Monday, July 22, 2013

Rheumatoid Arthritis, Symptoms, Analysis and Treatment

Rheumatoid Arthritis - a systemic disease of ligament, mainly affecting small joints of potential job erosive and destructive polyArthritis of unknown etiology on a complex autoimmune pathogenesis.

Causes of the disease on this morning are unknown. Indirect graph, such as increasing the sum of white blood cell monetary institution and erythrocyte sedimentation stride (ESR) indicate the infectious nature of the process. It is believed that the disease develops is because of him infection, which causes a compromised body's defense mechanisms in genetically susceptible some individuals, with formation of so-called. clues complexes (of the antibodies, computer viruses, etc.. ), which are deposited in tissues and imply joint damage. But the ineffectiveness whereas antibiotic Treatment of RA would indicate the incorrectness from the assumption.

The disease is characterized by high disability (70%), would likely comes pretty early. Normally the causes of death for this disease are infectious complications and renal failure.

Treatment concentrates relieving pain, slowing diseases progression and restore ruined by surgery. Early detection of disease via modern tools can very reduce the harm that may be inflicted joints and other way tissues.

For the initially may occur after heavy physical exercise, emotional shock, fatigue, differences during the period, the far reaching consequences of adverse factors or maybe infection.


Rheumatoid Arthritis is distributed worldwide and it influences all ethnic groups. Number of 0, 5-1% (up 5% in the elderly) ratio M: R = 1: 3 peak of lack of life onset - 30-35 years


As largely autoimmune diseases, there throughout 3 main factors:

1. Hereditary the likelihood of autoimmunity.

2. Infection every point Hypothetical triggers of rheumatic diseases

Paramyxovirus - viruses, mumps, measles, respiratory syncytial infection

Hepatitis B virus

Herpes parasites - herpes simplex spyware, herpes zoster, cytomegalovirus, Epstein-Barr virus (much higher in the synovial fluid of RA patients

Retroviruses -- T-lymphotropic virus

3. Start-up every point (hypothermia, insolation, intoxication, mutagenic prescriptions, endocrinopathy, stress, etc. ). For many women, duration of breast-feeding reduces acquire waterborne illnesses RA. Breastfeeding for 24 or more months reduces the risk brewing RA by half.

The training disease

Rheumatoid Arthritis progresses at your three stages. In one of the first stage, the swelling of the synovial bags causing pain, heat and swelling about the joints. The second stage is perhaps rapid cell division leading to compaction of the rest synovial membrane. In the third stage, the inflamed component release an enzyme understanding that attacks the bones and then cartilage, which often just brings into play deformation of the plagued joints, increasing pain and decrease motor functions.

Typically, the virus progresses slowly at let's start with, with the gradual implementation of clinical Symptoms for several time, much less - subacute or maybe acute. In about some / 3 of handbags fever occurs, and others - a mono-or oligoarticular locale, and articular syndrome often doesn't clinical specificity, which heavily complicates the differential evaluate. Articular syndrome is derived from morning stiffness for more than 30 minutes and similar expressions through the second half of the night - Symptoms of "stiff gloves", "corset"; ongoing spontaneous pain in the joints, increasing during effective movements. The disappearance of a typical stiffness depends on the activity of the process: the harder activity, the greater together restraint. For the joint feeling sick in Rheumatoid Arthritis is characterized by monotony, the duration, efficiency of residual effects once you have Treatment.

There may require to be prodromal clinical Symptoms (mild short lived pain, pain relationship with meteorological conditions, autonomic dysfunction). Can be sure "joint damage" and "joints omission. " Rheumatoid Arthritis is typically combined with other joint pain diseases - OsteoArthritis, arthritis rheumatoid, systemic connective tissue cancer.

Allocate the following methods for the clinical course of them Rheumatoid Arthritis:

The classic version of the (symmetric defeat both minor and major joints

Mono-or oligoArthritis, mainly affecting the massive joints, most often the excess knee. Severe disease onset and reversibility of predominantly manifestations during 1-1, 5 months (arthralgias are migratory in the wild, radiographic changes are broken, anti-inflammatory drugs offer relatively positive effect in the latter there are individuals Symptoms of Rheumatoid Arthritis).


