Mkb 10 rheumatology. Rheumatoid arthritis seronegative mcb

Gouty arthritis ICD code 10

According to the International Classification of Diseases 10 revision, rheumatoid arthritis is seropositive and seronegative. These two species also have their own classification and each subspecies of the disease has its own code.

Seronegative RA, ICD-10 code - M-06.0:

• Still's disease in adults - M-06.1;
• bursitis - M-06.2;
• rheumatoid nodule - M-06.3;
• inflammatory polyarthropathy - M-06.4;
• other specified RA - M-06.8;
• seronegative RA, unspecified - M-06.9.

Seropositive RA, ICD-10 code - M-05:

• Felty's syndrome - M-05.0;
• rheumatoid lung disease- M-05.1;
• vasculitis - M-05.2;
• rheumatoid arthritis involving other organs and systems - M-05.3;
• other seropositive RA - M-05.8;
• unspecified RA - M-05.9.

A disease that develops due to the deposition of uric acid salts in the joints and organs. This happens when metabolism is disturbed in the human body and uric acid crystals (or urates) are deposited in the kidneys and joints.

This leads to inflammation, difficulty in movement, and deformation of the joint. The kidneys also suffer, in which crystals are deposited, which disrupts the normal functioning of the excretory system.

There is a classification of diseases, which lists all the names and categorized by development, treatment, clinical picture. This classification is called the ICD (International Classification of Diseases).

Gouty arthritis ranks under the name ICD 10.

Gout and gouty arthritis and their place in ICD 10

When a patient comes to a medical facility and is diagnosed with gouty arthritis, ICD code 10 is written on a card. This is done so that the doctors and the rest of the staff understand what the patient's diagnosis is.

All diseases according to the ICD classification are clearly divided into their groups and subgroups, where they are indicated by letters of the alphabet and numbers, respectively. Each group of diseases has its own designation.

Also, there are generally accepted norms of therapy, as a single main criterion, tactics or method of treatment that is prescribed to all patients with a particular disease. Further, judging by the patient's condition, the development of the disease or other concomitant pathologies, he is prescribed symptomatic therapy.

The entire classification of diseases of the musculoskeletal system in the ICD is located under the letter M, and each type of such pathology is assigned its own number from M00 to M99. Gouty arthritis in the ICD is in place of M10, in which there are subgroups with designations for various types of gouty arthritis. This includes:

• Gout, unspecified
• Gout associated with impaired renal function
• Medicinal
• Secondary
• lead
• idiopathic

When a patient contacts a medical institution, a detailed history is taken, laboratory (analyses) and instrumental methods (X-ray, ultrasound, and so on) study the disease. After an accurate diagnosis, the doctor sets the ICD 10 code and prescribes the appropriate treatment and symptomatic therapy.

Cause of gouty arthritis according to ICD 10

It has been proven that gouty arthritis most often affects men and only at the age, and women, if they get sick, only after menopause. Young people are not exposed to the disease due to the fact that hormones, of which a sufficient amount is released in young people, are able to remove uric acid salts from the body, which does not allow crystals to linger and settle in the organs.

With age, the amount of hormones decreases due to the inhibition of certain body processes and the process of removing uric acid no longer proceeds as intensively as before.

Osteoarthritis deformans, abbreviated as DOA, refers to chronic joint diseases. It leads to the gradual destruction of articular (hyaline) cartilage and further degenerative-dystrophic transformation of the joint itself.

ICD-10 code: M15-M19 Arthrosis. These include lesions caused by non-rheumatic diseases and predominantly affecting the peripheral joints (limbs).

• Spread of disease
• The structure of the joint
• Development of DOA
• Symptoms
• Diagnostics

Arthrosis knee joint in the international classification of diseases it is called gonarthrosis and has the code M17.

In practice, there are other names for this disease, which are synonyms according to the ICD10 code: deforming arthrosis, osteoarthritis, osteoarthritis.

Spread of disease

Osteoarthritis is considered the most common disease of the human musculoskeletal system. More than 1/5 of the world's population is affected by this disease. It is noted that women suffer from this disease much more often than men, but this difference is smoothed out with age. After the age of 70, more than 70% of the population suffers from this disease.

The most “vulnerable” joint for DOA is the hip joint. According to statistics, it accounts for 42% of cases. The second and third places were shared by the knee (34% of cases) and shoulder joints (11%). For reference: there are more than 360 joints in the human body. However, the remaining 357 account for only 13% of all diseases.

The structure of the joint

A joint is an articulation of at least two bones. Such a joint is called simple.

In the knee joint, which is complex, having 2 axes of movement, three bones articulate. The joint itself is covered by the articular capsule and forms the articular cavity.

It has two shells: outer and inner. functional outer shell protects the articular cavity and serves as a place for attachment of ligaments.

ICD code 10 rheumatoid arthritis

The ICD-10 code for seropositive rheumatoid arthritis is M05.

International Classification of Diseases 10th Revision (ICD-10) Class 13 M05 Seropositive rheumatoid arthritis. M05.0 Felty's syndrome Causes of pain in the right side - Woman - Jun 21 If you suffer from pain and tingling in the right side, then kidney pain may appear in the lumbar region. Code Seropositive rheumatoid arthritis in the international classification of diseases ICD-10. M00-M99 Diseases of the musculoskeletal system and

ICD-10: Diseases of the musculoskeletal system and connective International Classification of Diseases (ICD-10). M00-M99 Arthritis - pain, inflammation and loss of mobility in one or more joints. Can a leg hurt only the next day after a bone fracture? most likely an injury. When I fell off the bike and broke my finger on my hand, at first I didn’t feel anything too much. Went on to ride. But in the morning it grabbed me specifically - the finger turned blue, swollen, it was impossible to touch it. with a fracture you wouldn't be running yesterday. contusion It's just a muscle problem. Give her at least a day to lie down, so that the inflammation does not go up.

Arthritis and arthrosis (joint diseases) - the difference and how to treat But why do many people complain of joint pain? The first blow is taken by the knee joints, joints of the elbows, hands. A cold is of some importance (for example, arthrosis in workers in hot shops). Additionally. The code. Nosology.

ICD 10 - INFLAMMATORY POLYARTHROPATHY (M05-M14) Other arthritis (M13). [localization code see above] Excl.: arthrosis (M15-M19). M13.0 Polyarthritis, unspecified. M13.1 Monoarthritis, not

• About the Medical Center - Mediaart If necessary, you will be given a sick leave. If you have headaches, back pain, neuralgia, sciatica, osteochondrosis - a neurologist ICD 10 code: M05-M14 INFLAMMATORY POLYARTROPATHIES. rheumatic fever(I00) rheumatoid arthritis. youthful (M08.
• Rheumatoid arthritis: causes, symptoms and treatment ICD 10 code: M06 Other rheumatoid arthritis.
• Arthritis - During the period of exacerbation, the joints hurt, so at this time it is very important. My mother-in-law has been treating arthritis for a long time, her joints are very inflamed, Definition of rheumatoid arthritis, causes, pathogenesis, classification of the disease, Seronegative RA, ICD-10 code - M06. 0:.

International Classification of Diseases ICD-10 - codes and

Academy of Success and Healthy lifestyle. Joints hurt 5 Nov Joints hurt - help yourself. Do not miss the opportunity to do a good deed: click on the button from Facebook, Vkontakte or International Classification of Diseases ICD-10 - codes and codes of diagnoses and M03.0 Arthritis after meningococcal infection (a39.8)

The true story of the hermit Agafya Lykova, who revealed the family secret of the treatment of joint diseases!

Moscow. Talk show Let them talk. In this studio, we discuss real-life stories that are impossible to keep silent about.

Today in our studio the Hermit Agafya Lykova. Everyone knows her firsthand! On all central channels, she began to flicker because of her unusual fate. Agafya Lykova is the only living representative of a family of Old Believers hermits. For many centuries this family managed to maintain longevity and perfect health, living in the taiga, far from civilization, medicines, doctors. Using the power of nature and its gifts, they possessed truly good health and incredibly stable immunity. After that. As all of Russia found out about Agafya, thousands of letters from viewers began to come to our program with a request: “Ask Agafya Lykova to tell some secret recipe of her family.” All letters were in the same way - everyone wanted to receive at least a small prescription that would help improve or maintain health. Well, if viewers ask, then you need to find out her recipes and the secrets of longevity. After all, thousands of Russians cannot be wrong - if they ask, then it will help!

Hello Andrey and dear audience. Probably, I would hardly agree to give out the recipe of my ancestors if I didn’t know how many people in Russia, and throughout the world, suffer from osteochondrosis and terrible joint pain. Perhaps my ancient recipe will help to get rid of such diseases once and for all.

Our editors, together with the operators, came to you in the taiga. It was "-29" outside, it was terribly cold, but you didn't care how much! You were standing in light clothes, with a scarf on your head and holding a yoke with two 10-liter buckets filled with water on one shoulder. And you, after all, are already 64 years old. We were amazed: before us stood elderly woman, which simply glowed with longevity and health.
When we entered the house, we saw that you were preparing some kind of cream-like mixture. Can you tell us more?

My father and my mother knew the family recipes that they received from their parents, and they received from theirs. Many of my prescriptions are hundreds of years old and have been used by my entire generation. All of these recipes are included in this book.

Agafya, tell me, what was the last thing you managed to win? You are the same person as all Russians. In any case, could something be bothering you?

Yes, of course, I suffered from many diseases, but I got rid of them very quickly, since I have my family recipe book. The last thing I was sick with was pain in my joints and back. The pains were terrible, and the dampness in the room only exacerbated my illness. Legs and arms did not bend and ached a lot. But I got rid of this disease in 4 days. I have a great-grandmother's recipe for this ailment. So be it, I will tell it to you, let the people get rid of ailments.

After these words, Agafya opened her old book with recipes and began to dictate the composition to us. Below we will talk about how to cure arthrosis in 4 days! In the meantime, let's talk about the remaining dialogue with Agafya:

What is this tool and how to use it correctly?

The basis of this cream antlers of the Altai deer - the most valuable substance. which is extracted only once a year from deer antlers. They are mined only in one place, in the north-west of Siberia. In the spring, the Altai maral sheds its horns, and the locals go to search for them in the taiga. Based on maral antlers, I prepare a cream for joint pain, bruises and sprains. Due to the healing properties of the substance, local residents in the 19th century destroyed almost the entire population of the Altai deer. Therefore, industrial production of antlers is impossible.

-Thank you, Agafia. Many Russians will now get rid of joint pain forever.

Release Notes (934)

Liana | 18.09. - 23:58

Thank you very much for the recipe and the opportunity to buy Artropant! I have been using it for 3 days already, the joints really stopped bothering me!

Minnie | 20.09. - 13:12

It's good that ancient recipes have been preserved! I've had enough of these pills! My mom uses cream. She is 68, and she has more than enough health. Although recently she complained of severe pain in the lower back and elbows! And now it's just unrecognizable! Thank you for your channel!

Angelina | 20.09. - 04:57

Evgeniya | 22.09. - 23:21

How long does Artropant go? Pay immediately?

Ann | 25.09. - 20:30

Paying is easy, there are instructions and options. The cream went to Tyumen for 4 days! The wait was worth it, as I have been smearing for 5 days already. The bones hurt a lot, now they don’t bother at all! Thank you channel!

Baby mouse | 25.09. - 04:57

Is it good for overall health?

Elena | 27.09. - 23:29

I treat them for muscle pain. Improvement began already on the 2nd day. I highly recommend this cream to everyone!

Mary | 27.09. - 05:31

That's what folk medicine can do! To hell with drugs! Fortunately, the cream costs a penny, relative to the treatment itself!

Mkb 10 code reactive arthritis

Elizabeth · 10.09. 01:16:08

ICD code 10: m06 Other rheumatoid m06.9 Rheumatoid arthritis Pain in the groin? -. ethnoscience The pain may not appear immediately, but gradually. You may be disturbed by pain in the groin, in the abdomen, a feeling of discomfort when walking and exercising. ICD-10: Diseases Code. Nosology Seropositive rheumatoid arthritis: m05.0: Syndrome

ICD-10: Diseases of the musculoskeletal system and Arthritis mkb 10 arthritis mkb code 10, rheumatoid arthritis mkb how to quickly get rid of a clogged nose. \ Make an inhalation: put one tablet of validol and half a pipette of iodine on a liter cup of boiling water. Mix everything and breathe only through the nose until the water cools down. I even cured sinusitis in this way. Buy NAZOL and there is no problem if you blow your nose a lot of water, splash it there or pour it and blow your nose. or a lot of sprays, there are drops. Cut off. Joke. Naphthyzin. Any vasoconstrictor sprays or drops. Nazol, nazivin, for the nose and many others. They work for several hours. They start working in a few minutes. Get rid of a stuffy nose? HM. was somewhere. And here, you take an ax, put it from below and, with a sharp movement, pull it up. Peel the onion or spread with an asterisk, rinse the nose with a solution of water and salt. for 1 glass (150-200 ml) - 1-1.5 teaspoons of salt, close one of the nostrils and draw in water. do this procedure 2-3 times a day! + nose drops Get well soon! bake an onion head in the oven or in the microwave, cut it in half, wrap it in a towel, put it on the bridge of your nose until it cools down, squeeze the juice from the cooled onion, drip it into your nose. In 10 sessions, you can cure not only a clogged nose, even sinusitis. it is better to turn to a specialist, otherwise you can bring it to a chronic stage, then nothing will help Nusudex tablet - and there are no problems for half a day or more. Well, then - at home, steam your legs, mustard in socks, or smear caviar with oil (alcohol) and hot tea with raspberries or hot milk. And in order to sleep with a stuffy nose and not suffer, lubricate the wings of the nose (externally) with a drop of camphor oil or simply put a cotton swab moistened with camphor near the bed.

Pain in the jaw Dec 3 Headache, pain in the eyes, pain in the ears, pain in the face, pain in the jaw When the mouth is open, the head mandible turned into a cavity

ICD-10 classification and codes of arthritis of the knee the ICD 10 code must be entered in the person's medical history. rheumatoid arthritis;

PHARMATEKA » Problems of discogenic dorsalgia: pathogenesis Gate's symptom: back pain during forced hip flexion in Minor's Symptom 1: when getting up from a lying position, a patient with Mkb 10 code reactive arthritis, Mkb 10 code reactive arthritis. [rheumatoid arthritis]

1. Arthritis code mkb 10 - knee joint, treatment If the site was useful to you, then please mark it by adding it to your bookmarks:

2. Psychosomatic disorders in diseases - Bookap Moreover, with the exception of angina pectoris and myocardial infarction, pain in the area with the most insignificant, minimal physical exertion. fingertips are directed to the chin, elbows are directed to the sides. Rheumatoid arthritis The international RA code is rheumatoid arthritis. ICD-10

3. ICD 10 - Seropositive rheumatoid arthritis (M05) Rheumatoid arthritis ICD 10: ICD code 10 Rheumatoid arthritis ICD 10 refers to xiii

4. Pavlyuchenkova starred from Roland Garros - Tennis. Sports / 1 day before the end of the second round match against Dutch Kiki Bertens due to back pain. All tennis players have shoulder problems. ICD 10 code: m05 Seropositive rheumatoid arthritis m05.0 Felty's syndrome. rheumatoid

Rheumatoid arthritis - description, causes, symptoms (signs), diagnosis, treatment.

Short description

Rheumatoid arthritis(RA) is an inflammatory rheumatic disease of unknown etiology, characterized by symmetrical chronic erosive arthritis of peripheral joints and systemic inflammatory lesions of internal organs.

Working classification of rheumatoid arthritis (1980) Form: Rheumatoid arthritis: polyarthritis, oligoarthritis, monoarthritis Rheumatoid arthritis with systemic manifestations Special syndromes: Felty's syndrome, Still's syndrome in adults By serobelonging(according to the presence of RF): seropositive, seronegative With the flow: rapidly progressive, slowly progressive (assessment of the rate of development of destructive changes in the joint during long-term follow-up) By activity: I - low, II - moderate, III - high activity X-ray stage: I - periarticular osteoporosis, II - the same + narrowing of the interarticular spaces + single erosions, III - the same + multiple erosions, IV - the same + ankylosis H availability of functional ability: 0 - preserved, I - professional ability preserved, II - professional ability lost, III - self-service ability lost.

