Internal illnesses. Rheumatoid arthritis (lecture notes)

Lecture notes, cheat sheets
Free library / Directory / Lecture notes, cheat sheets

Internal illnesses. Rheumatoid arthritis (lecture notes)

Lecture notes, cheat sheets

Table of contents (expand)

LECTURE No. 44. Rheumatoid arthritis

Rheumatoid arthritis is a chronic systemic connective tissue disease with a progressive lesion of predominantly peripheral (synovial) joints, similar to erosive-destructive polyarthritis.

Classification. When making a diagnosis, a division is made:

1) according to clinical characteristics: poly-, oligo-, monoarthritis, the presence of visceritis, combination with other rheumatic diseases;

2) by the presence of rheumatoid factor: seropositive, seronegative;

3) according to the degree of activity: minimal I, moderate II, maximum III, remission;

4) according to the x-ray stage: I - osteoporosis, II - narrowing of the joint spaces, III - erosion, IV - ankylosis;

5) by functional insufficiency: I degree - professional ability is preserved, II degree - is lost, III degree - the ability to self-service is lost.

Clinic. The main syndromes are articular (damage mainly to small joints of the hands and feet, ulceration of the cartilage of the surface of the joints, deformity, ankylosing, morning stiffness syndrome), cardiac (myocarditis, endocarditis with the formation of a superficial heart disease, pericarditis), pulmonary (adhesive pleurisy, fibrosing pneumonitis) , renal (chronic glomerulonephritis, amyloidosis), trophic disorders (rheumatoid nodules in the periarticular tissues of the affected joints), vascular (digital arteritis in the nail phalanges), asthenovegetative (fever, weight loss), anemic (secondary iron deficiency anemia).

The main clinical forms are articular (the main form of manifestation of the disease - in 80% of cases), benign, articular-visceral, Felty's syndrome (1% of cases - pancytopenia, enlargement of the spleen and peripheral lymph nodes), malignant, rapidly progressive form, Sjögren's syndrome (involvement parenchyma of the salivary and lacrimal glands with subsequent atrophy).

The basis of diagnosis are major and minor criteria.

К big criteria include the following:

1) morning stiffness;

2) pain during movement or soreness of at least one joint;

3) joint swelling;

4) swelling of at least one more joint (established with an interval of no more than 3 months);

5) symmetry of swelling of the joints;

6) subcutaneous nodules;

7) typical radiological changes in the joints with the inclusion of periarticular osteoporosis;

8) rheumatoid factor in the blood;

9) characteristic changes in synovial fluid;

10) characteristic histological changes in the synovial membrane;

11) characteristic histology of rheumatoid nodules.

In the presence of seven criteria, the diagnosis is considered reliable, less than seven criteria - probable.

Small Criteria:

1) subcutaneous rheumatoid nodules;

2) medium or high titers of rheumatoid factor;

3) characteristic radiological changes in the joints;

4) the presence of a symptom of morning stiffness (at least 30 minutes);

5) the presence of a rheumatoid hand (ulnar deviation, "walrus flipper").

If these signs are present, a diagnosis of rheumatoid arthritis can be made.

Additional diagnostic study. The examination algorithm corresponds to that adopted for systemic connective tissue diseases. High titers of rheumatoid factor are found, with x-ray studies - narrowing of the interarticular gaps, erosion, ankylosis.

Complications. Complications are subluxations, ankylosing, bursitis, cysts, secondary iron deficiency anemia, amyloidosis, neurocirculatory dystonia of mixed origin, recurrent iridocyclitis, atrophic changes in regional muscles, secondary infections.

Differential diagnostics. Should be carried out with acute rheumatism, reactive polyarthritis, systemic lupus erythematosus, rheumatoid-like syndromes (Bekhterev's disease, Sjögren's, Reiter's disease, psoriatic arthropathy), deforming osteoarthritis, gout.

Treatment. Non-steroidal anti-inflammatory drugs are prescribed (butadione, indomethacin, voltaren, ortofen, brufen, naproxen, ketoprofen, ponstan, etc.), preference is given to long-acting drugs. Hormone therapy is carried out (corticosteroids, with the ineffectiveness of non-steroidal anti-inflammatory drugs and the ongoing activity of the process - 15-20 mg with a slow decrease and the addition of non-steroidal anti-inflammatory drugs in increasing doses). Cytostatic immunosuppressants are administered (decrease in the formation of immune complexes and rheumatoid factor) - azathioprine pr 50 mg 2-3 times a day, chlorbutin 2 mg 2-3 times a day; D-penicillinamine, cuprenil 0,15-0,3 g 2-3 times a day for 4-5 months, delagil. Basic therapy is carried out with gold preparations (krizanol 2 ml intramuscularly once a week for 1-7 months), aminoquinoline preparations are used: rezoquin, plaquenil 8-0,12 g, 0,25 tablet at night for 1-10 months. Plasmapheresis, hemosorption (to remove immune complexes) is also carried out.

Physiotherapy treatment, physiotherapy exercises, sanatorium treatment, surgical methods of correction are shown - to restore the function of the joints.

Flow. The course of the disease depends on the form: with articular - slowly progressive with gradual deformation of the joints (10-15 years), with articular-visceral - rapidly progressive (2-3 years).

Forecast. With the articular form, the prognosis is favorable, with the articular-visceral form - unfavorable.

Prevention. To prevent the development of relapses of the disease, long-term use of basic drugs, non-steroidal anti-inflammatory drugs is carried out.

