Rheumatoid arthritis is a chronic inflammatory connective tissue disease of unknown cause that affects the strongest locomotor system.
Characteristic pathology of the disease lasting inflammation of the synovial membrane of peripheral joints, which is symmetrically distributed with it.
The disease can manifest mild clinical picture in which only some of the affected joints or a severe form of the disease with severe deformities. The most common variant of the disease of moderate severity.
According to epidemiological data, the disease affects about 1% of the population, but that this disorder is more common in females and up to 4 times compared to males. The disease usually begins 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 the 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 to the body. Other theories say autoimmune mechanism. Be that as it may, the real cause of the disease has not yet been discovered.
The clinical picture
The disease in the majority of cases, slow but progressive. Can start without cause, or he may provoke some stress, for example. childbirth, miscarriage, any serious disease. Only exceptionally acute disease starts, sudden attacks, which presents serious inflammation of one or more joints.
The patient is in a grace period unwell, exhausted, as if he lacks vital energy. It may develop increased sweating, decreased appetite and sleep rhythm disorder. These general symptoms may be referred to a doctor for about rheumatoid arthritis, but not necessarily because many diseases have similar clinical picture, for example. disease chronic fatigue.
After initial nonspecific phase occurs first characteristic, recognizable signs of the disease. One such character is the morning stiffness of the joints, the patient is most directly experienced the hand and finger joints. When joints fail to stretch the patient does not feel any major problems until the next morning when it will be repeated again in the stiffness of the joints. As time goes by morning stiffness were more severe and longer lasting.
Shortly after the morning stiffness and pain occurs, which is initially present only periodically, or some movement in the joint, and later became a permanent presence.
In the initial definition of the disease, we mentioned that the strongest attacks locomotor system, which is primarily related to the joints. Joints become swollen over time. At first, the island is not hard and can be embedded, because we work in the effusion of inflammatory articular rheumatoid arthritis saccus. Differentiation to other similar diseases in terms of grasping the joints, swollen joints that are symmetrical and are usually the first joints swollen fingers and feet . Affected joints are hand (metacarpophalangeal) and finger (proximal interphalangeal joints)
After the small joints of the disease can be spread to larger wrists, the knees, elbows and shoulders.
Chronic inflammation of the small joints of the hand result in deformation of the hand in terms of turning the ulnar side of the finger, with the entire hand can be due to degeneration of the wrist to be deflected radially.
In addition to the joint, changes may also occur in other organs and organ systems.
The skin subcutaneous nodules occur, especially in patients showing severe clinical picture. The skin may show signs and vasculitis, and ischemic necrosis and ulceration may occur, and skin atrophy.
From internal organs were observed changes in the heart and lungs. The heart may show a disturbance in the sense of pericarditis, while pleurisy occurs in the lungs, and diffuse interstitial pulmonary fibrosis.
Caplan's syndrome separate clinical entity, which means the simultaneous appearance of rheumatoid arthritis and Pneumoconiosis. The disease is characterized by diffuse appearance of nodes in the lungs of 1-2 cm.
An eye infection can occur sclera and episcleritis is developed.
The nervous system can be affected by mononeurituse, or indirectly as in the case of carpal tunnel syndrome.
Feltyev syndrome represents a separate syndrome. Simply put it is the rheumatoid arthritis that is accompanied by enlarged lymph nodes (lymphadenopathy), and spleen. In addition to the shortage occurs in the number of cells of three lineages, anemia, thrombocytopenia and granulocytopenia. All this is accompanied by very severe systemic signs of illness.
Any diagnosis starts with history and from conversations with the patient. The patient may present data on the same or a similar illness in the family, as well as information about the abovementioned general symptoms of the disease such as fatigue, insomnia, weakness, etc.. It should definitely seek information on morning stiffness.
Physical search is mainly focused on the examination of joints, the existence of deformation, failure to function, the existence deformity
Important role in the diagnosis of rheumatoid arthritis have laboratory tests, which can be divided into three distinct groups.
Laboratory tests for inflammatory activity: a standard measure erythrocyte sedimentation rate, which in the case of increased inflammation. Besides, it can be asked and C-reactive protein.
Hematological tests. In blood we are anemia, specifically anemia. The level of serum iron is 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 dilutions of serum. Thus, the normal titer 1:32 and 1:64 and more pathological. However, it should be noted that the findings of rheumatoid factors in serum not absolutely certain diagnostic significance, since it can be found in and under certain other diseases.Therefore laboratory, which is the rule in medicine, should be seen in context of the overall findings and impressions about the symptoms of disease, but also in the context of the general condition of the patient.
From other tests are used to: Search synovial fluid, radiological examinations such as X-ray or MRI, scintigraphy, arthrography and arthroscopy.
