Rheumatoid arthritis is an autoimmune pathology, which is characterized by the development of an inflammatory process in the tissues of the joints and cartilage. According to statistics, 1% of the total population suffers from this disease, which is approximately 58 million people. Women are more susceptible to this pathology: there are 4 women for 1 sick man.
This is a really dangerous disease that has a chronic course with a tendency to gradually worsen the patient's condition. Untimely and incorrect treatment of the disease leads to disability.
Main reasons
To understand how to differentiate rheumatoid arthritis from other joint pathologies, and to know how to cure the disease, it is necessary to find out the features of the etiology, pathogenesis, clinic and diagnosis of rheumatoid arthritis.
The term "etiology" means finding out the causes of the disease. Pathogenesis is a step by stepthe development of the disease, which determines its clinical manifestations, methods of diagnosis and treatment.
The reason for the development of this disease is not completely clear. Two theories of its origin are most widespread: hereditary and infectious. In favor of the first of them is the presence of cases of the development of the disease in several generations of the same family. This is due to a genetic predisposition to arthritis in the presence of a special gene of the HLA group.
The infectious theory is confirmed by cases of the development of pathology in people who have had hepatitis B, measles, rubella, herpes, mumps. The role of tubercle bacilli in joint damage is now being actively discussed.
Researchers separately identify groups of people who are most susceptible to rheumatoid arthritis:
- women over 45;
- patients with a positive family history: rheumatoid arthritis in immediate family;
- often sick.
The main links of pathogenesis
Rheumatoid arthritis is an autoimmune disease. This means that its development is associated with increased activity of the immune system and impaired immune response. The body produces antibodies against its own cells, which act as an antigen. In this case, the cells of the joints and cartilage suffer. The antibody settles on their surface and causes inflammation.
Another mechanism is immunocomplex. Autoantibodies are formed against their own immunoglobulins. These antibodiescontribute to the formation of rheumatoid factor. Knowledge of this indicator is very important for the differential diagnosis of rheumatoid arthritis, since it is specific for autoimmune diseases. With pathologies such as gout or osteoarthritis, rheumatoid factor is not formed.
Rheumatoid factor, together with immunoglobulin, makes up immune complexes that affect joints, cartilage, bones.
Classification
Depending on the etiology, pathogenesis, clinic, diagnosis and treatment of rheumatoid arthritis, it is divided into separate groups. Thus, the clinical manifestations and the number of affected joints determine the following types of pathology:
- monoarthritis - damage to one joint;
- oligoarthritis - inflammation of two or three joints;
- polyarthritis - extensive inflammation of more than three joints.
Depending on the characteristics of pathogenesis and diagnostic criteria, they are distinguished:
- seronegative arthritis - rheumatoid factor not detected;
- seropositive arthritis - rheumatoid factor is present and can be detected in joint fluid.
Separately, there are specific groups of the disease, with which it is also necessary to conduct differential. diagnosis of rheumatoid arthritis. These include juvenile rheumatoid arthritis (affecting children under 16 years of age), Still and Felty syndrome (severe forms of the disease with damage to internal organs).
In the article we presented a photo of the symptoms, diagnosis and treatment of rheumatoid arthritis.
Clinical manifestations
In the differential diagnosis of rheumatoid arthritis, specific clinical manifestations of joint damage are taken into account. These include:
- The onset of inflammation in the small joints of the arms and legs, wrists, elbows and knees.
- Symmetry of the inflammatory process, that is, simultaneous damage to the joints on two arms or legs.
- Inflammation is accompanied by severe pain.
- A symptom specific to rheumatoid arthritis is morning stiffness, which is manifested by difficulty in moving the affected joints.
- Redness of the skin around the joints during an active inflammatory process.
- When the course of the disease worsens and polyarthritis develops, large joints begin to be affected.
Also, when diagnosing rheumatoid arthritis, it is important to consider which joints are damaged. The most characteristic inflammation of the 2nd and 3rd metacarpophalangeal joints, proximal interphalangeal, elbow and knee, wrist and ankle. That is, if the distal interphalangeal, 1st metacarpophalangeal, proximal interphalangeal joints of the 5th finger are affected, rheumatoid arthritis must be ruled out.
