Rheumatoid arthritis: symptoms, causes, treatment of rheumatoid arthritis in St. Petersburg

How the disease develops

Rheumatoid arthritis is an autoimmune disease, that is, associated with a malfunction of the immune system. In arthritis, immune cells mistakenly mistake joint cells for foreign elements - viruses, bacteria - and try to destroy them. This process continues for years..

Often the disease begins with damage to the knee joint. At the beginning of the disease, the patient feels weak, unwell, loses appetite, loses weight, and the temperature can rise to 37-39 degrees. In this case, joint problems fade into the background or are completely absent. As the disease develops, more and more joints are involved in the process, and after treatment of exacerbations, the joints become less mobile and deformed.

Over time, symptoms associated with damage to internal organs and systems appear: lungs, heart, blood vessels, kidneys, eyes, salivary glands. With rheumatoid polyarthritis, dense subcutaneous nodules often form.

Description of the disease

Rheumatoid arthritis (RA) affects the joints. The pathology is characterized by inflammation of the wrist and phalangeal areas, shoulder, elbow, knee, ankle and hip joints. Systemic lesions lead to their destruction.

The exact cause of the pathology is unknown. Factors that contribute to the progression of arthritis include:

genetic predisposition;
viral infections;
smoking.

The disease triggers the process of antibody production. First, macrophages migrate to the affected area of the synovial membrane. This causes inflammatory processes in the blood vessels. Macrophages and lymphocytes produce cytokines and chemokines that provoke joint inflammation. Systemic manifestations are thought to be caused by the release of enzymes and inflammatory mediators. This leads to the destruction of articular cartilage. In severe cases, the bone is also destroyed.

Clinical manifestations begin with morning joint stiffness, loss of appetite and general weakness. The greatest progress of RA is observed in the first year. The affected joints become swollen and tender. The slightest movement brings pain. The synovium thickens, and the joint capsule stretches and becomes deformed.

Symptoms of rheumatoid arthritis

The main signs of rheumatoid arthritis are:

symmetrical damage to the small joints of the hands: if several joints on one hand hurt, then these same joints hurt on the other;
morning stiffness occurs due to a decrease in range of motion and changes in muscles.

The following symptoms can warn of the disease:

joint pain is felt most strongly at night and early in the morning;
fever up to 38 degrees, insomnia;
fatigue, weakness, loss of appetite, weight loss;
rheumatoid nodules in the elbow area.

Diagnostics

The diagnosis of seropositive rheumatoid arthritis is made on the basis of characteristic clinical signs and is confirmed by:

Laboratory research:
biochemical blood test - increasing the level of C-reactive protein (CRP) - a blood plasma protein that signals the presence of inflammation;
immunological tests:
determining the presence of rheumatoid factor;
detection of anti-citrullinated antibodies (ACCP) - may appear earlier than RF, at the initial stage of development, therefore they are an early diagnostic sign;
detection of increased blood levels of pro-inflammatory cytokines interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF alpha).
Instrumental research:
MRI
– early (pre-radiological) disorders are detected;
Ultrasound
reveals changes in periarticular tissues and a decrease in the volume of synovial fluid.

Causes of rheumatoid arthritis

The main cause of the disease is autoimmune inflammation. Under the influence of genetic factors and infection (presumably viral), immune complexes are formed in the body, which are deposited in tissues and, above all, in the cartilage tissue of the joints. Further, inflammation develops in the places of deposition. The onset of the disease can be triggered by:

infection - immune cells can react to microbes and viruses that remain in the joints after an infection;
hypothermia, acute respiratory infections, flu, sore throat;
joint injuries;
long-term experiences, stress;
hereditary predisposition.

Relatives of patients with rheumatoid arthritis are susceptible to the disease. Notably, breastfeeding for two years reduces the risk of rheumatoid arthritis in women by half.

Etiology

The reasons for the development (etiology) of RA have not been definitively established. It is believed that the disease is based on two factors:

genetic
– hereditary predisposition to autoimmune processes, which is confirmed by frequent family diseases;
infectious
– past viral infections; for example, Epstein-Barr virus, which causes infectious mononucleosis.

