Rheumatoid arthritis can also trigger a variety of symptomsthroughout the body. It is unknown if its exact cause, although many of the various factors (including genetic predisposition) that may influence the autoimmune reaction. About 1% of the populationsuffers from this disease, which affects women two to three times more often than men. Rheumatoid arthritis is presented first inindividuals between 25 and 50 years of age, but may do so at any age. In some cases, the disease resolves spontaneously and treatment alleviates symptoms in three out of four people. However, at least one person in 10 is disabled.
In this disease, the immune system attacks the tissue that lines and protects the joints. Finally, cartilage, bone and ligaments of the jointdeteriorate, causing the formation of scar tissue within the joint, which decays at a rate varies.
Rheumatoid arthritis can be started abruptly with inflammation in many joints at the same time, but more often begins subtly gradually affects many joints. The inflammation is generally symmetrical, ie when affecting an articulation of a side, corresponding to the other side is also affected. The small joints of the fingers, toes, wrists, elbows and ankles tend to ignite in the first place. Inflamed joints are often painful and frequently are rigid, especially immediately after getting up or after a prolonged period of inactivity. Some people feel tired and weak, especially during the early afternoon.
The affected joints and can increase rapidly deform. Can also be a rigid position (contracture), which prevents or opening extending completely. The fingers tend to bend toward the little finger on each hand, causing the displacement of the tendons of the fingers. The swollen wrists may lead to carpal tunnel syndrome. The cysts that develop behind the knees affected may burst, causing pain and swelling in the legs. Nearly 30% to 40% of persons suffering from rheumatoid arthritis hard has swellings (nodules) under the skin, often near zones patients.
Rheumatoid arthritis can cause a slight fever and, in some cases, a blood vessel inflammation (vasculitis) that damages the nerves in the legs or sores (ulcers). Inflammation of the lining around the lungs (pleurisy) or the casing of the heart (pericarditis), or inflammation and scarring of the lungs can cause chest pain, difficulty breathing and an abnormal cardiac function. Some people develop inflamed lymph nodes, Sjögren’s syndrome or ocular inflammation.
Still’s disease is a variant of rheumatoid arthritis in that appears first high fever and other symptoms generalized.
It can be difficult to distinguish rheumatoid arthritis from many other diseases that can cause arthritis. Diseases which appear in some respects with rheumatoid arthritis are the acute rheumatic fevercaused by gonococcal arthritis, Lyme disease, Reiter’s syndrome, psoriatic arthritis, ankylosing spondylitis, gout, osteoarthritis andpseudogout .
Rheumatoid arthritis can produce symptoms very characteristic.However, it may be necessary to analyze the liquid which is extracted with a joint or a biopsy needle (extraction of a sample of tissue is examined under a microscope) of nodes to establish a diagnosis. The characteristic changes in the joints can be detectedon radiographs.
Some typical features of rheumatoid arthritis can be seen on the results of laboratory tests. For example, 9 out of 10 persons suffering from rheumatoid arthritis have a sedimentation velocityhigher red blood cell. Most have a mild anemia. On rare occasions,the value of white blood cells is abnormally low. In the latter case, if the individual spleen also has a large and rheumatoid arthritis, is said to be suffering from the disease called Flety.
Most people with RA have antibodies in their blood characteristic.Seven out of ten individuals have an antibody called rheumatoid factor. This factor also has other diseases (such as chronic liver diseases and certain infections), although in some cases this factorappears without any evidence of disease.
In general, the higher the value of the rheumatoid factor in the blood,the more serious the rheumatoid arthritis and poor prognosis. The value of rheumatoid factor may decrease when the joints are lessinflamed and increase the check on the outbreak inflammatory.
There are various treatments, from classic and simple measuressuch as rest and proper nutrition, to the drugs and surgery. The treatment begins with less aggressive measures, progressing to the more aggressive if necessary.
