Clinical guidelines in rheumatoid arthritis: specificity, diagnosis, treatment

Rheumatoid arthritis is a serious illness, attracting the attention of doctors from different countries. The lack of clarity of the causes, the severity of the complexity of healing due to the importance of cooperation of doctors to study the disease. Clinical guidelines are developed by the Association of rheumatology with the aim of developing a unified scheme for the identification of disease, development of therapies, the use of modern medicines.

Classification of the disease according to the clinical recommendations

Rheumatoid arthritis in terms of clinical guidelines is described as a chronic disease. The disease causes the autoimmune response of the body bright change protective reaction caused by unclear reason. According to the ICD 10 symptoms of rheumatoid arthritis coded M05-M06 (belong to the class of inflammatory pathologies).

Patients, characterize severe pathological condition, which occurs in different ways in different stages. Clinical guidelines consider several periods of the disease:

1. Over the early period (up to six months of developing the disease).
2. The early period (from six months to a year).
3. A detailed period (from one to two years).
4. The late period (from two years of existence of the disease).

Early detection of the disease increases the chances of stopping the pathological process. Medical staff are advised to seek help immediately after finding a suspicious of negative symptoms.

Clinic rheumatoid arthritis noted the following manifestations:

• inflammation of the joints (often found lesions of the joints of the hands);
• sensation of stiffness in the limbs, especially upon awakening;
• fever;
• permanent weakness;
• high sweating;
• loss of appetite;
• the appearance of subcutaneous nodules.

A distinctive feature of the disease is a manifestation of the symmetry of the inflamed joints. For example, inflammation on the right foot is accompanied by a similar lesion of the left limbs. Contact your doctor if symmetrical lesions immediately!

Survey of patients using x-ray show the presence of several stages:

• stage No. 1 shows a small reduction in bone density in the periarticular area;
• phase 2 marks the extension of bone lesions, the appearance of gaps, the initial signs of bone deformation;
• phase 3 reveals pronounced osteoporosis, accompanied by bright deformations of bone tissue, articular luxations
• stage No. 4 highlights bright bone lesions, joint failure joints, growths on joints.

An important condition for correct classification is the professionalism of the medical staff. Experienced doctor right klassificeret disease, will highlight the development of the disease, to clarify the symptoms.

Remember — a distrust of the doctor impedes the performance of treatment. In the absence of contact with the health worker should ask for healing to another specialist.

The basic principles of disease diagnosis

To make a proper medical report is quite difficult. Doctors are guided by the following principles of diagnosis of the disease:

1. The unique characteristics of the disease does not exist. Do not expect specific manifestations of rheumatoid arthritis. It is important to realize that suspicions the doctor should definitely confirm reliable studies (e.g., radiography, laboratory methods).
2. Final medical report shall be made by the doctor. Be sure the therapist directs the patient to a specialist if suspicious symptoms (prolonged stiffness, the presence of tumor sphere joint).
3. If in doubt, should hold a Council of experts that help to put the correct medical opinion.
4. It is important to remember the need for analysis of the possibility of other diseases. The doctor needs to look at all the possible diseases with similar manifestation of symptoms.

Important! When inflammation of a joint do not expect changes in other joints! Do not delay treatment to the doctor, wasting time. Early treatment (preferably before six months of the disease) will give a chance for complete preservation of the quality of life of patients.

Differential diagnosis of pathology based on clinical recommendations

The doctor diagnosis of rheumatoid arthritis according to clinical recommendations is complex in several ways. Base productions medical reports serve as classification criteria described in the guideline. When doctors wary of the following symptoms:

• the patient complains of various pains in the joint area;
• patients are morning stiffness (about an hour patients is difficult to move the joints);
• the affected areas are swelling;
• inflammation is bothering the patient for at least two weeks.

Of joint damage employees assess on a five-point system. Unit is exposed in a situation of inflammation from 2 to 10 large joints, maximum 5 points the patient with multiple inflamed joints (at least 10 major joints, at least one minor).

Remember — a disease is striking slowly. The development of the disease is characterized by slow increasing pain for several months. Patients with the absence of prominent symptoms, but this symptom is alarming for the doctor. Be sure to track the intensity of negative symptoms, the frequency of manifestations of pain, strength pain.