The risk of developing RA increases under the influence of the following triggers: hypothermia, stress, hormonal imbalances, injuries, living in a cold, humid climate, etc.

Complications of rheumatoid arthritis

Damage to the joints leads to fairly rapid disability of patients, loss of the ability not only to work, but also to care for themselves independently. The prognosis depends on the degree of damage to internal organs, especially the kidneys.

Unfortunately, there is no prevention for rheumatoid arthritis. However, you can reduce the rate of progression of the disease and prevent complications if you follow certain rules. First of all, it is necessary to regularly take basic therapy drugs under the supervision of the attending physician, to avoid hypothermia and infections.

Treatment approaches in our clinic

The specialists of the Paramita clinic apply advanced techniques and use innovative practices. At the same time, we use two opposing approaches: Western and Eastern medicine.

The Western approach involves treating a specific organ and neutralizing the source of the disease in a specific location. The Eastern approach to rheumatoid pathologies is that the doctor views the body as an integral substance. In this case, diseases look like an imbalance between body systems.

We combine proven techniques of the East and innovative methods of Western medicine.
Read more about our unique method of treating arthritis

The combination of methods leads to the best result. For the examination, modern laboratory research techniques and hardware methods are used. A treatment plan is drawn up after assessing all factors. In addition to basic treatment, the following techniques are used:

pharmacopuncture;
massages of various types;
vacuum therapy;
hirudotherapy;
acupuncture;
manual and Su-Jok therapy;
kinesitherapy and autohemotherapy
electropuncture and electrosleep;
electrophoresis and photodynamic treatment.

Using all possibilities guarantees effectiveness and rapid improvement of the clinical picture. Even if we are not talking about a complete recovery, doctors at the Paramita clinic quickly relieve pain and improve the patient’s condition.

The priority is to minimize side effects and eliminate pain. Joint mobility will be significantly increased. You will be able to perform various operations without experiencing pain.

An integrated approach allows not only to quickly eliminate symptoms, but also to prevent relapses. The body is rebooted. After treatment you will feel renewed. This manifests itself in an improvement in overall well-being and mood. This, according to Paramita doctors, is the ultimate goal of treating rheumatoid pathologies. Patients are treated by highly qualified specialists. The clinic's activities are licensed by the Ministry of Health of the Russian Federation.

Themes

Joints, Pain, Treatment without surgery Date of publication: 04/13/2020 Date of update: 11/12/2020

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Rheumatoid arthritis is one of the most severe joint diseases, occurring with many complications. Rheumatoid arthritis affects people of all ages, but most often those over 30. Among women, about 5 times more suffer from rheumatoid arthritis than among men. In general, according to various scientists, this disease affects 1-2% of the population.

As you know, most types of arthritis, and, in particular, rheumatoid arthritis, are autoimmune diseases. That is, with arthritis, those immune cells-lymphocytes, which should recognize and destroy strangers invading the body (bacteria, viruses, etc.), for some reason “go off course” and perceive the cells of their own body as enemies, in first of all - joint cells. And they actively attack them, as if trying to destroy them.

The reasons why protective cells suddenly begin to regard the cells of their native organism as strangers may be different. Sometimes autoimmune aggression can be triggered by some kind of infectious disease or a latent, sluggish infection. In addition, sometimes rheumatoid arthritis develops as a continuation of reactive or infectious arthritis. Occasionally, the onset of the disease is provoked by trauma or prolonged or severe trauma.

But much more often, arthritis develops as a result of severe emotional shock and severe stress.

In at least half of my patients, the disease began after severe blows of fate: dismissal from work, divorce, loss of loved ones, etc., especially if these blows of fate were preceded by many years of exhausting experiences. Or if shocks are superimposed on certain character traits.

Most clinicians have long recognized, to one degree or another, the role of emotions in the development of rheumatoid arthritis. Back in the first half of the twentieth century. American researchers A. Johnson, L. Shapiro and F. Alexander, in the course of numerous studies, identified character traits that are most often found in “arthritic” patients.