Statistical data. Frequency - 1% in the general population. The predominant age is 22–55 years. The predominant gender is female (3:1). Incidence: 23.4 per 100,000 population in 2001

Causes

Etiology unknown. Various exogenous (viral proteins, bacterial superantigens, etc.), endogenous (type II collagen, stress proteins, etc.) and nonspecific (trauma, infection, allergy) factors can act as "arthritogenic" factors.

genetic features. 70% of RA patients have HLA - DR4 Ag, the pathogenetic significance of which is associated with the presence of a rheumatoid epitope (section b - chain of the HLA molecule - DR4 with a characteristic amino acid sequence from the 67th to the 74th position). The effect of the “gene dose”, that is, the quantitative-qualitative relationship between the genotype and clinical manifestations, is discussed. The combination of HLA - Dw4 (DR b 10401) and HLA - Dw14 (DR b 1 * 0404) significantly increases the risk of developing RA. On the contrary, the presence of antigens - defenders, for example HLA - DR5 (DR b 1 * 1101), HLA - DR2 (DR b 1 * 1501), HLA DR3 (DR b 1 * 0301) significantly reduces the likelihood of RA.

Pathogenesis. The pathological process in RA is based on a generalized immunologically determined inflammation. early stages diseases reveal Ag - specific activation of CD4 + - T - lymphocytes in combination with hyperproduction of pro-inflammatory cytokines (tumor necrosis factor [TNF - a], IL - 1, IL - 6, IL - 8, etc.) against the background of a deficiency of anti-inflammatory mediators (IL - 4, soluble IL-1 antagonist). IL - 1 plays an important role in the development of erosion. IL - 6 stimulates B - lymphocytes to the synthesis of RF, and hepatocytes - to the synthesis of proteins of the acute phase of inflammation (C - reactive protein [CRP], etc.). TNF-a causes the development of fever, pain, cachexia, is important in the development of synovitis (it promotes the migration of leukocytes into the joint cavity by enhancing the expression of adhesion molecules, stimulates the production of other cytokines, induces the procoagulant properties of the endothelium), and also stimulates the growth of pannus (granulation tissue penetrating into the cartilage from the synovial tissue and destroying it). An important prerequisite is the weakening of the endogenous synthesis of HA - hormones In the late stages of RA in conditions chronic inflammation tumor-like processes are activated due to somatic mutation of fibroblast-like synovial cells and defects in apoptosis.

Symptoms (signs)

CLINICAL PICTURE

1. General symptoms: fatigue, subfebrile condition, lymphadenopathy, weight loss.
2. Articular syndrome Symmetry - important feature RA Morning stiffness lasting more than 1 hour Characteristically symmetrical lesions of the proximal interphalangeal, metacarpophalangeal, radiocarpal, metatarsophalangeal joints, as well as others proximal interphalangeal joints), "hands with lorgnette" (with mutilating arthritis) Rheumatoid foot: fibular deviation, hallux valgus deformity of the first finger, pain in the heads of the metatarsophalangeal joints Rheumatoid knee joint: Baker's cyst, flexion and valgus deformities Cervical spine: subluxations of the atlantoaxial joint Cricoarytenoid joint : coarsening of the voice, dysphagia.
3. Periarticular tissue injury Tenosynovitis in the area of ​​the wrist joint and hand Bursitis, especially in the area of ​​the elbow joint Damage to the ligamentous apparatus with the development of hypermobility and deformities Muscle damage: muscle atrophy, myopathies, more often medicinal (steroid, as well as against the background of taking penicillamine or aminoquinoline derivatives).
4. Systemic manifestations Rheumatoid nodules are dense subcutaneous formations, typically localized in areas that are often traumatized (for example, in the region of the olecranon, on the extensor surface of the forearm). Very rarely found in internal organs (for example, in the lungs). Observed in 20-50% of patients Ulcers on the skin of the legs Eye damage: scleritis, episcleritis; with Sjögren's syndrome - dry keratoconjunctivitis Heart damage: dry, rarely effusion, pericarditis, vasculitis, valvulitis, amyloidosis. Patients with RA tend to early development atherosclerosis Lung involvement: interstitial pulmonary fibrosis, pleurisy, Kaplan's syndrome (rheumatoid nodules in the lungs in miners), pulmonary vasculitis, bronchiolitis obliterans Renal damage: clinically mild mesangial or (less often) membranous glomerulonephritis, renal amyloidosis Neuropathy: compression (carpal tunnel syndrome), sensory-motor neuropathy, multiple mononeuritis (as part of rheumatoid vasculitis), cervical myelopathy (rarely) against the background of subluxation of the atlanto-occipital joint Vasculitis: digital arteritis with the development of gangrene of the fingers, microinfarcts in the nail bed Anemia due to a slowdown in iron metabolism in the body caused by dysfunction of the reticuloendothelial system; thrombocytopenia Sjögren's syndrome - autoimmune exocrinopathy, clinical manifestations: dry keratoconjunctivitis, xerostomia Osteoporosis (more pronounced during GC therapy) Amyloidosis Felty's syndrome: symptom complex, including neutropenia, splenomegaly, systemic manifestations, often leads to the development of non-Hodgkin's lymphoma Still's syndrome Major criteria: fever 39 °C or more for one or more weeks; arthralgia 2 weeks or more; macular or maculopapular salmon-colored rash that appears during a fever; blood leukocytosis >10109/l, granulocyte count >80% Minor criteria: sore throat, lymphadenopathy, or splenomegaly; increased levels of serum transaminases, not associated with drug toxicity or allergies; absence of RF, absence of antinuclear antibodies (ANAT).

Diagnostics

Laboratory data Anemia, an increase in ESR, an increase in CRP levels correlate with RA activity Synovial fluid is turbid, with low viscosity, leukocytosis is above 6000 / μl, neutrophilia (25–90%) RF (anti-IgG antibodies of the IgM class) is positive in 70–90% of cases Sjögren detect ANAT, AT to Ro / La OAM (proteinuria within the framework of nephrotic syndrome caused by amyloidosis of the kidneys or drug-derived glomerulonephritis) An increase in creatinine, serum urea (assessment of renal function, a necessary stage in the selection and control of treatment).

instrumental data X-ray examination of the joints early signs: osteoporosis, cystic enlightenment of the periarticular parts of the bone. Erosions of the articular surfaces are formed earlier in the area of ​​the heads of the metacarpophalangeal and metatarsophalangeal joints Late signs: narrowing of the joint spaces, ankylosis Regional features: subluxations of the atlantoaxial joint, protrusion of the femoral head into the acetabulum.

American Rheumatological Association Diagnosis Criteria for Rheumatoid Arthritis (1987) At least 4 of the following Morning stiffness >1 hour Arthritis of 3 or more joints Arthritis of the joints of the hands Symmetric arthritis Rheumatoid nodules RF Radiographic changes The first four criteria must have existed for at least 6 weeks. Sensitivity - 91.2%, specificity - 89.3%.

Treatment

TREATMENT

General tactics. Since the highest rate of increase in radiological changes in the joints is observed in the early stages of RA, active therapy (NSAIDs in an adequate dose + basic drugs) should be started within the first 3 months after the diagnosis of reliable RA. This is especially important in patients with risk factors for an unfavorable prognosis, which include high RF titers, a pronounced increase in ESR, damage to more than 20 joints, the presence of extra-articular manifestations (rheumatoid nodules, Sjogren's syndrome, episcleritis and scleritis, interstitial lung disease, pericarditis, systemic vasculitis). , Felty's syndrome). The use of GC is indicated in patients who do not "respond" to NSAIDs or have contraindications to their appointment in an adequate dose, and also as a temporary measure until the effect of basic drugs. Intra-articular administration of HA is intended for the treatment of synovitis in 1 or several joints, which complements, but does not replace, complex treatment.

Mode. Patients should form a stereotype of movements that counteracts the development of deformities (for example, to prevent ulnar deviation, one should open a tap, dial a telephone number and other manipulations not with the right, but with the left hand).

DRUG TREATMENT

Non-steroidal anti-inflammatory drugs Non-selective inhibitors of cyclooxygenase (COX) Diclofenac 50 mg 2–3 r/day remains the “gold standard” Long-acting diclofenac 100 mg/day Arylpropionic acid derivatives remain relevant as having the lowest percentage of gastrointestinal complications: Ibuprofen 0.8 g 3–4 r/day Naproxen 500–750 mg bid Ketoprofen 50 mg 2–3 r/day (high analgesic activity) Derivatives of enolic acids Piroxicam 10-20 mg 2 r / day Selective inhibitors of COX - 2 Meloxicam 7.5-15 mg / day Nimesulide 0.1-0.2 g 2 r / day Celecoxib 0.1 g 2 r / day.

Application tactics NSAIDs Patients at risk of developing gastropathy and gastrointestinal bleeding (age over 75 years, history of gastrointestinal ulcers, simultaneous use of low doses of acetylsalicylic acid and HA, smoking) can be prescribed selective or specific COX-2 inhibitors, either (subject to high individual effectiveness - non-selective COX inhibitors in combination with misoprostol 200 mcg 2-3 r / day or proton pump inhibitors (omeprazole 20-40 mg / day) In patients with impaired renal function, NSAIDs should be treated with extreme caution. COX-2 inhibitors should continue to take small doses of acetylsalicylic acid at the same time.

Classification of rheumatoid arthritis ICD 10

Sometimes doctors confuse arthritis with osteoarthritis.

This disease is one of the urgent problems in medicine. Rheumatoid arthritis has an ICD-10 code: M05-M14. ICD 10 - International Classification of Diseases of the 10th revision. This disease is characterized by inflammation of the joints, wear of cartilage tissue. Many patients complain of redness of the skin and itching in the affected area. Even doctors sometimes confuse arthrosis and arthritis. In fact, these are completely different types of diseases. Arthrosis is rather an age-related degeneration of the articular cavities. Arthritis is an inflammatory process of the joints. Inaction often leads to disability.

Origin of systemic disease

Rheumatoid arthritis is a terrible disease that affects not only the elderly, but also infants. This disease extends to all categories of ages. It's like an epidemic, it spares no one.

In ICD 10, rheumatoid arthritis is listed under the code M06. The abnormal work of the immune system of the patient's body is taken as the basis for the occurrence of the disease. The body is made up of cells whose functions are based on the protection of the immune system. Protective cells begin to be produced after an infection, but instead of destroying the microorganisms that triggered the infectious disease, they begin to attack healthy cells, destroying them. The damage to the cartilaginous tissues of the joints begins, which leads to irreversible destruction in the patient's body.

Lack of treatment leads to deformation of the area where rheumatoid arthritis is developed. Serious deformity does not pass without a trace, many symptoms begin to disturb the patient. Joints swell and bring hellish discomfort. Cartilage and bone continue to break down, threatening the patient with disability.

Patients with rheumatoid arthritis with the code ICD 10

The codification of microbial 10 is necessary only for doctors, not many patients understand and understand it. Why is it necessary? Suppose a patient is admitted to the hospital with acute pain and his doctor is not available. Taking a card where it is written - rheumatoid arthritis code M06 according to microbial 10, the medical staff knows the patient's medical history, why severe pain, and how to act in this or that case. That is why classification is important for doctors.

Why is it necessary to write the coding on the patient card:

• To avoid misunderstandings between the patient and the medical staff.
• Taking the card, the doctor knows the patient's complaints, what worries him the most.
• The hospital staff knows what they're up against.
• There is no need to once again explain to the doctor what kind of illness you have, it is written in the card.

Health care has provided for all the nuances in advance, even if they are insignificant, but it is very convenient, especially for the hospital staff. After all, the patient is not always able to explain why he is sick.

Varieties of the disease of the musculoskeletal system

Rheumatoid arthritis according to the 10th international classification is a disease of the musculoskeletal system, which has many varieties. The international classification distinguishes the following codes for rheumatoid arthritis: M06.0, M06.1, M06.2, M06.3, M06.4, M06.8, M06.9. These are the main points into which the disease is divided. In fact, each type has several sub-items. In the ICD 10 system, rheumatoid arthritis has a code from M05 to M99.

Rheumatoid arthritis is of several types:

• traumatic;
• reactive;
• psoriatic;
• juvenile.

There are cases when people with identical symptoms are assigned to different categories of the disease. The nature of the course is different, the degree of the disease can also be different, but the signs are the same.

If the disease is not treated, complications may occur:

• disability;
• development of osteoporosis;
• fractures and other injuries;
• immobilization.

Symptomatic manifestations of the disease

The clinical picture of the disease in all varieties is largely similar. The main types of symptoms in all classifications of the disease:

• inflammation of the joint capsule - swelling;
• affects at least 3 articular joints at the same time;
• the joints cease to function properly, morning stiffness is observed, which significantly worsens the patient's well-being;
• the temperature in the affected area rises, the swelling is hot to the touch and the state of health worsens;
• inflammation spreads to the internal organs;
• increased risk of getting a heart attack;
• sharp pain;
• swelling and redness of the articular surfaces.

The main symptom is the presence of an inflammatory process. Rheumatoid arthritis is a progressive disease with periods of temporary improvement.

ICD 10. Rheumatoid arthritis: symptoms and treatment

According to ICD 10, rheumatoid arthritis belongs to the class M: inflammatory polyarthropathies. In addition to it, this includes JRA (juvenile or juvenile rheumatoid arthritis), gout and others. The causes of this disease are still not fully understood. There are several theories about its development, but no consensus has yet been formed. The infection is thought to cause dysregulation of the immune system in predisposed individuals. As a result, molecules are formed that destroy the tissues of the joints. Against this theory is the fact that rheumatoid arthritis (ICD code - 10 M05) is poorly treated with antibacterial drugs.

Medical history

Rheumatoid arthritis is an ancient disease. The first cases of it were discovered during the study of the skeletons of the Indians, whose age was about four and a half thousand years. In the literature, the description of RA is found from 123 AD. People with characteristic symptoms of the disease were captured on the canvases of Rubens.

As a nosological unit, rheumatoid arthritis was first described by the physician Landre-Bove at the beginning of the nineteenth century and called it "asthenic gout." The disease received its present name half a century later, in 1859, when it was mentioned in a treatise on the nature and treatment of rheumatic gout. For every one hundred thousand people, fifty cases are detected, most of them women. By 2010, more than forty-nine thousand people had died from RA worldwide.

Etiology and pathogenesis

RA is such a common disease that it has a separate chapter in ICD 10. Rheumatoid arthritis, like other joint pathologies, is caused by the following factors:

Predisposition to autoimmune diseases in the family;

The presence of a certain class of histocompatibility antibodies.

Measles, mumps (mumps), respiratory syncytial infection;

All family of herpes viruses, CMV (cytomegalovirus), Epstein-Barr;

3. Trigger factor:

Stress, medication, hormonal disruptions.

The pathogenesis of the disease consists in an abnormal reaction of the cells of the immune system to the presence of antigens. Lymphocytes produce immunoglobulins against body tissues instead of destroying bacteria or viruses.

Clinic

According to ICD 10, rheumatoid arthritis develops in three stages. In the first stage, swelling of the joint capsules is observed, which causes pain, the temperature rises and the shape of the joints changes. In the second stage, the cells of the tissue that covers the joint from the inside begin to divide rapidly. Therefore, the synovial membrane becomes dense and rigid. In the third stage, inflammatory cells release enzymes that destroy joint tissues. This causes difficulty with voluntary movements and leads to physical defects.

Rheumatoid arthritis (ICD 10 - M05) has a gradual onset. Symptoms appear gradually, it can take months. In extremely rare cases, the process can begin acutely or subacutely. The fact that the articular syndrome (pain, defiguration and local temperature increase) is not a pathognomonic symptom makes the diagnosis of the disease much more difficult. As a rule, morning stiffness (the inability to move the joints) lasts about half an hour, and it intensifies when active movements are attempted. A harbinger of the disease is pain in the joints when the weather changes and general meteosensitivity.

Variants of the clinical course

There are several options for the course of the disease, which the doctor in the clinic should be guided by.

1. Classical when the damage to the joints occurs symmetrically, the disease progresses slowly and there are all its precursors.

2. Oligoarthritis with damage to exclusively large joints, as a rule, the knee. It begins acutely, and all manifestations are reversible within one and a half months from the onset of the disease. At the same time, joint pains are volatile in nature, there are no pathological changes on the radiograph, and treatment with NSAIDs (non-steroidal anti-inflammatory drugs) has a positive effect.

3. Felty syndrome It is diagnosed if an enlarged spleen with a characteristic pattern of blood changes joins the disease of the joints.

4. Juvenile rheumatoid arthritis(code according to ICD 10 - M08). A characteristic feature is that they are ill children under 16 years of age. There are two forms of this disease:

With allergic septic syndrome;

The articular-visceral form, which includes vasculitis (inflammation of the joints), damage to the valves of the heart, kidneys and digestive tract, as well as damage to the nervous system.

Classification

As in the case of other nosological units reflected in the ICD 10, rheumatoid arthritis has several classifications.

