Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic, slowly progressive systemic disease of the connective tissue of an infectious-allergic nature with a primary lesion of the peripheral joints. The pathological process leads to the complete destruction of articular tissues, to gross deformations and the development of ankylosis, which leads to loss of joint function and disability.

In women, the disease is diagnosed 3 times more often than in men. Pathology develops in people of any age and even in children (juvenile rheumatoid arthritis), but the peak occurs at the age of 40-50 years. The prevalence of the disease is 5.2% for women and 2.5% for men. In the international classification of diseases 10 revision (ICD 10) of this pathology assigned code M05.

What it is?

Rheumatoid arthritis is a systemic disease of the connective tissue with a predominant lesion of the small joints of the erosive-destructive polyarthritis of unknown etiology with complex autoimmune pathogenesis.

Causes of development

The exact factors contributing to the appearance of rheumatoid arthritis have not been established. Supposed causes of rheumatoid arthritis:

  • weakened immunity and allergies;
  • obesity;
  • liver and kidney disease;
  • various injuries, operations in the anamnesis;
  • viruses and bacteria (latent infection);
  • stress and prolonged depression;
  • overdose of hormonal drugs;
  • bad habits;
  • heredity.

Whatever factor causes this disease, it will necessarily entail a violation of the immune system.

Pathogenesis

Rheumatoid arthritis specialists refers to autoimmune diseases. This group of diseases is characterized by the behavior of cell-defenders – lymphocytes. Instead of actively diagnosing foreign bacteria, fungi, viruses, and destroying them, they begin to attack their own healthy cells.

This pathological process of disturbing the interaction of cells of the immune system in the immune response consists of the following steps:

Synoviocytes acquire the features of macrophages, secrete proinflammatory cytokines, primarily tumor necrosis factor alpha, interleukin 1, become antigen-presenting cells and cause activation of T-helper type 1.

In the cells of the synovial fluid and in the synovial membrane of the joint, a large number of T-helper type 1, releasing gamma-interferon and activating macrophages, appear.

Activated macrophages and monocytes produce proinflammatory cytokines: tumor necrosis factor alpha, IL-1, IL-6.

Increasing the concentration of IL-8 in the synovial fluid causes a high concentration of neutrophils in it.

IL-1 causes fever, osteoclast activation, which contributes to osteoporosis of the subchondral bone plate. The tumor necrosis factor causes the appearance of adhesion molecules on the surface of endotheliocytes, promoting exudation, causes weight loss, anemia of chronic inflammation. I16, activating hepatocytes, causes an increase in their production of C-reactive protein; activates B-lymphocytes (turning them into plasma cells).

In the blood, the concentration of immunoglobulin-producing plasma cells increases significantly.

In blood and synovial fluid in 80% of patients, the concentration of IgM and IgG to the changed IgG Fc region (rheumatoid factors) sharply increases.

The secretion of endothelial growth factor contributes to the proliferation of capillaries of synovial tissue. Angiogenesis and proliferation of active fibroblasts, synoviocytes lead to the formation of pannus – an aggressive tissue that has signs of tumor-like growth that can invade the cartilage, the articular surface of the bone, forming erosion, and the ligamentous apparatus. It is important to note that the constituent pannus clone of uncontrollably multiplying, aggressive synoviocytes is formed relatively late – after a few months from the onset of the disease.

Physiotherapy

Physiotherapy treatments:

  • Laser therapy;
  • Ultrasound treatment;
  • Induction;
  • Pulse current treatment;
  • Ultraviolet irradiation;
  • Electrophoresis with medical preparations;
  • Mud therapy;
  • Paraffin therapy and other physiotherapeutic methods.

Physiotherapeutic methods have an effective therapeutic effect at the onset of the disease, and in addition – during the rehabilitation period.