Diagnosis of Rheumatoid Arthritis (RA) - For many years there was no specific test it would unambiguously confirm the existence of the disease. Currently, decides disease based on biochemical records of blood, changes in both joints are visible on x-rays, and the utilization of basic clinical markers, but also with the general clinical manifestations up to fever, malaise, and weight loss

In your research of blood examined ESR, Rheumatoid factor, platelet count, etc. The most advanced analysis is the choice titer of antibodies to monitor cyclic citrulline-containing peptides -- ACCP, anti-CCP, anti-CCP. The specificity of this occurence indicator is 90%, though it may be present in 79% of many sera from patients mutually RA.

Diagnostically important clinical features are the lack of discoloration of the skin on the inflamed joints, the trend of tenosynovitis flexors or extensors associated with fingers and the sourcing of amyotrophy, typical natural brushes, so-called "Rheumatoid hand or foot.

The criteria for second-rate prognosis are:

1. Early damage of large joints and each side Rheumatoid nodules
2. swollen lymph nodes
3. involvement of the latest joints in the the following exacerbation;
4. systemic diseases;
5. persistent disease activity with no remission for over a year;
6. persistent rise in the ESR;
7. early appearance (within the primary year) and high titers whereas Rheumatoid factor
8. early (up to consume four months), radiographic alterations in the affected joints - an abrupt progression of destructive moves;
9. Detection of antinuclear antibodies try to LE-cells
10. Carrier antigens HLA-DR4


Rheumatoid Arthritis will start at any joint, individuals often starts from small joints in both fingers, hands and wrists. Typically, joint damage thought of as symmetric, for example in the event the sore joint on his right hand, then ill function as same joint on many left. The more joints afflicted the greater number of advanced stages of fungus.

Other common Symptoms contain:

Morning stiffness. Generally, the greater sum of the constraint, the health issue activity.
Flu-like Symptoms, of predominantly low heat.
Pain during prolonged sitting
Outbreaks well-versed in disease activity are accompanied by remission.
Muscle pain
Loss these kind of appetite, depression, weight loss, anemia, cold and / and consequently sweaty palms and feet
Violation of numerous glands near the eyes and mouth, causing insufficient production of many tears and saliva.


In the employment of infection need the prudent antibacterial therapy. In the absence of bright extra-articular manifestations (eg, decent fevers, Felty's syndrome or polynervopathy) Treatment of many joint syndrome begin with buying a non-steroidal anti-inflammatory drugs (NSAIDs). Instead in the most agonizing joints injected corticosteroids. An important point in the united states Treatment of Rheumatoid Arthritis is stopping Osteoporosis - restoration of their calcium balance when it's about increasing its absorption at the minimum intestine and reduced an individual's excretion. Sources of calcium are dairy (especially cheese, which contains from 400 to 1000 mg of them calcium per 100 g of a typical product, as well just like cheese, to a lesser total cottage cheese, milk, bitter cream), almonds, hazelnuts and just walnuts, etc., and calcium supplements put together with vitamin D or there active metabolite.

Importance have the ability Treatment is therapeutic show off, aimed at maintaining maximum joint mobility and looking after muscle mass.

Physiotherapy (electrophoresis from you nonsteroidal anti-inflammatory drugs, hydrocortisone phonophoresis) and just spa Treatment. With wise mono-and oligoArthritis includes delivery of isotopes of an incredibly, yttrium, etc., With persistent strains of joints is finished reconstructive surgery.

Modern Therapy

Systemic drug therapy involves should you use four classes of junk:

1. nonsteroidal anti-inflammatory prescriptions (NSAIDs),
2. basic drugs
3. glucocorticosteroids (GCS)
4. natural agents.

Non-steroidal anti-inflammatory drugs
NSAIDs remain as soon as possible line of therapeutic agents more or less directed primarily to the management of of acute manifestations of each one disease, as well that ensuring stable clinical and consequently are laboratory remission.

In the acute phase of illness use of NSAIDs, corticosteroids, pulse therapy with corticosteroids or put together with cytotoxic immunosuppressive agents.

Current NSAIDs have reasonable anti-inflammatory effect which is because of inhibition of the tangible cyclooxygenase (COX) - critical enzyme of arachidonic plaque created by sugar metabolism. Of particular interest contains the discovery of two isoforms a good COX, which are known as COX-1 and COX-2 whilst in the play different roles in governing the synthesis of prostaglandins (PG). Proved that NSAIDs inhibit the activity of COX isoforms, but their anti-inflammatory activity derives from inhibition of COX-2.

Most of this known NSAIDs inhibit mostly COX-1 activity, which explains the look of complications such as gastropathy, renal system failure, encephalopathy, hepatotoxicity.

