Rheumatoid arthritis: symptoms and treatment

Rheumatoid arthritis

is a chronic inflammatory disease of connective tissue that most often manifests itself in the small joints of the hands and feet.
The danger of the disease lies in its systematic nature and high degree of disability. Being an autoimmune disease, rheumatoid arthritis can affect almost any joint in the body
, and also often leads to
polyarthritis
(affecting 4 or more joints). It can also manifest itself in the organs of the body - the heart, lungs, eyes, kidneys, blood vessels and others. As a result, up to 70% of patients partially or completely lose their ability to work and the ability to self-care, and in especially severe cases left without treatment, even death is possible.

Rheumatoid arthritis affects 1 to 5% of people over 45 years of age, with women getting sick on average 3-5 times more often than men due to their naturally high immunity. Therefore, it is important to be attentive to the slightest manifestations of the disease, diagnose it in time and choose good drugs for rheumatoid arthritis in accordance with the doctor’s prescriptions.

Rheumatoid arthritis is a chronic inflammatory disease of connective tissue

Development of rheumatoid arthritis

Arthritis

is a general term that refers to various types of inflammation and destructive processes occurring inside the joint. Rheumatoid arthritis belongs to the category of autoimmune diseases and involves the progression of inflammatory processes in the joint, the occurrence of which is caused by tissue damage by immune cells for various reasons, attacking the tissues of the body's own.

Inflammatory processes involve degeneration (destruction) of cartilage and further breakdown of bone tissue. Due to the fact that cartilage tissue, as a rule, is not restored, and bone tissue is deformed, during the development of rheumatoid lesions, almost irreversible consequences arise (deformation of joints, a significant decrease in mobility).

Frequent and at the same time severe pain and, as a consequence, inactivity in the absence of treatment inevitably lead to disability of patients.

Scope of application of cytostatics

Cytostatics are used for all malignant tumors, not excluding diseases of the blood and lymphatic tissue, tumors of the brain and gonads. Cyclophosphamide and antimetabolites in disproportionately lower doses than in oncology are used in rheumatology.

Each cytostatic drug has its own spectrum of antitumor activity, for example, doxorubicin and fluorouracil work great for breast cancer, but are ineffective for small cell lung cancer. Chemotherapy for intestinal carcinomas is not possible without fluorouracil, and doxorubicin is useless for them.

Causes of rheumatoid arthritis

Scientists around the world are working to identify the most likely causes of rheumatoid arthritis.

Today, most experts are of the opinion that rheumatoid arthritis is a multifactorial disease, which suggests its development in the presence of a complex of diverse causes.

Possible prerequisites for the occurrence of rheumatoid arthritis may include:

genetics, namely, a predisposition to disorders of the immune system (antigens have been identified that can lead to the transformation of humoral and cellular immunity);
the presence in the body of infectious agents that can cause various types of immune changes (more than half of the diagnosed patients have elevated levels of antibodies to the Epstein-Barr virus).

The trigger factors that provoke the appearance of rheumatoid arthritis include:

hypothermia;
increased exposure to ultraviolet radiation (prolonged exposure to sunlight);
intoxication (in particular microbial toxins);
previous bacterial infections;
the influence of certain medications;
disruption of the endocrine system;
emotional shock.

At the same time, there is an interesting fact that breastfeeding for two or more years significantly reduces the likelihood of developing the disease.

Mechanism of action of cytostatics

Two driving mechanisms:

changes in the structure of DNA, including abnormal twisting that prevents the strands from diverging during division, as well as repair disorders - restoring the continuity of the strand when damaged;
cell division disorder is a disorder in the formation of the cell spindle, which separates chromosomes into daughter cells, typical of herbal preparations.

Not only each group, but also each cytostatic has its own mechanism of antitumor action, or rather, several mechanisms of damage, most of which are unknown.

Main signs and symptoms of rheumatoid arthritis

The first signs of rheumatoid arthritis are morning stiffness in joint movement, accompanied by the onset of inflammatory processes.

Initially, the small joints of the limbs are at risk of tissue resolution, which leads to the appearance of such signs of rheumatoid arthritis as the feeling of spending the night in a corset or tight gloves.

In the initial stage of the disease, the pain is of moderate intensity, but quite noticeable and sometimes comparable to toothache. It is difficult to touch the joints, any perfect movement greatly intensifies the sensation, which forces you to initially take the most comfortable positions.

The initial symptoms of rheumatoid arthritis may persist for a long period of time.

Late stages of development are accompanied by such a sign of rheumatoid arthritis as visually noticeable deformation of the joints. It is worth noting that during this period it is difficult for a person to perform simple household operations, which significantly reduces the quality of life.

In order to simplify the determination of treatment, all symptoms of rheumatoid arthritis are usually classified into two groups:

Extra-articular manifestations – signal disturbances in the functioning of internal organs:
thinning and dry skin;
deformation and fragility of the nail plate;
hemorrhages on the skin, internal bleeding;
inflammation and enlargement of lymph nodes.
Joint manifestations indicate the development of degenerative-dystrophic processes in the joints:
visually noticeable development of the disease (swelling, stiffness, local increase in temperature);
the appearance of boring pain.

