Diagnosis of rheumatoid arthritis

To diagnose rheumatoid arthritis, your doctor should check your medical history and perform a physical examination.

The doctor checks the radiography of the spine 
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The doctor looks for certain features of rheumatoid arthritis, including edema, heat, and limitation of joint movement ( stiffness ) throughout the body, lumps or lumps under the skin. 
The doctor may also ask if you notice fatigue or an overall feeling of stiffness. 
The pattern of joints affected by arthritis can help distinguish rheumatoid arthritis from other diseases. 
Your doctor should recommend some blood tests to identify antinuclear antibodies (ANA) levels of inflammation and other markers that aid in diagnosis and evaluation. 
Probably prescribes an x-rayto determine if there was a loss of bone in the margins of the joints, called erosion, along with loss of joint cartilage . 
The MRI is used mainly for patients with impaired column cervical.

 

Laboratory studies

Programmed serological testing does not greatly facilitate the diagnosis of RA in patients with early rheumatoid arthritis and is not useful to know how the disease progresses. 
Laboratory studies useful in suspected RA are divided into three categories: inflammation markers, haematological parameters and immunological parameters, the following tests are performed:

  • Erythrocyte sedimentation rate (ESR), erythrocyte sedimentation rate (ESR),
  • Level of C – reactive protein (CRP),
  • Complete blood count,
  • Rheumatoid factor (RF) tests,
  • Antinuclear antibody test (ANA).

 

The markers of inflammation

The rate of erythrocyte sedimentation and the level of CRP are related to the activity of the disease. The time PCR value is correlated with radiographic progression.

Hematologic parameters
complete blood count shows anemia in chronic diseases and is linked to the stages of the disease. 
Anemia may indicate blood loss that normally occurs in the gastrointestinal tract and is caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs). Anemia can also be caused by antirheumatic drugs. 
Thrombocytosis is an excess of platelets in the blood that is quite common in rheumatoid arthritis and is linked to the complication of the disease. Thrombocytopenia is a term that is used to indicate a low platelet count in the blood, may be a rare complication of therapy and may occur in patients with Felty’s syndrome.
Leukocytosis is a term to describe the increase of leukocytes in the blood is usually mild in RA. Leukopenia is a lack of leukocytes and may be a consequence of a treatment or a consequence of Felty’s syndrome that can then respond to treatment.

Immunological
parameters Immunological parameters include autoantibodies, such as rheumatoid factor and antinuclear antibodies (ANA). 
Rheumatoid factor (RF) is present in about 60-80% of patients with RA in the course of the disease (but less than 40% of patients with RA). 
RF values ​​vary over time, but usually remain elevated even in the phases of drug-induced remission. 
Rheumatoid factor is not specific for rheumatoid arthritis, but is present in other connective tissue diseases, infections and autoimmune diseases, also located in 5% of healthy people.

 

Differential diagnosis

The doctor should exclude:

 

Treatment for rheumatoid arthritis

There is no known cure for rheumatoid arthritis. 
Today, the goal of treatment is to reduce joint pain and inflammation, improve function, prevent deformities, and destroy joints. 
Early medical intervention is essential to improve outcomes. 
Aggressive treatment can improve function, block joint damage, and prevent disability from working.

Strengthening Exercises for Rheumatoid Arthritis

The best treatment for the disease consists of a combination of medications, rest, strengthening exercises and joint protection, the doctor should also explain to the patient and family the possibility of developing the disease and how they should behave. 
The most successful treatment is the close collaboration between doctor, patient and family. 
Two families of medications are used to treat rheumatoid arthritis: “fast acting” first-line drugs and slow-acting “second-line drugs” (also known as DMARDs disease-modifying antirheumatic drugs). 
Top-line medications, such as aspirin and cortisone ( corticosteroids ) are used to reduce pain and inflammation.
Second-line drugs have a slow action, such as methotrexate (Rheumatrex) and Hydroxychloroquine (Plaquenil) promote remission of the disease and prevent progressive joint destruction. 
The aggressiveness of RA varies among affected individuals. 
Those with non-frequent forms, less destructive of the disease or who settle down after a few years of activity may be treated with resting plus anti-inflammatory medications. 
In general, improving function, reducing disability, and destroying joints is achieved if rheumatoid arthritis is treated with second-line drugs (DMARDs disease-modifying antirheumatic drugs) also in the following months after diagnosis.
Most people require more aggressive second-line drugs, such as methotrexate, in addition to other anti-inflammatory drugs. Sometimes these second-line drugs are used together. In some cases, with severe joint deformity, surgery is required.

