The most effective drugs for rheumatoid arthritis

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.

Arthritis symptoms

Manifestations of the disease depend on its clinical form and severity of the process. The main symptoms of arthritis include local manifestations of inflammation in the joint - pain, redness and swelling of surrounding tissues, limited mobility, deformation as pathological changes progress. There is also a local increase in temperature, the affected area becomes hot when touched.

Infectious

The course of the disease depends on the type of pathogen. Often there is a sharp increase in temperature, chills, headache, and weakness. Tuberculous arthritis occurs in a chronic form, is difficult to treat and leads to severe dysfunction of the affected joint. With gonorrhea, as a rule, acute serous inflammation develops. Viral lesions go away after the infection is cured.

Gouty

Gout is a metabolic disorder that is accompanied by the deposition of uric acid salts - urates - in the joints. They penetrate the tissues, forming gouty nodes or tophas. The metatarsophalangeal joints of the thumbs are usually affected first, followed by arthritis in other areas. During an exacerbation of the disease, acute inflammation develops with tissue swelling and severe pain. After several attacks of gout, the joint becomes deformed and its function is impaired.

Rheumatoid

An autoimmune reaction develops with damage to the body’s own tissues, including joints. The causes of the disease have not been precisely established, but it is known that inflammation is triggered by infection in the body. At the onset of the disease, there is an increase in body temperature, the patient is worried about morning stiffness - a gradually passing limitation of mobility after waking up, pain and swelling at the site of inflammation. Symptoms may spontaneously disappear for several months, followed by exacerbation and progression of the disease. Damage to the hand and fingers is typical, but there are cases of atypical reactive arthritis with inflammation of the knee or shoulder joint. Gradually, without treatment, articular cartilage is destroyed, connective tissue grows, subluxations and dislocations occur, leading to disability of the patient.

Traumatic

Develops after injury to large joints - hip, knee, shoulder and others. There is pain, swelling and crunching when moving. With a closed injury and aseptic inflammation, spontaneous recovery is possible. With an open wound, the infection penetrates deep into the tissue and can cause purulent inflammation.

Psoriatic

It is characterized by damage to the terminal interphalangeal joints of the fingers and nails with simultaneous asymmetric damage to several other areas. The course of the disease occurs with relapses and remissions.

Reactive

This form is associated with a toxic-allergic reaction to an infection that develops within a week after a bacterial, viral or fungal infection. It occurs acutely, affecting 1-3 large joints. Characterized by pain at the site of inflammation, redness, swelling of surrounding tissues, and limited mobility. Other symptoms of inflammatory damage to the eye mucosa and urinary tract may also be present.

Juvenile idiopathic

Arthritis of unknown cause in children under sixteen years of age. It is believed that the basis is the genetic predisposition of the child. Prolonged exacerbations alternate with remissions and lead to early disability of the patient.

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.

Causes of Arthritis

Arthritis is a consequence of damage to the articular cartilage or the entry of microorganisms into the synovial fluid.
In the first case, the pathology occurs due to degenerative processes in tissues due to injury or osteoarthritis. The causes of inflammatory arthritis are infection and waste products of microorganisms when:

• migration of the pathogen through blood and lymphatic vessels from nearby tissues;
• infectious diseases affecting the entire body - tuberculosis or gonorrhea;
• toxic-allergic effects of by-products of microorganisms;
• an allergic reaction to the body’s own tissues after an infection or in the presence of a permanent focus of inflammation, accompanied by a disruption in the functioning of the immune system;
• injury to the joint and infection through the wound or aseptic inflammation.

The following factors contribute to the occurrence of the disease:

• hereditary predisposition;
• increased load on the musculoskeletal system;
• infectious diseases;
• consuming large amounts of caffeine;
• smoking;
• excess weight;
• allergic reaction;
• metabolic disorders;
• traumatic injury;
• hypovitaminosis and lack of nutrients;
• pathology of the nervous system;
• malfunctions of the immune system;
• improper diet, consumption of alcoholic beverages;
• hormonal disorders;
• stinging insect bites;
• hypothermia of the body.

