Sunday, July 22, 2012

Rheumatoid Arthritis


Rheumatoid arthritis is a chronic inflammatory disease of connective tissue, of unknown cause that most powerfully affects the locomotor system.
A characteristic pathological findings of the disease lasting inflammation of the synovial membrane of peripheral joints, which is symmetrically distributed with it.


The disease may express mild clinical course in which they affected only some joints or a severe illness with severe deformities. The most common variant of the disease is of moderate strength.

According to epidemiological data, the disease affects approximately 1% of the population, provided that this disorder is more common in women and up to 4 times compared to males. The disease usually starts in the fourth or 5 decade of life. Some family studies have shown a genetic predisposition for the disease.

The cause of the disease
For now, it still does not know for sure what could be a direct cause of the disease. There are several assumptions. One of them says that it is a response to an infectious agent in the body, which consequently leads to damage of the organism. Other theories say the autoimmune mechanism. However, the real cause of the disease has been discovered.

The clinical picture
The disease in most cases develop slowly but progressively. Can start without cause, or may induce some stress, such as. childbirth, miscarriage, any serious illness. Only exceptionally the disease begins with acute, sudden attacks, which presents severe inflammation of one or more joints.

The patient is in a grace period unwell, exhausted, as it lacks vital energy. There may be a sweating, weak and appetite disturbance in sleeping patterns. These general symptoms may be referred to a doctor for about rheumatoid arthritis, but not necessarily, because many diseases have similar clinical picture, eg.disease of chronic fatigue.

After initial nonspecific phase occurs first characteristic, recognizable signs of the disease. One such character is the morning stiffness in the joints, the patient is most directly seen in the joints of the fingers of the hand. When joints fail to stretch the patient does not feel any major problems until the next morning when they will again repeat the stiffness of the joints. As time goes by morning stiffness are more severe and longer lasting.

Shortly after the morning stiffness and pain occurs, which is initially present only periodically, or in some movement in the joint, and later became a permanent presence.

The initial definition, we mentioned that the disease attacks the strongest linear system, which is primarily related to the joints. Joints become swollen over time. Initially the island was not hard and can be pressed, because we are working on inflammatory articular effusion in rheumatoid arthritis vreću.Karakteristika to some other similar diseases in terms of grasping the joints, swelling of the joints that are symmetrical and are usually the first joints swollen fingers and toes . Affected joints are hand (metacarpophalangeal) and fingers (proximal interphalangeal joints)

After the small joints of the disease can spread to larger joints, the knees, elbows and shoulders.

Chronic inflammation of the small joints of the hand result in the deformation of the fists in the sense of turning the finger ulnar side, while the whole hand may be due to degeneration of the wrist to be deflected radially.

In addition to the joints, changes may occur in other organs and organ systems.

Appear on the skin subcutaneous nodules, especially in people who show more severe. The skin may show the signs of vasculitis, and ischemic necrosis, and ulceration may occur, and skin atrophy.
Of the internal organs were observed changes in the heart and lungs. Heart can show the disorder in terms of pericarditis, while pleuritis occurs in the lungs, and diffuse interstitial pulmonary fibrosis.

Caplan's syndrome is a separate clinical entity, which means simultaneous occurrence of rheumatoid arthritis and Pneumoconiosis. The disease is characterized by diffuse appearance of nodes in the lung 1-2 cm.

An eye infection can occur and the sclera develops episcleritis.

The nervous system can be affected by mononeurituse, or indirectly as in the case of carpal tunnel syndrome.

Feltyev syndrome seems isolated syndrome. Simply put it is about rheumatoid arthritis, which is accompanied by an increase of lymph nodes (lymphadenopathy), and spleen. In addition there is a deficit in the number of cells of three lineages, anemia, thrombocytopenia and granulocytopenia. All this is accompanied by very severe systemic signs of illness.

Diagnosis
Every diagnosis begins with a history, or from conversation with the patient. The patient may present data on the same or similar illness in the family, as well as information about the abovementioned general disease symptoms such as fatigue, insomnia, weakness, and the like. It should definitely look for information about morning stiffness.

Physical search is mainly focused on the examination of the joints, the existence of deformation, failure to function, the existence derformiteta.

Important role in the diagnosis of rheumatoid arthritis have laboratory tests, which can be divided into three different groups.

Laboratory tests for inflammation activity: a standard measure erythrocyte sedimentation rate, which in the case of elevated inflammation. It can also be requested and the concentration of C-reactive protein.

Hematologic tests. In blood, we are anemia, specifically norocitne normokromne anemia. The level of iron in the serum decreased.

Immunological tests. Search the presence of rheumatoid factor in serum. This is done so. Waaler-Rose test. The test results are read by different serum dilutions. This is a normal titer 1:32, and 1:64 and more pathological. However, it should be noted that the findings of rheumatoid factor in serum does not absolutely certain diagnostic significance, since it can be found in and the other diseases. Therefore, laboratory findings, as is the rule in medicine, should be viewed in the context of the overall findings and impressions about the symptoms of the disease, but in the context of the general condition of patients.

Of the other tests are used: a search of joint fluid, radiological examinations such as X-ray or MRI, scintigraphy, arthrography and arthroscopy.

Therapy
As with many other diseases which is not recognized or discovered the underlying cause of disease, and rheumatoid arthritis with no specific causal therapy. Therefore, treatment is aimed at symptomatic mitigate the course of disease. This primarily refers to relieve pain, calm the inflammatory process and maintenance (link-motion treated RA) functionality of the locomotor system especially the joints. This kind of treatment is short-lived, but may extend throughout life. Therefore, it is the duty of every physician, and patient with each other to establish good contact with the building of trust and education, all with the aim to empower patients and that it needs to provide support and willingness to pursue treatment. This is important to note, because clinical experience suggests that autoimmune diseases (when the body attacks itself) often occur in people of lower directs the spirit and confidence.

As an anti inflammatory drugs are currently used drugs in the systemic group of antimalarials, gold salts, penicilinamin, sulfasalazine, and immunosuppressive agents as a last resort.

Pain and inflammation can be repaired using non-steroidal anti-inflammatory drugs (aspirin, andol, ibuprofen). When poor performance of these drugs can resort to the use of corticosteroids.

Physical therapy, and often moving, very important component in maintaining health.

When failure is all the previous methods, or in case of any serious consequences of disease, the doctor will need to use surgical methods to repair caused degenerative changes in joints and tendons.

Disease course and prognosis
The disease has a progressive course in spite of periods of remission (improvement). Periods of relieving the symptoms are often accompanied by deterioration. These phases are frequently updated.

Prognosis is unfavorable. There can not think of a quick death. An adverse outcome is mainly related to the loss of opportunities to do everyday activities. About 50% of patients, despite proper treatment stations within 10 years unable to work.

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