of knee pads, instep supports, canes when walking;
• a complex of therapeutic and health-improving physical education, which can be performed in different starting positions and in water.

Gymnastics should not cause discomfort or pain. Squats and exercises with bent knees should be avoided. A visit to the pool is recommended.

Physiotherapeutic procedures:

• heat treatment;
• magnetic therapy for joints;
• ultrasound;
• massage;
• hydrotherapy;
• acupuncture;
• laser therapy;
• electrical pulse stimulation of muscles.

To prescribe any physiotherapeutic procedures, the patient must have no contraindications. The patient must forever get rid of bad habits and drinking coffee in large quantities.

Diet

The goal of therapeutic nutrition for arthritis is to normalize the immune response, reduce inflammatory reactions and restore full range of motion of the affected joint.

Nutrition for arthritis is selected by your doctor and depends on:

• forms of the disease;
• degree of joint damage;
• concomitant diseases;
• severity of clinical manifestations.

Regardless of the type of arthritis, general nutritional rules for recovery have been developed:

• food should be low-calorie, the diet is aimed at not gaining excess weight, which puts stress on the joints - it is necessary to remove extra pounds;
• it is necessary to balance the supply of all necessary components;
• Food should be steamed; it can be boiled or stewed, but not fried;
• to restore the damaged structure of the joint, it is recommended to eat food from boiled bones (jellied meat), which you can eat as much as you like, they contain natural chondroprotectors that restore cartilage tissue, but such dishes cannot be consumed if you have gout;
• You can’t eat fatty meat – fats can only be of plant origin;
• freshly squeezed juices from fruits, beets and carrots help enrich the body with vitamins, remove toxins and waste from it;
• You should give up alcohol, strong coffee and tea, limit the use of pickles, seasonings and hot spices, except ginger and turmeric.

In general, nutrition for arthritis corresponds to the standard diet (general version) or treatment tables according to Pevzner No. 15, 10, 6, which are prescribed for different types of arthritis. The energy value of the diet is 2170-2400 kilocalories per day, and the nutrient content corresponds to the following scheme:

• proteins - 85-90g, of which 45-50g are animal proteins;
• fats – 70-80g, of which 25-30g are vegetable fats;
• carbohydrates - 300-330g, of which no more than 30-40g complex sugars.

If you are overweight, a hypocaloric diet is indicated, the energy value of which is 1340-1550 kilocalories per day.

Folk remedies

Before using traditional methods for arthritis, be sure to consult with your doctor.

1. Birch leaves (2.5 teaspoons), stinging nettle leaves (2.5 teaspoons), tricolor violet grass (2.5 teaspoons). Take the infusion 1/2 cup 4 times a day before meals.
2. Lubricate the knee with honey, apply mustard plaster and tie it. Hold until a burning sensation appears, then remove the mustard plaster, and wrap the knee with honey, as with a compress, and keep it overnight.
3. Mash the ranunculus flowers and apply to the knee for 2 hours, then remove and wrap the sore spot overnight.
4. Grate the radish or horseradish on a fine grater. Apply the paste or the juice itself to the painful area. Leave for 40 minutes. The course for arthritis is 10 procedures every other day.
5. If salts are deposited in the joint, cut the onion head in half. Pour one drop of tar into the middle of each half and apply to the sore spot.
6. Beat the yolk with apple cider vinegar. Apply the application until dry. Use several times a week for a month.
7. Garden purslane for arthritis. Grind the grass. Mix with cold water, in a ratio of one spoon per glass of liquid. Place on the fire and boil for ten minutes. Cover the container with a towel and place in a warm place for two hours. Then strain. Take the finished infusion three times a day, one tablespoon.

Medical Internet conferences

Clinical case of psoriatic arthritis associated with exudative psoriasis

Ivanov S.D.

Scientific supervisor: Ph.D., assistant V.N. Sherstneva

Federal State Budgetary Educational Institution of Higher Education Saratov State Medical University named after. IN AND. Razumovsky Ministry of Health of the Russian Federation

Department of Dermatovenereology and Cosmetology

Purpose of the work: to describe a clinical case of psoriatic arthritis associated with exudative psoriasis.

Clinical case of psoriatic arthritis associated with exudative psoriasis

Ivanov S.D.

Scientific supervisor: Ph.D., assistant V.N. Sherstneva

Federal State Budgetary Educational Institution of Higher Education Saratov State Medical University named after. IN AND. Razumovsky Ministry of Health of the Russian Federation

Department of Dermatovenereology and Cosmetology

Purpose of the work: to describe a clinical case of psoriatic arthritis associated with exudative psoriasis.

Psoriasis is a systemic chronic disease of a multifactorial nature, characterized along with inflammatory changes in the skin, damage to visceral organs, joints and periarticular structures. [1,2].

The prevalence of psoriatic arthritis (PsA) in the population of patients with psoriasis varies from 6.2% to 42%, its onset is noted in the age period of 30-50 years. Clinical manifestations of PsA develop gradually, leading to disability and having a negative impact on the duration and quality of life of patients. [3,4,5].

The etiology of this disease is unknown. The pathogenetic mechanisms of PsA, like psoriasis, are very complex and not fully understood. The leading role is given to immunological disorders, which involve elements of innate and adaptive immunity. [6,7,8]. Dendritic cells are a key link in the processing and presentation of antigens to T lymphocytes, initiating the formation of cytokines (iL-12, iL-23); participating in the proliferation and differentiation of Th1 and Th17, secreting pro-inflammatory mediators iL-17, iL-22 and tumor necrosis factor α. According to the results obtained by different researchers, these cytokines, interacting with other inducers of inflammation, serve as the most important link in the development of PsA. [9,10,11], with characteristic clinical manifestations in the form of peripheral arthritis, enthesitis, dactylitis and spondylitis. The main symptoms of PsA common to these variants include pain and swelling in the joints, along the tendons, at the points of attachment of entheses, as well as limited mobility in the joints. [12].