1. According to clinical manifestations:

Very early, when symptoms last up to six months;

Early, if the disease lasts up to a year;

Expanded - up to 24 months;

Late - with a disease duration of more than two years.

2. X-ray stages:

- First. There is a thickening and compaction of the soft tissues of the joint, single foci of osteoporosis.

- Second. The process of osteoporosis captures the entire epiphysis of the bone, the joint space narrows, erosion appears on the cartilage;

- Third. Deformation of the epiphyses of bones, habitual dislocations and subluxations;

- Fourth. Ankylosis ( complete absence joint space).

3. Immunological characteristics:

For rheumatoid factor:

Seropositive rheumatoid arthritis (ICD 10 - M05.0). This means that rheumatoid factor is detected in the patient's blood.

seronegative rheumatoid arthritis.

For antibodies to cyclic citrulline peptide (Anti-CCP):

Seropositive rheumatoid arthritis;

4. Functional class:

• First- All activities are protected.
• Second- interrupted professional activity.
• Third- maintains the ability to self-service.
• Fourth- all types of activities are disrupted.

Rheumatoid arthritis in children

Juvenile rheumatoid arthritis ICD 10 distinguishes into a separate category - as an autoimmune disease of young children. Most often, children get sick after a serious infectious disease, vaccination or joint injury. Aseptic inflammation develops in the synovial membrane, which leads to excessive accumulation of fluid in the joint cavity, pain, and ultimately to thickening of the wall of the articular capsule and its adhesion to the cartilage. After some time, the cartilage is destroyed, and the child becomes disabled.

The clinic distinguishes between mono-, oligo- and polyarthritis. When only one joint is affected, it is, respectively, monoarthritis. If up to four joints are subject to pathological changes at the same time, then this is oligoarthritis. Polyarthritis is diagnosed when almost all joints are affected. Systemic rheumatoid arthritis is also distinguished, when other organs are affected in addition to the skeleton.

Diagnostics

In order to make a diagnosis, it is necessary to correctly and fully collect an anamnesis, conduct biochemical blood tests, make x-rays of the joints, as well as serodiagnosis.

In a blood test, the doctor pays attention to the erythrocyte sedimentation rate, rheumatoid factor, and the number of blood cells. The most progressive at the moment is the detection of anti-CCP, which was isolated in 2005. This is a highly specific indicator that is almost always present in the blood of patients, in contrast to rheumatoid factor.

Treatment

If the patient has had an infection or it is in full swing, then he is shown a specific antibiotic therapy. When choosing drugs, pay attention to the severity of the articular syndrome. As a rule, they start with non-steroidal anti-inflammatory drugs and at the same time corticosteroids are injected into the joint. In addition, since RA is an autoimmune disease, the patient needs plasmapheresis to eliminate all immune complexes from the body.

Treatment is usually lengthy and can take years. This is due to the fact that drugs must accumulate in the tissues. One of key points therapy is the treatment of osteoporosis. For this patient, they are asked to follow a special calcium-rich diet (dairy products, almonds, walnuts, hazelnuts), as well as take calcium and vitamin D supplements.

Rheumatoid arthritis is a chronic disease in which the synovial membrane becomes inflamed, causing joints to become stiff and swollen. Gradually, inflammation destroys the ends of the bone and the cartilage that covers the articular surfaces. The structure and functions of the ligaments that give the joint strength are disrupted, and it begins to deform.

Most often, the disease affects several joints and usually begins on one of the small ones - the hand or foot. As a rule, the disease develops symmetrically. The eyes, lungs, heart, and blood vessels may be involved in the inflammatory process. The disease usually develops slowly, but clinically manifests itself abruptly.

Rheumatoid arthritis is an autoimmune disease, i.e. the synovial membrane, and in some cases other parts of the body, are damaged by their own antibodies.

At-risk groups

Women over 60 years of age are more likely to get sick, men - 3 times less often. The disease may be hereditary. Lifestyle doesn't matter.

General symptoms

• weakness;
• pale skin;
• shortness of breath on any exertion;
• poor appetite.

The general symptoms are partly due to, and it occurs because the amount of bone marrow in which blood cells are formed decreases.

Characteristics

• joints lose mobility, hurt and swell;
• on areas experiencing pressure (for example, on the elbows), characteristic nodules appear.

Since the disease simultaneously brings pain and immobilizes, patients often begin. In women with rheumatoid arthritis, the condition may improve during pregnancy, but after the birth of the child, the attacks resume.

With the course of the disease, due to low mobility, the density of the bones connecting in the joint decreases, they become brittle and break easily. In severe cases, osteoporosis of the entire skeleton develops.

In addition, it may develop, i.e. inflammation of the articular bag. Swollen tissues in the wrist compress the median nerve, causing numbness, tingling, and pain in the fingers. If the walls of the arteries that supply blood to the fingers become inflamed, it develops, in which, especially in the cold, the fingers begin to hurt and turn white. Rarely, the spleen and lymph nodes are enlarged. The heart bag - the pericardium - can become inflamed. In some cases, the whites of the eyes become inflamed.

For rheumatoid arthritis, it is characteristic that attacks lasting from several weeks to several months are replaced by relatively asymptomatic periods. A similar but distinctive form of arthritis occurs in children (see juvenile rheumatoid arthritis).

Diagnostics

It is usually based on the anamnesis and the results of a general examination of the patient. Blood tests are done to confirm the presence of antibodies (called rheumatoid factor) and determine the severity of the inflammation. The destruction of bones and cartilage is assessed by x-rays of the affected joints.

Health care

Rheumatoid arthritis is incurable. The task of the doctor is to take the symptoms of the disease under control and prevent the disease from progressing so that the joints do not collapse further. There are many drugs, the choice of which depends on the severity and stage of development of the disease, the age of the patient and his general state of health.

If there are only mild symptoms, they will be prescribed. However, at the beginning of the disease, the doctor may prescribe stronger drugs that change its course. They should limit the permanent destruction of the joints, but they will have to be taken for several months before improvement occurs. First assign or . If the symptoms do not go away, gold compounds are prescribed, or. New drugs that target tumor necrosis factor may also be used. Since all these drugs are characterized by severe side effects, the patient should be under constant supervision.

With anemia, which often accompanies rheumatoid arthritis, the hormone erythropoietin is prescribed to improve the condition, which increases the formation of red blood cells.

Splints or corsets will most likely be recommended to reduce stress on a particularly painful joint and prevent deformity. To strengthen the muscles and not lose the mobility of the joints, gentle, but regular exercise is suitable. For this, physiotherapy and / or occupational therapy is carried out. To relieve pain, hydrotherapy is prescribed, as well as hot or cold heating pads. For very severe pain, the doctor may give an intra-articular injection of corticosteroids. If the joint is severely destroyed, surgical implantation is performed, replacing it with a prosthesis.

Precautionary measures

Most people with rheumatoid arthritis are able to lead normal lives, but lifelong medication is needed to manage symptoms. Approximately 1 in 10 patients develop severe disability due to persistent attacks of the disease. In order to monitor the development of the disease and the response to treatment, you need to regularly donate blood for analysis. Sometimes attacks gradually weaken, and the disease exhausts itself, but in these cases some irreversible changes may remain.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols MH RK - 2013

Rheumatoid arthritis, unspecified (M06.9)

Rheumatology

general information

Short description

Approved by the minutes of the meeting
Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan
No. 23 dated 12/12/2013

Rheumatoid arthritis (RA)- an autoimmune rheumatic disease of unknown etiology, characterized by chronic erosive arthritis (synovitis) and systemic damage to internal organs.

I. INTRODUCTION

Protocol name: Rheumatoid arthritis
Protocol code:

ICD-10 codes:
M05 Seropositive rheumatoid arthritis;
M06 Other rheumatoid arthritis;
M05.0 Felty's syndrome;
M05.1 Rheumatoid lung disease;
M05.2 Rheumatoid vasculitis;
M05.3 Rheumatoid arthritis involving other organs and systems;
M06.0 seronegative rheumatoid arthritis;
M06.1 Still's disease in adults;
M06.9 Rheumatoid arthritis, unspecified.

Abbreviations used in the protocol:
APP - Russian Association of Rheumatologists
ACCP - antibodies to cyclic citrullinated peptide
DMARDs - basic anti-inflammatory drugs
VAS - Visual Analog Scale
GIBP - genetically engineered biological preparations
GC - glucocorticoids
GIT - gastrointestinal tract
STDs - sexually transmitted diseases
LS - medicines
MT - methotrexate
MRI - magnetic resonance imaging
NSAIDs - non-steroidal anti-inflammatory drugs
OSZ - general health
RA - rheumatoid arthritis
RF - rheumatoid factor
CRP - C-reactive protein
Ultrasound - ultrasonography
FK - functional class
NPV - number of swollen joints
COX - cyclooxygenase
FGDS - fibrogastroduodenoscopy
ECG - electrocardiogram
ECHO KG - echocardiogram

Protocol development date: 2013
Patient category: patients with RA
Protocol Users: rheumatologists, therapists, general practitioners.

Classification

Clinical classification

Working Classification of Rheumatoid Arthritis (APP, 2007)

Main diagnosis:
1. Seropositive rheumatoid arthritis (M05.8).
2. Seronegative rheumatoid arthritis (M06.0).

Special clinical forms of rheumatoid arthritis
1. Felty's syndrome (M05.0);
2. Still's disease in adults (M06.1).
3. Probable rheumatoid arthritis (M05.9, M06.4, M06.9).

Clinical stage:
1. Very early stage: duration of illness<6 мес..
2. Early stage: disease duration 6 months - 1 year.
3. Advanced stage: disease duration >1 year with typical RA symptoms.
4. Late stage: the duration of the disease is 2 years or more + severe destruction of small (III-IV X-ray stage) and large joints, the presence of complications.

The degree of disease activity:
1. 0 - remission (DAS28<2,6).
2. Low (DAS28=2.6-3.2).
3. II - medium (DAS28=3.3-5.1).
4. III - high (DAS28>5.1).

Extra-articular (systemic) signs:
1. Rheumatoid nodules.
2. Cutaneous vasculitis (necrotizing ulcerative vasculitis, nail bed infarcts, digital arteritis, livedoangiitis).
3. Neuropathy (mononeuritis, polyneuropathy).
4. Pleurisy (dry, effusion), pericarditis (dry, effusion).
5. Sjögren's syndrome.
6. Eye damage (scleritis, episcleritis, retinal vasculitis).

Instrumental characteristic.
The presence or absence of erosions [according to radiography, magnetic resonance imaging (MRI), ultrasound(ultrasound)]:
- non-erosive;
- erosive.

X-ray stage (according to Steinbroker):
I - periarticular osteoporosis;
II - periarticular osteoporosis + narrowing of the joint space, there may be single erosions;
III - signs of the previous stage + multiple erosions + subluxations in the joints;
IV - signs of previous stages + bone ankylosis.

Additional immunological characteristic - antibodies to cyclic citrullinated peptide (ACCP):
1. Anti-CCP - present (+).
2. Anti - CCP - absent (-).

Functional class (FC):
I class - the possibilities of self-service, non-professional and professional activities are fully preserved.
II class - the possibilities of self-service, non-professional occupation are preserved, the possibilities of professional activity are limited.
Class III - self-service opportunities are preserved, opportunities for non-professional and professional activities are limited.
Class IV - limited self-service opportunities for non-professional and professional activities.

Complications:
1. Secondary systemic amyloidosis.
2. Secondary osteoarthritis
3. Osteoporosis (systemic)
4. Osteonecrosis
5. Tunnel syndromes (carpal tunnel syndrome, compression syndromes of the ulnar, tibial nerves).
6. Subluxation in the atlanto-axial joint, incl. with myelopathy, instability of the cervical spine
7. Atherosclerosis

Comments

To the heading "Main diagnosis". Seropositivity and seronegativity are determined by the test for rheumatoid factor (RF), which must be carried out using a reliable quantitative or semi-quantitative test (latex test, enzyme immunoassay, immunonephelometric method),

To the heading "Disease activity". Assessment of activity in accordance with modern requirements is carried out using the index - DAS28, which evaluates the pain and swelling of 28 joints: DAS 28 =0.56. √ (CHBS) + 0.28. √ (NPV) + 0.70 .Ln (ESR) + 0.014 NOSZ, where NVR is the number of painful joints out of 28; NPV - the number of swollen joints; Ln - natural logarithm; HSSE is the general health status or overall assessment of disease activity as judged by the patient on the Visual Analogue Scale (VAS).
DAS28 value >5.1 corresponds to high disease activity; DAS<3,2 - умеренной/ низкой активности; значение DAS< 2,6 - соответствует ремиссии. Вычисление DAS 28 проводить с помощью специальных калькуляторов.

To the heading "Instrumental characteristic".
Modified stages of RA according to Steinbroker:
I stage- periarticular osteoporosis, single small cystic enlightenments bone tissue(cysts) in the subchondral part of the articular surface of the bone;
2A stage - periarticular osteoporosis, multiple cysts, narrowing of joint spaces;
2B stage - symptoms of stage 2A of varying severity and single erosions of the articular surfaces (5 or less erosions);
Stage 3 - symptoms of stage 2A of varying severity and multiple erosions (6 or more erosions), subluxations and dislocations of the joints;
4 stage - symptoms of stage 3 and ankylosis of the joints.
To the rubric "Functional class". Description of characteristics. Self care - dressing, eating, personal care, etc. Non-professional activities - creativity and / or recreation and professional activities - work, study, housekeeping - are desirable for the patient, specific to gender and age.

Flow options:
According to the nature of the progression of joint destruction and extra-articular (systemic) manifestations, the course of RA is variable:
- Prolonged spontaneous clinical remission (< 10%).
- Intermittent course (15-30%): recurrent complete or partial remission (spontaneous or induced by treatment), followed by an exacerbation with the involvement of previously unaffected joints in the process.
- Progressive course (60-75%): increase in joint destruction, damage to new joints, development of extra-articular (systemic) manifestations.
- Rapidly progressive course (10-20%): constantly high disease activity, severe extra-articular (systemic) manifestations.

Special clinical forms
- Felty's syndrome - a symptom complex, including severe destructive damage to the joints with persistent leukopenia with neutropenia, thrombocytopenia, splenomegaly; systemic extra-articular manifestations (rheumatoid nodules, polyneuropathy, chronic trophic ulcers of the legs, pulmonary fibrosis, Sjögren's syndrome), a high risk of infectious and inflammatory complications.
- Adult Still's disease is a peculiar form of RA, characterized by a severe, rapidly progressive articular syndrome in combination with generalized lymphadenopathy, maculopapular rash, high laboratory activity, significant weight loss, prolonged relapsing, intermittent or septic fever, RF and ANF seronegativity.

Diagnostics

II. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT

List of basic and additional diagnostic measures before planned hospitalization

Laboratory research:
1. Complete blood count
2. Urinalysis
3. Microreaction
4. Fecal occult blood test
5. Activity of liver enzymes (ALT, AST)
6. Contents of creatinine, urea, total protein, glucose, bilirubin, cholesterol
7. The content of C-reactive protein (C-RP), rheumatoid factor
8. Antibodies to cyclic citrullinated peptide (ACCP)
9. At the initial diagnosis - ELISA for STDs (chlamydia, gonorrhea, trichomonas), with a positive result, preliminary sanitation of the focus of infection is required before hospitalization

Instrumental examination:
1. X-ray of OGK; FLG;ECG
2. X-ray of the hands - annually
3. Radiography of the pelvic bones (detection of aseptic necrosis of the femoral head) and other joints - according to indications
4. FGDS
5. Ultrasound of the abdominal organs

List of additional diagnostic measures (according to indications):
1. Hepatitis B, C and HIV markers
2. Daily proteinuria;
3. ECHO-KG
4. Biopsy for amyloidosis
5. CT scan of the thoracic segment

The list of the main diagnostic measures in the hospital
1. KLA deployed with platelets
2. Coagulogram
3. CRP, RF, ACCP, protein fractions, creatinine, triglycerides, lipoproteins, ALT, AST, thymol test
4. Echocardiography
5. Ultrasound of the abdominal organs and kidneys
6. R-graphic brushes

The list of additional diagnostic measures in the hospital:
1. FGDS according to indications
2. R-graphy of the pelvic bones and other joints - according to indications
3. R-graphy of OGK - according to indications
4. Urinalysis according to Nechiporenko - according to indications
5. Densitometry according to indications
6. Determination of Ca, alkaline phosphatase
7. Feces for occult blood
8. Ultrasound of the joints - according to indications
9. Consultation of narrow specialists - according to indications
10. Analysis of synovial fluid

Diagnostic criteria for RA.

To make a diagnosis of RA, a rheumatologist should use the criteria of the American League of Rheumatologists (1997).