As with many other diseases that is not recognized or detected by the underlying cause of the disease, and rheumatoid arthritis with no specific causal therapy. Therefore, it is aimed at symptomatic treatment of the disease mitigated. It refers mainly to relieve pain, calm the inflammatory and Maintenance (link-motion treated RA) functionality musculoskeletal system particularly the joints. This type 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 a good relationship with the building of trust and education, all with the aim to empower patients and to provide support for the need and the will to persist in treatment. It is important to note, because clinical experience suggests that the autoimmune disease (where the body attacks itself) often occur in people of lower spake spirit and confidence.
As a way to treat inflammation of the currently used drugs from the group of systemic antimalarials, gold salts, penicilinamin, sulfasalazine, and as a last resort immunosuppressants.
Pain and inflammation can be repaired using non-steroidal anti-inflammatory drugs (aspirin, andol, ibuprofen). In weak results of these drugs may resort to the use of corticosteroids.
Physical therapy, and often moving, very important component in maintaining health.
When all previous methods fail or in case of any serious consequences of disease, the doctor will have to use surgical methods for repairing degenerative changes occurred in the joints and tendons.
Disease course and prognosis
The disease has a progressive course despite periods of remission (improvement). Periods of relieving the symptoms often associated with deterioration. These phases are frequently updated.
Prognosis is unfavorable. This does not include the quick death. An unfavorable outcome of the disease is mainly related to the loss of opportunities to engage in everyday activities. About 50% of patients, despite proper treatment station within 10 years unable to work.
Retrieved from medicina.hr
Rheumatoid arthritis is important to detect the time
Rheumatoid arthritis (RA) is one of the most common autoimmune disease from which, according to estimates, in Europe, affecting about three million, while in Serbia the disease troubling about 35 000 people.
Nutrition in patients with rheumatic diseases, treatment and easier to perform daily activities were the subject of the meeting of patients with rheumatoid arthritis with experts at the Institute of Rheumatology Serbia.
Experts have suggested that, in addition to pronounced and chronic pain, suffering from rheumatoid arthritis are most concerned about limitations due to movement of the joint which can not perform daily activities - zavtranje and tap wrench, open and close the bottle, closure and Removing clothes ...
The cause of RA is still unknown, and it is believed to lie in a combination of innate susceptibility to infection and disease. These changes lead to chronic inflammation of the joints that will eventually lead to permanent damage, pain and disability.
Thanks to modern biological drugs is now possible in time to stop the disease before permanent disability occurs.
According to a rheumatologist, it is very important to detect the disease at the time (morning stiffness longer than 30 minutes, the pain of a handshake and symmetrical swelling of joints of hands and feet) and contact your doctor promptly to the patient to a specialist, who will then start the treatment.
RA treatment aims to relieve pain, stiffness, swelling, and symptoms and signs of inflammation, stopping structural joint damage, physical function normalization after stopping the inflammation and joint damage.
The people popularly (but incorrectly) called "rheumatism" is actually a group of diseases that are mainly expressed in the locomotive apparatus (hands, feet, spine, joints) but they all share the pain and limited movement of the affected body part. Rheumatic diseases are gupu in connective tissue diseases.According to the current understanding of rheumatic diseases, many have a sensitizing the organism to various allergens (see more under allergies). They were also relatively frequent changes in the joints in the form of pain (arthralgia) or true inflammation (arthritis) with other signs of allergy (hives, edema Kvinkeov etc.).
Connective tissue is among the supporting tissue along with cartilage and bone.
All of these tissues are made up of: cells and intercellular substance, which is different in each group.
Connective tissue cells are different: fibrocytes (fixed connective tissue cells), mesenchymal cells (undifferentiated cells of the supporting tissues of the embryo), histiocytes (loose tissue cells with phagocytic capacity - devouring foreign particles), leukocytes (white blood cells - the main role of their defense organism); metachromatic cells (a type of connective tissue cell that has different colors), fat cells (fat cells where the fat is deposited) and pigment cells (in which the pigment is present - and that gives color to the cells.
This is important, because it determines the role of connective tissue cells and the role of connective tissue, which thanks to them not only supportive.
Various supporting tissues
According međućelijskoj substances, supporting tissues are classified as connective, cartilage and bone tissue. Connective tissue is the softest, but it may become a more solid - cartilaginous and cartilaginous exceed the toughest - bone.
Connective tissue connects bone to form tendons, joint capsule, surrounds individual muscles and muscle groups and connects them with the bones. In addition, it envelops various organs and enters them together with blood vessels and nerves and the cells listed above as needed, each done their part.
Intercellular substance consists of fiber in base substance and tissue fluid.
Starting material was visible homogna and transparent. Has the properties of colloidal solution, and the consistency of salt varies from state to gel state. It is rich in acid mucopolysaccharides (carbohydrates group), hyaluronic acid, chondroitin sulfuric acid, ii.
It houses the fiber: collagen (parallel bundles of collagen fibers albumoida) elastic (thin fibers, do not build a bundle composed of elastin and albumin are elastic) and reticular (very thin, abundantly branched and form a network - that is stretchable reticulum ). These fibers are found in the collagen because the difference between them more physical than the chemical composition.