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:

1. Extra-articular manifestations – signal disturbances in the functioning of internal organs:
   decrease in muscle mass;
2. thinning and dry skin;
3. deformation and fragility of the nail plate;
4. hemorrhages on the skin, internal bleeding;
5. inflammation and enlargement of lymph nodes.
6. Joint manifestations indicate the development of degenerative-dystrophic processes in the joints:
   symmetrical damage to small joints;
7. visually noticeable development of the disease (swelling, stiffness, local increase in temperature);
8. the appearance of boring pain.

Symptoms

The initial stage of the disease has virtually no obvious symptoms. Over time, slight stiffness appears in the affected joints. As a rule, it occurs in the morning, as the secretion of glucocorticoids decreases. It is difficult for the patient to move, movements are inhibited. Sometimes you need help getting up. But after 30 minutes - an hour everything returns to normal. The clinic can be rolled out over several months or even years, gradually intensifying.

Primary symptoms also include:

• periodic joint pain;
• loss of appetite;
• increased fatigue.

Second stage

characterized by rapid cell division and thickening of the synovial membrane. There is symmetrical swelling of the joints, the skin in the affected areas has an increased temperature. Sudden pain is also observed, intensifying with active movement. To complete the process, they need the same amount of rest time that was spent moving.

Third stage

― active phase of inflammation involving cartilage and bones. The affected joints begin to deform, which leads to increased pain and loss of motor function.

Rheumatoid arthritis often has concomitant joint diseases, and vague symptoms make differential diagnosis difficult. Among the most beneficial combinations are rheumatism, osteoarthritis and other systemic pathologies of connective tissue. The only specific manifestation of rheumatoid arthritis can be called nodules, so-called subcutaneous formations on the extensor surface. They can be detected by palpation.

Extra-articular manifestations of RA

Pathological processes caused by rheumatoid arthritis that occur outside the joints occur in a third of patients. These symptoms also complicate diagnosis and influence the choice of treatment tactics. Among them:

• Cutaneous vasculitis (ulcerative-necrotic, livedoangiitis, infarction of the nail bed).
• Sjogren's syndrome (damage to the salivary and lacrimal glands).
• Eye lesions (scleritis - inflammation of the deep layer of the eye, episcleritis - inflammation of the connective tissue of the eye).
• Interstitial lung disease (inflammation of the alveoli, pulmonary capillaries and other tissues).

As a result of inflammation accompanying rheumatoid arthritis, pathologies of the cardiovascular, respiratory, and nervous systems may occur. The most serious complication is AA amyloidosis, which causes kidney failure.

Separately, it is worth highlighting various associated diseases that are not directly caused, but are associated with RA. These are coronary heart disease, thromboembolism, anemia, psychoneurological disorders, among which depression deserves attention. Like any other autoimmune disease with chronic inflammation, rheumatoid arthritis affects psychological well-being. The patient is recommended to undergo psychological courses and a comprehensive, comprehensive examination.

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).

Antinuclear antibodies (ANA)

Using the ANA test, you can determine the presence of antinuclear antibodies (antibodies to nuclear antigens) in the blood.

ANAs are a group of specific autoantibodies that are produced by our body's immune system in case of autoimmune disorders. Antibodies have a damaging effect on the body's cells. In this case, a person experiences various painful symptoms, such as pain in muscles and joints, general weakness, etc.

Detection of antibodies belonging to the ANA group (for example, antibodies to double-stranded DNA) in blood serum helps to identify an autoimmune disease, monitor the course of the disease and the effectiveness of its treatment.

1 Blood test for ACCP

2 Blood test for C-reactive protein

3 Blood test for ACCP

When is a blood test for antinuclear antibodies necessary?

Detection of antinuclear antibodies may be a sign of the following autoimmune diseases:

• polymyositis;
• dermatomyositis;
• systemic lupus erythematosus;
• mixed connective tissue disease;
• scleroderma;
• Sjögren's syndrome and disease;
• Raynaud's syndrome;
• autoimmune hepatitis

How is the antinuclear antibody test performed?

Blood for antinuclear antibodies is taken from a vein in the elbow, on an empty stomach. Before the study, you do not have to adhere to any diet.

In some cases, in order to differentiate various autoimmune diseases, additional clarifying tests for autoantibodies from the group of antinuclear antibodies, the so-called ANA immunoblot, may be required.