American League of Rheumatology Criteria (1997).
Morning stiffness - stiffness in the morning in the area of ​​​​the joints or periarticular tissues, which persists for at least 1 hour, existing for 6 weeks.
Arthritis of 3 or more joints - swelling of the periarticular soft tissues or the presence of fluid in the joint cavity, determined by the doctor in at least 3 joints.
Arthritis of the joints of the hands - swelling of at least one of the following groups of joints: radiocarpal, metatarsophalangeal and proximal interphalangeal.
Symmetrical arthritis - bilateral damage to the joints (metacarpophalangeal, proximal interphalangeal, metatarsophalangeal).
Rheumatoid nodules are subcutaneous nodules (established by a doctor), localized mainly on protruding parts of the body, extensor surfaces or in periarticular areas (on the extensor surface of the forearm, near the elbow joint, in the region of other joints).
RF - detection of elevated titers in blood serum by any standardized method.
X-ray changes typical for RA: erosions or periarticular osteoporosis, bone decalcification (cysts), localized in the wrist joints, joints of the hands and most pronounced in clinically affected joints.
RA is diagnosed when at least 4 out of 7 criteria are met, with criteria 1 through 4 being met for at least 6 weeks.
For the new diagnostic criteria, four groups of parameters were selected, and each parameter, based on multivariate static analysis, received a score, with a score of 6 or more, a definite diagnosis of RA was established.
It is necessary to collect information about comorbidities, previous therapy, the presence of bad habits.

Complaints and anamnesis
Start Options
Characterized by a variety of options for the onset of the disease. In most cases, the disease begins with polyarthritis, rarely manifestations of arthritis can be moderately expressed, and arthralgia, morning stiffness in the joints, deterioration in general condition, weakness, weight loss, low-grade fever, lymphadenopathy, which may precede clinically pronounced joint damage, predominate.

Symmetrical polyarthritis with gradual(within a few months) an increase in pain and stiffness, mainly in the small joints of the hands (in half of the cases).

Acute polyarthritis with a predominant lesion of the joints of the hands and feet, severe morning stiffness (usually accompanied by the early appearance of RF in the blood).

Mono-, oligoarthritis of the knee or shoulder joints with subsequent rapid involvement in the process of small joints of the hands and feet.

Acute monoarthritis of large joints, resembling septic or microcrystalline arthritis.

Acute oligo- or polyarthritis with pronounced systemic phenomena (febrile fever, lymphadenopathy, hepatosplenomegaly) are more often observed in young patients (reminiscent of Still's disease in adults).

"Palindromic rheumatism": multiple recurrent attacks of acute symmetrical polyarthritis of the joints of the hands, less often of the knee and elbow joints; last several hours or days and end with complete recovery.

Recurrent bursitis and tendosynovitis especially often in the area of ​​the wrist joints.

Acute polyarthritis in the elderly: multiple lesions of small and large joints, severe pain, diffuse edema and limited mobility. Received the name "RSPE-syndrome" (Remitting Seronegative symmetric synovitis with Pitting Edema - remitting seronegative symmetric synovitis with "pincushion" edema).

Generalized myalgia: stiffness, depression, bilateral carpal tunnel syndrome, weight loss (usually develops in old age and resembles polymyalgia rheumatica); the characteristic clinical signs of RA develop later.

Physical examination

Joint damage
The most characteristic manifestations at the onset of the disease:
- pain (on palpation and movement) and swelling (associated with effusion into the joint cavity) of the affected joints;
- weakening of the force of compression of the brush;
- morning stiffness in the joints (duration depends on the severity of synovitis);
- rheumatoid nodules (rare).

The most characteristic manifestations in the advanced and final stages of the disease:
- Brushes: ulnar deviation of the metacarpophalangeal joints, usually developing after 1-5 years from the onset of the disease; damage to the fingers of the "boutonniere" type (flexion in the proximal interphalangeal joints) or "swan neck" (overextension in the proximal interphalangeal joints); deformity of the hand according to the type of "lorgnette".
- Knee joints: flexion and valgus deformity, Baker's cyst.
- Feet: subluxations of the heads of the metatarsophalangeal joints, lateral deviation, deformity of the thumb.
- cervical spine: subluxations in the area of ​​the atlantoaxial joint, occasionally complicated by compression of the spinal cord or vertebral artery.
- Crico-arytenoid joint: coarsening of the voice, shortness of breath, dysphagia, recurrent bronchitis.
- Ligament apparatus and synovial bags: tendosynovitis in the area of ​​the wrist and hand; bursitis, more often in the elbow joint; synovial cyst on the back of the knee joint (Baker's cyst).

Extra-articular manifestations
Sometimes they can prevail in the clinical picture:
- Constitutional symptoms: generalized weakness, malaise, weight loss (up to cachexia), subfebrile fever.
- The cardiovascular system: pericarditis, vasculitis, granulomatous lesions of the heart valves (very rare), early development of atherosclerosis.
- Lungs:pleurisy, interstitial lung disease, bronchiolitis obliterans, rheumatoid nodules in the lungs (Kaplan's syndrome).
- Skin:rheumatoid nodules, thickening and hypotrophy of the skin; digital arteritis (rarely with the development of gangrene of the fingers), microinfarcts in the nail bed, livedo reticularis.
- Nervous system:compression neuropathy, symmetric sensory-motor neuropathy, multiple mononeuritis (vasculitis), cervical myelitis.
- Muscles:generalized amyotrophy.
- Eyes:dry keratoconjunctivitis, episcleritis, scleritis, scleromalacia, peripheral ulcerative keratopathy.
- Kidneys:amyloidosis, vasculitis, nephritis (rare).
- Blood system: anemia, thrombocytosis, neutropenia.

Cardiovascular and severe infectious complications are risk factors for poor prognosis.

Laboratory research
Objectives of the laboratory examination
- confirmation of the diagnosis;
- exclusion of other diseases;
- assessment of disease activity;
- evaluation of the forecast;
- evaluation of the effectiveness of therapy;
- identification of complications (both the disease itself and the side effects of the therapy).

Clinical significance of laboratory tests
General blood analysis:
- leukocytosis/thrombocytosis/eosinophilia - severe course of RA with extra-articular (systemic) manifestations; combined with high RF titers; may be associated with GC treatment.
- persistent neutropenia - exclude Felty's syndrome.
- anemia (Hb< 130 г/л у мужчин и 120 г/л у женщин) - активность заболевания; исключить желудочное или кишечное кровотечение.
- increase in ESR and CRP - differential diagnosis of RA from non-inflammatory diseases of the joints; assessment of the activity of inflammation, the effectiveness of therapy; predicting the risk of progression of joint destruction.

Biochemical research:
- decrease in albumin correlates with the severity of the disease.
- an increase in creatinine is often associated with NSAID and/or DMARD nephrotoxicity.
- an increase in the level of liver enzymes - the activity of the disease; hepatotoxicity of NSAIDs and DMARDs; liver damage associated with the carriage of hepatitis B and C viruses.
- hyperglycemia - glucocorticoid therapy.
- dyslipidemia - glucocorticoid therapy; inflammation activity (decrease in high-density lipoprotein cholesterol concentrations, increase in low-density lipoprotein cholesterol concentrations).

Immunological study:
- an increase in RF titers (70-90% of patients), high titers correlate with severity, progression of joint destruction and the development of systemic manifestations;
- an increase in anti-CCP titers - a more "specific" marker of RA than RF;
- increase in ANF titers (30-40% of patients) - in severe RA;
- HLA-DR4 (DRB1*0401 allele) - a marker of severe RA and poor prognosis.

In the synovial fluid in RA, there is a decrease in viscosity, a loose mucin clot, leukocytosis (more than 6x109/l); neutrophilia (25-90%).

In the pleural fluid, the inflammatory type is determined: protein> 3 g / l, glucose<5 ммоль/л, лактатдегидрогеназа >1000 U/ml, pH 7.0; RF titers > 1:320, complement reduced; cytosis - cells 5000 mm3 (lymphocytes, neutrophils, eosinophils).

Instrumental Research
X-ray examination of the joints:
Confirmation of the diagnosis of RA, stages and assessment of the progression of the destruction of the joints of the hands and feet.
Changes characteristic of RA in other joints (at least in the early stages of the disease) are not observed.

Chest X-ray indicated for the detection of rheumatoid lesions of the respiratory system, and concomitant lesions of the lungs (COPD tuberculosis, etc.).

Magnetic resonance imaging (MRI):
- a more sensitive (than radiography) method for detecting joint damage in the onset of RA.
- early diagnosis of osteonecrosis.

Doppler ultrasonography: more sensitive (than radiography) method for detecting joint damage in the onset of RA.

High resolution computed tomography: diagnosis of lung injury.

Echocardiography: diagnosis of rheumatoid pericarditis, myocarditis and CAD-associated heart disease.

Dual energy x-ray absorptiometry

Diagnosis of osteoporosis in the presence of risk factors:
- age (women>50 years, men>60 years).
- disease activity (persistent increase in CRP >20 mg/l or ESR >20 mm/h).
- functional status (Steinbroker score >3 or HAQ score >1.25).
- body mass<60 кг.
- receiving GC.
- sensitivity (3 out of 5 criteria) for diagnosing osteoporosis in RA is 76% in women and 83% in men, and specificity is 54% and 50%, respectively.

Arthroscopy shown for differential diagnosis RA with villous-nodular synovitis, osteoarthritis, traumatic joint injury.

Biopsy indicated for suspected amyloidosis.

Indications for expert advice:
- Traumatologist-orthopedist - to resolve the issue of surgical intervention.
- Oculist - with damage to the organs of vision.

Differential Diagnosis

Differential Diagnosis often performed with diseases such as osteoarthritis, rheumatic fever (table 1).

Table 1. Clinical and laboratory characteristics of rheumatoid arthritis, rheumatoid arthritis and osteoarthritis

sign	Rheumatoid arthritis	rheumatic fever	Osteoarthritis
Pain in the joints in the acute phase morning stiffness Signs of joint inflammation Joint mobility Heart failure Course of the disease Amyotrophy Association with focal infection X-ray of the joints Hyper-Y-globulinemia Titer ASL-O, ASL-S Rheumatoid factor The effect of the use of salicylates	Intensive Expressed Constantly expressed limited slightly Myocardial dystrophy progressive Expressed, progressing Expressed Osteoporosis, narrowing of joint spaces, usura, ankylosis Noticeably increased characteristic Less than 1:250 Positive in seropositive variant of RA Weakly expressed	Intensive Missing Expressed in the acute phase Limited in the acute phase rheumatic heart disease or heart disease Arthritis resolves quickly Missing Expressed No change Increased in the acute phase Only in the acute phase Over 1:250 Negative Good	Moderate Missing not expressed Normal or limited Missing slowly progressive Weakly expressed not expressed Narrowing of joint spaces, exostoses Fine Missing Negative Missing

At the onset of RA, joint damage (and some other clinical manifestations) is similar to joint damage in other rheumatic and non-rheumatic diseases.

Osteoarthritis. Slight swelling of the soft tissues, involvement of the distal interphalangeal joints, lack of severe morning stiffness, increased pain by the end of the day.

Systemic lupus erythematosus. Symmetrical lesions of the small joints of the hands, wrist and knee joints. Arthritis, non-deforming (with the exception of Jaccous arthritis); there may be soft tissue edema, but intra-articular effusion is minimal; high titers of ANF (however, up to 30% of RA patients have ANF), rarely - low titers of RF; radiographs show no bone erosions.

Gout. Diagnosis is based on the detection of crystals in the synovial fluid or tophi with characteristic negative birefringence on polarizing microscopy. In the chronic form, there may be a symmetrical lesion of the small joints of the hands and feet with the presence of tophi; possible subcortical erosion on radiographs.

Psoriatic arthritis. Monoarthritis, asymmetric oligoarthritis, symmetrical polyarthritis, mutilating arthritis, lesions of the axial skeleton. Frequent damage to the distal interphalangeal joints, spindle-shaped swelling of the fingers, skin and nail changes characteristic of psoriasis.

Ankylosing spondylitis. Asymmetric mono-, oligoarthritis of large joints (hip, knee, shoulder), spinal column, sacroiliac joints; possible involvement of peripheral joints; HLA-B27 expression.

reactive arthritis. Arthritis oligoarticular and asymmetric, with a predominant lesion lower extremities, HLA-B27 expression. Caused by infection by various microorganisms (Chlamydia, Escherichia coli, Salmonella, Campylobacter, Yersinia and etc.); Reiter's syndrome: urethritis, conjunctivitis and arthritis; the presence of pain in the heel areas with the development of enthesitis, keratoderma on the palms and soles and circular balanitis.

Bacterial endocarditis. Damage to large joints; fever with leukocytosis; heart murmurs; a blood culture study is mandatory in all patients with fever and polyarthritis.

Rheumatic fever. Migrating oligoarthritis with a predominant lesion of large joints, carditis, subcutaneous nodules, chorea, erythema annulare, fever. Specific (for streptococci) serological reactions.

Septic arthritis. Usually monoarticular, but may be oligoarticular; with a primary lesion of large joints; may be migratory. Blood culture, aspiration of fluid from the joint cavity with the study of the cellular composition, Gram stain and culture; RA patients may also have septic arthritis.

Viral arthritis. Characterized by morning stiffness with symmetrical damage to the joints of the hands and wrist joints, RF, viral exanthema can be detected. In most cases, it resolves spontaneously within 4-6 weeks (with the exception of arthritis associated with parvovirus infection).

Systemic scleroderma. Raynaud's phenomenon and thickening of the skin; arthritis, usually arthralgia, can rarely be detected; limitation of range of motion associated with the attachment of the skin to the underlying fascia.

Idiopathic inflammatory myopathies. Arthritis with severe synovitis is rare. Inflammation of the muscles, characterized by proximal muscle weakness, increased levels of CPK and aldolase, arthralgia and myalgia, pathological changes on the electromyogram.

Mixed connective tissue disease. In 60-70% of cases, arthritis can be deforming and erosive. Characteristic features of SLE, systemic scleroderma and myositis; characteristic of AT to ribonucleoprotein.

Lyme disease. In the early stages - migrating erythema and cardiovascular pathology, in the later stages - intermittent mono- or oligoarthritis (in 15% of patients it can be chronic and erosive), encephalopathy and neuropathy; 5% of healthy people have positive reactions to Lyme borreliosis.

Rheumatic polymyalgia. Diffuse pain and morning stiffness in axial joints and proximal muscle groups; swelling of the joints is less common; expressed ESR; rarely occurs before the age of 50 years. Pronounced response to glucocorticoid therapy; in 10-15% it is combined with giant cell arteritis.

Behçet's disease. Differential diagnosis with scleritis in RA.

Amyloidosis. Periarticular deposition of amyloid; there may be an effusion in the joint cavity. Congo red staining of aspirated joint fluid.

Hemochromatosis. Increase in bone structures of the 2nd and 3rd metacarpophalangeal joints; an increase in the level of iron and ferritin in serum with a decrease in transferrin-binding ability; X-rays may show chondrocalcinosis. Diagnosed by liver biopsy.

Sarcoidosis. Chronic granulomatous disease, in 10-15% accompanied by chronic symmetrical polyarthritis.

Hypertrophic osteoarthropathy. Oligoarthritis of the knee, ankle and wrist joints; periosteal neoplasm of bone; deep and aching pain. "Drumsticks", association with pulmonary disease, pain in the limbs in a certain position.

Multicentric reticulohistiocytosis. Dermatoarthritis, periungual papules, painful destructive polyarthritis. Characteristic changes in the biopsy of the affected area of ​​the skin.

Familial Mediterranean fever. Recurrent attacks of acute synovitis (mono- or oligo-articular) of large joints associated with fever, pleurisy and peritonitis.

Relapsing polychondritis. Widespread progressive inflammation and destruction of cartilage and connective tissue; migrating asymmetric and non-erosive arthritis of small and large joints; inflammation and deformity of the cartilage of the auricle.

Fibromyalgia. Widespread musculoskeletal pain and stiffness, paresthesias, unproductive sleep, fatigue, multiple symmetrical trigger points (11 out of 18 are enough for a diagnosis); laboratory researches and research of joints - without pathology.

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Treatment

Tactics of treatment of patients with RA

RECOMMENDATIONS FOR THE TREATMENT OF PATIENTS WITH RHEUMATOID ARTHRITIS
According to modern standards, the treatment of RA should be based on the following basic principles:
The main goal is to achieve complete (or at least partial) remission.

