According to ICD 10, rheumatoid arthritis belongs to class M: inflammatory polyarthropathies. In addition to it, this includes JRA (juvenile or juvenile rheumatoid arthritis), gout and others. The causes of this disease are still not fully understood. There are several theories about its development, but no consensus has yet been formed. The infection is thought to cause dysregulation of the immune system in predisposed individuals. As a result, molecules are formed that destroy the tissues of the joints. Against this theory is the fact that rheumatoid arthritis (ICD code - 10 M05) is poorly treated with antibacterial drugs.
Case history
Rheumatoid arthritis is an ancient disease. The first cases of it were discovered during the study of the skeletons of the Indians, whose age was about four and a half thousand years. In the literature, the description of RA is found from 123 AD. People with characteristic symptoms of the disease were captured on the canvases of Rubens.
As a nosological unit, rheumatoid arthritis was first described by the doctor Landre-Bove at the beginningnineteenth century and called it "asthenic gout". The disease received its present name half a century later, in 1859, when it was mentioned in a treatise on the nature and treatment of rheumatic gout. For every one hundred thousand people, fifty cases are detected, most of them women. By 2010, more than forty-nine thousand people had died from RA worldwide.
Etiology and pathogenesis
RA is such a common disease that it has a separate chapter in ICD 10. Rheumatoid arthritis, like other joint pathologies, is caused by the following factors:
1. Heredity:
- susceptibility to autoimmune diseases in the family;
- the presence of a certain class of histocompatibility antibodies.
2. Infections:
- measles, mumps (mumps), respiratory syncytial infection;
- hepatitis B;
- all family of herpes viruses, CMV (cytomegalovirus), Epstein-Barr;
- retroviruses.
3. Trigger factor:
- hypothermia;
- intoxication;
- stress, medication, hormonal disruptions.
The pathogenesis of the disease is an abnormal reaction of the cells of the immune system to the presence of antigens. Lymphocytes produce immunoglobulins against body tissues instead of destroying bacteria or viruses.
Clinic
According to ICD 10, rheumatoid arthritis develops in three stages. In the first stage, swelling of the joint capsules is observed, which causes pain,the temperature rises and the shape of the joints changes. In the second stage, the cells of the tissue that covers the joint from the inside begin to divide rapidly. Therefore, the synovial membrane becomes dense and rigid. In the third stage, inflammatory cells release enzymes that destroy joint tissues. This causes difficulty with voluntary movements and leads to physical defects.
Rheumatoid arthritis (ICD 10 - M05) has a gradual onset. Symptoms appear gradually, it can take months. In extremely rare cases, the process can begin acutely or subacutely. The fact that the articular syndrome (pain, defiguration and local temperature increase) is not a pathognomonic symptom makes the diagnosis of the disease much more difficult. As a rule, morning stiffness (the inability to move the joints) lasts about half an hour, and it intensifies when active movements are attempted. A harbinger of the disease is joint pain when the weather changes and general weather sensitivity.
Clinical course options
There are several options for the course of the disease, which the doctor should be guided by in the clinic.
1. Classic, when joint damage occurs symmetrically, the disease progresses slowly and there are all its precursors.
2. Oligoarthritis affecting exclusively large joints, usually the knees. It begins acutely, and all manifestations are reversible within one and a half months from the onset of the disease. At the same time, joint pains are volatile in nature, there are no pathological lesions on the radiograph.changes, and treatment with NSAIDs (non-steroidal anti-inflammatory drugs) has a positive effect.
3. Felty's syndrome is diagnosed if an enlarged spleen with a characteristic pattern of blood changes joins the disease of the joints.
4. Juvenile rheumatoid arthritis (ICD code 10 - M08). A characteristic feature is that they are ill children under 16 years of age. There are two forms of this disease:
- with allergic septic syndrome;
- articular-visceral form, which includes vasculitis (inflammation of the joints), damage to the valves of the heart, kidneys and digestive tract, as well as damage to the nervous system.
Classification
As in the case of other nosological entities reflected in ICD 10, rheumatoid arthritis has several classifications.
1. According to clinical manifestations:
- very early when symptoms last up to six months;
- early if the disease lasts up to a year;
- deployed - up to 24 months;
- late - with a disease duration of more than two years.
2. X-ray stages:
- First. There is a thickening and compaction of the soft tissues of the joint, single foci of osteoporosis.
- Second. The process of osteoporosis captures the entire epiphysis of the bone, the joint space narrows, erosion appears on the cartilage;
- Third. Deformation of the epiphyses of bones, habitual dislocations and subluxations;
- Fourth. Ankylosis (complete absence of the joint space).
3. Immunologicalfeature:
For rheumatoid factor:
- seropositive rheumatoid arthritis (ICD 10 - M05.0). This means that the patient has rheumatoid factor in the blood.
- seronegative rheumatoid arthritis.
According to antibodies to cyclic citrulline peptide (Anti-CCP):
- seropositive rheumatoid arthritis;
- seronegative rheumatoid arthritis (ICD 10 - M06).
4. Function class:
- First - all activities are saved.
- Second - professional activity is violated.
- Third - the ability to self-service remains.
- Fourth - all activities are disrupted.
Rheumatoid arthritis in children
Juvenile rheumatoid arthritis ICD 10 distinguishes into a separate category - as an autoimmune disease of young children. Most often, children get sick after a serious infectious disease, vaccination or joint injury. Aseptic inflammation develops in the synovial membrane, which leads to excessive accumulation of fluid in the joint cavity, pain, and ultimately to thickening of the wall of the articular capsule and its adhesion to the cartilage. After some time, the cartilage breaks down and the child becomes disabled.
In the clinic, mono -, oligo - and polyarthritis are distinguished. When only one joint is affected, it is, accordingly, monoarthritis. If up to four joints are subject to pathological changes at the same time, then this is oligoarthritis. Polyarthritis is diagnosed when almost all joints are affected. There are also systemic rheumatoid arthritis,when other organs besides the skeleton are affected.
Diagnosis
In order to make a diagnosis, it is necessary to correctly and fully collect an anamnesis, conduct biochemical blood tests, make x-rays of the joints, as well as serodiagnosis.
In a blood test, the doctor pays attention to the erythrocyte sedimentation rate, rheumatoid factor, the number of blood cells. The most progressive at the moment is the detection of anti-CCP, which was isolated in 2005. This is a highly specific indicator that is almost always present in the blood of patients, unlike rheumatoid factor.
Treatment
If the patient has had an infection or it is in full swing, then specific antibiotic therapy is indicated for him. When choosing drugs, pay attention to the severity of the articular syndrome. As a rule, they start with non-steroidal anti-inflammatory drugs and at the same time corticosteroids are injected into the joint. In addition, since RA is an autoimmune disease, the patient needs plasmaphoresis to eliminate all immune complexes from the body.
Treatment is usually lengthy and can take years. This is due to the fact that drugs must accumulate in the tissues. One of the key points of therapy is the treatment of osteoporosis. For this patient, they are asked to follow a special diet with a high content of calcium (dairy products,almonds, walnuts, hazelnuts), and take calcium and vitamin D supplements.