A basic principle of treatment is to rest the affected joint, as theyuse it worsens inflammation. The regular periods of rest serve torelieve pain. Sometimes a brief absolute rest in bed helps relieve asevere outbreak in its most active and painful step. They may usesplints to immobilize and provide rest to one or several joints, but it will take some of the same systematic movements to preventstiffness.
It is advisable to follow a regular diet and healthy. The increased symptoms appear in some cases after eating certain foods. A dietrich in fish and vegetable oils, but low in red meat, may have minorbeneficial effects on inflammation.
The main categories of drugs used to treat rheumatoid arthritis are the nonsteroidal anti-inflammatory drugs (NSAIDs), medicines fordelayed action, corticosteroids and immunosuppressive drugs. In general, the stronger the drug, the greater its potential side effects.Therefore it requires a very strict monitoring.
The anti-inflammatory drugs (See Section 2, Chapter 13) and (See Section 6, Chapter 61), like aspirin and ibuprofen, are most often used, because they reduce swelling in affected joints and soothe the pain. Aspirin is the cornerstone of the traditional treatment of rheumatoid arthritis, however, the novel anti-inflammatory drugs may have fewer side effects and are generally easier to administer, but are more expensive.
Generally the treatment of aspirin begins with a tablet (325 mg) four times a day, but the dosage may be increased to give sufficient relief. The tinnitus is a side effect that indicates that the dose is too high. The stomach complaints (a common side effect in high doses) and ulcers can be prevented or eating food taking antacids or other drugs at the same time. Misoprostol can be useful for preventing irritation of the stomach lining and the formation of ulcers of the stomach (gastric) in individuals at high risk of manifesting such conditions, but in turn can cause diarrhea and, furthermore, does not prevent nausea or abdominal pain resulting from taking aspirin or other anti-inflammatory drugs.
In case of intolerance to aspirin, we experience other anti-inflammatory drugs. However, all they can cause stomach disorders and are contraindicated in patients with active ulcers of the gastrointestinal tract (peptic ulcers). Other less common side effects are headache, confusion, increased blood pressure, swelling (edema) and sometimes, renal disease.
Drugs of delayed action
The medicinal action at times delayed alter the course of the disease, although it may be necessary to several months treatment (which may be dangerous side effects) to verify any improvement.The physician should monitor and follow up treatment. These drugs are prescribed to the anti-inflammatory drugs were not effective after two or three months of treatment or in the case of rapid progress of the disease. The delayed action of drugs that are currently used are penicillamine, hydroxychloroquine and sulphasalazine.
The gold compounds (which are often slow the appearance of deformations bone) may also cause a temporary remission of the disease. These compounds are administered at weekly injections, although it has a preparation which is administered orally. Weekly doses remain until it has been administered a total of up to one gram or appearance of side effects or a significant improvement. If the drug is effective, the frequency of injections may be decreased gradually. The improvement may last several years thanks to a maintenance dose.
Compounds of gold tend to affect many organs adversely, so they are contraindicated in people suffering from liver or kidney problems, or certain blood disorders. Therefore, one must carry out analyzes of blood and urine samples before starting the treatment, and often during the same (up to once weekly). The side effects of these medicines consists of potentially dangerous eruption, burnings and decrease of blood cells. Less often, gold compounds affect the liver, lungs, and nerve, and rarely cause diarrhea. The treatment is suspended if it appears any of these serious side effects.
Penicillamine has beneficial effects similar to those of gold compounds and can be used when they are not effective or causes side effects when intolerable. The dosage is gradually increased to see improvement. Side effects are, among others, the inhibition of formation of red blood cells in bone marrow, kidney, muscle disease, rash and a bad taste in the mouth. Treatment should be discontinued if these symptoms appear. Penicillamine also tends to cause certain disorders such as myasthenia gravis, Goodpasture’s syndrome and SLE like syndrome. During treatment, blood tests and urine tests are carried out every 4 weeks or 4 weeks.