Diagnostics allows you to specify a medical report by undertaking the following procedures:

1. Radiography allows us to see changes in the area of the joints. The doctor examines the condition of the articular slits, analyzes the presence of joint dislocations (subluxations), studying the density of the bones, see the cysts, diagnose the presence of lesions. The study used for the primary analysis of disease. Next, the patient is recommended to annually repeat the procedure of the survey.
2. Magnetic resonance imaging is more sensitive in comparison with carrying out x-rays. By MRI imaging reveals inflammatory processes in the synovial membranes, bone lesions, lesions of the connective tissue (around the joints).
3. Ultrasonic diagnostics allows you to see pathological changes in the joints. Medical officer is able to see the erosion affected areas, connective tissue proliferation of the synovial membrane, the presence of pathological effusions (accumulations of fluid). Prenatal testing demonstrate the limits of the affected area, allow you to track the intensity of inflammation.

Instrumental examinations complement the diagnosis. However, the results of this diagnostic is unlawful to put medical opinion. The presence of the disease must be confirmed by laboratory tests!

Of great importance for a correct medical report laboratory methods are:

• A blood test for antibodies against cyclic citrullinaemia peptide. This method allows to diagnose diseases at an early stage. The analysis allows to confirm the medical report, to highlight the shape of disease, to analyze for. Through the analysis of medical staff predict the speed of progression of the disease. Normally, the content of specific antibodies does not exceed 20 IU/ml. Elevated is a cause for concern. Often positive results of the analysis ahead of the manifestation of negative symptoms.
• Test to possess rheumatoid factor helps to diagnose the disease. In the absence of disease indicators of zero or above 14 IU/ml (figures a single for minors, adults, seniors).
• Research on viruses in the body (tests for HIV, various types of hepatitis).

Tests for antibodies and a test for the presence of rheumatoid factor is taken from the patient's vein. It is recommended to go to the lab in the morning, do not eat before testing. The day before visiting the laboratory is unacceptable to eat fatty foods, smoked products. Serum blood is able to clot, depriving the patient of the correct results.

Modern trends in the treatment of disease

Hearing that the disease cannot be cured, the sick feeling of emptiness, anxiety and hopelessness. To succumb to depression is not necessary — medical staff will help you to overcome the disease. Traditionally, chronic rheumatoid arthritis to treat through a comprehensive treatment:

1. Basic anti-inflammatory drugs help to arrest the inflammatory processes in patients. Patients leave about the effectiveness of preparations of gold positive reviews.
2. Nonsteroidal anti-inflammatory drugs substantially improved the health of patients by reducing pain. The doctor examines each situation individually, choosing the optimum combination of medicines that is appropriate to a particular patient.
3. Glucocorticoids contribute to the suppression of abnormal reactions of the body, allowing to suppress the symptoms of the disease. Hormonal therapy with caution used in treatment of minors, fearing to disturb the development of children's organisms. Adult patients drugs of this series are issued in situations of absence confirmation of results from previous treatment.

The most difficult thing in the treatment of disease — selection of effective medicines. Predicting the impact of the drug on a particular patient is impossible. Doctors have to observe the action of the medication for about three months (the minimum time is about a month). The absence of the expected result of forcing to change the dose of medicines or change the drug.

A new method in rheumatology recognizes the use of genetic engineering. This group of drugs is genetically engineering designs that inhibit the atypical reaction of the body.

Hope for recovery of patients give injections of infliximab. Infliximab, a synthesis of human and mouse DNA, allowing contact with the negative factors, to neutralize immune responses to extinguish atypical reaction. The end result is the elimination of rheumatoid arthritis. A clear advantage of Remicade:

• quick effect (come to a clear improvement after a couple of days).
• high performance (repayment of the mechanism of development of ailment);
• the duration of positive results (multiple years the patients forget about the unpleasant diagnosis);
• efficiency even in running situations.

The disadvantages of the use of infliximab in treatment of rheumatoid arthritis:

1. The necessity of being under a dropper (the medicine is injected course).
2. A variety of side effects (the likelihood of nausea, pains of the head, disorders of the heart, allergic reactions, other adverse reactions).
3. Extremely high price (over 100 milligrams of the drug patients have to pay about $ 400).

The lack of funds for treatment — no reason to be sad. Through experimentation, medical staff give patients free heal. There is no possibility in the experimental group, taking part in testing new drugs. It is important to follow the news, study modern forums, to submit applications for pilot studies.

Biological medicines — another novelty in the field of the fight against disease. The main action of the medicines due to the establishment of specific links with protein molecules that suppress atypical reactions. Clinical practice guidelines for rheumatoid arthritis put forward a proposal to use the new biologic drugs for disease treatment.

The use of several biological medicines — big mistake. You should not consider drugs are harmless, you can mix different types, assign self-treatment. Treated only under the supervision of medical staff!

Rheumatoid arthritis is an extremely complex illness that requires careful treatment. Final healing is impossible, but current clinical guidelines allow you to extinguish manifestations of the disease, to minimize the negative effects, allow patients to enjoy life.