Rheumatoid arthritis: reversibility of changes

Diagnosis of de Quervain's disease

The leading symptom is pain in the area of ​​the styloid process of the radius (along the lateral surface of the wrist joint on the side of the thumb). The pain is more pronounced with movements of the hand and thumb. In some cases, the pain continues at night and radiates to the hand and forearm. Palpation of the area of ​​the styloid process of the radius is painful. The Finkelstein symptom is important: the patient presses the thumb to the palm, and presses it on top with the other fingers (the hand is clenched into a fist, but the first finger is not above, but below the others). In this position, the patient moves the hand to the elbow side, which, if the symptom is positive, is accompanied by severe pain.

Treatment of de Quervain's disease: non-steroidal anti-inflammatory drugs (Voltaren, Nimesil, etc.) are used orally and locally, physiotherapy, rest. Blockades with diprospan or Kenalog have a good effect.

Diagnosis and treatment of hand arthritis

If suspicious symptoms appear, you should see a kinesiotherapist. Today, traditional treatment for arthritis of the hand includes taking medications that dull the pain, temporarily relieve swelling, but, unfortunately, do not restore limb mobility. Patients are also prescribed products for nutrition and improvement of joint trophism, vitamins, but due to chronic inflammation, these substances are simply not absorbed by the joint tissues.

Physiotherapy may provide temporary relief from symptoms. Physical therapy is also prescribed to treat hand arthritis. In advanced stages, medicine can only offer the patient surgery (endoprosthetics).

Kinesitherapy for the treatment of hand arthritis is a fundamentally new approach, which is based not on relieving symptoms, but on eliminating the very cause of the pathology. A set of special exercises provides a natural effect on the joints and surrounding tissues.

During the first consultation at our center, the kinesiotherapist examines and interviews the patient, conducts testing on multifunctional simulators and myofascial topographic diagnostics.

Based on the results of the examination, a treatment program for hand arthritis is drawn up. It is based on strictly dosed effects of loads on certain muscle groups, which are performed with a safe amplitude. Kinesitherapy helps improve blood supply to the joint, normalizes the trophism of its structures, helps relieve swelling, as a result of which pain and stiffness disappear.

The advantages of kinesitherapy are:

• versatility (suitable for patients of any age and size);
• affordability (compared to expensive surgeries and medications);
• soft and natural effect on the articular-ligamentous apparatus.

Diagnosis of arthritis of the wrist joint

The main manifestation is joint pain and swelling. There is often slight redness in the joint area, and sometimes morning stiffness. The clinical picture can be quite varied, depending on the cause of the arthritis. X-ray examination may show no changes. The tests showed an increase in ESR and C-reactive protein (this is typical for all arthritis). In arthritis caused by a certain disease, other indicators may change (increased blood uric acid in gout, increased rheumatoid factor in rheumatoid arthritis, etc.).

Treatment

In the first and second stages of the disease, the patient is prescribed anti-inflammatory drugs, physiotherapy, and painkillers. Maximum wrist immobilization is also indicated. If the third degree of arthritis is diagnosed, only surgical treatment will be effective.

The orthopedist prescribes treatment based on the stage and cause of arthritis. So, for example, if the disease is represented by an acute purulent form, arthrotomy may be prescribed. This procedure involves installing a drain to drain pus. Based on bacteriological analysis, the traumatologist identifies the causative agents of the inflammatory process in order to select the most effective antibiotic. If the patient’s chronic arthritis has worsened, in addition to immobilization, rheumatologists use physiotherapeutic techniques. Professional massage helps well, relieves the condition of exercise therapy, ultrasound and other hardware techniques. Also, patients suffering from a chronic form of arthritis of the wrist joint should constantly remember about the reasonableness of the load on the sore hand. It is recommended to adhere to a diet and include special therapeutic exercises in your lifestyle.