Connective tissue is divided into: 1 unformed second formed the third connective tissue with special properties.
First Unformed connective tissue is then divided according to the number of binding cells and the intercellular substance:
a) rare connective tissue that has many cells and little intercellular substance and is widespread throughout the body and allows the body hypermobility, eg hypermobility of the skin to the ground, esophagus and trachea in the environment, bladder, etc.. This tissue in addition to the mechanical role has a role in metabolism, the deposit of fat, water retention, and renewal of all types of supporting tissue in the body's defense against bacteria and other harmful effects.
b) dense connective tissue is composed of densely compacted bundles of collagen fibers with a few elastic fibers and a small number of cells. It is part of the connective skin, submucosa of the entire gastrointestinal tract (digestive tract), and the matrix the urethra.
Second Formed connective tissue is made of properly arranged all the listed components (cells and intercellular substance from its elements) that can meet the mechanical requirements. It builds tendons, fibrous membrane, and other links.
3rd Connective tissue with special properties: it is one slimy, elastic, reticular, and adipose tissue pigment.
The difference is mainly in the elementary substances and the role of tissue that is strictly dedicated.
A wide variety of symptoms
This extensive overview is given in order to understand the concept - connective tissue disease. It is clear that the tissues in all parts of the body and the changes - disease - can occur in one place, in many places, but they can be all over the body, and is applicable to several diseases and systemic disease name.
If there is a change in the body, they are played out in the interstitium (interstitial spaces stem cell organs that are affected) and not the stem cells of the body.
According to the current understanding of rheumatic diseases, many have a sensitizing the organism to various allergens (see more under allergies). They were also relatively frequent changes in the joints in the form of pain (arthralgia) or true inflammation (arthritis) with other signs of allergy (hives, edema Kvinkeov etc.)
This applies only to certain diseases and still during the examination.
For such a broad group of diseases, which present different pathological processes with various development sopstvnim whether inflammatory or non-inflammatory nature, degenerative or metabolic processes, acute or chronic course, the only joint pain. For this reason it is necessary classification of groups with more similarities to testing, monitoring and treatment could be adequately standardized and implemented in all health facilities.
Here, the application of the following classifications:
And inflammatory rheumatism
First Rheumatic fever
Second Rheumatoid arthritis and its variants
3rd Spondiloartritis Ankilopoetica (M. Bechterew - Marie - Stumpl)
4th Other forms of systemic connective tissue diseases
a) systemic lupus eritemni (process on facial skin)
b) Polyarthritis nodoza
Degenerative rheumatism II
Arthritis and spondylosis deformans and spondiloartritis.
Metabolic III Rheumatism - Gout
IV rheumatism - fibrositis
(Muscular rheumatism or miofibritis, tendinitis, bursitis, tendovaginitis, neuritis, paniculitis or cellulitis).
Rheumatic disease of the first group (I) are systemic connective tissue diseases (affects connective tissue of the whole body), very deteriorated condition, have an evolutionary process and have permanent effects. It is believed that the basis of these diseases is the body hypersensitivity to certain allergens.
The second group (II) includes arthritis or degenerative diseases (arthrosis), a local nature, and pathological changes manifest themselves in one or more joints. They do not have a systematic character and do not affect the general health status of patients. Degeneraivnih change occurs (damage cells and tissues, the loss of specific properties of cells and reduced the ability of cells to reproduce, adapt and heal), articular cartilage and bone, often in the course of the aging process and the lack of sex hormones (first decrease, and then a complete lack of).
It is important to note that there is individual susceptibility related to genetic factors. The main symptom is pain stronger or weaker intensity and is characterized by durability. This pain is more intrusive, spoils the mood and a sense of tension in the beleaguered joint (joint pain) and muscle spasms, but without the stiffness in the joints and lasting consequences.
The third group (III), metabolic rheumatism (gout)
Nataje disorder of purine metabolism (compound purine bases and uric acid) which results in an increase of uric acid in the blood and the deposition of urate (uric acid salt) in the tissues of the joints (one or more), leading to inflammation, pain, stiffness, and deformity.
The fourth group (IV) This includes all forms of rheumatism - fibroziti. They are characterized by local inflammation of connective tissue on one wrist, and can be extended to the surrounding muscles. It can be caused or aggravated by hard work, moisture, and excessive obesity might be provoking factor. Injuries and congenital anomalies may affect this type of disease, and degenerative rheumatism in older people.
All those who have any kind of problem rheumatic pain respond to weather changes, and often anticipating. Weather instability acting on the autonomic nervous system (which works without the participation of our will) and causes in sensitive people joint pain and migraine headaches. This mechanism is related to the electrical state of the atmosphere. Amounts of positive and negative ions in the air charging affect the nervous system by reducing the negative ions, and positive reinforce the excitability of nerves. Any increase in the excitability of nerves causing joint pain, bad feelings and resentment.
Rheumatic diseases are more common, more and more cause temporary inability to work or permanent disability. Early and correct diagnosis and proper treatment can influence the course and outcome of disease.