Internal illnesses. Rheumatoid arthritis (most important)

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Internal illnesses. Rheumatoid arthritis (most important)

Lecture notes, cheat sheets

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52. RHEUMATOID ARTHRITIS

Chronic systemic disease of the connective tissue with a progressive lesion of predominantly peripheral (synovial) joints according to the type of erosive-destructive polyarthritis.

Classification:

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 surface of the joints, deformation, ankylosis, morning stiffness syndrome), cardiac (myocarditis, endocarditis with the formation of shallow 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 area of the nail phalanges), asthenovegetative (fever, weight loss), anemic (secondary iron deficiency anemia).

Main clinical forms: articular (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 of the parenchyma of the salivary and lacrimal glands with subsequent atrophy).

The basis of diagnosis are major and minor criteria.

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

If all criteria are met, a diagnosis of rheumatoid arthritis can be made.

Diagnostic research. The examination algorithm corresponds to that adopted for systemic connective tissue diseases.

Treatment. Non-steroidal anti-inflammatory drugs are prescribed, with preference given to long-acting drugs. Hormone therapy (corticosteroids) is carried out, if non-steroidal anti-inflammatory drugs are ineffective and the process remains active - 15-20 mg with a slow decrease and the addition of non-steroidal anti-inflammatory drugs in increasing doses). Basic therapy is carried out with gold preparations (cryzanol 2 ml intramuscularly once a week for 1-7 months), aminoquinoline preparations: rezoquin, plaquenil. Plasmapheresis and hemosorption are performed.

Flow. With the articular form - slowly progressive with gradual deformation of the joints (10-15 years), with the articular-visceral - rapidly progressive (2-3 years).

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

Prevention. Long-term use of basic drugs, non-steroidal anti-inflammatory drugs.

Author: Myshkina A.K.

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