Causes of the disease

The etiology of arthritis is different. Prerequisites for its development may be:

- bacterial infection,

- pathologies of metabolic functions, for example gout,

- rheumatic changes in bones,

- autoimmune diseases,

- injuries leading to dysfunction of the joint - sprains, fractures.

The disease negatively affects the entire system of protective functions of the body. On this basis, autoimmune arthritis : the body reacts aggressively to its own organs, perceiving them as foreign.

Rheumatoid arthritis

Rheumatoid arthritis is a systemic disease that affects connective tissue. For the most part, it affects small joints and proceeds as erosive-destructive polyarthritis. It often has unclear causes and a complex development mechanism associated with autoimmune processes.

The name of this disease, translated from ancient Greek, conveys its etiology: ῥεῦμα means “flow”, the suffix -oidny - “similar”, ἄρθρον - “joint”, the suffix –itis (itis) - a state of inflammation.

RA is characterized by a high percentage of disability in patients - about 70% of them suffer from its consequences throughout their lives. Complications of the disease are deadly; in most cases, renal failure and complications of infections that develop against its background lead to death.

REASONS FOR THE DEVELOPMENT OF RHEUMATOID ARTHRITIS

So far, doctors have not been able to establish the exact causes of RA in patients.

Presumably, they can be infections, which indirectly confirms an increase in the level of leukocytes and ESR (erythrocyte sedimentation rate) in the blood. It is believed that infectious diseases lead to pathologies of immunity in people who have a hereditary tendency to this. Against this background, immune complexes are formed (complexes of antibodies, viruses, etc.) that can be deposited in the tissues of the joints and damage them. However, there is also data that negates this assumption, in particular the lack of results in the treatment of rheumatoid arthritis with antibiotics.

There are three factors that influence the development of rheumatoid arthritis, which are called the “rheumatological triad”.

Heredity:

• genetic predisposition to pathologies of autoimmune processes;
• the presence of certain types of MHC II class antigens (HLA-DR 1, HLA-DR 4);

Infections (presumed influencing factor):

• paramyxoviruses (mumps, RS virus, measles);
• hepatoviruses (hepatitis B);
• herpes viruses (herpes simplex, cytomegalovirus, herpes zoster, Epstein-Barr virus, which is observed in synovial fluid)
• retroviruses (T-lymphotropic virus).

External factors that “trigger” the disease, after exposure to which it can appear for the first time:

• hormonal changes;
• hypothermia or hyperinsolation;
• toxic infections;
• stress and emotional turmoil;
• heavy physical activity;
• fatigue;
• taking medications with mutagenic properties;
• disruption of the endocrine glands;
• other unfavorable factors.

CLASSIFICATION OF RHEUMATOID ARTHRITIS

There are several methods for classifying RA.

According to the clinical picture:

• very early stage – up to 6 months;
• early stage – 6-12 months;
• advanced stage – 1-2 years;
• late stage – more than 2 years.

By activity (according to DAS28 indicator):

• 0 (remission) – up to 2.6;
• 1 (low) – 2.6-3.2;
• 2 (average) – 3.2-5.1;
• 3 (high) – more than 5.1.

According to instrumental indicators:

• there is erosion;
• radiographic stage (1-4).

According to immunological indicators:

• Rheumatoid factor – sero-positive/sero-negative;
• Anti-CCP – sero-positive/sero-negative.

According to the remaining capabilities:

• A person is able to take care of himself, conduct personal affairs and work.
• A person is able to take care of himself and conduct personal affairs, but cannot work fully.
• A person is able to take care of himself, but cannot fully manage personal affairs and work.
• The ability to fully function in any aspect is lost.

SYMPTOMS OF RHEUMATOID ARTHRITIS

RA affects all joints, but it usually affects the small joints of the hands first. One of its features is that, as a rule, the disease spreads symmetrically, that is, for example, if the left wrist hurts, then the right one will also start to hurt.