Medications for rheumatoid arthritis

Medications for first-line rheumatoid arthritis. 
Acetylsalicylic acid (aspirin), naproxen (Naprosyn®) and ibuprofen (Motrin®) are examples of non-steroidal anti-inflammatory drugs (NSAIDs). Aines are medicines that can reduce swelling, pain, and inflammation of tissues. 
Aspirin is an effective anti-inflammatory drug for rheumatoid arthritis taken at higher doses than those used in the treatment for headache and fever . 
The newer NSAIDs are as effective as aspirin in reducing inflammation and pain and require fewer doses per day. 
The most common side effects of aspirin and other NSAIDs are stomach pain , stomach pain , gastrointestinal ulcers and bleeding . In order to reduce the gastrointestinal side effects, NSAIDs are usually taken after eating. 
Other gastroprotective agents are often recommended to protect the stomach from a possible ulcer. These drugs include antacids, sucralfate (Carafate®) and proton pump inhibitors (Prazol®, etc.). The newer NSAIDs include selective COX-2 inhibitors such as celecoxib (Celebra®) that provide anti-inflammatory effects, but with lower risk of stomach irritation and bleeding.
Corticosteroid drugs can be taken orally or injected directly into the tissues and joints. They are stronger in NSAIDs in reducing inflammation and restoring function and joint mobility. Corticosteroids are useful for short periods during severe exacerbation of rheumatoid arthritis or when the disease does not respond to non-steroidal anti-inflammatory drugs. However, corticosteroids can have serious side effects. These side effects are weight gain, face swelling, thinning of the skin, osteoporosis , ecchymosis , cataracts , risk of infection, muscle atrophy and destruction of large joints such as the hip.

DMARDs for rheumatoid arthritis

Disease-modifying antirheumatic drugs (DMARDs) are medications that help slow or stop the progression of rheumatoid arthritis. The drug most commonly used to treat RA is methotrexate. Other DMARDs are sulfasalazine (Salazoprin) leflunomide (Arava). 
The task of DMARDs is to suppress the immune system. However, these drugs are not selective to their purpose. This decreases immune defense in general and increases the likelihood of contracting certain infections. 
DMARDs in general and in particular methotrexate have led to significant improvements in treatment for severe rheumatoid arthritis.

Biological Treatment
The most recent and most effective treatments for rheumatoid arthritis are biological and consist of genetically modified proteins. These drugs are created to inhibit specific components of the immune system that play an important role in inflammation. 
Biological drugs are usually used when other medications have failed to stop the inflammation caused by arthritis. Biological medications can slow or even prevent the progression of rheumatoid arthritis. 
Inhibitors of tumor necrosis factor help to reduce pain and inflammatory joint damage by blocking a protein called tumor necrosis factor (TNF). 
For some patients, these drugs stop the progression of rheumatoid arthritis.
Recent studies have shown benefits when TNF antagonists are combined with methotrexate. TNF blockers include Enbrel and Humira. 
Other biological drugs that suppress different areas of the immune system include Orencia. 
Because the biological drug suppresses the immune system, it also increases the risk of infection. 
Actemra (tocilizumab) is one of the most effective drugs in the treatment for rheumatoid arthritis. It is a monoclonal antibody that binds to the receptor of a protein (interleukin-6) in the cytokine family. This molecule could cause inflammation, but tocilizumab prevents action.