Also among the symptoms noted is a violation of the general condition of the patient, fever, loss of appetite, weight loss.
Specific changes on the skin are characteristic - subcutaneous nodules. Not larger than 2 cm in diameter, they either appear or disappear. Their most common localization is the back surface of the hands, but they can also appear on the back of the head,on the skin of the forearm, and sometimes on the surface of internal organs (heart or lungs).
Symptoms, diagnosis and treatment of rheumatoid arthritis of the fingers are directly related.
Diagnostic criteria
As you can see from the section above, the described disease causes a lot of different symptoms, and not all patients have them all. Therefore, to simplify the diagnosis, certain criteria for the diagnosis of rheumatoid arthritis have been identified:
- Morning stiffness for at least one hour, which bothers the patient for more than 1.5 months.
- Inflammation of three or more joints.
- The defeat of the joints of the hand.
- Symmetrical defeat.
- The presence of rheumatoid nodules on the skin.
- Rheumatoid factor positive.
- Changes in the bones of the joints on x-rays.
A doctor has the right to confirm the presence of rheumatoid arthritis when a patient has 4 or more criteria from the list above.
Additional diagnostic methods
When making a diagnosis, not only the symptoms of the disease are taken into account, but also the data of additional examination methods. The following tests are used to diagnose rheumatoid arthritis:
- general and biochemical blood tests;
- determination of rheumatoid factor in blood and joint fluid;
- radiography of affected areas;
- abdominal ultrasound;
- joint puncture;
- skin nodule biopsy.
Changes in CBC are not strictly specific to rheumatoid arthritis. They are also present in other autoimmune inflammatory processes. Characterized by an increase in the erythrocyte sedimentation rate (ESR), an increase in the number of leukocytes (leukocytosis), a decrease in the concentration of platelets and erythrocytes is possible.
In a biochemical test for the diagnosis of rheumatoid arthritis, an increase in the level of C-reactive protein and gamma globulin is observed. These changes are also non-specific.
Rheumatoid factor is determined both in the blood and in the joint fluid. Depending on its presence, the type of rheumatoid arthritis is determined. If the arthritis is seropositive, the severity and activity of the process are recognized by the amount of rheumatoid factor. If rheumatoid factor is not identified, the diagnosis of seronegative rheumatoid arthritis focuses on other diagnostic criteria.
X-ray stages of the disease
X-ray helps to establish the neglect of the pathological process. Therefore, it is essential in the diagnosis of rheumatoid arthritis.
The following stages of pathology are distinguished:
- Softening and destruction of the marginal sections of the bone (epiphyses).
- Reducing the distance between the articular surfaces, narrowing the joint space. The patient develops isolated ulcerations on the bones (usuras).
- The gap narrows even more, a large number of usura is characteristic, subluxations of the joints are observed, the shape of the hand changes, it deviates towards the ulnaforearms.
- Complete immobility in the joints (ankylosis) joins the changes of the 3rd stage.
X-ray examination is especially important in the diagnosis of seronegative rheumatoid arthritis, since in the absence of rheumatoid factor, X-ray is the main criterion for the severity of the disease.
Features of early diagnosis of rheumatoid arthritis
The named disease has a progressive course with the development of irreversible changes in the joints, so it is so important to identify it and start treatment as early as possible. The diagnostic criteria presented by us in the relevant section are quite informative, but have a significant drawback - with their help it is possible to make a diagnosis only at later stages. Therefore, in America and Europe, indicators have been developed that allow you to identify the disease at the very beginning. There are four main groups:
- Number and size of affected joints (from 1 to 10, small or large).
- Presence or absence of rheumatoid factor.
- ESR and C-reactive protein levels (normal or elevated).
- Duration of symptoms (more or less than 6 weeks).
Each of the categories is awarded a certain number of points:
- The defeat of 1 large joint - 0 points, 2-10 large joints gives 1 point, 4-10 small - 3 points, more than 10 small - 5 points.