What do the test data mean?

Antinuclear antibodies (another name is antinuclear factor ) indicate the presence of some kind of autoimmune disorder, but do not precisely indicate the disease that caused it, since the ANA test is a screening test. The goal of any screening is to identify people at increased risk of a particular disease.

A healthy person with normal immunity should not have antinuclear antibodies in the blood or their level should not exceed the established reference values.

A normal ANA value implies an antibody titer not exceeding 1: 160. Below this value, the test is considered negative.

A positive test for antinuclear antibodies (1:320 or more) indicates an increase in antinuclear antibodies and the presence of a disease of an autoimmune nature in a person.

Currently, two methods are used to detect antinuclear antibodies: indirect immunofluorescence reaction using the so-called Hep2 cell line and enzyme-linked immunosorbent assay. Both tests complement each other, and therefore they are recommended to be performed simultaneously.

The following types of ANA antinuclear bodies can be distinguished in the indirect immunofluorescence reaction:

• homogeneous coloring - can be with any autoimmune disease;
• spotty or speckled coloration may occur with systemic lupus erythematosus, scleroderma, Sjögren's syndrome, rheumatoid arthritis, polymyositis and mixed connective tissue disease;
• peripheral coloring – characteristic of systemic lupus erythematosus;

If the test for antinuclear antibodies is positive, it is necessary to perform an immunoblot of antinuclear antibodies to clarify the type of autoimmune disease and make a diagnosis.

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.

Classification

According to ICD-10, the disease is systematized into the following groups:

1. Seropositive RA:

• Felty's syndrome.
• RA with involvement of other organs and systems.
• Unspecified forms.

2. Youth RA.

3. Other RAs:

• Seronegative type.
• Still's disease.
• Rheumatoid bursitis.
• Rheumatoid nodule.
• Other specified and unspecified arthritis.

According to clinical manifestations, the disease is divided into the primary stage (less than 6 months have passed since the onset of the disease), early (from 6 months to a year), advanced (from 1 year) and late (more than 2 years). Rheumatoid arthritis is distinguished by the degree of loss of functionality, immunological factors, disease activity, and instrumental characteristics.

For doctors, immunological characteristics are of greatest importance. The presence of rheumatoid factor in the blood or the presence of anti-CCP (seropositive and seronegative RA). The results of tests that reveal these values ​​allow you to correctly plan therapy.

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.

Symptoms and types of arthritis

There are several bases for classifying arthritis, which are used in making a diagnosis, clarifying the causes and symptoms of arthritis of the joints, and selecting treatment.

Due to origin

Based on their origin, arthritis is caused by:

1. Infectious or parasitic infection of the body
   . Reactive inflammation of the joints and periarticular tissues, as well as other symptoms of arthritis, can occur 4-6 weeks after the disease, as the body’s response to the vital activity of the pathogens themselves or a massive amount of antigens produced to combat them. Infectious arthritis also includes generalized pathologies that affect more than 3 joints and are associated with chronic infections (tuberculosis, syphilis, viral hepatitis, HIV and others). Infectious arthritis can also be triggered by the unwanted growth of microflora in the cecum in the postoperative period, as well as infection by worms or protozoa. In rare cases, inflammatory pathology occurs as a response to vaccination (usually occurs in children). With penetrating wounds and injuries, which are accompanied by ruptures of blood vessels, as well as with bites of blood-sucking insects in the periarticular area, direct infection of the joint capsule is possible.
2. Non-infectious reasons
   . Symptoms and causes of arthritis of the joints may depend on the presence in the body of such pathologies as: - neoplasms (arthritis develops due to metastasis to articular or periarticular tissues or due to the body’s immune response to a tumor); - diseases of the blood and blood vessels (anemia, hemorrhages); - pancreatitis, pancreatic cancer (due to the influence of enzymes on the synovium of the joint); — decompression sickness due to non-compliance with safety precautions when diving; - metabolic disorders (diabetes mellitus, gout); - hormonal changes in the body (hormonal imbalances, menopause in men and women, age-related changes); - allergies to food, drugs, vaccines or chemicals, rejection of prostheses by the body; — bruises, sprains and ruptures of ligaments, muscles, tendons, fractures, as well as other injuries (including repeated microtraumas, for example, when working with vibration equipment); - wear of the joint due to instability of chondrocytes and other pathologies of cartilage tissue; - monotonous loads and the unfavorable influence of climatic and sanitary conditions in the workplace (in this case we can talk about the so-called benign arthritis, which goes away by itself when conditions change).
3. Unspecified reasons
   . As a rule, these include secondary arthritis, which occurs against the background of autoimmune diseases (including hepatitis, rheumatoid polyarthritis, amyloidosis, systemic vasculitis, and others). Since the causes of these diseases are still not clear, the accompanying symptoms and types of arthritis also have an unspecified etiology.