Thus, with regards to the nature of blocking COX, NSAIDs are split into selective and nonselective COX-2 inhibitors.

Representatives of this selective COX-2 inhibitors are meloxicam, nimesulide, celecoxib. These drugs have minimal results and retain high anti-inflammatory and analgesic activity. COX-2 inhibitors bring in all programs to understand all the Treatment of Rheumatoid Arthritis, which rely upon NSAIDs. Meloxicam (Movalis) in early Treatment of inflammatory activity assigned to 15 mg / day and subsequently transferred to 7. 5 mg / day as restoration therapy. Nimesulide is assigned a dose of 100 mg two times a day.

Celecoxib (Celebrex) - carrying out inhibitor of COX-2 - is a member of 100-200 mg twice half a day. Selection for the elderly dosage of the drug is not required. However, patients with bodyweight below the median (50 kg) it's going desirable to begin Treatment of our lowest recommended dose.

You should avoid combining several NSAIDs, because of a person's effectiveness remain unchanged, and potential risk of side effects increases.

Basic Preparations

Basic drugs continue on play a pivotal role using the Treatment of Rheumatoid Arthritis, but now lately there has been a new approach for destination. In contrast with regard to the well-known tactic of gradual Treatment of Rheumatoid Arthritis ("principle of that pyramid"), is now advocated important aggressive Treatment of basic drugs after a couple of diagnosis, the purpose just that - changed the availability of Rheumatoid Arthritis and remission raise. The reason for this are having less early Rheumatoid Arthritis penile deformation, Osteopenia, and severe consequence, formed by autoimmune elements, the high likelihood of remission.

The main drugs of basic management of Rheumatoid Arthritis include: methotrexate, sulfasalazine, loose change preparations, D-penicillamine,. By by signifies the reserve include cyclophosphamide, azathioprine, cyclosporine A CONTRACT. The new group contains the following drugs: Remicade.

Ineffective for anyone 1. 5-3 months of basic drugs are to replaced or put together with corticosteroids in low levels, thus reducing the total Rheumatoid Arthritis before the start of the first. Six months - a crucial period, no later than that might be adjusted effective basic proper.

The best preparation for the start of basic therapy in rigorous Rheumatoid Arthritis and RF-positivity, presence of extraarticular manifestations of methotrexate rrs - cytotoxic immunosuppressive broker, which is well accepted for prolonged use and allows fewer side effects than other drugs about this group.

In the Treatment of basic drugs carefully monitored the activity of the disease and secondary effects.


A new approach is should you use high doses of corticosteroids (pulse therapy) in combination with slow acting tools and they will improve the efficiency of the identical latter; combinations of methotrexate by signifies salts of gold, sulfasalazine, together with selective immunosuppressive agent cyclosporin THE KIND OF.

With a high measure of inflammatory activity are tried corticosteroids, and in cases of systemic manifestations of Rheumatoid Arthritis an amount of pulse therapy is used up. Corticosteroids only or put together with cytostatic drugs - cyclophosphamide. SCS is also used as supporting anti-inflammatory therapy after failure advisors medicines.

In some drawers, corticosteroids are used in something local therapy. The indications for their own reasons are: mostly mono-or oligoArthritis of large joints,

Biological agents

In Rheumatoid Arthritis a good synovial membrane, for confused reasons, secrete a great deal of the enzyme glucose-6-phosphate dehydrogenase that will destroys the disulfide bonds scenario cell membrane. In this example, there is "leakage" of proteolytic enzymes relating to the cell lysosomes, which damage surrounding bones and normal cartilage. The body responds about by making cytokines, among using tumor necrosis factor -the SOME OTHER TNF. Cascade of these emotions and thoughts in cells are because of cytokines, further aggravating the Symptoms of this disease. Chronic Rheumatoid inflammation linked to TNF-α, often causing problems for the cartilage and hips, leading to physical disability.

The Treatment uses a monoclonal antibody towards the cytokine TNF-the A, which is effective with high appreciation in binding to TNF, in its soluble and transmembrane forms bringing about neutralizing activity of TNF.

During the growth of Rheumatoid Arthritis, Joint damage in men or women with Rheumatoid Arthritis sometimes appears as a narrowing to understand all the joint space between our bones and erosion of bone using the articular space. Clinical trials of monoclonal antibody showed its use so slow erosion and narrowing need to space between the our bones.


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