Steroids for Rheumatoid Arthritis
For severe rheumatoid arthritis or when RA symptoms worsen, your doctor may recommend steroids or cortisone to relieve the pain and stiffness of the affected joints. 
In most cases, they can be used temporarily to calm the sudden deterioration of a symptom. However, in some people steroids are needed to control pain and inflammation in the long run. 
Steroids can be prescribed as injections directly into the inflamed joint or one can take a pill. Potential side effects of long-term steroids include high blood pressure , osteoporosis and diabetes. But when you use them properly, corticosteroids are usually effective and quickly improve pain and inflammation.

 

Pregnancy

Pregnancy changes the immune status. For decades, pregnancy improvements in RA have been observed. 
Given that limited data suggest a significant risk of preterm birth, preeclampsia, or restriction of fetal growth in pregnant women with RA, no gynecological check is necessary beyond usual (eg stabilize disease prior to conception using drugs safe for pregnancy and breastfeeding). 
Medications considered to be low risk in pregnancy include immunomodulatory agents, antimalarial drugs, and azathioprine. Anakinra and TNF inhibitors may be used until the end of conception.
Before starting treatment, patients should receive advice about the risk of abnormal development of some regions of the fetus during pregnancy and the adverse effects of medications used to treat rheumatoid arthritis. 
NSAIDs should be avoided in the third trimester of pregnancy.

 

Exercises for rheumatoid arthritis

Exercises are an essential part of the treatment for rheumatoid arthritis. 
When joints are hard and painful, exercise may be the last thing that comes to mind. With rheumatoid arthritis, regular physical activity is one of the best care you can do. 
People who perform the exercises live longer, with or without rheumatoid arthritis. 
Regular physical activity can reduce the overall pain of rheumatoid arthritis. 
The exercises help keep bones strong. Osteoporosis can be a problem with rheumatoid arthritis, especially for those who take steroids. Physical activity in the gym helps bones maintain density. 
Exercises are used to increase or maintain muscle strength.
Regular physical exercise improves functionality and allows you to perform various tasks. 
People with rheumatoid arthritis who attend the gym feel better and are able to cope better with the problems.

 

Natural Treatments for Rheumatoid Arthritis

There are several alternative therapies for rheumatoid arthritis. Tell your doctor if you are considering the possibility of trying them. 
Heat and cold : The use of heat and cold is one of the best natural treatments for relieving joint pain from rheumatoid arthritis. 
A cold compress reduces inflammation and swelling. Heat relaxes the muscles and stimulates blood flow.

 

Prevention of rheumatoid arthritis

Although arthritis can not be prevented, many people are able to prevent early treatment ability and a personalized exercise program. Although it is unclear whether rheumatoid arthritis can be prevented without smoking, smoking is associated with the onset of rheumatoid arthritis.

 

Surgery for rheumatoid arthritis

Surgical intervention in patients with RA can relieve pain, correct deformities, and improve function.

Many surgical techniques are available to achieve these goals, such as removal or reconstruction of soft tissues, fusions, and joint prostheses .

The timing of surgery is a complex decision and depends on the age of the patient, the stage of the disease, the level of disability and the position of the joints involved. 
Early surgical intervention can help maintain a patient’s independence. 
Deformity in the hand or wrist may lead to loss of grip, so the patient is not able to perform the activities of daily living. 
Surgical treatments for hand and wrist RA include synoviectomy, osteotomy, tendon realignment, reconstructive surgery, arthroplasty, and arthrodesis . 
Instability of the cervical spine can be observed in patients with RA who have degeneration of the bones and ligaments of the cervical spine.
Degeneration of the atlas crosslink can lead to instability in C1-C2. A small traumacan cause neurological consequences due to instability. 
Care should be exercised in the assessment of RA patients after minor falls, car accidents and other injuries. 
Cervical spine lesions may occur spontaneously. 
Patients with cervical spine pain and neurological damage that do not respond to treatments may be candidates for surgery. 
In some cases, rheumatoid arthritis affects the joints of the lower limbs: knee and hip. 
Serious damage to the joints could be corrected with hip  and knee replacementsurgery.

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