According to clinical manifestations

Arthritis can affect both small and large joints, being limited to one joint or affecting several at once. Therefore, rheumatologists divide the disease into the following types:

• monoarthritis
  (affects only one joint);
• oligoarthritis
  (observed in 2-3 joints);
• polyarthritis
  (occurs in 4 or more joints at the same time).

According to symptoms

According to the severity of arthritis symptoms:

• acute arthritis
  (characterized by sudden onset, severe pain and rapid progression);
• arthritis with a chronic course
  (develops slowly, periods of remission alternate with periods of exacerbation, pain is less pronounced than with acute arthritis).

There are many symptoms of arthritis

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.

Treatment

Therapy is aimed at containing the progression of the disease, reducing inflammation and preventing joint deformation and loss of functionality. The following medications are prescribed:

• Non-steroidal anti-inflammatory substances. They reduce pain to some extent and slow down the progression of RA. May include inhibitors and blockers for IL-1, IL-6, TNF-alpha. They do not block the development of erosion and disease, therefore they are used as aids.
• Glucocorticoids. Prescribed in combination with anti-inflammatory drugs. Allows you to control the development of severe monoarticular and oligoarticular symptoms. Not used on a regular basis, as they often cause unpleasant metabolic effects.
• Basic drugs. Essential medications that can significantly slow the progression of arthritis. Courses of treatment range from several weeks to several months. The drugs differ in chemical composition and pharmacology. They are combined with each other to select the optimal treatment with the greatest effect. According to statistics, ⅔ of patients who completed the course experience significant improvement, more than half of them achieve complete remission. However, you should be aware of the toxicity of these drugs. The doctor and patient must weigh all the risks and conduct regular monitoring of the patient’s condition.

Thus, the main treatment includes basic drugs, especially methotrexate, biological antagonist drugs, and immunomodulatory drugs. Other methods of auxiliary therapy include physiotherapeutic procedures, therapeutic exercises, and a balanced combination of physical activity and rest. Quitting alcohol and smoking can prolong the patient's life. Joint curvature can be corrected through surgical correction.

Forecast

Rheumatoid arthritis shortens a person's life expectancy for a number of reasons. The risk of heart disease doubles. This is caused by the presence of chronic inflammation. The situation can be aggravated by concomitant pathologies, for example, diabetes, obesity, alcoholism.

With the development of AA amyloidosis, despite treatment, the average life expectancy of the patient is about 10 years from the onset of the disease. Without therapy, the period is estimated at several years. A common cause of death is kidney failure. On average, RA shortens life by 3 to 7 years due to the high risk of infections and gastrointestinal bleeding.

Drug therapy is also not perfect. It can cause concomitant diseases and become one of the factors in the development of malignant neoplasms. Criteria for poor prognosis include:

• early (up to 4 months) x-ray changes in joints;
• persistent increase in erythrocyte sedimentation rate;
• constant involvement of new joints;
• carriage of HLA-DR4 antigens.

About 10% of patients are doomed to severe disability with loss of self-care skills. Rheumatoid arthritis is most severe in women, smokers, and Caucasians.

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”.

Arthritis stages

Determining the stage of arthritis is an important diagnostic step

, which allows you to select appropriate treatment and monitor the rate of disease progression. Experts distinguish 4 stages, depending on the severity of the symptoms of arthritis, damage to cartilage and bone tissue.