Rheumatoid arthritis is also characterized by:

• stiffness in movement in the morning - its duration depends on its stage;
• fatigue and general weakness;
• disorder of the autonomic system;
• flu-like symptoms, including fever;
• muscle pain;
• pain during prolonged inactivity, for example, sitting;
• lack of appetite and weight loss;
• anemia;
• depressive disorders;
• chronic course with exacerbations and remissions.

There are three stages of development of rheumatoid arthritis.

At the first stage, in most cases, periarticular edema of the synovial bursae manifests itself. Its symptoms:

• pain;
• local increase in temperature;
• swelling of surrounding tissues.

At the second stage, the cells of the synovial tissue begin to rapidly divide and the synovial membrane becomes denser.

In the third stage, inflamed cells secrete an enzyme that negatively affects bones and cartilage, which leads to their:

• soreness;
• deformations;
• loss of the ability to move normally.

Most often, the disease begins slowly and its clinical picture develops over months or even years. However, in rare cases it can be subacute or acute. Approximately 2/3 of cases have the form of polyarthritis, and only 1/3 manifests itself as mono- or oligoarthritis. With the stage of the disease, the number of joints affected by it also increases.

It is worth noting that there are “defeat joints” that are most often affected by RA, as well as “exception joints” that are practically not affected by it.

“Joints affected” (by disease frequency):

• II and III metacarpophalangeal;
• proximal interphalangeal metatarsophalangeal;
• knee and wrist;
• elbows and ankles.

"Joints of exception":

• distal interphalangeal;
• I metacarpophalangeal (thumb).

The articular syndrome that occurs with this disease sometimes does not have a clear clinical picture, which complicates its diagnosis. It proceeds monotonously, for a long time and can manifest itself even after treatment for RA. In general, it is characterized by:

• stiffness, when it seems that the body is wearing a corset or thick gloves, lasting more than half an hour, appearing in the morning, as well as in the second half of the night - the further the inflammatory process has gone, the longer the stiffness lasts;
• joint pain that is constantly disturbing and appears suddenly, increasing with increased activity.

Prodromal clinical symptoms of RA include:

• minor transient pain;
• the occurrence of painful sensations when the weather changes;
• their connection with autonomic disorders.

Among the symptoms of RA there are also those not related to the joints, which manifest themselves in the form of other diseases. This:

• Cardiovascular system – vasculitis, granulomatous valve disease, pericarditis, atherosclerosis.
• Respiratory system – interstitial diseases, pleurisy.
• Skin – rheumatoid nodules, thickening and hypotrophy, livedo reticularis.
• Nervous system – compression neuropathy, multiple mononeuritis, sensory-motor neuropathy, cervical myelitis.
• Vision – episcleritis, sicca keratoconjunctivitis, scleritis, peripheral ulcerative keratopathy.
• Kidneys – amyloidosis, vasculitis, nephritis, NSAID nephropathy.
• Blood – anemia, neutropenia, thrombocytosis.

CLINICAL COURSE OF TYPES OF RHEUMATOID ARTHRITIS

RA has many variations in its clinical course.

Classical

Small and large joints are affected, the disease develops slowly.

Mono- and oligoarthritis, mostly affecting large joints

As a rule, with this type of RA, the knee joints are the first to be affected. The disease immediately becomes noticeable; it is highly advisable to begin its treatment immediately, since if you start it in the first 1-1.5 months, then it is reversible. At this stage, there are no changes on radiographs and treatment with anti-inflammatory drugs is quite effective.

Its first symptom is migrating pain in the joints. Subsequently, its signs are similar to the classical ones.

With pseudoseptic syndrome

It is characterized by:

• fever with significant daily temperature fluctuations;
• chills;
• increased sweating;
• weight loss and muscle mass;
• anemia;
• vasculitis;
• viscerite.

Sometimes the clinical manifestations of arthritis may be subtle.

Articular-visceral RA

Symptoms of this form of arthritis include:

• rheumatoid vasculitis;
• damage to organs - kidneys, digestive system, lungs, heart;
• damage to the nervous system.