Peripheral arthritis is most characterized by changes in several distal interphalangeal joints of the hands and feet, dactylitis and finger deformities.

With dactylitis, inflammation forms simultaneously along the flexor and extensor tendons of the fingers, and dense swelling, purple coloration of the affected skin, and “sausage-shaped deformation” of the fingers are visualized.

Enthesitis is an early stage of PsA with a predominant localization in the enthesis of the Achilles tendon and plantar aponeurosis, and the resulting severe pain makes movement difficult. Any of the listed clinical forms of PsA can be combined with damage to the spine (spondylitis) and manifest not only with back pain, worsening at night, but also with stiffness and limited mobility in the cervical, thoracic or lumbar regions. [13,14].

Patients suffering from severe, prognostically, inflammatory lesions of the joints have an increased risk of developing comorbid conditions such as arterial hypertension, coronary heart disease, type 2 diabetes mellitus, obesity, endothelial dysfunction of the great vessels, etc. [15].

Description of a clinical case.

Patient K., 21 years old, was hospitalized on January 14, 2019 at the clinic of skin and venereal diseases of the Saratov State Medical University named after. IN AND. Razumovsky with a diagnosis: disseminated, exudative, papular-plaque psoriasis, progression phase, severe stage, psoriatic polyarthritis, onychodystrophy. Off-season.

Upon admission, she complained of itchy rashes on the scalp, upper and lower extremities, torso, swelling and pain in the joints.

Considers himself sick for 3 years, when a scaly pink rash first appeared on the scalp and gradually spread to the trunk and limbs. The onset of the disease is associated with severe psycho-emotional stress, accompanied by loss of voice for 3 weeks. Exacerbation of dermatosis was observed several times a year, regardless of the season. She was treated at the clinic at her place of residence. She received hepatoprotectors, antihistamines, B vitamins, external agents - with temporary improvement. Over the last year and a half, I began to experience pain in my left knee joint, and then in the joints of both hands and left foot. Twice she was treated at the regional dermatovenerological clinic with the above diagnosis. The positive dynamics were insignificant. This relapse has been observed since the end of November 2021. I didn’t go to the doctor. She independently used external therapy - Kartolin and Belosalik, without effect. I applied for a consultation at the clinic of skin and venereal diseases of the Saratov State Medical University named after. IN AND. Razumovsky, and was hospitalized due to the progression of the pathological process on the skin, the presence of articular syndrome and the ineffectiveness of therapy carried out on an outpatient basis.

She grew and developed according to her age. Denies contacts with infectious patients. Heredity is not burdened. Denies bad habits. Denies blood transfusions.

The lesion is widespread with a predominant localization on the skin of the extremities and scalp. Morphological elements are represented by single nummular epidermal-dermal papules, merging into round-shaped plaques with a diameter of up to 10-12 cm with dense, grayish-yellow scaly crusts on the surface and a bright pink corolla along the periphery, free from peeling. PASi index 40.4. (Fig.1)

Visual changes in the form of soft tissue swelling are present in the area of ​​the interphalangeal joints of the hands and feet, as well as the left knee and ankle. The range of active and passive movements in these joints is difficult. (Fig. 2). There are pinpoint impressions on the nail plates of the 5th fingers of both hands.

During the examination, general and biochemical blood tests revealed no deviations from physiological norms, with the exception of an increase in ESR to 54 mm/h. Rheumatoid factor is negative. X-rays of the joints of the hands, feet, knees and ankles do not reveal degenerative-dystrophic changes.

Consulted by a gynecologist, therapist (repeatedly), and physiotherapist. There were no restrictions for the treatment of the main dermatological problem.

Complex therapy was carried out: cytostatic drugs (Metojet 22.5 mg IM once a week, in combination with folic acid 5 mg per week - 3 rounds), antihistamines (Loratadine 10 mg orally once a day), detoxification therapy (Reamberin solution 400.0 ml IV drip every other day No. 5), antibacterial drugs (ceftriaxone solution 1.0 intramuscularly 2 times a day for 10 days), hepatoprotectors (Heptor 400 mg orally 2 times a day for 10 days), photochemotherapy (PUVA) with ammifurin 4 times a week No. 16, magnetic therapy on the area of ​​affected joints No. 15, externally (white salik 1 time per day).

During 4 weeks of treatment, the patient showed positive dynamics: reduction in swelling and pain in the affected joints, regression of skin rashes, PASi index 20.4, decrease in ESR to 35 mm/h (Fig. 3)

Conclusion: The described case of PsA is of interest due to the relatively early development of pathological changes in the musculoskeletal system in a patient with exudative psoriasis. Prescribing adequate and timely therapy can help not only resolve efflorescence on the skin, but also interrupt the progression of inflammatory changes in the joints, reduce the risk of comorbid conditions and, consequently, improve the quality of life.

Prevention

People who are at risk due to their professional activities should take care of the prevention of joints. And also for patients:

• with heredity to arthritis;
• those who have had viral diseases;

You can reduce the risk of developing pathology if you adhere to several rules. The attending physician is obliged to talk about preventive measures, especially for elderly people. Prevention of joint arthritis includes:

• weight control;
• avoiding injuries while walking and playing sports;
• protecting joints from excessive stress.

If you feel pain returning or notice redness or swelling, consult your doctor. Timely seeking medical help will prevent severe joint destruction.