Rheumatoid arthritis

In the group of rheumatic diseases, rheumatoid arthritis, which is abbreviated to RA, is the "most representative" representative of inflammatory altered joints. We have no hard evidence that an inflammatory disease called rheumatoid arthritis was known before Christ, no skeletal changes found in Europe that could correspond to the bone damage caused by this vicious inflammatory rheumatic disease have been detected. The Greek origin of the word "Rheuma", which means "to flow", very aptly denotes the course of events in inflamed joints. Some "bad" body currents begin to form in the joints. Inflammatory inner joint membranes (synovium) produce more joint fluid than the joint can resorb. This course of excess joint fluid caused by inflammation results in swelling of the joint - a characteristic symptom of RA. Very often the swelling is symmetrically expressed on the limbs, affecting multiple joints (polyarthritis). On the fists are the wrist but also the root joints of the fingers. The onset of RA is uncharacteristic because the first signs of the disease may resemble the ailments we have in the virus as general signs of infection.

Rheumatoid arthritis is a disease caused by various factors that are arranged in an immune imbalance so that the articular membranes react with a violent inflammatory change. The disease most often begins at a younger age, 3 times more often in women. Only about 2% of the Croatian population suffers from RA (unlike osteoarthritis, which affects about 25% of women and 20% of middle-aged men). The destructive action of the inflammatory altered inner joint membrane then leads to damage to the articular cartilage, bones and tendons resulting in joint stiffness. Spontaneous pain is potentiated in work activities, especially on pressure. Joint stiffness is also characterized after prolonged rest. Morning joint stiffness in RA usually lasts longer than 30 minutes! With the use of the joint, the pain, unlike arthritic changes, increases in the joint affected by RA. Gradually, due to the progression of the damage, there is a deformation of the hands and feet - deviation of the palm outwards and bizarre stiffness of the toes. Along with pain in the joints (arthralgia) and muscles (myalgia), increased sweating, fever, fatigue, lack of appetite, weight loss, poor sleep). The pains are seldom of an acute nature, more often occur insidiously, have a slow progressive course. In rare cases, the disease may subside spontaneously.

Diagnosis RA

We are also sure that this is a disease of the second half of the second millennium. The characteristic clinical picture of RA was first described only in 1858. Immunology, a science that developed intensively in the second half of the 20th century, made a great contribution to the interpretation of the origin of rheumatoid arthritis. Genetic research, thanks to the latest advances, may better interpret the predisposition of individual families to inflammatory rheumatic diseases. HLA typing at the DR locus - especially DRB1 are most often positive in RA but, like DR 3 DR 4 are not solid evidence of disease. As well as HLA DQ, they occur more often in other so-called autoimmune diseases. The onset and development of RA is certainly related to a late-recognized disorder in the immune system that controls (and stimulates) our defense mechanisms.

The interpretation that the breakdown of the immune system occurs in psycho-labile people, but also people who have experienced stressful situations, tries to fit the theory of the multiple factors of RA. Therefore, it is important that the patient has a history of indicating a possible familial predisposition to rheumatic diseases. Perhaps some external factors may contribute to the development of inflammatory rheumatic disease (viruses, poor diet, frequent infections) but there is no solid evidence for this. We cannot confirm that there is rheumatoid arthritis caused by professional activities. Some demanding professions when joints are exposed to hypothermia, higher stresses, vibrations, can potentiate the progression of RA damage. Therefore, a work history is important, especially with regard to the medical prognosis of work opportunities of people with RA.

Rheumatoid arthritis belongs to a group of diseases that affects all joints, but most commonly the small joints of the hands and feet. However, it can also occur in the joints of the spine and even the jaw joints (chewing disorder), and even the small joints of the larynx (hoarseness in RA). Unlike osteoarthritis (OA), also known as osteoarthritis, which also most commonly first occurs in small wrist joints and is said to be a localized inflammation (most often due to mechanical overload) that begins in the cartilage of the joint, RA that begins in the joint synovial membrane , which, like a tumor, swells in the joint and destroys cartilage, then tendons and bone. Rheumatoid arthritis is unfortunately a systemic disease, which means that it spreads throughout the body. After the joints, RA affects the tendon and muscle and the nervous system, the eye, but also vital organs such as the kidneys, lungs, heart,

Laboratory blood findings such as increased sedimentation (SE> 29), leukocyte count L> 8000, anemia, the presence and increase in the titer of the so-called. Rheumatism factor (RF) in the blood as a reflection of immune imbalance are of particular importance for assessing the degree of the disease as well as the effect of treatment, so they need to be repeated several times a year. An RF titer higher than 1:64 is considered positive for RA. although there are so-called seronegative RA - with characteristic changes without findings of elevated RF titer. Sometimes additional laboratory tests of blood, serum and less often punctured joint fluids are useful. The degree of inflammation is most often analyzed, which, in addition to accelerated SE, is visible in elevated CRP, antiCCP, haptoglobinoma and fibrinogen, but also in decreased C3 and C4, iron (Fe) in serum. IgG, IgA or IgM findings may also be sought to elucidate changes in immunoglobulin synthesis in RA. X-ray images of the hands and feet are useful, although in the early stages of RA they do not yet show characteristic morphological changes. Somewhat more information about the initial RA can give us the so-called. non-aggressive methods (considering the dose of ionizing radiation in X-ray processing) ultrasound examination (US) of joints and tendons of hands and feet, shoulders and sometimes knees. Magnetic resonance imaging (MR) is the most accurate but expensive, so MRs are being developed to show only the hands or feet.

Treatment of rheumatoid arthritis

The prevailing negativity regarding the treatment and cure of inflammatory rheumatic diseases, among which rheumatoid arthritis is the most common, has been overcome by new insights into the multiple causes of the disease. Treatment must be tailored to each patient - at each stage of the disease. Even lay people know that joint inflammation is characterized by heat, pain, redness of the joint, but also swelling and accompanying functional incapacity. Thus, RA also has periods of turbulent inflammatory activity, but also of spontaneous calm. Unfortunately, treatment is not yet causal but only symptomatic, as the immediate cause of RA has not been discovered. Unlike RA, we know the cause of purulent angina - the bacterium Streptococcus, which is sensitive to many antibiotics, especially penicillin. "Penicillin" for the treatment of RA is not yet available, so we must approach the treatment of symptoms, among which the inflammation is the most impressive.

If the patient suspects rheumatic arthritis (importance of early enough self-recognition of the disease), it is advisable to keep the joints from straining (resting) to contact a rheumatologist as soon as possible who will determine the degree of the disease, the sequence of medical treatment, therapy! , rehabilitation, perhaps even suggest a treatment for RA in a spa or suggest treatment for disability retirement.

The basic principles of treatment are:

• alleviation of inflammation (salicylates, nonsteroidal antirheumatic drugs),
• influence on the course of the inflammatory process (basic therapy: s-cytostatics, synthetic antimalarials, gold salts, sulfasalazine),
• corticosteroids (more often topically in the form of injections into the joint)
• immunosuppressants (cytostatics)
• biological drugs

Physical and occupational therapy (rehabilitation)

To deal with more severe deformities of the hands and feet, splints are prescribed, especially at rest. In more severe forms of the disease, rheumatic nodules also appear on the joints, which must not be confused with arthritic nodules on the end joints of the fingers. RA does not affect the end joints of the fingers.