Excessive emotional restraint, the habit of always keeping your feelings under control and hiding negative emotions under the guise of emphasized friendliness increases the risk of developing arthritis.

It is clear that not every reserved person who grew up under the influence of strict parents will develop arthritis. For arthritis to occur, a certain trigger is necessary. Most often, according to my observations, the role of such a “trigger button” is played by long-held anger, guilt and self-hatred for real or imaginary offenses, and especially strong (or lingering) resentment that arises against the background of chronic grief.

Moreover, it is not so important with whom a person with a predisposition to arthritis is offended or angry - with his parents, spouse, children, friends, or even just “at life.” If sufficiently strong negative emotions are present, then a response from the body’s hormonal system automatically occurs, stress hormones are released, and the likelihood of an autoimmune response from the body, such as an attack against its own joints, increases.

You can read more in the article: psychosomatics of rheumatoid arthritis

Development of rheumatoid arthritis

With rheumatoid arthritis, the immune system always fails. As a result of this failure, immune cells are directed to various organs of the body, especially the joints, and attack them as if they recognized foreign agents in the joint cells. And they continue to do this for years - perhaps even when there is no foreign material left in the joints. They secrete special substances - inflammatory mediators, which penetrate into the attacked joint, cause the death of some of its cells, and over time provoke damage to the joint.

In rheumatoid arthritis, the synovial membrane of the joint is especially affected. Inflammation primarily affects that part of it that is directly adjacent to the cartilage. The synovial membrane swells and hypertrophies over time, that is, it grows. Later, this overgrown synovium can grow into the cartilage and other tissues of the joint, and sometimes even into the bone, weakening the structure of the entire joint. It swells, becomes deformed and, without proper treatment, gradually collapses.

Pain in the joints with rheumatoid arthritis intensifies most often in the second half of the night, in the morning.

Until about noon the pain is very intense; patients compare them to toothache. However, in the afternoon the pain becomes weaker, and in the evening it is often insignificant. What is also characteristic is that at the beginning of the disease, joint pain often decreases after active movements or warm-up. And they do not get worse from stress, as happens with arthrosis. However, any relief from rheumatoid arthritis usually lasts only until the middle of the night, and around 3-4 hours the attacks of joint pain resume.

Along with inflammation of the joints of the upper extremities, rheumatoid arthritis almost always affects the small joints of the feet. The joints at the base of the toes become inflamed, which manifests itself as pain when pressing under the “pads” of the toes. It is symptomatic that the joints of the legs become inflamed as symmetrically (on the right and left limbs) as in the arms.

Large joints, such as the shoulders, knees, elbows and ankles, usually become inflamed later, after several weeks or months. Although there are other types of rheumatoid arthritis, in which the first to become inflamed are the shoulder or knee joints, or the heel tendons, and inflammation of the small joints of the hands and feet “joins” later. This form of arthritis most often occurs in people over 65-70 years of age.

In addition to intense pain, rheumatoid arthritis is characterized by morning stiffness. Patients describe morning stiffness as a feeling of “stiffness in the body and joints” or as a feeling of “tight gloves on the hands,” less often as a feeling of “a tight corset on the body.”

With a relatively mild course of rheumatoid arthritis, morning stiffness usually disappears within an hour or two after the patient gets out of bed. But in severe cases of the disease, this unpleasant sensation can persist until one o’clock in the afternoon or even longer.

Many patients develop rheumatoid nodules under the skin. They are quite dense to the touch, usually about the size of a pea, and are most often located just below the bend of the elbows. But sometimes rheumatoid nodules also appear on the hands, feet and other places. More often there are few of them (1-2), but sometimes they are formed in large quantities. Usually the nodules are relatively small (2-3 cm in diameter), but quite large ones are also found.

Very often, the symptoms listed above are accompanied in patients by a feeling of weakness, deterioration of sleep and appetite, a moderate increase in temperature (up to 37.2-38 ° C), and chills.

