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Rheumatoid arthritis (RA), contrary to appearances, does not only concern joint pain. It's an autoimmune disease whose causes are unknown. Prompt diagnosis and treatment are important, because the sooner the therapy is started, the more likely the patient is to maintain physical fitness and a relatively normal life. What are the symptoms of RA and how can I stop the progression of the disease?

Rheumatoid arthritis,otherwiseRA , also known as articular rheumatism and sometimes also referred to asrheumatoid arthritis pondsaffects about 350,000 Poles (0.5-1.5% of the population). As with other autoimmune diseases, women are the majority.

RAoccurs 3 times more often in them than in men. One of the reasons may be hormonal changes during pregnancy, breastfeeding and menopause. The disease generally begins between the ages of 40 and 50, but it also affects people who have recently entered adulthood.

RA - what is this disease?

Rheumatoid arthritis - RAis a systemic (systemic) disease of connective tissue with an immune background. Therefore, it does not only affect the joints, but is where it begins and causes the greatest havoc.

Its beginning is inflammation of the synovium, which leads to its hypertrophy and thickening. As the disease progresses, the membrane cuts the joint cartilage from the source of nutrients, i.e. the synovial fluid.

It causes their damage, erosions and further, irreversible destruction of joint and periarticular tissues:

  • joint bags
  • tendons and their sheaths
  • ligaments

Over time, joints become deformed and their functions are impaired. The patient gradually loses mobility.

In the course ofRA , other organs and systems are often involved, such as :

  • lungs
  • heart
  • kidneys
  • vascular system
  • nervous system
  • secondary amyloidosis
  • Sjörgen's team

Extra-articular complications of the disease can be life-threatening.

Rheumatoid arthritis: causes

This is not worth considering as the etiology ofRAremains unknown. For some unknown reason, the immune systemattacks its own tissues, leading to chronic inflammation. However, the factors that take part in this process are known.

The first is the genetic factor. We may be predisposed to rheumatoid arthritis if we inherit the HLA-DRB1 gene.

However, environmental factors must also be present for the disease to attack (smoking, infections, autoantigens). They initiate disorders of the immune system, involving the stimulation of T lymphocytes to release pro-inflammatory cytokines.

Rheumatoid arthritis (RA): symptoms

The most common symptomsRAare pain and swelling in the small joints of the hands and feet. In the early stage of the disease, these symptoms are less often related to the so-called large joints:

  • shoulder
  • ulnar
  • iliac
  • knee
  • jumping

It is characteristic that the symptoms occur symmetrically, i.e. in the same joints on both sides of the body.

Their morning stiffness, lasting at least an hour, is also typical. The disease may be accompanied by:

  • feeling tired
  • low-grade fever and fever
  • lose weight
  • lack of appetite

Its course is very diverse, but it usually resembles a sinusoid: periods of exacerbation alternate with periods of remission, e.g. during pregnancy the disease often mutes and becomes active again after birth.

See what the joints affected by RA look like

See gallery 4 photos

Rheumatoid arthritis (RA): diagnosis

After one year of disease, if not properly treated, many people can find erosions of the articular surfaces. Meanwhile, patients often wait much longer to make a diagnosis, although thanks to the new criteria for classification of rheumatoid arthritis (ACR / EULAR) in force since 2010, they can be diagnosed at an early stage.

They introduce a special point scale that takes into account:

  • number of joints occupied
  • serological test results (rheumatoid factor RF and antibodies against ACPA citrulline peptide)
  • determination of acute inflammatory phase indicators (ESR and / or CRP c-reactive protein)
  • duration of symptoms (over 6 weeks)

A result of 6 or more confirmsRZS .

The classification criteria are constructed in such a way that they do not exclude the disease even with negative results of serological tests (it happens in about 5% of patients). As part of the diagnostics, X-rays of the hands and feet are also performed at the onset of the disease. Then it repeats every 2years to assess disease progression.

You can also assess the disease activity, which is important especially in the treatment, using the DAS28 index, taking into account both clinical symptoms and laboratory test results. For its calculation, the following are taken into account:

  • number of painful joints and number of swollen joints
  • OB
  • subjective assessment of disease activity by the patient

DAS28 below 2.6 indicates remissionRA , above 5.1 indicates high activity.

Rheumatoid arthritis (RA): treatment

It is believed that therapy should be started within 3-6 months from the onset of symptoms. Medicines at our disposal cannot cureRA , but they inhibit the progression of the disease. If given early, they increase the chance of achieving and maintaining remission of the disease or its low activity. This prevents irreversible changes in the joints that may lead to disability and extra-articular complications.

The basis of therapy are drugs modifying the course of the disease (methotrexate, leflunomide, sulfasalazine or the less effective cyclosporin A and arechine). They inhibit the multiplication of inflammatory cells.

The administration of non-steroidal anti-inflammatory drugs is recommended only in exacerbation of the disease, as they increase the risk of gastritis and peptic ulcer disease. There is no such adverse effect on the digestive system as an anti-inflammatory drug with a slightly different mechanism of action, but it is expensive.

Glucocorticoids are used during periods of high activityRAor in the absence of treatment effects with disease-modifying drugs, but only for a short time as they have many side effects.

A breakthrough in the treatment ofRAturned out to be biological drugs targeted at individual pro-inflammatory cytokines. They reduce pain, significantly inhibit the progression of the disease, and when administered in the first phase, they prevent joint damage. They are generally administered with a disease-modifying drug for one to two years or longer, depending on the indication.

They calm down the disease for a few, several months or longer. They should be returned to during periods of exacerbation. They are reimbursed by the National He alth Fund, but as part of therapeutic programs. You have to meet certain criteria in order to use them. The main reason is the lack of treatment effects with two disease-modifying drugs after six months of treatment.

RA: rehabilitation is needed

Inflamed joints must be spared, but not deprived of movement. This is because their mobility decreases, the secretion of synovial fluid and the muscles weaken. BecauseKinesiotherapy (treatment with movement) is of great importance for maintaining fitness.

It also relieves pain and reduces stress. Special sets of exercises are initially performed under the supervision of a physiotherapist, and then at home, according to his instructions. Pharmacological treatmentRAis supported by well-chosen treatments, e.g.

  • cryotherapy
  • laser therapy
  • iontophoresis with anti-inflammatory drugs
  • massages

At least part of your holiday is worth spending in sanatoriums, which offer many ailments-alleviating treatments (e.g. peat baths, sulphide baths, massages), and most of all, relaxation.

Important

9 advice for rheumatics

  • Eat properly. Limit your consumption of processed foods, as they contain preservatives, dyes, and other additives that contribute to the formation of free radicals that increase inflammation. Eat a lot of vegetables and fruits, because they are rich in antioxidants that eliminate excess free radicals. Do not feel sorry for oily sea fish. They contain omega-3 acids (EPA and DHA), reducing inflammation. Avoid animal fats, fatty meats, and meats, as saturated fatty acids in these foods increase pain and disease progression.
  • Move your joints even though they hurt.
  • Protect yourself from infections - they exacerbate the symptoms of RA.
  • Avoid being in cold and humid places.
  • Make sure you get a good night's sleep.
  • Avoid heavy physical work to prevent overstressing your joints.
  • Maintain a he althy body weight so as not to overload the joints of the feet, knees and hips.
  • Distribute the load over many joints, e.g. pick up a cup, kettle with two hands, and reduce the effort you put into various activities.
  • Try to keep a balance between relaxation and physical activity. Don't overwork yourself, even when you're in good shape.

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Spine, bones, joints