rheumatoid arthritis

Rheumatoid arthritis

It is a chronic inflammatory connective tissue disease caused by an autoimmune reaction. The cause is unknown.

Symptoms

Symmetrical inflammation of multiple joints (leading to destruction of cartilage and bone epiphysis, changes in non-joint, systemic changes, atrophy of interosseous muscles and thenar muscle atrophy, attachment tendon and tendons sheaths, subluxation of distal palmar phalanges, changes "swan neck".

Diagnosis

Uses two established standards of procedure. Older - ACR (American College of Rheumatology) 1987 implies the necessity to meet 4 of 7 following criteria:

• morning stiffness of joints lasting at least 1 hour, min. 6 weeks

• inflammation of three or more joints occurring at the same time,
established by a physician, lasting for at least 6 weeks

• arthritis hand (wrist, metacarpophalangeal or proximal interphalangeal ) lasting for at least 6 weeks

• symmetric arthritis lasting at least 6 weeks

• the presence of rheumatoid nodules

• the presence of rheumatoid factor

• radiological changes - erosions and osteoporosis.

Newer eligibility criteria (ACR classification criteria and the EULAR, 2010 r) are used for patients who suffer from overt synovitis of at least one joint (swelling) and the inability to explain another disease of arthritis (lupus erythematosus, psoriatic arthritis, gout ). It is estimated attachment joints, rheumatoid factor, laboratory markers of inflammation, duration of symptoms.

Types - depending on the severity of changes

A. Type of mild progression (5% -10% of patients), disease-modifying drugs inhibit the growth of the disease. Rheumatoid factor is present only in a few percent of the patients.

B. Type of slight progression (5-10% of patients). Rheumatoid factor is present in most patients. Symptomatic treatment brings relief, although there constant progression of the disease.
C. Type of high disease progression (60% -90% of patients). Rheumatoid factor is present in high concentration from the beginning of the disease. Rapid progress and destruction, despite treatment.


The treatment - are used disease-modifying drugs (to prevent destructive changes in the course of rheumatic diseases), such as: gold salts, azathioprine, cyclosporine, penicillamine, hydroxychloroquine, leflunomide, methotrexate, NSAIDs (e.g. diclofenac) and glucocorticoids; recently are used modern biological treatment (TNF inhibitors, drugs that reduce the activity of autoimmune T cells, interleukin-1 inhibitors, monoclonal antibodies against B cells, inhibitors of T cell stimulation, interleukin-6 blockers).