Severe variant of rheumatoid arthritis

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Rheumatoid arthritis is one of the most severe joint diseases, occurring with many complications. Rheumatoid arthritis affects people of all ages, but most often those over 30. Among women, about 5 times more suffer from rheumatoid arthritis than among men. In general, according to various scientists, this disease affects 1-2% of the population.

As you know, most types of arthritis, and, in particular, rheumatoid arthritis, are autoimmune diseases. That is, with arthritis, those immune cells-lymphocytes, which should recognize and destroy strangers invading the body (bacteria, viruses, etc.), for some reason “go off course” and perceive the cells of their own body as enemies, in first of all - joint cells. And they actively attack them, as if trying to destroy them.

The reasons why protective cells suddenly begin to regard the cells of their native organism as strangers may be different. Sometimes autoimmune aggression can be triggered by some kind of infectious disease or a latent, sluggish infection. In addition, sometimes rheumatoid arthritis develops as a continuation of reactive or infectious arthritis. Occasionally, the onset of the disease is provoked by trauma or prolonged or severe trauma.

But much more often, arthritis develops as a result of severe emotional shock and severe stress.

In at least half of my patients, the disease began after severe blows of fate: dismissal from work, divorce, loss of loved ones, etc., especially if these blows of fate were preceded by many years of exhausting experiences. Or if shocks are superimposed on certain character traits.

Most clinicians have long recognized, to one degree or another, the role of emotions in the development of rheumatoid arthritis. Back in the first half of the twentieth century. American researchers A. Johnson, L. Shapiro and F. Alexander, in the course of numerous studies, identified character traits that are most often found in “arthritic” patients.

Excessive emotional restraint, the habit of always keeping your feelings under control and hiding negative emotions under the guise of emphasized friendliness increases the risk of developing arthritis.

It is clear that not every reserved person who grew up under the influence of strict parents will develop arthritis. For arthritis to occur, a certain trigger is necessary. Most often, according to my observations, the role of such a “trigger button” is played by long-held anger, guilt and self-hatred for real or imaginary offenses, and especially strong (or lingering) resentment that arises against the background of chronic grief.

Moreover, it is not so important with whom a person with a predisposition to arthritis is offended or angry - with his parents, spouse, children, friends, or even just “at life.” If sufficiently strong negative emotions are present, then a response from the body’s hormonal system automatically occurs, stress hormones are released, and the likelihood of an autoimmune response from the body, such as an attack against its own joints, increases.

You can read more in the article: psychosomatics of rheumatoid arthritis

Development of rheumatoid arthritis

With rheumatoid arthritis, the immune system always fails. As a result of this failure, immune cells are directed to various organs of the body, especially the joints, and attack them as if they recognized foreign agents in the joint cells. And they continue to do this for years - perhaps even when there is no foreign material left in the joints. They secrete special substances - inflammatory mediators, which penetrate into the attacked joint, cause the death of some of its cells, and over time provoke damage to the joint.

In rheumatoid arthritis, the synovial membrane of the joint is especially affected. Inflammation primarily affects that part of it that is directly adjacent to the cartilage. The synovial membrane swells and hypertrophies over time, that is, it grows. Later, this overgrown synovium can grow into the cartilage and other tissues of the joint, and sometimes even into the bone, weakening the structure of the entire joint. It swells, becomes deformed and, without proper treatment, gradually collapses.

Pain in the joints with rheumatoid arthritis intensifies most often in the second half of the night, in the morning.

Until about noon the pain is very intense; patients compare them to toothache. However, in the afternoon the pain becomes weaker, and in the evening it is often insignificant. What is also characteristic is that at the beginning of the disease, joint pain often decreases after active movements or warm-up. And they do not get worse from stress, as happens with arthrosis. However, any relief from rheumatoid arthritis usually lasts only until the middle of the night, and around 3-4 hours the attacks of joint pain resume.

Along with inflammation of the joints of the upper extremities, rheumatoid arthritis almost always affects the small joints of the feet. The joints at the base of the toes become inflamed, which manifests itself as pain when pressing under the “pads” of the toes. It is symptomatic that the joints of the legs become inflamed as symmetrically (on the right and left limbs) as in the arms.

Large joints, such as the shoulders, knees, elbows and ankles, usually become inflamed later, after several weeks or months. Although there are other types of rheumatoid arthritis, in which the first to become inflamed are the shoulder or knee joints, or the heel tendons, and inflammation of the small joints of the hands and feet “joins” later. This form of arthritis most often occurs in people over 65-70 years of age.