Juvenile rheumatoid arthritis

Juvenile RA is defined as RA that develops in children under 16 years of age. Shows itself:

• allergic septic syndrome;
• in the articular-visceral form with limited visceritis.

Felty's syndrome

The symptoms combine polyarthritis and splenomegaly (enlarged spleen). It may be accompanied not by splenomegaly, but by neuropenia, leukocytopenia or visceritis.

Still's syndrome

It develops as polyarthritis, affecting the joints and spine, with severe pain and deformities.

DIAGNOSIS OF RHEUMATOID ARTHRITIS

For quite a long time, doctors could not develop a technique that could reliably make a diagnosis of rheumatoid arthritis. Modern diagnosis of RA consists of a number of studies, including:

• blood tests (general and biochemical) - platelet count, ESR, rheumatoid factor and other characteristic indicators;
• X-ray – to detect joint changes.

Examination for the presence of clinical manifestations – articular syndrome, fever, weakness, weight loss and others – also plays a huge role. Checked:

• changes in skin tone in the area of ​​inflammation;
• inflammation of the synovial bursae of the fingers;
• muscle trophism disorders;
• the presence of a “rheumatoid hand” (characteristic deformities).

Nowadays, such an effective technique as serum analysis for antibodies to cyclic citrulline-containing peptide (ACCP, anti-CCP, anti-CCP) is often used. This is a very significant factor, since they are detected in 79% of patients with rheumatoid arthritis and the specificity of the analysis is approximately 90%.

Based on the data obtained, it is possible to make a diagnosis and predict the further development of the disease. Unfortunately, one cannot always expect favorable progression of the disease. This is influenced by:

• early manifestations - the appearance of symptoms in the first year, in particular, rheumatoid nodules, rapid damage to large joints, changes on X-rays become noticeable within the first four months;
• joint destruction develops rapidly;
• enlarged lymph nodes;
• increase in ESR level;
• systemic nature of the disease;
• exacerbation lasting more than a year;
• new joint lesions as the disease intensifies;
• high titers of rheumatoid factor;
• poor responsiveness to basic therapy.

Therefore, the sooner the disease is detected and its treatment begins, the less harm it will cause to the body.

TREATMENT OF ARTHRITIS

For the most part, RA treatment is associated with relieving symptoms of the disease, reducing pain and slowing its progression. In some cases, surgeons have to intervene to repair the damage.

Modern medicine has a lot to offer to patients with rheumatoid arthritis, since in recent years doctors have developed new effective techniques. In particular, genetically engineered biological drugs have been invented that help patients transfer the disease into a stage of long-term remission. They affect the immunological causes of RA development.

An important part of treating rheumatoid arthritis is preventing associated complications. One of them is osteoporosis - a calcium-containing diet and other measures are prescribed to help normalize its level in the body. The patient also needs to regularly engage in exercise therapy in order to maintain mobility and muscle mass as much as possible.

If necessary, the patient can be prescribed physical therapy and spa treatment, but they can only help if the arthritis is in a mild stage.

It is worth noting that there are natural factors that reduce the likelihood of developing rheumatoid arthritis in women - breastfeeding. If a mother feeds her child for 2 years or more, then the likelihood of her developing RA becomes three times less.

Our clinic specialists will select the necessary treatment for you.

Therapeutic measures for gouty arthritis

Optimal, effective therapy is chosen by experienced specialists after a comprehensive examination of the patient. Doctors at the Arthro-clinic medical institution successfully cure the disease. Innovative equipment and productive techniques make it possible to quickly establish the causes of the disease, determine the degree of pathology and immediately begin to cure the patient.

A necessary condition for successful therapy is adherence to a gentle regimen for the affected joint. The doctor will be able to choose the appropriate means to ensure immobility of the affected organ - an elastic bandage or an orthosis.

Take care of yourself and be healthy!