Rheumatoid Arthritis

Definition

Rheumatoid arthritis is a constitutional disease, inflammatory disorders in which there are in all connective tissues of the body. The main feature is polyarthritis with predilection for smaller joints, such as the proximal interphalangeal, metacarpophalangeal and the metatarsophalangeal joint, with a tendency for symmetrical distribution after the disease has been established. Arthritis is produced by a chronic inflammatory-proliferative formation of the synovial membrane. Both constitutional signs such as inflammation of the synovial activity are subject to variations in gravity, with a strong tendency for inexplicable remissions and exacerbations.

Juvenile rheumatoid arthritis

The onset of rheumatoid arthritis in children, certain features distinguish it from the usual picture seen in adults. The constitutional symptoms, particularly fever, tend to be more severe and may even precede the development of arthritis, sometimes many weeks or months. Can be seen some varieties of non-specific rashes, usually of erythema multiforme. The nodules are rare. Uveitis is frequent and may lead to blindness. They are most common signs of pericarditis or cardiac valvular lesions, as is also the ordinary swelling of lymph nodes, liver and spleen. He was given the name of Still's disease in which the juvenile rheumatoid great is visceral, in general, it is assumed that the degree of manifestations in rheumatoid arthritis in children is as varied as in the adult and that does not justify the separation of this combination as a pathological entity separately. Monoarticular involvement early in the disease is more common in children than in adults.

Certain skeletal abnormalities occur in children mainly by interfering with normal growth rate of secondary bone centers. Rheumatoid inflammation in the vicinity of these centers may temporarily accelerate its growth and cause premature epiphyseal then welding. This can result in failure of certain bones as the jaw, to fully develop. It is also remarkable in juvenile rheumatoid arthritis, a predilection for involvement of the cervical spine, leading to ankylosis of the cervical vertebrae; other parts of the spine are spared. The tests for rheumatoid factor positive are in a smaller percentage of rheumatoid arthritis children than for adults.

Etiology and pathogenesis

The cause of rheumatoid arthritis is not known. Intensive efforts have failed to establish that the disease is caused by an infectious agent-specific up or nutritional deficiency, by metabolic aberrations, endocrine secretions by defective, or unbalanced, and defined by a mechanism involving dysfunction of the autonomic nervous system, or by somatic emotional disturbances and personality. Ideas on the facts desencandeantes in rheumatoid arteritis are currently dominated by concepts of autoimmunity, or at least the function of the immune response in mediating tissue injury.

Rheumatoid arthritis is a disease of autoimmune origin characterized by a chronic inflammation of the synovial membrane, a small bag located deep in the face of the articular surfaces. Has the power to produce irreversible damage to the capsule and the articular cartilage, since these structures are replaced by granulation tissue. Rheumatoid arthritis is the opposite of osteoarthritis. The mechanical arthritis is a disease which is exacerbated, especially when the patient moves, the arthritis is unlike is an inflammatory disease which is believed caused by an infectious agent. Perhaps a viral or bacterial protein that is installed in the synovium. The protein would cause an immune reaction that would trigger the potent macrophage infiltration and nodes that are observed in arthritic joints.

These immune cells release enzymes that play a key role in the destruction of tissue. Although statistical considerations suggest a hereditary influence, judicious genetic studies in selected populations and identical twins have clearly indicated that heredity is not a dominant factor in rheumatoid arthritis. Evidence is accumulating impressive come to suggest the importance of an immune mechanism in the pathogenesis of the disease, although the initial events still remain unclear.

Modes early rheumatoid arthritis

The clinical manifestations of this disease vary greatly from one patient to another, and in the same patient at different times. The degrees of intensity of the constitutional and articular manifestations are not necessarily parallel, and several ways to start may represent embarrassing problems in early diagnosis of the disease. The symptoms may be found in approximately two thirds of patients. The most common are: easy fatigue, weakness, weight loss and vasomotor disturbances, feeling of numbness and tingling of the hands and feet. Patients with rheumatoid arthritis often relate the onset of his illness with the onset of disorders that tend to exhaust the physical and / or emotional problems: acute infection, contagion, hard work, anxiety and emotional tension. An insidious onset, gradual, is considered most characteristic, and occurs in slightly more than half of patients.

Pain on movement and stiffness are usually noted in only one or a few joints, followed by edema. Although almost any of the joints of the body may be initially committed within a few weeks the small joints of the hands and feet are usually affected. An acute onset is not uncommon: pain and swelling in multiple joints suddenly appear, associated with chills, fever and prostration. Sometimes, particularly in children, the febrile reaction is the outstanding feature and may precede any joint compartment by several months.

Clinical manifestations. Symptoms.

Pain in affected joints varies considerably and is not always proportional to the degree of swelling. Pain at rest, not relieved by analgesics and heat, is quite unusual, except when there is severe acute inflammation. The pain is more persistent movement and is noted particularly with twisting movements of hands and wrists, and feet and knees while supporting weight. The rigidity is perhaps the most constant symptom. Characteristically, patients with rheumatoid arthritis feel worse upon rising in the morning, and requires a period of half an hour to several hours to "make it more agile." Such a patient usually has its most marked improvement in the late morning or early afternoon. You may experience additional episodes of stiffness and pain after periods of rest during the day, or accompanied by fatigue in the afternoon or evening.

There are frequent episodes of muscle pain and tenderness, especially around the neck and shoulders. The constitutional symptoms vary greatly in intensity. The degree of fatigue and weight loss are very common, are often associated with real malaise and weakness. Fever is usually of low intensity but were well-documented cases of persistent daily high temperature from 38.8 to 40.0 ° C, without reasonable explanation. Moreover, there may be no temperature rise.

Clinical course and prognosis

Rheumatoid arthritis can follow a course comparatively brief, a few months, and there may be a complete resolution of symptoms for several months or even years. In most patients, however, the disease returns, in each recurrence and assumes a more chronic form. Even in patients in whom the disease runs a chronic progressive course, lasting for years, there are often periods of relative comfort, alternating with periods of disease activity. With each exacerbation, new relationships can be compromised, and the function may be more limited in joints previously affected.

Treatment

Basic Principles. Rheumatoid arthritis is a chronic systemic disease, and doctors should constantly remind yourself of this fact. Local treatment for painful joints often provides symptomatic relief, but much more must be done to achieve satisfactory results. The physician must also recognize that rheumatoid arthritis is subject to spontaneous remissions and exacerbations, which might cause them to give effective therapeutic agents useless. It is important to use a multiple treatment program, carefully tailored to the needs of each patient, rather than relying on a single measure. The methods of committed value applicable to a greater or lesser extent for each patient with rheumatoid arthritis can be summarized under the titles of (1) resting (2) relief of pain, (3) maintenance of joint function by physical, (4) prevention and deformity correction by orthopedic application of the principles, and (5) correction of any factors that are detrimental to patient health.

The beginning of this program of treatment can often be better run by a few weeks of hospital care. The hospital not only provides resources for home and nursing care, and gives the opportunity to indoctrinate the patient in the use of relatively simple analgesics and physiotherapy, but also allow you to carefully review all factors related to their overall health .