Rheumatoid arthritis

It is a chronic, inflammatory joint disease that occurs symmetrically. It has a prevalence of 1% in the adult population and predominates in women with a ratio of 3: 1 in relation to men. The most common age of onset is between 40 and 60 years.

How is it produced?

It is an inflammatory disease that appears in genetically predisposed individuals, in whom there is a triggering factor causing the inflammatory reaction. These factors are not fully known, but could be infectious, viral or bacterial agents. These would cause an immune response in the patient, causing the subsequent inflammatory process.

Symptoms

The beginning of the painting is insidious. The most frequent form of appearance is symmetric arthritis in the wrists, hands, feet and knees with a slowly progressive evolution. In other cases, arthritis affects only one joint.

Initially,, which can range from a minor discomfort to an intense and persistent pain that increases with mobility. There is increased heat without redness of the joint and morning stiffness characteristically appears, in the form of numbness of the hands when getting up in the morning and which can last more than 1 hour.

The affectation is symmetrical, chronic with a tendency to deformation as a consequence of the destruction of cartilage and bone. The most characteristic deformities in the hands are ulnar deviation and flexion of the interphalangeal joints of the fingers ("gooseneck fingers"). The temporomandibular joint and the cervical spine can be affected as the only vertebral segment.

It is a predominantly joint disease, but there are extra-articular symptoms such as fatigue and predominantly anorexia.

In the skin can be found rheumatoid nodules, which are bumps of the skin that usually appear in areas of friction such as the ankle, knee, back of the fingers and tibia, among others. They are usually painless and disappear spontaneously or with treatment. They appear slowly and reach a variable size of up to several centimeters in diameter.

Other extra-articular manifestations are: vasculitis, pleuropulmonary involvement (pleuritis, pericarditis, myocarditis), ocular alterations (scleritis, episcleritis), neurological (nerve entrapment, cervical compression), bone (osteoporosis) and hematological disorders in the form of anemias.

Diagnosis

There are diagnostic criteria for rheumatoid arthritis that are based on clinical involvement, laboratory values, and characteristic radiological involvement.

Clinical criteria include: morning stiffness greater than 1 hour, arthritis in three or more joint areas, arthritis of the joints of the hands, symmetric arthritis, and rheumatoid nodules; the analytical criteria: positive rheumatoid factor and among the radiological criteria, typical alterations of rheumatoid arthritis in radiographs of the hands and wrists.

A patient has rheumatoid arthritis if he meets 4 of the 7 criteria described, taking into account that clinicians must be present for at least 6 weeks.

Treatment

There is no curative treatment, but drugs that, on the one hand, reduce pain by improving function and quality of life, and on the other hand, reduce the progression of the disease.

It is essential to explain the disease and the objectives of the treatment to the patient, bearing in mind that the objective of the treatment is not the cure of the disease but the reduction of pain and the prevention of sequelae.

The basic program includes rest in the acute phases of the disease, combined with regular exercise to maintain muscle tone and thus avoid joint stiffness and deformity, anti-inflammatory drugs (NSAIDs), rest splints, and a proper diet. indomethacin is the NSAID of choice.

Other pharmacological therapies include the so-called disease-modifying drugs, among which the gold salts, chloroquine, salazopyrin, and immunomodulatory agents (methotrexate, cyclosporine, and leflunominda) stand out.

Lately, biological therapies have been introduced that are representing a great advance in the treatment of these patients.