- Negative RF gives 0 points, low level - 2 points, high level - 3 points.
- Normal C-reactive protein and ESR - 0 points,level up - 1 point.
- If symptoms last less than 6 weeks - 0 points, and longer than 6 weeks - 1 point.
All these points are summed up. And if the total is more than 6, the doctor can confirm the diagnosis. This is the reason for the appointment of appropriate therapy, since there is a direct dependence of treatment on the symptoms and diagnosis of rheumatoid arthritis of the fingers or other joints.
Features of juvenile rheumatoid arthritis
Symptoms and diagnosis of juvenile rheumatoid arthritis (JRA) have their own characteristics. So, with the named pathology, certain groups of joints are affected:
- lower spine;
- joints between the temporal bone and the lower jaw.
Unlike adults, larger joints are more likely to become inflamed in children. The course of the disease can be acute and chronic. In the first case, the child's condition is severe, the temperature rises to 38-39 ° C, an allergic rash appears on the skin. The joints become inflamed sharply, this is accompanied by severe pain. The process is bilateral.
In a chronic course, large joints are first damaged on the one hand, inflammation proceeds sluggishly, without significant pain. If infants are ill, it results in the child being unable to sit or walk.
Another difference between this disease and adult rheumatoid arthritis is the defeat of the lymphatic system with an increase in lymph nodes. In severe forms (Still's syndrome), the autoimmune process affects the heart with the development of myocarditis, increasesliver and spleen. These changes can be seen with ultrasound.
Changes in blood tests in children are more pronounced. High leukocytosis due to neutrophils is characteristic, the level of ESR is significantly increased. These changes indicate the activity of the process.
What diseases should be differentiated with
Joint damage is characteristic of many diseases. It can be autoimmune, as in rheumatoid arthritis, or infectious, as in reactive arthritis. It can also occur with metabolic changes in the joint (with osteoarthritis) or be associated with the formation of uric acid crystals (with gout).
Thus, the differential diagnosis of rheumatoid arthritis of the fingers should be carried out with the following diseases:
- purulent or reactive arthritis;
- tuberculous arthritis;
- rheumatoid arthritis;
- systemic lupus erythematosus;
- psoriatic arthritis;
- osteoarthritis;
- gout;
- Ankylosing spondylitis.
Features of infectious and tuberculous arthritis
For purulent arthritis is characterized by an acute onset with a significant increase in body temperature, redness and heat of the skin around the joint. As a rule, only one of them is affected. A previous infection will help to suggest the correct diagnosis.
In the blood test, a high leukocytosis with a large number of neutrophils is determined. But if the symptoms and blood picture still do not allow for a definitive diagnosis, in the differential diagnosis withrheumatoid arthritis will help puncture the joint with the study of joint fluid. In arthritis of an infectious nature, bacteria and neutrophils are determined in it, and in rheumatoid arthritis, rheumatoid factor is present.
The defeat of the joints with a tubercle bacillus occurs gradually and is asymptomatic for a long time. X-ray shows bone destruction, but it does not show usuration, subluxation, and ankylosis.
Differences between rheumatic and rheumatoid arthritis
The defeat of small joints and the formation of subcutaneous nodules in rheumatism leads to difficulties in the differential diagnosis of rheumatoid arthritis and rheumatic arthritis. Despite the similarity of names, these are two different pathologies.
Inflammation of the joints in rheumatism - rheumatoid arthritis - is accompanied by damage to the heart muscle and nervous tissue. As a result, specific conditions such as myocarditis and chorea develop.
Articular syndrome in rheumatism also has distinctive features:
- inflammation of large joints;
- asymmetric inflammation;
- "Volatile" involvement of the joints, that is, the defeat of one is quickly replaced by the defeat of the other.
Inflammation of the joints in rheumatism is not as progressive as in rheumatoid arthritis. It does not lead to dislocations and ankylosis, and after recovery there are no residual effects.
Differences between rheumatoid arthritis and gout
BThe nature and localization of the inflammatory process plays a big role in the differential diagnosis of rheumatoid arthritis and gouty arthritis.