Possible complications of the disease

If you do not seek qualified help in a timely manner, as well as without treatment for rheumatoid arthritis, there is a high probability of complications, including:

heart failure/myocardial infarction;
renal failure;
violation of metabolic processes;
inflammation of the serous membranes of internal organs;
the occurrence of bronchopleural fistulas (a direct channel between the bronchial tree and the pleural cavity).

Classification of rheumatoid arthritis

The development of rheumatoid arthritis is classified into stages. It is important that in the early stages the disease can be quite successfully treated with medications, but in the later stages they may be ineffective. The prognosis of disability depends on the stage of the disease.

In addition to the clinical ones, there are also radiological stages of rheumatoid arthritis. Let's look at it in detail.

First stage (initial)

It proceeds quite favorably and practically does not manifest itself in any way. As a rule, there are no painful sensations, the general condition of the body is satisfactory.

It is almost impossible to identify the disease on your own.

The main symptoms of early stage rheumatoid arthritis are:

discomfort in the joints, barely noticeable pain;
compaction with a finger (visually noticeable thickening);
compaction of periarticular tissues;
stiffness of movement mainly in the morning.

X-ray manifestations:

thinning of bone tissue;
extremely rarely - the formation of light areas on the affected tissue.

Treatment for early-stage rheumatoid arthritis is quite simple, and the prognosis is favorable.

Second stage

It has a more pronounced clinical picture. Diagnosis of rheumatoid arthritis is carried out mainly at this stage.

Among the most pronounced symptoms of rheumatoid arthritis of the second stage are:

damage to several groups of joints at once;
the occurrence of quite severe pain, which weakens with active movements and stress;
feeling of stiffness, as if “the body has gone numb”;
visually noticeable changes (local redness of the skin).

X-ray manifestations:

changes in bone tissue according to the type of erosion;
cartilage deformation;
swelling and inflammation of the joint capsule.

Treatment of stage 2 rheumatoid arthritis is predominantly medicinal. The prognosis is favorable.

Third stage

Characterized by serious changes. There are pronounced pains and limited joint mobility.

Signs of stage three rheumatoid arthritis are:

spread of the disease to large joints of the body;
local increase in temperature, feeling of heat;
formation of subcutaneous nodules (mainly near the affected joints);
noticeable deformation of cartilage tissue;
muscle atrophy, loss of joint mobility.

X-ray manifestations:

thinning of bone tissue, the occurrence of erosions;
noticeable atrophy of the muscular frame;
joint deformation;
salt deposits, as well as calcification of joints.

Treatment of rheumatoid arthritis at this stage is carried out only in a hospital setting. The prognosis is conditionally unfavorable.

Fourth (terminal) stage

An extremely severe course of the disease, accompanied by a large number of complications.

Diagnosis of rheumatoid arthritis at this stage determines such signs as:

severe pain that prevents rest;
pain in the eye sockets, chest discomfort;
partial or complete loss of sensation in the limbs;
significant decrease in motor activity;
spread of the inflammatory process to large muscles;
gastrointestinal tract damage;
the occurrence of a large number of ulcers/rashes.

X-ray manifestations:

obviously noticeable osteoporosis;
many erosions/cysts;
tissue fusion;
total deformation (not subject to restoration).

Treatment of stage four rheumatoid arthritis is only in a hospital setting. The prognosis is extremely unfavorable.

Side effects of cytostatics

Toxic reactions are caused by damage to normal tissues, which are usually very sensitive to cytostatics:

blood cells, which is clinically manifested by changes in tests, most often leukopenia and neutropenia, thrombocytopenia and much less often - anemia;
bone marrow gradually slows down the rate of restoration of hematopoietic sprouts, active tissue is replaced by connective and fatty tissue, and in blood tests the level of all formed elements decreases;
mucous membranes react with necrosis with rejection, which is manifested by stomatitis, colitis, enteritis, pneumonitis and inflammation of the venous endothelium;
the gonads respond by disrupting spermatogenesis and stopping menstruation;
skin appendages - hair falls out, nails become coarser and change their structure.

The drug may have not only general, but also individual toxic manifestations, in which nerve cells or renal tubules, hepatocytes or muscle fibers of the heart selectively die. Sensitivity to drugs is very individual, and the spectrum and severity of adverse reactions also vary.

Diagnosis of rheumatoid arthritis

You should go for a diagnosis of rheumatoid arthritis if the following symptoms occur:

painful symmetrical swelling/edema of several joints;
the occurrence of morning stiffness;
presence of subcutaneous nodules;
changes on the radiograph (detection of osteoporosis/erosions/cysts).

In order to clarify the suspected diagnosis, the following methods are used:

MRI (magnetic resonance imaging) – makes it possible to determine the condition of the periarticular tissues;
puncture (extracting a sample of joint (synovial) fluid) - helps determine the presence of specific cells and leukocytes.

Treatment of rheumatoid arthritis with non-drug methods

Despite the fact that the disease cannot be completely cured, fighting it makes sense and, with the right approach, gives the best possible results.