To achieve this goal:
1. Treatment of DMARDs should begin as early as possible;
2. Treatment should be as active as possible with a change (if necessary) in the treatment regimen within 2-6 months;
3. When choosing therapy, it is necessary to take into account:
- risk factors for poor prognosis, which include high RF titers, increased ESR and CRP, rapid development of joint destruction
- length of time between onset of symptoms and initiation of DMARD therapy:
a) if it is more than 6 months, therapy should be more active;
b) in the presence of risk factors, the drug of choice is methotrexate (initial dose of 7.5 mg / week) with a rapid (within about 3 months) increase in dose to 20-25 mg / week;
c) the effectiveness of therapy should be assessed using standardized clinical and radiological criteria.

The use of non-pharmacological and pharmacological methods, the involvement of specialists from other specialties (orthopedists, physiotherapists, cardiologists, neuropathologists, psychologists, etc.); treatment of patients should be carried out by rheumatologists, be as individualized as possible depending on clinical manifestations and activity.

Non-drug treatment
1. Avoid factors that can potentially provoke an exacerbation of the disease (intercurrent infections, stress, etc.).

2. Quitting smoking and drinking alcohol:
- smoking may play a role in the development and progression of RA;
- an association was found between the number of cigarettes smoked and positivity in the Russian Federation, erosive changes in the joints and the appearance of rheumatoid nodules, as well as lung damage (in men).

3. Maintain ideal body weight.

4. A balanced diet that includes foods high in polyunsaturated fatty acids (fish oil, olive oil, etc.), fruits, vegetables:
- Potentially suppresses inflammation;
- reduces the risk of cardiovascular complications.

5. Patient education (changing the stereotype of motor activity, etc.)

6. Therapeutic exercise (1-2 times a week)

7. Physiotherapy: thermal or cold procedures, ultrasound, laser therapy (with moderate RA activity)

8. Orthopedic support (prevention and correction of typical joint deformities and instability of the cervical spine, splints for the wrist, corset for the neck, insoles, orthopedic shoes)

9. Sanatorium treatment is indicated only for patients in remission.

10. Active prevention and treatment of comorbidities is necessary throughout the illness.

Medical treatment

Key points
To reduce joint pain, all patients are prescribed NSAIDs
- NSAIDs have a good symptomatic (analgesic) effect
- NSAIDs do not affect the progression of joint destruction

The treatment of RA is based on the application DMARD
- Treatment of RA with DMARDs should be started as early as possible, preferably within 3 months of symptom onset
- early treatment of DMARDs improves function and slows the progression of joint destruction
- "late" prescription of DMARDs (3-6 months after the onset of the disease) is associated with a decrease in the effectiveness of DMARDs monotherapy
- the longer the duration of the disease, the lower the effectiveness of DMARDs.
The effectiveness of therapy should be assessed by standardized methods.

Non-steroidal anti-inflammatory drugs (NSAIDs)
Basic provisions:
1. NSAIDs are more effective than paracetamol.
2. Treatment with NSAIDs should be combined with active DMARD therapy.
3. The frequency of remission against the background of NSAID monotherapy is very low (2.3%).

In the general population of patients with RA, NSAIDs in equivalent doses do not significantly differ in effectiveness, but differ in the frequency of side effects:
- since the effectiveness of NSAIDs in individual patients can vary significantly, it is necessary to individually select the most effective NSAID for each patient
- the selection of an effective dose of NSAIDs is carried out within 14 days.

Do not exceed the recommended dose of NSAIDs and COX-2 inhibitors: this usually leads to an increase in toxicity, but not the effectiveness of treatment.
It is recommended to start treatment with the appointment of the safest NSAIDs (short T1 / 2, no cumulation) and at the lowest effective dose.
Do not take 2 or more different NSAIDs at the same time (with the exception of low-dose aspirin).
Inhibitors (selective) COX-2 are not inferior in effectiveness to standard (non-selective) NSAIDs.

When choosing an NSAID, the following factors should be taken into account:
- safety (presence and nature of risk factors for side effects);
- the presence of concomitant diseases;
- the nature of the interaction with other drugs taken by the patient;
- price.

All NSAIDs (as well as selective COX-2 inhibitors) are more likely to cause side effects from the gastrointestinal tract, kidneys and of cardio-vascular system than placebo.
Selective COX-2 inhibitors are less likely to cause gastrointestinal damage than standard NSAIDs.
If there is a history of severe damage to the gastrointestinal tract, antiulcer therapy using proton pump inhibitors (omeprazole) is necessary.

Although an increase in the risk of thrombosis during treatment with COX-2 inhibitors (with the exception of rofecoxib) has not been proven, the following steps should be taken before the final decision on their cardiovascular safety:
- inform physicians and patients in detail about the potential cardiovascular side effects of all drugs that have the characteristics of COX-2 inhibitors;
- prescribe them with extreme caution in patients at risk of cardiovascular complications;
- conduct careful monitoring of cardiovascular complications (especially arterial hypertension) throughout the entire time of taking the drugs;
- Do not exceed recommended doses.

When administered parenterally and rectally, NSAIDs reduce the severity of symptomatic gastroenterological side effects, but do not reduce the risk of severe complications (perforation, bleeding).
In patients with risk factors for NSAID gastropathy, treatment should begin with COX-2 inhibitors (meloxicam, nimesulide).

Risk factors for the development of NSAID gastropathy include the following:
- age over 65;
- severe damage to the gastrointestinal tract in history (ulcers, bleeding, perforation);
- concomitant diseases (cardiovascular pathology, etc.);
- taking high doses of NSAIDs;
- combined use of several NSAIDs (including low doses of aspirin);
- taking GCs and anticoagulants;
- infection Helicobacter pylori.
Do not prescribe celecoxib to patients with a history of allergy to sulfonamides, cotrimaxosole.

Recommended doses of NSAIDs: lornoxicam 8mg. 16 mg/day in 2 divided doses, diclofenac 75-150 mg/day in 2 divided doses; ibuprofen 1200-2400 mg / day in 3-4 doses; indomethacin 50-200 mg/day in 2-4 doses (max. 200 mg); ketoprofen 100-400 mg/day in 3-4 doses; aceclofenac 200 mg in 2 doses; meloxicam 7.5-15 mg/day in 1 dose; piroxicam 20 - 20 mg / day in 1 dose; etoricoxib 120 - 240 mg / day in 1-2 doses; etodolac 600 - 1200 mg / day in 3 - 4 doses.

Note. When treating with diclofenac, the concentrations of aspartate aminotransferase and alanine aminotransferase should be determined 8 weeks after the start of treatment. When taking angiotensin-converting enzyme (ACE) inhibitors together, serum creatinine should be determined every 3 weeks.

Glucocorticoids (GC)
Basic provisions:
1. GK (methylprednisolone 4 mg) in some cases slow down the progression of joint destruction.
2. The ratio of effectiveness / cost of HA is better than that of NSAIDs.
3. In the absence of special indications, the dose of GC should not exceed 8 mg / day in terms of methylprednisolone and 10 mg in terms of prednisolone.
4. HA should only be used in combination with DMARDs.

Most of the side effects of GC are an inevitable consequence of GC therapy:
- more often develop with long-term use of high doses of GC;
- some side effects develop less frequently than in the treatment of NSAIDs and DMARDs (for example, severe damage to the gastrointestinal tract);
- possible prevention and treatment of some side effects (for example, glucocorticoid osteoporosis).

Indications for prescribing low doses of HA:
- suppression of inflammation of the joints before the onset of action of DMARDs.
- suppression of inflammation of the joints during exacerbation of the disease or the development of complications of DMARD therapy.
- ineffectiveness of NSAIDs and DMARDs.
- contraindications to the appointment of NSAIDs (for example, in elderly people with an "ulcerative" history and / or impaired renal function).
- achieving remission in some variants of RA (for example, in seronegative RA in the elderly, resembling polymyalgia rheumatica).

In rheumatoid arthritis, glucocorticoids should be prescribed only by a rheumatologist!

Pulse therapy GC(Methylprednisolone 250 mg):
severe systemic manifestations of RA at a dose of 1000 mg-3000 mg per course.
- used in patients with severe systemic manifestations of RA;
- sometimes allows you to achieve a quick (within 24 hours), but short-term suppression of the activity of inflammation of the joints;
- since the positive effect of GC pulse therapy on the progression of joint destruction and the prognosis has not been proven, its use (without special indications) is not recommended.

Local (intra-articular) therapy(betamethasone):
Basic provisions:
- used to suppress arthritis at the onset of the disease or exacerbations of synovitis in one or more joints, improve joint function;
- leads only to temporary improvement;
- the effect on the progression of joint destruction has not been proven.
Recommendations:
- repeated injections in the same joint no more than 3 times a year;
- use sterile materials and instruments;
- wash the joint before the introduction of drugs;
- eliminate the load on the joint within 24 hours after the injection.

Basic anti-inflammatory drugs (DMARDs)

Key points
To achieve the goal, it is necessary to prescribe early DMARDs to all patients with RA, regardless of the stage and degree of treatment activity, taking into account concomitant diseases and contraindications, long-term continuous, active treatment with a change (if necessary) in the regimen for 2-6 months, constant monitoring of therapy tolerance , informing patients about the nature of the disease, the side effects of the drugs used and, if appropriate symptoms appear, the need to immediately stop taking them and consult a doctor. When choosing therapy, it is necessary to take into account risk factors for an unfavorable prognosis (high titers of RF and / or ACCP, an increase in ESR and CRP, the rapid development of joint destruction).

Methotrexate (MT):
1. The drug of choice ("gold standard") for "seropositive" active RA.
2. Compared to other DMARDs, it has the best efficiency/toxicity ratio.
3. Interruption of treatment is more often associated with drug toxicity than with the lack of effect.
4. The main drug in the combined therapy of DMARDs.
5. Treatment with methotrexate (compared to treatment with other DMARDs) is associated with a reduced risk of mortality, including cardiovascular mortality

Recommendations for use:
1. Methotrexate is prescribed once a week (orally or parenterally); more frequent use can lead to the development of acute and chronic toxic reactions.
2. Fractional reception with a 12-hour interval (in the morning and evening hours).
3. If there is no effect when taken orally (or with the development of toxic reactions from the gastrointestinal tract), switch to parenteral administration (i / m or s / c):
- the lack of effect with oral administration of methotrexate may be due to low absorption in the gastrointestinal tract;
- the initial dose of methotrexate is 7.5 mg / week, and in the elderly and with impaired renal function 5 mg / week;
- do not prescribe to patients with renal insufficiency;
- Do not administer to patients with severe lung disease.
4. Efficacy and toxicity are assessed after about 4 weeks; with normal tolerance, the dose of methotrexate is increased by 2.5-5 mg per week.
5. The clinical efficacy of methotrexate is dose dependent in the range of 7.5 to 25 mg/week. Reception at a dose of more than 25-30 mg / week is not advisable (an increase in the effect has not been proven).
6. To reduce the severity of side effects, if necessary, it is recommended:
- use short-acting NSAIDs;
- avoid the appointment of acetylsalicylic acid (and, if possible, diclofenac);
- on the day of taking methotrexate, replace NSAIDs with HA in low doses;
- take methotrexate in the evening;
- reduce the dose of NSAIDs before and / or after taking methotrexate;
- switch to another NSAID;
- with insufficient efficacy and tolerability (not severe adverse reactions) of oral MT, it is advisable to prescribe a parenteral (subcutaneous) form of the drug;
- prescribe antiemetics;
- take folic acid at a dose of 5-10 mg / week after taking methotrexate (folic acid intake reduces the risk of developing gastrointestinal and hepatic side effects and cytopenia);
- to exclude the intake of alcohol (increases the toxicity of methotrexate), substances and foods containing caffeine (reduces the effectiveness of methotrexate);
- exclude the use of drugs with antifolate activity (primarily cotrimoxazole).
- in case of an overdose of methotrexate (or the development of acute hematological side effects), it is recommended to take folic acid (15 mg every 6 hours), 2-8 doses, depending on the dose of methotrexate.

Main side effects: infections, damage to the gastrointestinal tract and liver, stomatitis, alopecia, hematological (cytopenia), sometimes myelosuppression, hypersensitivity pneumonitis.

Sulfasalazine 500 mg- an important component of combination therapy in patients with RA or in the presence of a contraindication to the appointment of MT.
Recommendations for use.
1. The commonly used dose in adults is 2 g (1.5-3 g, 40 mg/kg/day) 1 g 2 times daily with food:
- 1st week - 500 mg
- 2nd week - 1000 mg
- 3rd week - 1500 mg
- 4th week - 2000 mg.
2. If sore throat, mouth ulcers, fever, severe weakness, bleeding, skin itching occur, patients should immediately stop the drug on their own.

Main side effects: damage to the gastrointestinal tract (GIT), dizziness, headaches, weakness, irritability, abnormal liver function, leukopenia, hemolytic anemia, thrombocytopenia, rash, sometimes myelosuppression, oligospermia.

Leflunomide drug:
1. The effectiveness is not inferior to sulfasalazine and methotrexate.
2. Surpasses methotrexate and sulfasalazine in terms of the effect on the quality of life of patients.
3. The frequency of side effects is lower than other DMARDs.
The main indication for the appointment: insufficient efficacy or poor tolerability of methotrexate.

Recommendations for use
1. 100 mg / day for 3 days (“saturating” dose), then 20 mg / day.
2. When using a "saturating" dose, the risk of interrupting treatment due to the development of side effects increases; careful monitoring of adverse reactions is required.
3. Currently, most experts recommend starting treatment with leflunomide at a dose starting at 20 mg/day (or even 10 mg/day); a slow increase in the clinical effect is recommended to be compensated by the intensification of concomitant therapy (for example, low doses of GCs).

Examinations before prescribing therapy	In dynamics
General blood analysis	Every 2 weeks for 24 weeks, then every 8 weeks
Liver enzymes (ACT and ALT)	Every 8 weeks
Urea and creatinine	Every 8 weeks
HELL	Every 8 weeks

Main side effects: cytopenia, damage to the liver and gastrointestinal tract, destabilization of blood pressure, sometimes myelosuppression.

4-aminoquinoline derivatives:
1. Inferior in clinical efficacy to other DMARDs.
2. Do not slow down the progression of joint destruction.
3. Positively affect the lipid profile.
4. Chloroquine has more side effects than hydroxychloroquine.
5. Potential indications for use:
- early stage, low activity, no risk factors for poor prognosis
- undifferentiated polyarthritis, if it is impossible to exclude the onset of a systemic connective tissue disease.

Recommendations for use:
1. Do not exceed the daily dose: hydroxychloroquine 400 mg (6.5 mg/kg), chloroquine 200 mg (4 mg/kg).
2. Carry out ophthalmological control before the appointment of aminoquinoline derivatives and every 3 months during treatment:
- questioning the patient about visual disorders;
- examination of the fundus (pigmentation);
- study of visual fields.
3. Do not prescribe to patients with uncontrolled arterial hypertension and diabetic retinopathy.
4. Do not use simultaneously with drugs that have an affinity for melanin (phenothiazines, rifampicin).
5. Explain to the patient the need for self-monitoring of visual impairment.
6. Recommend wearing goggles in sunny weather (regardless of the season).

Note: Reduce dose for liver and kidney disease.
Main side effects: retinopathy, neuromyopathy, pruritus, diarrhea.

Cyclosporine:
It is recommended to use when other DMARDs are ineffective. At the same time, cyclosporine is characterized by: a high frequency of side effects and a high frequency of unwanted drug interactions. Take orally 75-500 mg 2 times a day (<5 мг/кг/сут.).
Indications: RA severe forms of active course in cases where classic DMARDs are ineffective or their use is impossible.

Main side effects: increased blood pressure, impaired renal function, headaches, tremor, hirsutism, infections, nausea / vomiting, diarrhea, dyspepsia, gingival hyperplasia. With an increase in the level of creatinine by more than 30%, it is necessary to reduce the dose of drugs by 0.5-1.0 mg / kg / day for 1 month. With a decrease in creatinine levels by 30%, continue treatment with drugs, and if the 30% increase is maintained, stop treatment.

Azathioprine, D-penicillamine, cyclophosphamide, chlorambucil.
Potential indication: failure of other DMARDs or contraindications to their use.

Combination Therapy BPVP.
There are 3 main options for combination therapy: start treatment with monotherapy followed by the appointment of one or more DMARDs (for 8-12 weeks) while maintaining the activity of the process ; start treatment with combination therapy with subsequent transfer to monotherapy (after 3-12 months) with suppression of the activity of the process, combination therapy is carried out throughout the entire period of the disease. In patients with severe RA, treatment should be started with combination therapy, and in patients with moderate activity - with monotherapy, followed by transfer to combination therapy if treatment is insufficient.
Combinations of DMARDs without signs of poor prognosis:
- MT and hydroxychloroquine - with a long duration of RA and low activity;
- MT and leflunomide - with an average duration (≥ 6 months), the presence of poor prognosis factors;
- MT and sulfasalazine - with any duration of RA, high activity, signs of a poor prognosis;
- MT + hydroxychloroquine + sulfasalazine - in the presence of poor prognosis factors and in moderate / high disease activity, regardless of the duration of the disease.