When gout affects the small joints of the foot, inflammation of the joints of the big toe is especially characteristic. Inflammation is manifested by a sharp attack of pain, redness of the skin in the affected area, the inability to move a finger. Most often, an attack can be triggered by something: alcohol intake, stress, hypothermia, colds.
Specific formations appear on the skin - tophi. They arise due to the accumulation of uric acid crystals, which is detected in a biochemical blood test and during joint puncture. Typical localization - auricles, fingers, elbow joints.
Differences between rheumatoid arthritis and osteoarthritis
Special attention should be paid to the differential diagnosis of rheumatoid arthritis and osteoarthritis. Osteoarthritis is a common pathology in the elderly. With it, the joints are not damaged by autoimmune inflammation, as in rheumatoid arthritis. There is a metabolic disorder in the cartilage tissue and the destruction of collagen fibers, which as a result leads to the formation of cracks on the articular surfaces of the bones.
Osteoarthritis affects the joints that are most exposed to stress. This is primarily the knee and hip joints. At the same time, during movements, the patient can hear a characteristic crunch. Unlike rheumatoid arthritis, pain in osteoarthritis occurs at the end of the day after prolonged physical activity.loads. Sometimes there are sharp pains in the blockade of the joint.
A specific x-ray symptom in osteoarthritis is the growth of bone tissue to the sides (osteophytes). There is also a decrease in the distance between the articular surfaces of the bones.
The development of inflammation is not typical for metabolic changes in the cartilage, and therefore there are no characteristic changes in the general and biochemical blood tests (increased levels of leukocytes, ESR, C-reactive protein, gamma globulins).
Rheumatoid arthritis treatment
The symptoms, diagnosis and treatment of rheumatoid arthritis of the fingers or other joints are inextricably linked. Clinical manifestations and the severity of the disease determine the therapeutic tactics.
Treatment can be divided into two large groups: drug and non-drug. Therapy continues for a long time, sometimes it can be lifelong. To successfully control the disease, it is necessary to regularly use the medicines prescribed by the doctor.
Non-drug treatment includes physiotherapy, exercise therapy, and in advanced cases, surgical treatment is possible.
For the purpose of drug control for the disease, the following groups of drugs are used:
- immunosuppressive;
- nonsteroidal anti-inflammatory drugs (NSAIDs);
- antimalarial;
- corticosteroids;
- monoclonal antibodies.
Immunosuppressive agents are basic in the treatment of rheumatoid arthritis. They are able to blunt the immune response, thus inhibitingformation of antibodies against own cells. These are drugs such as Methotrexate, Azathioprine, Mercaptopurine and others.
Non-steroidal anti-inflammatory drugs and corticosteroids also have a similar effect. They reduce the formation of biologically active substances produced during the inflammatory process. This reduces inflammation and swelling of the joints.
Corticosteroids have a stronger effect, but at the same time cause more side effects. Therefore, they are prescribed rarely and in short courses, only with severe inflammation.
The most popular NSAIDs include: Iboprofen, Diclofenac, Nimesulide. Among corticosteroids, Dixamethasone, Prednisolone are most often used.
Antimalarial drugs (Plaquenil, Delagil) also reduce inflammation. They are only used as an adjunct to immunosuppressive medications.
Modern therapy for rheumatoid arthritis is carried out with the help of monoclonal antibodies. They affect specific links in the pathogenesis of the disease, without inhibiting the entire immune system. The main disadvantage of this group of drugs is their high cost. Therefore, the help of biological therapy is sought after the ineffectiveness of drugs from the main groups.
Possible Complications
Rheumatoid arthritis can affect not only joints, but also internal organs. When the process is running, the following complications develop:
- anemia;
- autoimmune inflammationlungs and pleura (pneumonitis and pleurisy);
- inflammation of blood vessels (vasculitis);
- inflammation of the heart muscle and the membrane surrounding the heart (myocarditis and pericarditis);
- inflammation of the glands.
Proper differential diagnosis of rheumatoid arthritis and timely prescribed treatment will help to avoid the development of these complications, as well as further deterioration of the course of the disease.