The key objective of non-drug and drug therapy is:

elimination of symptoms;
achieving stable and long-term remission;
inhibiting the activity of autoimmune reactions;
preventing or slowing down the manifestation of complications.

Physiotherapy

Physiotherapeutic methods are aimed at accelerating tissue repair/healing, as well as supporting muscle tone and maximizing joint mobility in rheumatoid arthritis.

Physiotherapy includes:

electrophoresis/phonophoresis (exposure to electric field/ultrasound);
balneotherapy (mineral water baths);
mud therapy.

It is best if the therapy is carried out in an inpatient setting.

Massage

An excellent treatment method, the use of which is necessary during the period of remission of the disease. The duration of the course and the duration of the sessions are determined by the nature of the disease.

Procedures should be performed only by a professional massage therapist, after consultation with the attending physician.

Therapeutic exercise (physical therapy)

Helps maintain mobility and also locally activates metabolic processes by improving blood circulation.

The set of exercises is selected in accordance with the current stage of the disease and taking into account the recommendations of the attending physician.

Orthopedic surgeries

Possibility of restoring the functionality and structure of joints. Today the following solutions are available:

arthroscopy is a minimally invasive intervention (involves pinpoint punctures) performed to treat joint damage;
endoprosthetics - replacement of components or an entire joint, providing mobility.

Indications and contraindications for the use of cytostatics

Antitumor drugs are used only with morphological confirmation of the diagnosis. Processes are not recognized as malignant if the morphological (histological) conclusion indicates “suspiciously for...”, there must be an accurate and 100% answer. If suspected, additional research is necessary - a repeat biopsy, IHC and even genetic research.

A global contraindication is predicted intolerance to chemotherapy in the presence of severe concomitant diseases or a serious condition caused by a malignant disease. When “the game is not worth the candle” and drug intervention threatens serious complications and death.

You cannot use drugs if they are known to be ineffective - outside the spectrum of activity.

Temporary contraindication: inflammatory and infectious diseases, residual complications after the previous course of treatment.

Today, the choice of antitumor drugs is so wide that it is not difficult to choose the optimal drug or even combination. However, if at least two lines of therapy are ineffective and the condition is progressively worsening, a third chemotherapy option is not always advisable.

Treatment of rheumatoid arthritis with drugs

How to treat rheumatoid arthritis using medications can only be determined by the attending physician who has a complete clinical picture of the patient’s disease.

Treatment of rheumatoid arthritis with drugs is carried out under the close supervision of a specialist and is adjusted in accordance with the existing/absent progress.

Chondroprotectors

A wide group of drugs that promote the regeneration of connective tissue and improve the condition of cartilage. Available in various forms (tablets/ointments).

Frequently prescribed ones include: “Artracam”, “Mukosat”, “Chondrolone”.

Antispasmodics

Helps relieve spasms of smooth muscles surrounding inflamed joints.

The most effective are “Spazmalgon”, “Trigan”, “Maxigan”.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

They have an anti-inflammatory effect and help inhibit the activity of the enzyme that causes destructive processes. The most commonly prescribed and at the same time very effective drug is Artradol.

Biological agents

Protein-based drugs. The key purpose is to suppress inflammatory processes due to its effect on the components of the immune system.

The most effective are: “Halofuginon”, “Humira”, “Orencia”.

What cytostatics are most often prescribed?

Only those that actively treat this malignant nosology and are optimal in a specific clinical case are prescribed. The widest range of activity is found in the antibiotic doxorubicin, alkylating platinum derivatives and cyclophosphamide, plant taxanes and the antimetabolites fluorouracil and methotrexate.

Clinical guidelines suggest using the most effective combinations of drugs with an optimal balance of effectiveness and toxicity. In our clinic, we select cytostatic therapy individually, depending on the sensitivity of the cancer tumor. We do not guarantee the absence of toxicity, but we can minimize its manifestations and accelerate the restoration of normal tissues.

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Nutrition

Compliance with the principles of a healthy diet helps to consolidate the favorable results of successful treatment and maintain remission for as long as possible. A diet for rheumatoid arthritis and a transition predominantly to plant foods helps to significantly reduce the exacerbations that occur.

How to treat rheumatoid arthritis with diet? Experts recommend eliminating allergenic foods (for example, tomatoes and eggplants), as well as introducing more vitamins and animal proteins, which helps reduce muscle loss. Preference should be given to lean meats, as well as sea fish and baked foods.

In addition, it is recommended to give up bad habits, since any intoxication can provoke an exacerbation.

What are cytostatics?

Chemotherapy is exclusively the use of cytostatics. In addition to chemotherapy, antitumor treatment includes endocrine effects using hormonal drugs, targeted therapy that “turns off” a certain biochemical reaction, and the use of biological - immuno-oncological agents, which themselves do not act on the malignant cell, but activate immune defenders.

Cytostatics damage all rapidly dividing cells - any malignant and normal cells in the blood, bone marrow and gonads. Over time, cell clones develop resistance to cytostatics, reducing the effectiveness of chemotherapy.