As the disease develops, in its advanced stage, permanent deformation of the fingers and hands occurs. More often than others, “ulnar deviation” of the hands develops, when the hands and fingers are fixed in the wrong position and deviate outward. The mobility of the wrist joints sharply decreases, the arms have difficulty bending and unbending at the wrists. Due to impaired blood supply, the skin on the hands and wrists becomes pale, dry, thinned, and the arm muscles atrophy. These phenomena intensify with increasing disease activity.

Gradually, more and more joints are involved in the pathological process. Knees, elbows, ankle and shoulder joints often become inflamed. Inflammation of the elbow, shoulder and ankle joints usually occurs relatively mildly, but leads to noticeable stiffness of the joint, sometimes to a rather sharp limitation of movements in the joint.

The situation is more complicated with the knee joints. Rheumatoid disease of the knees is often accompanied by the accumulation of a large amount of pathological fluid in the joint cavity, stretching the joint capsule. This accumulation of fluid in the knee is called a Baker's cyst. In the most severe cases, excess fluid in the cyst can lead to its rupture, and then the contents of the cyst spill into the soft tissue of the lower leg along its back surface. In this case, swelling of the lower leg appears, and sharp pain occurs in the leg. After some time, acute manifestations of the rupture usually subside, pain and swelling decrease. But if the inflammatory process in the knee continues, then the joint can “swell” again and again with all the ensuing consequences. And only when the activity of the inflammatory process is suppressed, the increased production of pathological fluid stops, and the rupture gradually heals.

In addition to inflammation of the joints, in the active phase of rheumatoid arthritis, the vertebral joints are sometimes involved in the inflammatory process. More often the cervical spine becomes inflamed, and then pain appears in the neck and under the back of the head. Sometimes they even try to treat such patients, suffering from inflammatory pain in the spine, with massage, manual therapy or heating - which is a gross medical error. All these attempts often lead only to an exacerbation of the disease and increased pain, since such manipulations during an active inflammatory process only intensify the inflammation.

Course of rheumatoid arthritis

The disease has a wave-like nature: periods of deterioration in the patient’s well-being are followed by periods of spontaneous improvements. Without proper treatment, patients suffer for many years, sometimes throughout their lives.

Proper treatment, coupled with restoration of mental balance, can lead to long-term remissions, significant improvement in well-being, and even complete recovery. However, few patients are able to radically and permanently change their attitude towards life, control their mental and physical state, and live in a state of “inner peace.” Therefore, either after the next unrest, or after a cold or hypothermia, the patient’s condition can again deteriorate significantly.

On top of this, over time, various complications in the functioning of internal organs are added to the damage to the joints. Rheumatoid damage to the lungs, heart, liver, kidneys, blood vessels and intestines often occurs. Sometimes rheumatic muscle inflammation develops - polymyalgia, which is a serious complication of arthritis. All of the above complications can not only seriously worsen the patient’s already imperfect condition, but can even pose a threat to his life. That is why it is important to begin treating rheumatoid arthritis as early as possible, and to treat the patient comprehensively and thoughtfully in order to interrupt the development of the disease at the initial stage, without leading to complications and without waiting for irreversible consequences.

Modern drug therapy

Systemic drug therapy includes the use of four groups of drugs:

symptomatic treatment - non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids (GCS), basic antirheumatic drugs, genetically engineered biological (disease-controlling) drugs with cytostatic immunosuppressants.

Nonsteroidal anti-inflammatory drugs

Glucocorticosteroids

Basic antirheumatic drugs

Prognosis Generally favorable with early contact with a rheumatologist and adequately selected treatment. In the late stage, in the presence of systemic manifestations of rheumatoid arthritis, the risk of heart disease increases, the mechanism is unknown; the presence of chronic inflammation is considered a significant factor. It is possible that the use of new biological drugs can increase life expectancy and reduce risks for the cardiovascular system, as well as slow down the development of atherosclerosis. Limited studies demonstrate a reduction in the risk of cardiovascular disease, while an increase in total cholesterol levels is observed while the atherogenic index remains unchanged.