Genetically engineered biological preparations
Anti-B cell drug rituximab (RTM) and interleukin 6 receptor blocker tocilizumab (TCZ) are used to treat RA.
Indications:
- patients with RA, insufficiently responding to MT and/or other synthetic DMARDs, with moderate/high activity of RA in patients with signs of poor prognosis: high disease activity, RF + /ACCP + , early onset of erosions, rapid progression (appearance of more than 2 erosions for 12 months even with a decrease in activity);
- persistence of moderate/high activity or poor tolerance of therapy with at least two standard DMARDs, one of which should be MTX for 6 months and more or less than 6 months if it is necessary to stop the DMARD due to the development of side effects (but usually not less than 2 months);
- the presence of moderate / high RA activity or an increase in the titers of serological tests (RF + / ACCP +) should be confirmed in the process of 2-fold determination within 1 month.

Contraindications:
- pregnancy and lactation;
- severe infections (sepsis, abscess, tuberculosis and other opportunistic infections, septic arthritis of non-prosthetic joints within the previous 12 months, HIV infection, hepatitis B and C, etc.);
- heart failure III-IV functional class (NYHA);
- demyelinating diseases of the nervous system in history;
- age less than 18 years (decision on each case individually).

Treatment of GEBAs in adult patients with severe active RA in case of failure or intolerance of other DMARDs can be started with inhibition of tumor necrosis factor (etanercept, infliximab).

etanercept is indicated for adults in the treatment of moderate to severe active rheumatoid arthritis in combination with methotrexate, when the response to DMARDs, including methotrexate, has been inadequate.
Etanercept may be given as monotherapy if methotrexate has failed or is intolerable. Etanercept is indicated for the treatment of severe, active, and progressive rheumatoid arthritis in adults not previously treated with methotrexate.
Treatment with etanercept should be initiated and monitored by a physician experienced in the diagnosis and treatment of rheumatoid arthritis.
Etanercept in the form of a ready solution is used for patients weighing more than 62.5 kg. In patients weighing less than 62.5 kg, a lyophilisate should be used to prepare the solution.
The recommended dose is 25 mg etanercept twice weekly, 3 to 4 days apart. An alternative dose is 50 mg once a week.
Therapy with etanercept should be continued until remission is achieved, usually no more than 24 weeks. The introduction of the drug should be discontinued if after 12 weeks of treatment there is no positive dynamics of symptoms.
If it is necessary to re-prescribe etanercept, the duration of treatment indicated above should be observed. It is recommended to prescribe a dose of 25 mg twice a week or 50 mg once a week.
The duration of therapy in some patients may exceed 24 weeks.
Elderly patients (65 years and older)
There is no need to adjust either the dose or the route of administration.

Contraindications
- hypersensitivity to etanercept or any other component of the dosage form;
- sepsis or risk of sepsis;
- active infection, including chronic or localized infections (including tuberculosis);
- pregnancy and lactation;
- patients weighing less than 62.5 kg.
Carefully:
- Demyelinating diseases, congestive heart failure, immunodeficiency conditions, blood dyscrasia, diseases predisposing to the development or activation of infections ( diabetes, hepatitis, etc.).

infliximab prescribed with respect to the dose and frequency of administration, in combination with GEBA treatment of adult patients with severe active RA in case of failure or intolerance of other DMARDs, you can start with inhibition of tumor necrosis factor (infliximab). Infliximab is prescribed in compliance with the dose and frequency of administration, in combination with MT.
Infliximab at the rate of 3 mg/kg of body weight according to the scheme. It is used in combination with MT with its insufficient effectiveness, less often with other DMARDs. Effective in patients with insufficient "response" to MT in early and late RA. Relatively safe in carriers of the hepatitis C virus. Side effects requiring interruption of treatment occur less frequently than during treatment with other DMARDs.
All patients should be screened for mycobacterial infection prior to infliximab in accordance with current national guidelines.

Indications:
- no effect ("unacceptably high disease activity") during treatment with methotrexate at the most effective and tolerable dose (up to 20 mg/week) for 3 months or other DMARDs
- 5 or more swollen joints
- an increase in ESR more than 30 mm / h or CRP more than 20 mg / l.
- activity corresponds to DAS>3.2
- ineffectiveness of other DMARDs (if there are contraindications for the appointment of methotrexate)
- The need to reduce the dose of HA.
- if there are contraindications to standard DMARDs, infliximab can be used as the first DMARD.

Infliximab is prescribed in accordance with the dose and frequency of administration, in combination with methotrexate. Therapy with infliximab is continued only if, after 6 months after the start of therapy, an adequate effect is noted. The effect is considered adequate if there is a decrease in the disease activity score (DAS28) by 1.2 points or more. Monitor treatment with DAS28 assessment every 6 months.

Contraindications:
- severe infectious diseases (sepsis, septic arthritis, pyelonephritis, osteomyelitis, tuberculosis and fungal infections, HIV, hepatitis B and C, etc.); - malignant neoplasms;
- pregnancy and lactation.

Recommendations for use:

- intravenous infusion at a dose of 3 mg / kg, the duration of the infusion is 2 hours;
- 2 and 6 weeks after the first injection, additional infusions of 3 mg / kg each are prescribed, then the injections are repeated every 8 weeks;
- re-administration of infliximab 2-4 years after the previous injection may lead to the development of delayed-type hypersensitivity reactions;
- Patients with RA who have signs of possible latent TB (history of TB or changes on chest x-ray) should be given advice on prophylactic anti-TB therapy prior to initiation of GIBT, in accordance with current national guidelines;
- if clinically warranted, patients with RA should be screened for possible tumors. If a malignant tumor is detected, treatment with anti-TNF drugs should be discontinued.

Golimumab used in combination with MT. Golimumab is effective in patients who have not previously received MTX, in patients with an insufficient “response” to MTX in early and late RA, and in patients who do not respond to other TNF-alpha inhibitors. It is applied subcutaneously.
Before initiating golimumab, all patients should be screened for active infections (including tuberculosis) in accordance with current national guidelines.

Indications:
Golimumab in combination with methotrexate (MT) is indicated for use in
quality:
- therapy of moderate and severe active rheumatoid arthritis in adults who have an unsatisfactory response to DMARD therapy, including MT;
- therapy of severe, active and progressive rheumatoid arthritis in adults who have not previously received MT therapy.
It has been shown that golimumab in combination with MT reduces the incidence of progression of joint pathology, which was demonstrated using radiography, and improves their functional state.
Golimumab is prescribed in compliance with the dose and frequency of administration, in combination with MT. Therapy with golimumab is continued only if an adequate effect is noted after 6 months after the start of therapy. The effect is considered adequate if there is a decrease in the disease activity score (DAS28) of 1.2 points or more. Monitor treatment with DAS28 assessment every 6 months.

Contraindications:
- hypersensitivity to the active substance or any excipients;
- active tuberculosis (TB) or other severe infections such as sepsis and opportunistic infections;
- moderate or severe heart failure (NYHA class III/IV) .

Recommendations for use:
- treatment is carried out under the supervision of a rheumatologist with experience in the diagnosis and treatment of RA;
- Golimumab 50 mg is injected subcutaneously once a month, on the same day of the month;
- Golimumab in patients with RA should be used in combination with MTX;
- in patients weighing more than 100 kg who have not achieved a satisfactory clinical response after administration of 3-4 doses of the drug, an increase in the dose of golimumab to 100 mg 1 time per month may be considered.

Patients with RA who have evidence of possible latent TB (history of TB or changes on chest x-ray) should be advised on prophylactic anti-TB therapy prior to initiation of GIBT, in accordance with current national guidelines.
When clinically warranted, patients with RA should be evaluated for possible tumors. If a malignant tumor is detected, treatment with anti-TNF drugs should be discontinued.

Rituximab. Therapy is considered as an option for the treatment of adult patients with severe active RA, with insufficient efficacy, intolerance to TNF-a inhibitors or with contraindications to their administration (presence of a history of tuberculosis, lymphoproliferative tumors), as well as with rheumatoid vasculitis or signs of a poor prognosis (high RF titers, an increase in the concentration of ACCP, an increase in ESR and CRP concentration, the rapid development of destruction in the joints) within 3-6 months from the start of therapy. Rituximab is prescribed according to the dose and frequency of administration (at least every 6 months), in combination with methotrexate. Therapy with rituximab is continued if an adequate effect is observed after the start of therapy and if this effect is maintained after repeated use of rituximab after at least 6 months. The effect is considered adequate if there is a decrease in the disease activity score (DAS28) of 1.2 points or more.

Tocilizumab. It is used for RA duration of more than 6 months, high disease activity, signs of poor prognosis (RF+, ACCP+, multiple erosions, rapid progression). Tocilizumab is prescribed in compliance with the dose and frequency of administration (1 time per month) as monotherapy or in combination with DMARDs in patients with moderate to severe rheumatoid arthritis. It leads to a stable objective clinical improvement and an increase in the quality of life of patients. Treatment in monotherapy or in combination with methotrexate should be continued if an adequate effect is noted after 4 months after the start of therapy. The effect is considered adequate if there is a decrease in the disease activity score (DAS28) of 1.2 points or more. With intravenous administration of tocilizumab in the blood serum, the level of markers of an acute inflammatory process, such as C-reactive protein and amyloid-A, as well as the erythrocyte sedimentation rate, decreases. Hemoglobin levels increase as tocilizumab reduces the effect of IL-6 on hepcidin production, resulting in increased iron availability. The greatest effect is observed in patients with rheumatoid arthritis with concomitant anemia. Along with the inhibition of the factors of the acute phase of inflammation, treatment with tocilizumab is accompanied by a decrease in the number of platelets within the normal range.

Indications for use:
- rheumatoid arthritis of moderate or high activity in monotherapy or as part of complex therapy (methotrexate, basic anti-inflammatory drugs), including to prevent the progression of radiographically proven joint destruction.
- systemic juvenile idiopathic arthritis alone or in combination with methotrexat in children older than 2 years.

Dosage and administration: The recommended dose for adults is 8 mg/kg body weight once every 4 weeks as an intravenous infusion over 1 hour. Tocilizumab is used as monotherapy or in combination with methotrexate and/or other basic therapy drugs.
Recommended doses in children:
- Body weight less than 30 kg: 12 mg/kg every 2 weeks
- Body weight 30 kg or more: 8 mg/kg every 2 weeks

Contraindications:
- hypersensitivity to tocilizumab or other components of the drug,
- acute infectious diseases and chronic infections in the acute stage,
- neutropenia (absolute number of neutrophils less than 0.5 * 109 / l),
- thrombocytopenia (platelet count less than 50 * 109 / l),
- an increase in ALT / AST levels by more than 5 times compared to the norm (more than 5N),
- pregnancy and lactation,
- children's age up to 2 years.

Recommendations for the treatment of anemia
Anemia due to chronic inflammation - intensify DMARD therapy, prescribe GC (0.5-1 mg/kg per day).
Macrocytic - vitamin B12 and folic acid.
Iron deficiency - iron preparations.
Hemolytic - HA (60 mg / day); with inefficiency within 2 weeks - azathioprine 50-150 mg / day.
Blood transfusions are recommended except for very severe anemia associated with a risk of cardiovascular events.

Felty syndrome:
- the main drugs - MT, the tactics of application are the same as in other forms of RA;
- GC monotherapy (>30 mg/day) leads only to a temporary correction of granulocytopenia, which recurs after a reduction in the dose of GC.
In patients with agranulocytosis, the use of GC pulse therapy according to the usual scheme is indicated.

Recommendations for the treatment of extra-articular manifestations of RA:
Pericarditis or pleurisy - GC (1 mg / kg) + DMARDs.
Interstitial lung disease - GC (1 - 1.5 mg / kg) + cyclosporine A or cyclophosphamide; avoid methotrexate.
Isolated digital arteritis - symptomatic vascular therapy.
Systemic rheumatoid vasculitis - intermittent pulse therapy with cyclophosphamide (5 mg / kg / day) and methylprednisolone (1 g / day) every 2 weeks. within 6 weeks, followed by lengthening the interval between injections; maintenance therapy - azathioprine; in the presence of cryoglobulinemia and severe manifestations of vasculitis, plasmapheresis is advisable.
Cutaneous vasculitis - methotrexate or azathioprine.

Surgical intervention
Indications for emergency or emergency surgery:
- Nerve compression due to synovitis or tendosynovitis
- Threatened or completed tendon rupture
- Atlantoaxial subluxation, accompanied by neurological symptoms
- Deformations that make it difficult to perform the simplest daily activities
- Severe ankylosis or dislocation of the mandible
- The presence of bursitis that disrupts the patient's performance, as well as rheumatic nodules that tend to ulcerate.

Relative indications for surgery
- Drug-resistant synovitis, tendosynovitis, or bursitis
- Severe pain syndrome
- Significant limitation of movement in the joint
- Severe deformity of the joints.

The main types of surgical treatment:
- joint prosthetics,
- synovectomy,
- arthrodesis.

Recommendations for perioperative management of patients:
1. Acetylsalicylic acid(risk of bleeding) - cancel 7-10 days before surgery;
2. Non-selective NSAIDs(risk of bleeding) - cancel 1-4 days in advance (depending on T1 / 2 drugs);
3. COX-2 inhibitors can not be canceled (there is no risk of bleeding).
4. Glucocorticoids(risk of adrenal insufficiency):
- minor surgery: hydrocortisone 25 mg or methylprednisolone 5 mg IV on the day of surgery;
- medium surgery - 50-75 mg of hydrocortisone or 10-15 mg of methylprednisolone IV on the day of surgery and prompt withdrawal within 1-2 days before the usual dose,
- major surgery: 20-30 mg methylprednisolone IV on the day of the procedure; rapid withdrawal within 1-2 days before the usual dose;
- critical condition - 50 mg hydrocortisone IV every 6 hours.
5. Methotrexate - cancel if available following factors:
- elderly age;
- kidney failure;
- uncontrolled diabetes mellitus;
- severe damage to the liver and lungs;
- GC intake > 10 mg/day.
Continue taking the same dose 2 weeks after surgery.
6. Sulfasalazine and azathioprine - cancel 1 day before surgery, resume taking 3 days after surgery.
7. Hydroxychloroquine may not be cancelled.
8. Infliximab you can not cancel or cancel a week before surgery and resume taking 1-2 weeks after surgery.

Preventive actions: smoking cessation, especially for first-degree relatives of patients with anti-CCP positive RA.

Prevention of tuberculosis infection: pre-screening of patients reduces the risk of developing tuberculosis during treatment with infliximab; in all patients, before starting treatment with infliximab and already receiving treatment, an X-ray examination of the lungs and a consultation with a phthisiatrician should be performed; with a positive skin test (reaction >0.5 cm), an X-ray examination of the lungs should be performed. In the absence of radiological changes, treatment with isoniazid (300 mg) and vitamin B6 should be carried out for 9 months, after 1 month. possible appointment of infliximab; with a positive skin test and the presence of typical signs of tuberculosis or calcified mediastinal lymph nodes, at least 3 months of therapy with isoniazid and vitamin Wb should be carried out before the appointment of infliximab. When prescribing isoniazid in patients older than 50 years, a dynamic study of liver enzymes is necessary.

Further management
All patients with RA are subject to dispensary observation:
- timely recognize the onset of exacerbation of the disease and correction of therapy;
- recognition of complications of drug therapy;
- non-compliance with recommendations and self-interruption of treatment - independent factors of poor prognosis of the disease;
- careful monitoring of clinical and laboratory activity of RA and prevention of side effects of drug therapy;
- visiting a rheumatologist at least 2 times in 3 months.
Every 3 months: general blood and urine tests, biochemical blood test.
Annually: lipid profile study (to prevent atherosclerosis), densitometry (diagnosis of osteoporosis), radiography of the pelvic bones (detection of aseptic necrosis of the femoral head).

Management of patients with RA during pregnancy and lactation:
- Avoid taking NSAIDs, especially in the II and III trimesters of pregnancy.
- Avoid taking DMARDs.
- You can continue treatment with HA at the lowest effective doses.