For the treatment of less severe rheumatoid arthritis hydroxychloroquine is used in preference to other compounds such as gold or penicillamine. Its side effects are usually mild (rashes, muscle pain and eye problems). However, some eye problems tend to be permanent and that individuals who take hydroxychloroquine should refer to the ophthalmologist before starting treatment and refer to it every six months for the same. If the end of 6 months did not notice any improvement in the drug treatment is stopped, otherwise, one can extend the time necessary.
Sulfasalazine is prescribed for more rheumatoid arthritis, increasing the dose gradually. The improvement is usually occur after 3 months. However, like other drugs of delayed action, usually cause stomach problems liver problems, changes in blood cells and skin rashes.
Corticosteroids (such as prednisone) drugs are surprisingly effective to reduce inflammation in any part of the body. Although steroids are effective in treatments of short, their effectiveness tends to decrease with time as rheumatoid arthritis, usually remains active for years. These medications usually do not slow the progression of the disease, in addition, prolonged use of corticosteroids invariably involves many side effects, affecting almost every organ in the body.
The most common side effects are thinning of the skin, bruising, osteoporosis, increased blood pressure, increased blood sugar and cataracts. Therefore, these drugs reserve for the immediate treatment of outbreaks when several joints are affected or when other medications have proved ineffective. They are also useful to treat inflammation of the joints at different points, for example in the membrane surrounding the lungs (pleuritis) or the housing of the heart (pericarditis). In most cases, we use the minimum effective dose due to the risk of side effects. For a quick relief and short-term, corticosteroids can be injected directly into the affected joint.However, long term generally accelerate the deterioration, especially when using excessively articulation (which does not hurt for some time due to the frequent administration of injections).
Immunosuppressive drugs (methotrexate, azathioprine and cyclophosphamide) are effective in the treatment of severe forms of arthritis. Suppress the inflammation, whereby corticosteroids can be administered in small doses and even be avoided.
However, these drugs have potentially fatal side effects, such as liver disease, lung inflammation, increased susceptibility to infections and withdrawal of blood cell production in bone marrow and, moreover, cyclophosphamide can produce bleeding in the urinary bladder. Finally, both as azathioprine, cyclophosphamide, may increase the risk of cancer.
The methotrexate, administered orally once a week, it is used with increasing frequency to treat rheumatoid arthritis in the early stages, since it is a fast-acting drug, being effective, in some cases, afterseveral weeks. You can also administer this medicine before prescribing drugs delayed action in the event of severe arthritis.People treated with methotrexate tolerate the drug, but must be strictly controlled. Should be avoided alcoholic beverages to minimize the risk of liver injury. Cyclosporin may be prescribed, which suppresses lymphocyte (a type of white blood cell), when other drugs are ineffective in the treatment of a severe arthritis.
A program for treatment for rheumatoid arthritis, together with the drug to reduce inflammation of the joints, may include exercise, physical therapy, application of heat in the inflamed joints, sometimes surgery. The gentle exercise avoids the rigidity of swollen joints. By reducing inflammation, active and regular exercise can be helpful, without the person reaches the extreme fatigue. In some cases, the exercise in the water can be easier.
The treatment of stiff joints consists of intensive exercise and in some instances the use of splints to gradually extend the joint. If drugs were not effective, surgery may be necessary. The surgical replacement of the knee or hip is the most effective way to restore mobility and function, when the joint disease is at an advanced stage.
It is also possible their extraction or fusion, especially the foot, to make walking less painful. It is possible to fuse the thumb and thus allow the person can use it to hold. You can also merge the upper end of the unstable vertebrae from the neck that does not compress the spinal cord.
People disabled by rheumatoid arthritis can use a variety of grants to carry out everyday tasks. For example, there is specially modified orthopedic shoes that can help you walk with less pain and devices such as handles that reduce the need to tighten by hand.