In addition to intense pain, rheumatoid arthritis is characterized by morning stiffness. Patients describe morning stiffness as a feeling of “stiffness in the body and joints” or as a feeling of “tight gloves on the hands,” less often as a feeling of “a tight corset on the body.”

With a relatively mild course of rheumatoid arthritis, morning stiffness usually disappears within an hour or two after the patient gets out of bed. But in severe cases of the disease, this unpleasant sensation can persist until one o’clock in the afternoon or even longer.

Many patients develop rheumatoid nodules under the skin. They are quite dense to the touch, usually about the size of a pea, and are most often located just below the bend of the elbows. But sometimes rheumatoid nodules also appear on the hands, feet and other places. More often there are few of them (1-2), but sometimes they are formed in large quantities. Usually the nodules are relatively small (2-3 cm in diameter), but quite large ones are also found.

Very often, the symptoms listed above are accompanied in patients by a feeling of weakness, deterioration of sleep and appetite, a moderate increase in temperature (up to 37.2-38 ° C), and chills.

As the disease develops, in its advanced stage, permanent deformation of the fingers and hands occurs. More often than others, “ulnar deviation” of the hands develops, when the hands and fingers are fixed in the wrong position and deviate outward. The mobility of the wrist joints sharply decreases, the arms have difficulty bending and unbending at the wrists. Due to impaired blood supply, the skin on the hands and wrists becomes pale, dry, thinned, and the arm muscles atrophy. These phenomena intensify with increasing disease activity.

Gradually, more and more joints are involved in the pathological process. Knees, elbows, ankle and shoulder joints often become inflamed. Inflammation of the elbow, shoulder and ankle joints usually occurs relatively mildly, but leads to noticeable stiffness of the joint, sometimes to a rather sharp limitation of movements in the joint.

The situation is more complicated with the knee joints. Rheumatoid disease of the knees is often accompanied by the accumulation of a large amount of pathological fluid in the joint cavity, stretching the joint capsule. This accumulation of fluid in the knee is called a Baker's cyst. In the most severe cases, excess fluid in the cyst can lead to its rupture, and then the contents of the cyst spill into the soft tissue of the lower leg along its back surface. In this case, swelling of the lower leg appears, and sharp pain occurs in the leg. After some time, acute manifestations of the rupture usually subside, pain and swelling decrease. But if the inflammatory process in the knee continues, then the joint can “swell” again and again with all the ensuing consequences. And only when the activity of the inflammatory process is suppressed, the increased production of pathological fluid stops, and the rupture gradually heals.

In addition to inflammation of the joints, in the active phase of rheumatoid arthritis, the vertebral joints are sometimes involved in the inflammatory process. More often the cervical spine becomes inflamed, and then pain appears in the neck and under the back of the head. Sometimes they even try to treat such patients, suffering from inflammatory pain in the spine, with massage, manual therapy or heating - which is a gross medical error. All these attempts often lead only to an exacerbation of the disease and increased pain, since such manipulations during an active inflammatory process only intensify the inflammation.

Course of rheumatoid arthritis

The disease has a wave-like nature: periods of deterioration in the patient’s well-being are followed by periods of spontaneous improvements. Without proper treatment, patients suffer for many years, sometimes throughout their lives.

Proper treatment, coupled with restoration of mental balance, can lead to long-term remissions, significant improvement in well-being, and even complete recovery. However, few patients are able to radically and permanently change their attitude towards life, control their mental and physical state, and live in a state of “inner peace.” Therefore, either after the next unrest, or after a cold or hypothermia, the patient’s condition can again deteriorate significantly.

On top of this, over time, various complications in the functioning of internal organs are added to the damage to the joints. Rheumatoid damage to the lungs, heart, liver, kidneys, blood vessels and intestines often occurs. Sometimes rheumatic muscle inflammation develops - polymyalgia, which is a serious complication of arthritis. All of the above complications can not only seriously worsen the patient’s already imperfect condition, but can even pose a threat to his life. That is why it is important to begin treating rheumatoid arthritis as early as possible, and to treat the patient comprehensively and thoughtfully in order to interrupt the development of the disease at the initial stage, without leading to complications and without waiting for irreversible consequences.

Modern drug therapy

Systemic drug therapy includes the use of four groups of drugs:

symptomatic treatment - non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids (GCS), basic antirheumatic drugs, genetically engineered biological (disease-controlling) drugs with cytostatic immunosuppressants.

