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Symptoms, diagnosis and treatment of rheumatoid arthritis

Symptoms, diagnosis and treatment of rheumatoid arthritis

Symptoms, diagnosis and treatment of rheumatoid arthritis


Rheumatoid arthritis (RA) is a systemic, chronic, autoimmune disease of unknown cause that predominantly affects the joints. Rheumatoid arthritis is thought to occur in genetically predisposed individuals under the influence of currently unknown or unknown external factors. Generally speaking, rheumatoid arthritis is considered to be the most common inflammatory rheumatic disease affecting an average of 1 to 1.5% of the population.

How Does Rheumatoid Arthritis Form?

What Are The Symptoms Of Rheumatoid Arthritis?

Rheumatoid arthritis outside the joints

Diagnosis of rheumatoid arthritis - what tests can be done?

How is rheumatoid arthritis treated?

Prognosis and course of rheumatoid arthritis

How Does Rheumatoid Arthritis Form?

The primary process begins in the synovium (the membrane that envelops the joint), which thickens due to constant inflammation (then called the panus) and is rich in enzymes and other substances that destroy the joint cartilage and bone and lead to irreversible changes in the joint. As a consequence, joint instability occurs, leading to the progressive development of deformities typical of rheumatoid arthritis.

 

The disease can occur at any age, most commonly seen between the ages of 20 and 40. The disease is three times more common in women.

 

What Are The Symptoms Of Rheumatoid Arthritis?

Rheumatoid arthritis in more than 80% of patients begins gradually, with general symptoms such as fatigue, malaise, weight loss, and mild fever.

 

After several weeks to months, the characteristic symptoms associated with the joints begin: pain, swelling and numbness. First there is joint pain that lasts longer and is more intense. Stiffness of the joints is most pronounced in the morning, at first it is of shorter duration, and afterwards it becomes longer and lasts up to several hours. It is this morning stiffness that is characteristic of rheumatoid arthritis.

 

The swelling of the joints is spindle-shaped and is caused by a bulge in the joint or a thickened joint membrane.

 

The most typical locations of arthritis are the wrists and the small joints of the hands and feet, although the involvement of the knees, ankles, elbows and shoulders is also common. It should be emphasized that all joints can be affected by inflammation (such as small joints between the hearing aids or larynx joints), so this can be manifested by hearing and hoarseness.

 

The disease is typical of the symmetry of the joint involvement, although the problems may be more intense on one side. As the disease progresses, the cartilage and bone under the cartilage are destroyed, and the joints lose their mobility and mobility, characteristic deformities for rheumatoid arthritis occur, which also reduces working capacity.

 

Rheumatoid arthritis outside the joints

Because rheumatoid arthritis is a systemic inflammatory disease, it can also be manifested by numerous extra-articular changes in the skin, lungs, corpuscles, heart, or blood vessels. On the skin can be found so-called rheumatoid nodes most commonly in the area of the elbows or at any site exposed to external pressure. Ulcers (wounds) can occur on the skin due to poor skin nutrition due to inflammation of the blood vessels that supply the skin with blood.

 

Furthermore, in the lungs, the disease can be manifested by interstitial lung fibrosis, pleuritis (inflammation of the duct), which is manifested by shortness of breath and cough. The heart can also be affected by inflammation, and is manifested by a disruption of the heart, difficulty breathing, pressure in the chest. Often occurs the so-called. dry eye (lack of tears) or inflammation of the eye - episcleritis. Nerves may also be involved.

 

The most common hematologic change is mild anemia, which correlates with inflammatory disease activity.

 

Diagnosis of rheumatoid arthritis - what tests can be done?

Diagnosis of rheumatoid arthritis is not easy as many other conditions may resemble this disorder. In addition, laboratory tests may be normal for months after the first onset of the problem.

 

Laboratory findings have accelerated erythrocyte sedimentation, elevated C reactive protein (CRP) values, and often develops anemia (so-called anemia due to chronic disease. Platelet counts are often elevated in patients with active rheumatoid arthritis.

 

About 70% of patients have a positive rheumatic factor (Waaler Rose test and Latex test are positive). Anticitrulline antibodies (so-called anti-CCP antibodies) have a high diagnostic value in many patients.

 

Classical radiological recordings of crooked wrists (eg, hands and feet) are examinations to determine and later monitor changes in the wrists and evaluate disease progression. In the early stages of the disease, while the changes are invisible by 'ordinary' RTG scan, very early changes that support arthritis can be observed by magnetic resonance imaging (MR). In addition, this technique also helps to understand the mechanism of the disease. However, unavailability and search price are major limiting factors in its application.

Ultrasound is applied at the beginning and during the follow-up of the disease, and targeted examination can detect early changes typical of rheumatoid arthritis.

 

Skeleton scintigraphy is sometimes used in early diagnostic processing to detect possible accumulation of radioisotopes in joints affected by inflammation.

 

How is rheumatoid arthritis treated?

The goal of treating rheumatoid arthritis is clinical remission or at least poor disease activity.

 

Clinical remission is defined in clinical practice by the absence of inflamed joints and the neat value of CRP.

 

Early diagnosis and early administration of medications are invaluable. Medication is used to control the inflammatory process and calm the disease. If left untreated, there is progressive bone destruction, joint deformity with complete loss of function.

 

The "gold standard" in the treatment of rheumatoid arthritis today is methotrexate, an immunosuppressant given in weekly doses. Initially, low doses of corticosteroids are used to calm inflammation. Of the other drugs in the group so-called. basic medicines have been successfully used medicines such as sulfasalazine, leflunomide, antimalarials.

 

Non-steroidal anti-rheumatics (NSAIDs) are also used which primarily reduce pain but also have some anti-inflammatory effect. Today, there are also NSAIDs on the market with fewer side effects on the digestive system, while maintaining the same anti-inflammatory effect - the so-called. coxibs or COX2 inhibitors.

 

If, over a period of time, consistent administration of drugs that modify the course of the disease (methotrexate, leflunomide, salazopyrine) has not been satisfactory, then biological drugs targeting cytokines or their receptors or immune cells involved in inflammation are administered. Today, several different biological drugs with different mechanism of action are used in the treatment of rheumatoid arthritis (TNF-α inhibitors, interleukin-6 inhibitors, CD20-directed antibodies, T lymphocyte costimulation inhibitors). Possible infections (tuberculosis, hepatitis) should be ruled out prior to administration of biological drugs. In addition, frequent monitoring of patients to monitor the efficacy of the drug as well as possible side effects is required during the application of biological therapy.

 

Kinesitherapy (medical exercises) and methods of physical therapy aiming at preserving the functional capacity of the patient occupy an important place in the treatment.

 

Surgical treatment of rheumatoid arthritis can be preventative at the early stage of the disease, but also a method of choice at a later stage (eg, replacement of artificial joints at the site of worn and diseased joints).

 

Prognosis and course of rheumatoid arthritis

The prognosis and course of rheumatoid arthritis are variable. At the very outset of the disease, education of patients and family members about the nature of the disease, therapeutic options, alarming clinical symptoms and lifestyle is necessary.

 

It is important to identify and diagnose rheumatoid arthritis as early as possible, as well as to start differentiating therapy as early as possible and to control the disease as successfully as possible. The goal is to achieve remission as quickly as possible and to maintain the patient's functional capacity for as long as possible.


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