Indicators of treatment efficacy and safety of diagnostic and treatment methods: achievement of clinical and laboratory remission.
In assessing the therapy of patients with RA, it is recommended to use the criteria of the European League of Rheumatologists (Table 9), according to which (%) improvements in the following parameters are recorded: TPS; NPV; Improvement in any 3 of the following 5 parameters: a patient's overall disease activity score; overall assessment of disease activity by the doctor; assessment of pain by the patient; health assessment questionnaire (HAQ); ESR or CRP.

Table 9 European League of Rheumatology Criteria for Response to Therapy

DAS28	DAS28 improvement over original >1.2 >0.6 and ≤1.2 ≤0.6
≤3.2	good
>3.2 and ≤5.1		moderate
>5.1			absence

The minimum degree of improvement is the effect corresponding to a 20% improvement. According to the recommendations of the American College of Rheumatology, achieving an effect below 50% improvement (up to 20%) requires a correction of therapy in the form of a change in the dose of DMARDs or the addition of a second drug.
In the treatment of DMARDs, treatment options are possible:
1. Reducing activity to low or achieving remission;
2. Decrease in activity without reaching its low level;
3. Little or no improvement.
With the 1st variant, treatment continues without changes; at the 2nd - it is necessary to change the DMARD if the degree of improvement in activity parameters does not exceed 40-50% or joining the DMARD with a 50% improvement in another DMARD or GIBP; at the 3rd - the abolition of the drug, the selection of another DMARD.

Hospitalization

Indications for hospitalization:
1. Clarification of the diagnosis and assessment of the prognosis
2. Selection of DMARDs at the beginning and throughout the course of the disease.
3. RA articular-visceral form of a high degree of activity, exacerbation of the disease.
4. Development of intercurrent infection, septic arthritis, or other severe complications of disease or drug therapy.

Information

Sources and literature

1. Minutes of the meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
   1. 1. Rheumatology, Ed. ON THE. Shostak, 2012 2. Endoprosthetics of the hip joint, Zagorodniy N.V., 2011 3. Clinical guidelines. Rheumatology. 2nd edition corrected and supplemented / ed. E.L. Nasonov. - M.: GEOTAR-Media, 2010. - 738 p. 4. Karateev D..E, Olyunin Yu.A., Luchikhina E.L. New classification criteria for rheumatoid arthritis ACR / EULAR 2010 - a step forward towards early diagnosis / / Scientific and practical rheumatology, 2011, No. 1, C 10-15. 5. Diagnosis and treatment in rheumatology. Problem approach, Pyle K., Kennedy L. Translated from English. / Ed. ON THE. Shostak, 2011 6. Smolen J.S., Landewe R., Breedveld F.C. et al. EULAR recommendations for the management of rheumatoid arthritis withsynthetic and biological disease-modifying antirheumatic drugs. AnnRheumDis, 2010; 69:964–75. 7. Nasonov E.L. New approaches to the pharmacotherapy of rheumatoid arthritis: prospects for the use of tocilizumab (monoclonal antibodies to the interleukin-6 receptor). Ter arch 2010;5:64–71. 8. Clinical recommendations. Rheumatology. 2nd ed., S.L. Nasonova, 2010 9. Nasonov E.L. The use of tocilizumab (Actemra) in rheumatoid arthritis. Scientific-practical rheumatol 2009; 3(App.):18–35. 10. Van Vollenhoven R.F. Treatment of rheumatoid arthritis: state of the art 2009. Nat Rev Rheumatol 2009;5:531–41. 11. Karateev A.E., Yakhno N.N., Lazebnik L.B. and other Use of non-steroidal anti-inflammatory drugs. Clinical guidelines. M.: IMA-PRESS, 2009. 12. Rheumatology: national leadership/ ed. E.L. Nasonova, V.A. Nasonova. - M.: GEOTAR-Media, 2008. - 720 p. 13. Emery P., Keystone E., Tony H.-P. et al. IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-TNF biologics: results from a 24-week multicenter randomized placebo-controlled trial. 14. West S.J. - Secrets of Rheumatology, 2008 15. AnnRheumDis 2008;67:1516–23. 16. Rational pharmacotherapy of rheumatic diseases: Сompendium/ Nasonova V.A., Nasonov E.L., Alekperov R.T., Alekseeva L.I. and etc.; Under total ed. V.A. Nasonova, E.L. Nasonov. - M.: Literra, 2007. - 448s. 17. Nam J.L., Wintrop K.L., van Vollenhoven R.F. et al. Current evidence for the management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: a systemic literature rewires informing the EULAR recommendations for the management of RA. 18. Nasonov E.L. The use of tocilizumab (Actemra) in rheumatoid arthritis. Scientific and practical rheumatology, 2009; 3(App.):18–35. 19. Vorontsov I.M., Ivanov R.S. - Juvenile chronic arthritis and rheumatoid arthritis in adults, 2007. 20. Belousov Yu.B. - Rational pharmacotherapy of rheumatic diseases, 2005. 21. Clinical rheumatology. Guide for practitioners. Ed. IN AND. Mazurova - St. Petersburg. Folio, 2001.- P.116 22. Paul Emery et al. "Golimumab, a human monoclonal antibody to tumor necrosis factor-alpha given as a subcutaneous injection every four weeks in patients with active rheumatoid arthritis not previously treated with methotrexate, ARTHRITIS & RHEUMATISM, Vol. 60, No. 8, August 2009, pp. 2272-2283 , DOI 10.1002/art.24638 23. Mark C. Genovese et al. "Effect of golimumab therapy on patient-reported rheumatoid arthritis outcomes: results from the GO-FORWARD study", J Rheumatol first issue April 15, 2012, DOI: 10.3899/jrheum.111195 24. Josef S Smolen "Golimumab therapy in patients with active rheumatoid arthritis after tumor necrosis factor inhibitor therapy (GO-AFTER study): a multicenter, randomized, double-blind, placebo-controlled, phase III study, Lancet 2009; 374:210–21

Information

III. ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION

List of developers
1. Togizbaev G.A. - Doctor of Medical Sciences, Chief Freelance Rheumatologist of the Ministry of Health of the Republic of Kazakhstan, Head of the Department of Rheumatology, AGIUV
2. Kushekbaeva A.E. - Candidate of Medical Sciences, Associate Professor of the Department of Rheumatology, AGIUV
3. Aubakirova B.A. - chief freelance rheumatologist in Astana
4. Sarsenbayuly M.S. - chief freelance rheumatologist of the East Kazakhstan region
5. Omarbekova Zh.E. - chief freelance rheumatologist in Semey
6. Nurgalieva S.M. - chief freelance rheumatologist of the West Kazakhstan region
7. Kuanyshbaeva Z.T. - chief freelance rheumatologist of Pavlodar region

Reviewer:
Seisenbaev A.Sh Doctor of Medical Sciences, Professor, Head of the Module of Rheumatology of the Kazakh National Medical University named after S.D. Asfendiyarov

Indication of no conflict of interest: missing.

Conditions for revision of the protocol: Availability of new methods of diagnostics and treatment, deterioration of treatment results associated with the use of this protocol

Attached files

Attention!

• By self-medicating, you can cause irreparable harm to your health.
• The information posted on the MedElement website and in the mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" cannot and should not replace an in-person consultation with a doctor. Be sure to contact medical facilities if you have any diseases or symptoms that bother you.
• The choice of drugs and their dosage should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
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ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Rheumatoid arthritis codes in the International Classification of Diseases

The most important thing in the diagnosis and treatment of any disease is to make the correct diagnosis. Understanding the causes and knowing the symptoms helps the doctor assess the situation and make a decision on the tactics of therapy, which is especially important with a wide variety of diseases in humans. The International Classification of Diseases 10th Revision (ICD-10) is not only disease statistics, but also a real assistant to the doctor in daily work. Rheumatoid arthritis is classified under Arthropathy and is a type of disease that affects the peripheral joints. Various kinds There are a lot of pathological processes associated with inflammation. To easily navigate among this variety, the specialist uses a convenient and detailed classification that takes into account all the nuances of joint diseases.

Arthropathy options

Articular diseases that mainly affect the limbs include the following types of pathology:

• infectious (in ICD-10 they have the code M00-M03);
• inflammatory pathology of the joints (M05-M14);
• arthrosis (M15-M19);
• other joint lesions (M20-M24).

Rheumatoid arthritis is included in the group "Inflammatory arthropathies", which indicates the nature of the disease and helps the doctor to correctly assess the causative factor of articular pathology.

Disease coding

The defeat of the joints by rheumatism manifests itself in a variety of ways, being the cause of diseases of the internal organs and forming complex syndromes. The doctor needs to select the correct code in ICD-10 in order to conduct effective treatment taking into account the possible damage not only to the joints, but also to other organs and systems human body. At the preliminary examination stage, a specialist can use a code that does not accurately indicate a specific disease, but as new diagnostic information is received, the diagnosis is corrected.

Table. ICD-10 code for various variants of rheumatoid joint disease

In the ICD-10, codes M07-M14 encode numerous joint diseases caused by any factors other than rheumatism. Their use involves identifying the exact causes and detecting typical symptoms of pathology.

For any type of joint disease, the doctor can find the appropriate ICD-10 code. It is important to conduct a complete diagnosis and identify the underlying causative factor of the disease in order to accurately determine the code.

Significance of the ICD-10

The classification of diseases used by doctors all over the world makes it possible to accurately account for all cases of severe articular pathology associated with rheumatic disease. Because of this, experts in different countries can learn and learn from other doctors, better understand the causes of inflammatory arthropathy and use advanced therapies. Rheumatoid arthritis requires a careful approach to examination and treatment, because this problem can become the basis for severe complications and disability of a person.

ICD-10 - generally accepted international classification of diseases

Having determined the diagnosis, the doctor will prescribe treatment. Rheumatoid arthritis should be treated comprehensively, providing a therapeutic effect with drugs, the action of which is aimed at removing pain and improving joint mobility. It is necessary to accurately and consistently follow the recommendations of a specialist in order to get rid of problems in the present and prevent complications in the future. This is especially important in the complicated course of articular disease, when there is damage to internal organs. The main factor treatment - basic therapy, prescribed for a long time. Be sure to use symptomatic treatment. The effectiveness of therapy will be much higher if therapeutic measures are started as early as possible, before external changes in small joints. That is why timely examination and correct diagnosis in accordance with ICD-10 is the best way to prevent complicated forms of the disease.

Classification of rheumatoid arthritis according to ICD 10

Here you will learn:

To facilitate the coordination of doctors and medical staff, a unified international classification has been developed, which is periodically updated with the discovery of new diseases. How is rheumatoid arthritis classified by ICD 10? What codes are assigned to certain varieties of this joint pathology? And what are the principles for diagnosing certain types of rheumatoid arthritis?

Objectives of the ICD-10

The full rubricator of the international classification of diseases of the tenth revision includes all currently known types of diseases, with each pathology assigned a specific alphanumeric code. It is required in order to simplify the electronic processing of information, speed up the process of compiling and issuing statistics, and also facilitate the coordination of medical staff at the highest and middle levels.

This careful division into subspecies allows for a more accurate diagnosis for the patient, as a result of which people with similar symptoms may belong to different diagnostic groups. A refined diagnosis makes it possible to prescribe and carry out more effective treatment, which is selected according to individual examination results, the nature of the disease and its uncharacteristic signs.

The affiliation of rheumatoid arthritis with the ICD 10 code to one or another variety allows you to complete the picture of the symptoms of the disease, because the set of characteristic manifestations of severe systemic inflammation in patients may differ. The main symptoms of rheumatoid arthritis include:

• general weakness and fever;
• changes in the structure of cartilaginous and bone tissues, which are accompanied by pain;
• joint mobility disorders, expressed in a change in gait, the inability to perform grasping movements with fingers, etc .;
• swelling and redness in the problem area.

Varieties and codes of rheumatoid arthritis according to ICD 10

Rheumatoid arthritis is represented by a wide list of varieties, so there are several groups of this pathology.

Code M-05 with an additional digital index assigned to:

• Felty's syndrome - M-05-0 - a complication that includes a triad: arthritis, splenomegaly (an increase in the volume of the spleen) and agranulocytosis (a decrease in the number of ranulocytes in the blood, which leads to a decrease in immunity);
• arthritis with lung tissue damage - M-05-1;
• vasculitis (chronic skin lesions) - M-05-2;
• complications of other internal organs - M-05-3;
• other varieties of seropositive rheumatoid arthritis - M-05-8;
• unspecified seropositive arthritis - M-05-9.

Code M-06 received seronegative varieties of rheumatoid arthritis, in which the rheumatic factor is not detected:

• Still's disease in patients of mature age - M-06-1 - an inflammatory disease with lesions of the skin, the nature of which has not been fully established;
• bursitis - M-06-2 - inflammation of the synovial joint bag;
• "nodules" - M-06-3 - subcutaneous neoplasms in the area of ​​joints affected by rheumatoid arthritis;
• rheumatoid arthritis - M-06-4 - inflammatory processes occur simultaneously in several joints;
• other varieties of seronegative arthritis - M-06-8;
• unspecified seronegative arthritis - M-06-9.

Juvenile (juvenile) rheumatoid arthritis according to the ICD received the M-08 code, and its varieties:

• ankylosing spondylitis (Bekhterev's disease) - M-08-1 - damage to the spine and sacroiliac joints;
• systemic - M-08-2 - a large-scale pathology that captures the joints, skin and internal organs;
• seronegative polyarthritis - M-08-3 - damage to a group of joints.

Principles of diagnosis of rheumatoid joint damage

It is customary to distinguish several clinical stages of the course of chronic autoimmune pathology:

• preliminary - the onset of the disease was recorded less than six months ago;
• early - the disease attacks the joints and the body on average from six months to a year;
• extended - the disease has been observed for more than a year, while the typical symptoms of rheumatoid arthritis persist at all stages of observation;
• late - the disease was diagnosed two years ago or more, while the patient has joint destruction and complications appear.

According to X-ray examinations, magnetic resonance imaging and ultrasound studies, a non-erosive or erosive nature of the pathology is established.

In addition, X-rays allow you to assign a particular stage to rheumatoid arthritis:

• Stage 1 - periarticular osteoporosis is detected on x-rays;
• Stage 2 - an obvious narrowing of the joint space, a few erosions are added to osteoporosis;
• Stage 3 - there is an increase in the number of erosions plus articular subluxations occur;
• Stage 4 - all of the above manifestations are supplemented by bone ankylosis (immobility of the joint due to deformation and growth of bone tissues).

In addition, the ICD-10 code for rheumatoid arthritis is supplemented by indicators of disease activity, which, in accordance with international standards, is calculated using the DAS28 index after assessing the condition of 28 joints.

The list of required tests includes:

• general analysis of blood and urine;
• microreaction;
• analysis of feces for the content of latent blood cells;
• activity of liver enzymes;
• analysis to determine the amount of urea, protein, glucose, cholesterol, etc.;
• tests for the presence of rheumatoid factor;
• determining the amount of C-reactive protein;
• activity of antibodies to cyclic citrullinated peptide.

The chronic nature of rheumatoid arthritis will cause patients to regularly bypass screenings, including doing:

• X-ray of OGK (chest organs),
• fluorography,
• radiography of the hands and pelvic bones,
• gastroscopy,
• Ultrasound of the abdominal organs.

Careful laboratory studies allow to exclude other types of diseases, confirm the diagnosis and assign an ICD-10 code to rheumatoid arthritis, assess the activity of the disease and its prognosis, as well as identify the effectiveness of ongoing therapy and timely detect side effects from both the disease itself and the treatment.

Rheumatoid arthritis

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan

general information

Short description

Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan

Rheumatoid arthritis (RA) is an autoimmune rheumatic disease of unknown etiology, characterized by chronic erosive arthritis (synovitis) and systemic damage to internal organs.

M05 Seropositive rheumatoid arthritis;

M06 Other rheumatoid arthritis;

M05.1 Rheumatoid lung disease;

M05.2 Rheumatoid vasculitis;

M05.3 Rheumatoid arthritis involving other organs and systems;

M06.0 Seronegative rheumatoid arthritis;

M06.1 Adult Still's disease;

M06.9 Rheumatoid arthritis, unspecified

APP - Russian Association of Rheumatologists

ACCP - antibodies to cyclic citrullinated peptide

DMARDs - basic anti-inflammatory drugs

VAS - Visual Analogue Scale

GIBP - genetically engineered biological preparations

GIT - gastrointestinal tract

STDs - sexually transmitted diseases

drugs - medicines

MRI - magnetic resonance imaging

NSAIDs - non-steroidal anti-inflammatory drugs

OSS - general health

RA - rheumatoid arthritis

RF - rheumatoid factor

CRP - C-reactive protein

Ultrasound - ultrasonography

FK - functional class

NPV – number of swollen joints

ECHO KG - echocardiogram

Protocol users: rheumatologists, therapists, general practitioners.