Treatment of seropositive arthritis

Currently, all specialists adhere to the tactics of early detection and active treatment of seropositive RA. This tactic allows in most cases to avoid disability and maintain a decent quality of life.

The main method of treating seropositive arthritis is drug therapy, other methods are of auxiliary value. This includes diet, physiotherapeutic procedures, therapeutic exercises, massage, folk and homeopathic remedies.

Drug treatment

Treatment of seropositive arthritis

Seropositive rheumatoid arthritis begins to be treated as early as possible, using several medications at once - symptomatic and basic.

Symptomatic drugs include medications that eliminate joint inflammation and pain, but do not act on the mechanism of disease development (pathogenesis). They are prescribed in short courses to eliminate acute symptoms of seropositive RA. This:

Nonsteroidal anti-inflammatory drugs (NSAIDs):
Nimesulide
is a more modern effective drug that has a minimum of side effects; prescribed orally in tablet form.
Glucocorticosteroid hormones (GCS - Prednisolone, Dexamethasone, Betamethasone) eliminate symptoms even faster, but have many side effects and require constant increase in dosage. Prescribed strictly according to indications in short courses, including injection into the joint cavity.

Basic drugs include medications that have a strong effect on the pathogenesis of the disease. They are prescribed in long courses, periodically checking the effectiveness of therapy with diagnostic tests. Such drugs include:

Basic anti-inflammatory drugs (DMARDs)
– Methotrexate, Sulfasalazine, Leflunomide. Suppress autoimmune processes, prescribed in long courses in the form of injections or oral administration; 2nd line drugs of this group, the use of which is not always practiced, include Tauredon (a gold drug), which suppresses immune processes and inflammation.
Genetically engineered biological drugs (GEBD, biological agents)
- this includes the most modern group of drugs (Infliximab, Tocilizumab, Abatacept, Rituximab) they contain antibodies to pro-inflammatory cytokines or suppress the functioning of certain parts of the immune system. Prescribed as part of complex drug therapy, sometimes causing allergic reactions.

Additional treatment methods

The attending physician may also include in the complex therapy of seropositive arthritis to alleviate the patient’s condition:

homeopathic and folk remedies;
physiotherapeutic procedures;
procedures for blood purification - plasmapheresis, hemosorption;
courses of physical therapy (physical therapy) and massage - physical activity is necessary, as it is the prevention of deformities and contractures;
in case of irreversible changes in the joints and their destruction in the later stages, when therapeutic measures have proven ineffective, refer the patient for surgery.

Social rehabilitation

Often patients become disabled due to illness, so it is important to talk with them about self-care, social independence and adaptation to the conditions in which they find themselves. Seniors will need devices to help them get around, from canes to wheelchairs/chairs.

Also, do not forget about items for cooking and conducting household processes. Rehabilitation also includes the installation of a special sleeping place, handrails, door openers and devices to help with undressing and dressing. If necessary, purchase a toilet seat.

In old age, you need to be especially careful about the health of your joints so that your active life lasts longer. Remember that purchasing medications on your own can only worsen the situation and harm your body. Each person is individual, so the doctor develops the treatment regimen personally. Many indicators are taken into account - from the stage of development of the pathology to concomitant diseases and tolerability of medications. Remember about regular medical examinations, walk more and eat healthy food!

References

Rheumatoid arthritis. Clinical recommendations. Association of Rheumatologists of Russia, 2021. - 102 p.
Rheumatology: National Guide / ed. E.L. Nasonova, V.A. Nasonova. - M.: GEOTAR-Media, 2008. - 720 p.
Kishkun, A.A. Guide to laboratory diagnostic methods. - M.: GEOTAR-Media, 2007. - 800 p.
Volkova, M.V., Kunder, E.V. Early arthritis: relevance, Immunopathology, diagnosis. Vestnik VSMU, 2013. - No. 3.
Medical microbiology, virology and immunology: a textbook for medical students / ed. ed. A.A. Vorobyov. — 2nd ed., corrections and additions. - M.: Medical Information Agency, 2012. - 704 p.