Author: Myshkina A.A.

<< Back: Nodular periarteritis

>> Forward: Allergy

We recommend interesting articles Section Lecture notes, cheat sheets:

▪ Criminology. Crib

▪ Theory and methodology of education. Lecture notes

▪ The budget system of the Russian Federation. Crib

See other articles Section Lecture notes, cheat sheets.

Read and write useful comments on this article.

<< Back

Latest news of science and technology, new electronics:

The existence of an entropy rule for quantum entanglement has been proven 09.05.2024

Quantum mechanics continues to amaze us with its mysterious phenomena and unexpected discoveries. Recently, Bartosz Regula from the RIKEN Center for Quantum Computing and Ludovico Lamy from the University of Amsterdam presented a new discovery that concerns quantum entanglement and its relation to entropy. Quantum entanglement plays an important role in modern quantum information science and technology. However, the complexity of its structure makes understanding and managing it challenging. Regulus and Lamy's discovery shows that quantum entanglement follows an entropy rule similar to that for classical systems. This discovery opens new perspectives in the field of quantum information science and technology, deepening our understanding of quantum entanglement and its connection to thermodynamics. The results of the study indicate the possibility of reversibility of entanglement transformations, which could greatly simplify their use in various quantum technologies. Opening a new rule ... >>

Mini air conditioner Sony Reon Pocket 5 09.05.2024

Summer is a time for relaxation and travel, but often the heat can turn this time into an unbearable torment. Meet a new product from Sony - the Reon Pocket 5 mini-air conditioner, which promises to make summer more comfortable for its users. Sony has introduced a unique device - the Reon Pocket 5 mini-conditioner, which provides body cooling on hot days. With it, users can enjoy coolness anytime, anywhere by simply wearing it around their neck. This mini air conditioner is equipped with automatic adjustment of operating modes, as well as temperature and humidity sensors. Thanks to innovative technologies, Reon Pocket 5 adjusts its operation depending on the user's activity and environmental conditions. Users can easily adjust the temperature using a dedicated mobile app connected via Bluetooth. Additionally, specially designed T-shirts and shorts are available for convenience, to which a mini air conditioner can be attached. The device can oh ... >>

Energy from space for Starship 08.05.2024

Producing solar energy in space is becoming more feasible with the advent of new technologies and the development of space programs. The head of the startup Virtus Solis shared his vision of using SpaceX's Starship to create orbital power plants capable of powering the Earth. Startup Virtus Solis has unveiled an ambitious project to create orbital power plants using SpaceX's Starship. This idea could significantly change the field of solar energy production, making it more accessible and cheaper. The core of the startup's plan is to reduce the cost of launching satellites into space using Starship. This technological breakthrough is expected to make solar energy production in space more competitive with traditional energy sources. Virtual Solis plans to build large photovoltaic panels in orbit, using Starship to deliver the necessary equipment. However, one of the key challenges ... >>

Random news from the Archive

Portable camera that sees polarized light 11.07.2019

Scientists from the Harvard School of Engineering and Applied Sciences. John A. Paulson (SEAS) has developed a very compact portable camera capable of displaying the polarization of an object in a single image, according to the SEAS website. The miniature camera will find useful applications in remote sensing, in the study of atmospheric chemistry, and in machine vision. It can also be installed in self-driving cars.

Polarization is a property of light in which oscillations of the electromagnetic field of a light wave propagate in only one direction. To illustrate this property, one can imagine a rope threaded through a narrow vertical slot in a fence. If you start to vibrate the rope from one side, on the other hand it will be able to pass only vertical vibrations, and, for example, horizontal vibrations, it will not miss at all. Polarized light is invisible to the human eye (but some species of shrimp and insects can see it), but it provides a lot of information about the objects it interacts with. Polarization can help with a XNUMXD reconstruction of an object, assess its depth, texture and shape, and distinguish artificial from natural objects, even if they have the same shape and color, said Paul Chevalier, SEAS researcher and one of the authors of the study.

The polarization-sensitive cameras that are in use today have a big disadvantage: they are very bulky. In addition, they often rely on moving parts and are expensive, severely limiting their potential applications.

The new camera, on the contrary, is quite small: only about two centimeters long, and is no more complicated than the camera on a smartphone. The researchers have developed a metasurface that uses an array of subwavelength nanoparticles to guide light based on its polarization. The light then forms four images, each showing a different aspect of polarization. By combining them, we get a complete snapshot of the polarization in each pixel.

This technology could be integrated into a mobile phone or car camera in the future, allowing widespread use of polarized images and new applications.

Other interesting news:

▪ stem cell management

▪ A piece of a neuron for sample processing

▪ ASUS ZenPad 8 (Z380M) and ZenPad 10 (Z300M) tablets

▪ Li-Pol batteries EEMB with increased discharge current

▪ Light iron flash bainite

News feed of science and technology, new electronics

Interesting materials of the Free Technical Library:

▪ section of the site Lecture notes, cheat sheets. Selection of articles

▪ article Dear friend, what else do you want? Popular expression

▪ article How did the Aztecs replace human meat in ritual soup after the ban on cannibalism? Detailed answer

▪ article Kidney tea. Legends, cultivation, methods of application

▪ article Power amplifier 60/120 watts on a microcircuit chip LM4780. Encyclopedia of radio electronics and electrical engineering

▪ article Card volt (seven ways). Focus Secret

Leave your comment on this article:

All languages of this page

Home page | Library | Articles | Website map | Site Reviews