Nonsteroidal anti-inflammatory drugs

Glucocorticosteroids

Basic antirheumatic drugs

Prognosis Generally favorable with early contact with a rheumatologist and adequately selected treatment. In the late stage, in the presence of systemic manifestations of rheumatoid arthritis, the risk of heart disease increases, the mechanism is unknown; the presence of chronic inflammation is considered a significant factor. It is possible that the use of new biological drugs can increase life expectancy and reduce risks for the cardiovascular system, as well as slow down the development of atherosclerosis. Limited studies demonstrate a reduction in the risk of cardiovascular disease, while an increase in total cholesterol levels is observed while the atherogenic index remains unchanged.

Diagnosis of rheumatoid arthritis

To verify the diagnosis:

General examination and medical history. Mobility, pain or swelling of joints, skin condition are assessed, lymph nodes, liver and spleen are palpated. The patient’s information about possible injuries, stress and previous infections is clarified.

A number of laboratory tests are prescribed:

Complete blood count (evaluate the number of red blood cells, leukocytes and platelets, hemoglobin level, ESR).
General urine analysis.
Urinalysis according to Nichiporenko (if indicated).
Biochemical blood test (assess ALT, AST, urea, creatinine, alkaline phosphatase, total protein, cholesterol, bilirubin, glucose, C-reactive protein).
Determination of rheumatoid factor in blood serum.
Determination of antibodies to cyclic citrullinated peptide (ACCP).
Coagulogram.
ELISA or PCR diagnosis of infections (hepatitis, HIV, chlamydia, gonorrhea, Trichomonas, Epstein-Barr virus).

Conduct instrumental research:

X-ray of the hands and feet, pelvic bones and other joints as indicated.
Ultrasound of joints and joint puncture followed by assessment of joint fluid.
Arthroscopy (examination of the joint cavity using a special device) with a biopsy and subsequent morphological examination of the tissue.
X-ray of the chest organs.
ECHO-KG and ECG.
Ultrasound of the abdominal organs and kidneys.
FGDS.
CT and MRI.

If necessary, consultations with other specialized specialists (ophthalmologist, traumatologist-orthopedist) are carried out.

Treatment of rheumatoid arthritis

Treatment of rheumatoid arthritis is aimed at reducing the severity of the disease, preventing joint destruction and reducing their function, improving quality of life and increasing life expectancy.

Non-drug treatment:

Purpose of a balanced diet: sufficient consumption of foods containing polyunsaturated fatty acids (fish oil, olive oil, etc.) is necessary.
Physiotherapy.
Physiotherapy: ultrasound, laser therapy, etc.

Drug treatment is the main treatment for rheumatoid arthritis.

cytostatic drugs, immunosuppressants, etc. The result of treatment with these drugs develops slowly (over 2-6 months or more), but is very stable.
Biotechnological drugs (R – Mab) are high-tech biological drugs that have a powerful anti-inflammatory effect, exerting a targeted effect on any link in the process of inflammation.
Targeted synthetic drugs also have a targeted effect on a specific inflammatory mechanism.
Glucocorticosteroids have a strong anti-inflammatory effect, act quickly, but the therapeutic effect is unstable.
Non-steroidal anti-inflammatory drugs. They have a rapid analgesic effect, but their anti-inflammatory effect is weak. Prescribed at an early stage of treatment of the disease to correct symptoms in combination with basic anti-inflammatory treatment. In addition to the systemic administration of drugs, their intra-articular administration is possible.

Starting treatment at an early stage of the disease allows you to achieve good results, maintain ability to work and quality of life. To achieve the best effect from therapy, it is necessary to give up bad habits (smoking, drinking alcohol), try to avoid psycho-emotional stress, and prevent infections.

Causes of pain after implantation

The most common reason for the development of pathology is the penetration of infection into the wound during or after surgery - for example, when using insufficiently sterile instruments or materials, the penetration of pathogenic bacteria through the edges of a loosely sutured wound, or when the sutures come apart. In some cases, with insufficiently qualified implantation, damage to the nerve structures of neighboring tissues occurs, which causes intense aching pain, which is practically uncontrollable by analgesics.

Another possible cause is the formation of a blood clot between the implant and the gum tissue, resulting from a damaged blood vessel or a bleeding disorder in the patient. Normally, after surgery, the patient experiences a subtle aching pain that goes away within 3 days, as well as slight bleeding, swelling and swelling at the operation site.

All this is a consequence of surgery and the reaction of the body’s immune system to it and goes away in 3-5 days. If the pain is severe, acute, there is severe swelling of the gums, fluid is released from under the installed structure, and all this continues for more than 5 days - this is a signal that you need to seek help from a doctor.