1st stage of arthritis

Arthritis can begin unnoticed by the patient himself, because most symptoms of joint arthritis appear only at the 2nd stage. Particularly attentive patients note slight stiffness in the diseased joints and slight swelling, which is not helped by reducing salt in the diet. Mild pain may be felt when flexing and extending the joint, especially sharply. Patients complain of increasing fatigue and decreased stamina.

The initial stage of disease of the knee or shoulder joint is especially insidious

- in this case, the symptoms of arthritis are usually attributed to age-related changes or fatigue after a hard day.

Parents can notice grade 1 arthritis in a child by a decrease in his activity, lack of interest in games, frequent falls and awkwardness when performing physical exercises. A sick child does not like to run, avoids physical work, is capricious and whines if he is forced to exercise.

Although difficult to diagnose, stage 1 arthritis is the most treatable

. With a late onset of the disease, the prognosis is favorable: therapy may result in complete restoration of cartilage tissue.

Stage 2 arthritis

At stage 2, the pain becomes difficult to ignore. The pain syndrome intensifies in the morning and at night and can disrupt the patient’s healthy sleep. The swelling is clearly visible from the outside, but the patient himself may notice an unusual knotty or spindle-shaped shape of the fingers, thickening of the limb (associated with the accumulation of synovial fluid) in the joint and other visual signs of inflammation. At the 2nd stage of arthritis of the leg joints, gait disturbances and pain when walking are added to the symptoms.

At stage 2, irreversible changes and erosions may appear on the synovial membrane

.
Without the use of chondroprotectors - for example, Artracam sachet
- it is quite difficult to stop or slow down the process of cartilage destruction.

Stage 3 arthritis

At stage 3, visual changes and pain become significant. The joint becomes deformed, and when performing movements there is severe stiffness and pain. The simplest everyday activities cause difficulties for the patient. Even in the absence of loads, during rest, diseased joints continue to bother the patient. At this stage, most patients partially lose their ability to work - they may be assigned a disability.

Stage 4 arthritis

At the last stage of arthritis, the affected joints completely lose mobility

.
Pain torments patients continuously, creating a serious psycho-emotional burden. At this stage, only surgical treatment is indicated, since the cartilage tissue is almost completely destroyed, and the edges of the bones begin to grow together. At stage 4, the disease is irreversible
, accompanied by loss of the ability to self-care and/or independent movement, and persistent contractures.

There are 4 stages of arthritis

To make a diagnosis and exclude similar diseases, a rheumatologist performs an initial examination, palpation (palpation) of the affected joint, as well as motor tests. At the first appointment, a medical history is taken, the patient is asked about the symptoms of arthritis, after which the specialist issues a referral for tests and hardware examinations. Among them:

• general and biochemical blood test, rheumatic factor test;
• X-ray examination (in 2 standard projections);
• puncture and analysis of synovial fluid;
• arthrography (x-ray examination with preliminary administration of a contrast agent - usually performed during an inflammatory process in the shoulder or knee joint);
• arthroscopy (insertion of a sensor directly into the joint cavity through a microincision);
• Ultrasound (for large joints such as the shoulder or hip);
• serological reactions to a pathogen or antibodies to an infectious agent.

Thus, X-ray examination helps to determine the width of the joint space, osteoporosis, proliferation of osteophytes, the presence of erosions, dislocations, subluxations, and deformities. If changes are not clearly visible or bone growths interfere with their assessment, and also if there is a need to examine soft tissues, additional computed tomography (CT) or magnetic resonance imaging (MRI) may be prescribed. Ultrasound also helps to assess the extent of the disease and the changes caused by it.

Be healthy and may arthritis pass you by!

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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.

Types of the disease depending on the course

Slowly progressive rheumatoid arthritis means that the disease develops over many years, gradually affecting the joints. The joints themselves do not suffer very much. This is where treatment helps and you can maintain a fairly comfortable standard of living.

The rapidly progressing type is characterized by frequent and severe exacerbations, joint damage is severe, treatment helps little. A person's quality of life deteriorates noticeably.

The simplest and easiest type for the patient is a disease without noticeable progression. You can live with it until you are very old without particularly suffering from symptoms.

C-reactive protein test

C-reactive protein ( CRP ) is a very sensitive element of a blood test that quickly responds to even the slightest damage to body tissue. The presence of C-reactive protein in the blood is a harbinger of inflammation, injury, and the penetration of bacteria, fungi, and parasites into the body.

