Rheumatoid arthritis - symptoms and prevention
RA, once called gout - is a chronic inflammatory disease, it affects the connective tissue of the body. Most often, it concerns both joints symmetrically. The disease is more common in women than in men, regardless of age.
The most characteristic symptom is swelling, pain and stiffness in the joints. The beginning of the disease is most often characterized by metacarpophalangeal-phalangeal and proximal interphalangeal arthritis of the hands, as well as metatarsophalangeal arthritis of the feet. Inflammation can also affect other joints. Skin of the hands becomes thins and excessively sweaty, atrophy of the interosseous and lumbrical muscles appears.
The American Rheumatism Association (ARA) presented the main criteria for the classification of rheumatoid arthritis, they are:
- morning stiffness lasting at least 1 hour sustaining for at least 6 weeks
- swelling of three or more joints lasting for at least six weeks
- swelling of the wrist, metacarpophalangeal, interphalangeal and proximal metacarpophalangeal joints, lasting a minimum of six weeks
- changes in X-rays typical for RA (erosions, osteoporosis)
- rheumatoid nodules
- rheumatoid factor (RF) in the serum? in the case of the presence of RF, seropositive rheumatoid arthritis is recognized; in the case of its absence and the presence of the required number of diagnostic symptoms, seronegative RA is recognized (typically progressing more smoothly)
Recognition of 4 or more criteria allows for the diagnosis of RA, it is also recommended to carry out appropriate tests to confirm the correctness of the diagnosis.
CHANGES VISIBLE IN X-RAY
The earliest change that indicates rheumatoid arthritis is inflammation of the synovial membrane of the joint. Irrepressible effusion is created then, the synovial membrane is enlarged, the destruction of adjacent tissues around the joint occurs (cartilage, bones, ligaments). Gradually, increasing destruction of the articular surfaces occurs, as well as damage to ligaments and joints distortion. Damage of the cartilage and other joint structures results in the formation of secondary degenerative changes in the joints. Over time, fibrous adhesions are formed, then bone, adhesions which lead to stiffening of the joints.
Rheumatoid Arthritis can be classified based on the degree of joint cartilage damage during functional examination using Seyfried's test. The functions taken into account during the examination:
- active movements in a full passive range of motion with a load lesser than submaximal.
- active movements are in full passive range of motion without any resistance.
- possible active movement in relief in full existing passive range of motion.
- slight movement in the conditions of relief or lack of any movement.
In any case, this examination is performed mainly to assess one joint and does not give an overall picture.
CHANGES OCCURING IN RA
RA is a disease of a systemic nature, but the most characteristic changes regard small joints of the hand. Edema, pain, stiffness, especially in the morning occurs.
In advanced stages of RA, the fingers arrange in the direction of the ulna, then we call it ulnar deviation. Muscular atrophy is also characteristic. Finally, the hand becomes inoperative, and small joints are stiffened.
Distortions of a 'swan neck' type occur - hyperextension in the proximal interphalangeal joint and flexion in the further interphalangeal joint; distortion with fingers of 'boutonnière' type, flexion in the proximal interphalangeal joint, hypertrophy in the further interphalangeal joint, 'boutonnière' thumb also called 'cobbler' - flexion in the metacarpophalangeal joint, hyperextension in the interphalangeal joint.
In 20% of the studied cases under the skin, especially on the elbows and knees and other areas exposed to pressure, rheumatoid nodules occur.
REHABILITATION IN RA
Movement is an element of comprehensive treatment, including:
- pharmacology: analgesic and anti-inflammatory, medication often changed for increasingly stronger;
- dietary supplementation: supplements rich with hyaluronic acid and chondroitin. Hyaluronic acid plays a key role in the production of synovial fluid. In conjunction with chondroitin, it has an analgesic effect, increases the range of motion. It is well absorbed from the gastrointestinal tract which has a huge impact on the strength and efficiency of the joints;
- physiotherapy: analgesic and anti-inflammatory with frequent changes, the following are used:
- thermotherapy, cryotherapy, electrotherapy
- spa treatment brine and hydrogen sulfide baths
Paraffin and peloid is contraindicated;
- occupational therapy: evidence that some movements are possible, various workshops are used;
- orthopedic equipment: balls, joint stabilizers, anti-deformation apparatus, scales;
- surgical treatment: elimination of deformity, contractures, frequent endoplastics;
- kinesiotherapy: adjusted to the disease specifics, the selection of exercises depends on the patient. The role of rehabilitation is to train the patient in the remission period so that he shows the greatest efficiency. Despite all efforts, in an acute inflammatory phase, the patient feels so much pain, that rehabilitation cannot do anything and we even lose what we have gained. This situation often breaks down the patient.
Rheumatoid arthritis is a disease that affects not only the joints, but also the surrounding tissue which only intensifies the already severe symptoms. In severe cases of rheumatoid arthritis, it can lead to dysfunction of various organs, including the:
- blood vessels
Sufficiently early commenced prevention is extremely important. Regular exercise should also be remembered, as well as proper diet that eliminates foods deepening inflammation and supplementation, which will provide nutrition of cartilage and at the same time inhibit the disease progression. Data from observational research of medical institutes indicate that about half of the patients discontinue treatment, mainly due to the adverse action of the used preparation or lack of expected effect.
It is worth to pay attention to the cause of joint ailments. Most often, the pain is caused by inflammation, which results not only from the mechanism in which the disease progresses, but also from the low level of synovial fluid or its poor quality. Through complementing natural deficiencies, we can affect the mitigation of RA.
Movement - try moderate activity, which will not additionally burden the joints. Exercises in relief will certainly proves themselves, as well as long walks or swimming.