Rheumatoid arthritis-classical treatment

Surgical treatment of RA can be preventive in the early stages of the disease, but also a method of choice at a later stage (total endoprotheses of hip, knee, etc.).
Without doubt, it is necessary to put emphasis on the need for early recognition and diagnosis of rheumatoid arthritis as the beginning of a differential combination therapy for better and more effective control of the disease. The success of treatment depends on the time of diagnosis, the ability of physicians to properly dose drug treatment and continued implementation of the method of physical therapy and kinesiotherapy.

Rheumatoid arthritis- is there any treatment and can we heal it

Medical treatment significantly changed in the last 10-15 years. Since the pathological process is taking place at several levels, using the "combination therapy" (a combination of several drugs) we try to act on different mechanisms of disease. Since the destructive changes of joint develop very early, especially in the first 2 years of illness, we are trying to suppress inflammation and prevent further development of the damage with a specific therapy. Today treatment is based on the setting diagnosis as earlier as possible and the beginning of combination therapy with several basic drugs from the beginning of the disease. "Gold standard" in the treatment of RA today is methotrexate, immunosuppressive drugs that is given in weekly doses. For the purpose of repressing inflammatory activities from the beginning of the disease is applied low-dose of corticosteroids. Successfully are used drugs like Sulfasalazine and resochina, and lesser gold salts. Application also have anti-rheumatics non-steroidal (NSAID), which have primarily analgesic effect, but also the anti-inflammatory effect. Today there are already on the market NSAIDs with fewer side effects in the area of digestive system, and with the same anti-inflammatory efficacy - koksibi or COX-2 inhibitors. Today they are registered or pending registration of new drugs called biologic agents.
In the treatment an imperative place has and a method of physical therapy and kinesiotherapy (therapeutic exercises) with the aim of preserving the functional abilities of patients in all stages of the disease. Such treatment should be strictly individual, respecting the various stages of the disease, existing joint damage, age and sex of patients and general cardiovascular changes.

Rheumatoid arthritis disease - Incurable and with variable flow

Prognosis and course of RA are variable. It should be emphasized that the lack of specific biological markers may impede the diagnosis of RA. However, by careful examination and taking into account the clinical and laboratory indicators, which are integrated into the existing criteria of American rheumatic society, it is possible to make a diagnosis.

Both patients and physicians must be prepared for variable course of the disease. After diagnosis, patients are often frightened, imagining themselves in the future as completely disabled and immobile. Attempts to argue with patients that such an outcome is not really common, allows him or her to fight with illness and actively participate in his or her treatment.
Unfortunately, there is no magic cure; no specific climatic factors or various diets will not change the course of the disease. The goal of treatment is to preserve as long as possible the functional ability of patients to all life's activities, in other words, reduce pain and discomfort, to preserve strength and joint function, prevent deformity and treat systemic complications. These goals can be achieved by drug therapy, physical and occupational therapy, and when necessary hospitalization.

Rheumatoid arthritis - development of disease III - What happens outside the joint?

In approximately one quarter of patients appear rheumatoid nodes, usually on the outside of the elbow, or the inside of the knee and are a sign of a more difficult and more active disease. On the eyes most common is so-called sicca syndrome - dry eye with a sense of scratching beneath the eyelids. On the lungs is possible a development of inflammation and pulmonary fibrosis. Although frequent, changes in the heart are without symptoms. The most common hematologic change is in the occurrence of mild anemia that correlates with the inflammatory component of diseases.

Rheumatoid arthritis - development of disease II

With the progression of the disease affected are almost all large and small joints, creating deformation typical of rheumatoid arthritis – move of the fingers of hands and feet towards outside, "Z" deformity of thumbs on the hand, "swan neck", "hole for the button”, hammer toes and various other defects. In the final stage very often there is no possibility of closing a fist so more difficult are everyday activities like cutting bread with a knife, opening jars, the inability of combing, washing, etc. The impossibility of extending elbows significantly limits the function of the hand, especially if it is associated with frequent limit movement in the shoulder joint.

Hips may be affected, but very rarely isolated. Knee is the most common, initially affected individual wrist. At this joint we have the easiest way to discover a swelling and synovial membrane thickening. Four-headed muscle of the femur weakness (in front) and the consequent instability of the knee joint are causing the further progress of deformation. Often we find cysts on the back of the knee joint, which when repeated movements of bending and extending the knee, can burst.

Rheumatoid arthritis - development of disease I

Irreparable changes

Usually begins gradually, with symmetrical effect to the joint of hands and feet, and later other joints. May be affected practically all the joints including small joints of the spine. Typically affect women between the ages of 35-55. External factors such as bacterial or viral infection, surgery, trauma, birth, psychological stress, in some patients coincide with the beginning of the disease. Spine is usually spared, except for neck parts, especially the joint in the upper part of the cervical spine.
However, most frequent is the gradual emergence of arthritis of the hands and feet (polyarthritis), with a typical morning stiffness of all affected joints. Morning stiffness usually lasts longer than an hour, sometimes for several hours, but in the beginning or in the milder phase of the disease may be shorter. Clinical signs of disease include painful swelling of joints with absence of skin redness and disturbed function of the joint. Later appears a significant limit of movement in the affected joint, joint instability and deformity with deterioration and weakness of muscles. Joint swelling is the most important early sign of disease. Although effect on the joints is classically symmetrical, identical small joints of the hands and feet may not be strongly affected on both sides.

Signs and symptoms of rheumatoid arthritis

As a result of inflammatory changes, there is instability in the joints that leads to progressive development of the typical deformation.

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that predominantly affects the joints. Usually begins in the third or fourth decade of life, although it is possible to start at any age. During illness, most of the joints, particularly in the limbs are typically affected symmetrically. Flow is variable and includes periods of worsening and improving, while a spectrum of clinical manifestations is wide, from the difficult to identify to deforming and destructive forms of the disease. Diagnosis depends primarily on clinical examination and fulfilling a sufficient number of clinical criteria. It is believed that today, there are 1% of people suffering from the disease of the adult population, while women predominate in all series, usually in relation 3:1.
The cause of the disease remains unknown. It is possible that some artritogeni factors serve only as a "trigger" - the initial driver of immunological events in the immune predisposed people by producing auto antibodies to their own proteins (immunoglobulin).
Primary process occurs in the inner (synovial) joint membrane, which, due to inflammation multiplies in thickness and becomes swollen, with ingrowths of new blood vessels and accumulation of inflammatory cells. Creating a binder and granulation tissue creates the so-called. panus, which gradually damages from the periphery and destroys bone and cartilage, creating irreparable changes in the joint material. As a result, there is instability in the joints that leads to progressive development of deformation typical of RA.

Picture 1 - The stage of progression of pathological changes in the joint
- Inflammation
- Spreading inflammation with the formation of panusa, starting the destruction of cartilage and secondary osteoporosis expressed
- Fibrous changes - fibrosis Ankylosis
- Bone Ankylosis with advanced osteoporosis