CRP more accurately shows the inflammatory process in the body than ESR (erythrocyte sedimentation rate). At the same time, C-reactive protein quickly appears and disappears - faster than the ESR changes.

Due to the ability of C-reactive protein to appear in the blood at the very peak of the disease, it is also called “acute phase protein.”

As the disease enters the chronic phase, C-reactive protein decreases in the blood, and when the process worsens, it increases again.

C-reactive protein is normal

C-reactive protein is produced by liver cells and is found in minimal amounts in the blood serum. The content of CRP in blood serum does not depend on hormones, pregnancy, gender, or age.

The norm of C-reactive protein in adults and children is the same - less than 5 mg/l (or 0.5 mg/dl).

A blood test for C-reactive protein is taken from a vein in the morning, on an empty stomach.

1 Blood test for uric acid levels

2 blood test for antinuclear antibodies

3 Blood test for rheumatoid factor

Causes of increased C-reactive protein

C-reactive protein may be elevated in the presence of the following diseases:

• rheumatism;
• acute bacterial, fungal, parasitic and viral infections;
• gastrointestinal diseases;
• focal infections (for example, chronic tonsillitis);
• sepsis;
• burns;
• postoperative complications;
• myocardial infarction;
• bronchial asthma with inflammation of the respiratory system;
• complicated acute pancreatitis;
• meningitis;
• tuberculosis;
• tumors with metastases;
• some autoimmune diseases (rheumatoid arthritis, systemic vasculitis, etc.).

With the slightest inflammation, in the first 6-8 hours the concentration of C-reactive protein in the blood increases tenfold. There is a direct relationship between the severity of the disease and changes in CRP levels. Those. The higher the concentration of C-reactive protein, the stronger the inflammatory process develops.

Therefore, changing the concentration of C-reactive protein is used to monitor and control the effectiveness of treatment of bacterial and viral infections.

Different reasons lead to different increases in C-reactive protein levels:

• The presence of chronic bacterial infections and some systemic rheumatic diseases increases C-reactive protein to 10-30 mg/l. With a viral infection (if there is no injury), the level of CRP increases slightly. Therefore, high values ​​indicate the presence of a bacterial infection .
• If neonatal sepsis is suspected, a CRP level of 12 mg/l or more indicates the need for urgent antimicrobial therapy.
• In acute bacterial infections, exacerbation of some chronic diseases, acute myocardial infarction and after surgery, the highest level of CRP is from 40 to 100 mg/l. With proper treatment, the concentration of C-reactive protein decreases within the next few days, and if this does not happen, it is necessary to discuss other antibacterial treatment. If after 4-6 days of treatment the CRP value has not decreased, but remains the same and even increased, this indicates the occurrence of complications (pneumonia, thrombophlebitis, wound abscess, etc.). After surgery, the more severe the operation, the higher the CRP will be.
• During myocardial infarction, protein increases 18-36 hours after the onset of the disease, decreases after 18-20 days and returns to normal by 30-40 days. With angina pectoris, it remains normal.
• In a variety of tumors, elevated levels of C-reactive protein can serve as a test to assess tumor progression and disease recurrence.
• Severe general infections, burns, sepsis increase C-reactive protein to enormous values: up to 300 mg/l or more.
• With proper treatment, the level of C-reactive protein decreases already on days 6-10.

Preparation for rheumatological tests

In order for analyzes to show objective information, it is necessary to adhere to certain rules. You need to donate blood in the morning, on an empty stomach. Approximately 12 hours should pass between taking tests and eating. If you're thirsty, drink some water, but not juice, tea or coffee. It is necessary to exclude intense physical exercise and stress. You cannot smoke or drink alcohol.

The multidisciplinary clinic "MedicCity" provides diagnostics of the highest level, experienced, qualified rheumatologists and specialists in more than 30 specialties. We treat arthritis, arthrosis, vasculitis, lupus erythematosus, osteoporosis, gout, rheumatism and many other rheumatological diseases. Do not delay your visit to the doctor, contact us at the slightest symptoms. High-quality diagnosis is 90% of successful treatment!