Classification

1. Seropositive rheumatoid arthritis (M05.8).

2. Seronegative rheumatoid arthritis (M06.0).

1. Felty's syndrome (M05.0);

2. Still's disease in adults (M06.1).

3. Probable rheumatoid arthritis (M05.9, M06.4, M06.9).

1. Very early stage: duration of illness<6 мес..

2. Early stage: disease duration 6 months - 1 year.

3. Advanced stage: disease duration >1 year with typical RA symptoms.

4. Late stage: the duration of the disease is 2 years or more + severe destruction of small (III–IV X-ray stage) and large joints, the presence of complications.

2. Low (DAS28=2.6-3.2).

3. II - medium (DAS28=3.3-5.1).

1. Rheumatoid nodules.

2. Cutaneous vasculitis (necrotizing ulcerative vasculitis, nail bed infarcts, digital arteritis, livedoangiitis).

3. Neuropathy (mononeuritis, polyneuropathy).

4. Pleurisy (dry, effusion), pericarditis (dry, effusion).

5. Sjögren's syndrome.

6. Eye damage (scleritis, episcleritis, retinal vasculitis).

The presence or absence of erosions [according to radiography, magnetic resonance imaging (MRI), ultrasound (ultrasound)]:

I - periarticular osteoporosis;

II - periarticular osteoporosis + narrowing of the joint space, there may be single erosions;

III - signs of the previous stage + multiple erosions + subluxations in the joints;

IV - signs of previous stages + bone ankylosis.

I class - the possibilities of self-service, non-professional and professional activities are fully preserved.

II class - the possibilities of self-service, non-professional occupation are preserved, the possibilities of professional activity are limited.

Class III - self-service opportunities are preserved, opportunities for non-professional and professional activities are limited.

Class IV - limited self-service opportunities for non-professional and professional activities.

1. Secondary systemic amyloidosis.

2. Secondary osteoarthritis

3. Osteoporosis (systemic)

5. Tunnel syndromes (carpal tunnel syndrome, compression syndromes of the ulnar, tibial nerves).

6. Subluxation in the atlanto-axial joint, incl. with myelopathy, instability of the cervical spine

DAS28 value >5.1 corresponds to high disease activity; DAS<3,2 – умеренной/ низкой активности; значение DAS< 2,6 – соответствует ремиссии. Вычисление DAS 28 проводить с помощью специальных калькуляторов.

Modified stages of RA according to Steinbroker:

Stage I - periarticular osteoporosis, single small cystic enlightenments of bone tissue (cysts) in the subchondral section of the articular surface of the bone;

Stage 2A - periarticular osteoporosis, multiple cysts, narrowing of the joint spaces;

2B stage - symptoms of stage 2A of varying severity and single erosions of the articular surfaces (5 or less erosions);

stage 3 - symptoms of stage 2A of varying severity and multiple erosions (6 or more erosions), subluxations and dislocations of the joints;

Stage 4 - symptoms of stage 3 and ankylosis of the joints.

To the rubric "Functional class". Description of characteristics. Self care - dressing, eating, personal care, etc. Non-professional activities - creativity and / or recreation and professional activities - work, study, housekeeping - are desirable for the patient, specific to gender and age.

According to the nature of the progression of joint destruction and extra-articular (systemic) manifestations, the course of RA is variable:

Prolonged spontaneous clinical remission (< 10%).

Intermittent course (15-30%): intermittent complete or partial remission (spontaneous or treatment-induced), followed by an exacerbation with involvement of previously unaffected joints in the process.

Progressive course (60-75%): increase in joint destruction, damage to new joints, development of extra-articular (systemic) manifestations.

Rapidly progressive course (10-20%): constantly high activity of the disease, severe extra-articular (systemic) manifestations.

Felty's syndrome - a symptom complex, including severe destructive damage to the joints with persistent leukopenia with neutropenia, thrombocytopenia, splenomegaly; systemic extra-articular manifestations (rheumatoid nodules, polyneuropathy, chronic trophic ulcers of the legs, pulmonary fibrosis, Sjögren's syndrome), a high risk of infectious and inflammatory complications.

Adult Still's disease is a peculiar form of RA, characterized by a severe, rapidly progressive articular syndrome in combination with generalized lymphadenopathy, maculopapular rash, high laboratory activity, significant weight loss, prolonged relapsing, intermittent or septic fever, RF and ANF seronegativity.

Arthritis mcb

Varieties of the disease of the musculoskeletal system

As a rule, arthritis worsens sharply - and this is how it differs, for example, from osteoarthritis. The disease manifests itself in sharp pains, which can intensify at rest or during movement.

Patients experience an increase in body temperature or skin over the affected joint. The joint swells, ceases to function in the usual mode.

His appearance is changing.

Why is the ICD code needed? It fits into the medical history after diagnosis. In the international classification, arthritis is assigned an index from M-00 to M-99. The number 10 next to the abbreviation means the tenth revision of this classification.

According to the flow time, they distinguish:

• acute arthritis - up to six months;
• protracted - up to a year;
• chronic - more than a year;
• recurrent - aggravated with a certain regularity.

There is a classification according to the type of affected joint:

• synarthrosis - pathology develops in a fixed connection of bones;
• amphiarthrosis - in a sedentary;
• diarthrosis - in a highly mobile.

With arthralgia, not only joints are involved in negative processes, but also muscles and ligaments, which can lead to their atrophy.

Rheumatoid arthritis

Three times more often than men, women suffer from rheumatoid arthritis, in which, along with damage to the small joints of the hands, pathologies of the eyes and lungs are observed. The formation of rheumatoid nodules is fixed (code M-06.3), as well as frequent insomnia. The code for this arthritis according to ICD 10 is M-05.

A variation of rheumatoid spondylitis is Still's syndrome, in which body temperature rises, inflammation appears on the skin, and lymph nodes increase. The code for Still's syndrome is I-00.

Features of rheumatoid spondylitis:

• women suffer more often - up to 75%;
• age of patients from 10 to 55 years;
• previous colds (tonsillitis, flu, etc.);
• the nature of the course of the disease - rapid progression;
• affects other organs - the heart, kidneys, lungs.

Reactive arthritis

Inflammatory pathology of the joints becomes the result of inflammation in influenza and some types of infectious diseases(tuberculosis, intestinal infection, etc.)

). This type of arthritis rarely becomes chronic, and with proper treatment, it is usually mild.

The ICD code for reactive arthritis is M-00 and M-03.

Rheumatoid arthritis according to the 10th international classification is a disease of the musculoskeletal system, which has many varieties. The international classification distinguishes the following codes for rheumatoid arthritis: M06.

9. These are the main points into which the disease is subdivided.

In fact, each type has several sub-items. In the ICD 10 system, rheumatoid arthritis has a code from M05 to M99.

Rheumatoid arthritis is of several types:

There are cases when people with identical symptoms are assigned to different categories of the disease. The nature of the course is different, the degree of the disease can also be different, but the signs are the same.

Today there are 21 classes of diseases, each of which contains subclasses with codes for diseases and conditions. Rheumatoid arthritis ICD 10 belongs to the XIII class "Diseases of the musculoskeletal system and connective tissue." Subclass M 05-M 14 "Inflammatory processes of polyarthropathy".

Symptoms of reactive arthritis mkb 10

The clinical picture of the disease in all varieties is largely similar. The main types of symptoms in all classifications of the disease:

• inflammation of the joint capsule - swelling;
• affects at least 3 articular joints at the same time;
• the joints cease to function properly, morning stiffness is observed, which significantly worsens the patient's well-being;
• the temperature in the affected area rises, the swelling is hot to the touch and the state of health worsens;
• inflammation spreads to the internal organs;
• increased risk of getting a heart attack;
• sharp pain;
• swelling and redness of the articular surfaces.

The main symptom is the presence of an inflammatory process. Rheumatoid arthritis is a progressive disease with periods of temporary improvement.

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Such arthritis may be in the group of reactive arthritis according to microbial 10, if there are additional symptoms in the signs that are characteristic of this particular type of disease:

Such arthritis can be classified as gouty arthritis according to microbial 10. This will happen if the following is found in the medical history and during the tests:

• general metabolic disorders
• renal dysfunction
• failures in the system of water-salt balance
• polyarthritis

If there is a diagnosis correctly made by a qualified specialist, the prognosis for a speedy recovery is always high.

Gouty arthritis according to ICD 10 and its symptoms

The main thing is to contact medical institutions in a timely manner, undergo all the prescribed examinations, take all the recommended tests and take the prescribed medications strictly according to the scheme prescribed by the attending physician.

A characteristic feature of the course of the disease is the symmetry of joint damage

Reactive arthritis is acute. In the first week, the patient has a fever, disorders of the gastrointestinal tract (GIT), acute intestinal malaise, general weakness.

In the future, the symptoms of arthritis progresses and is of a classic nature. At this stage of development, the disease can be divided into 3 types.

1. There is inflammation of the mucous membrane of the eyes (may develop conjunctivitis).
2. Pain in the joints becomes stronger, while motor activity decreases. In the areas affected by the infection, noticeable redness and swelling appear.
3. The organs of the genitourinary system become inflamed.

The complexity of determining the specific type of arthritis is due to different signs of diseases. In some cases, the joints are affected symmetrically, while in others, asymmetrically. Some patients are concerned about one joint, and some - several at once.

Pain appears with all types of inflammatory pathology, but it can be of a different nature - from aching, aggravated by immobility of the joints (gouty and rheumatoid arthritis) or during movement, to acute, which can only be eliminated by strong painkillers.

The degree of swelling can also be different - from slight to severe, as with gout. During the examination, changes in the physiologically correct location of the joint, instability of the ligaments, muscle hypertonicity are detected.

In the process of palpation, the following is revealed:

• the place of localization of pain;
• characteristic crunch with slight movements of the joints;
• increase in skin temperature.

To assess the degree of limited movement of the joints, the patient is asked to perform a series of simple exercises. With an asymmetric lesion, disturbances in the work of the motor function will be especially obvious.

In addition, a person tries to keep the joint motionless in order to reduce pain, which leads to gait disturbances or stiffness in movements (does not bend the elbow to the end, holds the head unnaturally, etc.).

For diagnostics, the following instrumental types of examinations are used:

• x-ray;
• Magnetic resonance imaging;
• bone scintigraphy;
• NMR spectroscopy;
• ultrasound examination of the joints;
• arthroscopy.

One of the laboratory tests is the puncture of the synovial fluid, which becomes cloudy with arthralgia, its viscosity decreases. It also has a low glucose content.

In addition, a biochemical blood test is done and immunological studies are carried out.

It is worth remembering that the course of treatment is determined only by a doctor. Depending on the diagnosis, medications may be prescribed, primarily anti-inflammatory non-steroids.

With rheumatoid inflammation, blood purification is sometimes carried out.

Traditional methods of treatment during remission also include physiotherapy, phono- and electrophoresis.

An effective preventive measure is sanatorium treatment with the restoration of the body in institutions specializing in inflammatory pathologies of bone tissues of various nature.

The International Classification of Diseases simplifies the coordination of all doctors and medical staff who work with the patient. For patients, the codes are just incomprehensible numbers in the medical history, because it is much more important for them to get qualified help and cure the disease they have discovered.

Today, to confirm whether a patient really has reactive arthritis, a whole range of laboratory tests is needed. Various specialists are involved in the examination of the patient.

It is necessary to be examined by a gynecologist, urologist and therapist. The attending physician will indicate the need for examination by other medical specialists.

After collecting the results of laboratory tests, anamnesis data, identifying clinical manifestations, the use of certain drugs is prescribed.

It is necessary to begin treatment of reactive arthritis with the destruction of the infectious focus, that is, the causative agents of the original disease. To do this, you need to undergo a comprehensive examination of the whole organism.

After determining the pathogen, sensitivity to drugs is established. A bacterial infection is treated with antibiotics.

Application antibacterial drugs recommended at the initial, most acute stage of the disease. In the future, their use becomes less effective. In some cases, symptomatic treatment is prescribed, in which non-steroidal drugs, such as ibuprofen, are used.

To prevent reactive arthritis from developing into a chronic form, timely treatment is necessary. Only the attending physician should make decisions about the intake of certain drugs by the patient. Self-medication is unacceptable.

An important point in the preventive measures associated with reactive arthritis is to prevent infection of the bone tissue. To do this, you must adhere to the elementary rules of personal hygiene.

Avoid getting intestinal infections into the body, wash hands before eating and after going to the toilet, use individual cutlery. Pay attention to the need for a heat treatment process for food before consumption.

Using a condom during sexual intercourse will protect against urinary tract infections. Having a regular sexual partner will reduce the risk of the disease. All of the above methods will contribute to the prevention of the disease.

It is easier to prevent a disease than to treat it. In the event of the first signs of the disease, it is necessary to consult a doctor as soon as possible.

Diagnosis and treatment of the disease

Illness is always a big problem for a person. When an ailment is detected, the patient is not so much interested in the subgroup and font of the disease in the international classification of diseases as a positive outcome.

Medicine is developing rapidly. Such a classification is an example of the fact that doctors keep up with the times, improve their methods, and improve their approach to patient care.

ICD code 10 rheumatoid arthritis

The ICD-10 code for seropositive rheumatoid arthritis is M05.

International Classification of Diseases 10th Revision (ICD-10) Class 13 M05 Seropositive rheumatoid arthritis. M05.0 Felty's syndrome Causes of pain in the right side - Woman - Jun 21 If you suffer from pain and tingling in the right side, then kidney pain may appear in the lumbar region. Code Seropositive rheumatoid arthritis in the international classification of diseases ICD-10. M00-M99 Diseases of the musculoskeletal system and

ICD-10: Diseases of the musculoskeletal system and connective International Classification of Diseases (ICD-10). M00-M99 Arthritis - pain, inflammation and loss of mobility in one or more joints. Can a leg hurt only the next day after a bone fracture? most likely an injury. When I fell off the bike and broke my finger on my hand, at first I didn’t feel anything too much. Went on to ride. But in the morning it grabbed me specifically - the finger turned blue, swollen, it was impossible to touch it. with a fracture you wouldn't be running yesterday. contusion It's just a muscle problem. Give her at least a day to lie down, so that the inflammation does not go up.

Arthritis and arthrosis (joint diseases) - the difference and how to treat But why do many people complain of joint pain? The first blow is taken by the knee joints, joints of the elbows, hands. A cold is of some importance (for example, arthrosis in workers in hot shops). Additionally. The code. Nosology.

ICD 10 - INFLAMMATORY POLYARTHROPATHY (M05-M14) Other arthritis (M13). [localization code see above] Excl.: arthrosis (M15-M19). M13.0 Polyarthritis, unspecified. M13.1 Monoarthritis, not

• About the Medical Center - Mediaart If necessary, you will be given a sick leave. If you have headaches, back pain, neuralgia, sciatica, osteochondrosis - a neurologist ICD 10 code: M05-M14 INFLAMMATORY POLYARTROPATHIES. rheumatic fever (I00) rheumatoid arthritis. youthful (M08.
• Rheumatoid arthritis: causes, symptoms and treatment
• Arthritis - During the period of exacerbation, the joints hurt, so at this time it is very important. My mother-in-law has been treating arthritis for a long time, her joints are very inflamed, Definition of rheumatoid arthritis, causes, pathogenesis, classification of the disease, Seronegative RA, ICD-10 code - M06. 0:.

International Classification of Diseases ICD-10 - codes and

Academy of Success and Healthy lifestyle. Joints hurt 5 Nov Joints hurt - help yourself. Do not miss the opportunity to do a good deed: click on the button from Facebook, Vkontakte or International Classification of Diseases ICD-10 - codes and codes of diagnoses and M03.0 Arthritis after meningococcal infection (a39.8)

The true story of the hermit Agafya Lykova, who revealed the family secret of the treatment of joint diseases!

Moscow. Talk show Let them talk. In this studio, we discuss real-life stories that are impossible to keep silent about.

Today we have the Hermit Agafya Lykova in our studio. Everyone knows her firsthand! On all central channels, she began to flicker because of her unusual fate. Agafya Lykova is the only living representative of a family of Old Believers hermits. For many centuries this family managed to maintain longevity and perfect health, living in the taiga, far from civilization, medicines, doctors. Using the power of nature and its gifts, they possessed truly good health and incredibly stable immunity. After that. As all of Russia found out about Agafya, thousands of letters from viewers began to come to our program with a request: “Ask Agafya Lykova to tell some secret recipe of her family.” All letters were in the same way - everyone wanted to receive at least a small prescription that would help improve or maintain health. Well, if viewers ask, then you need to find out her recipes and the secrets of longevity. After all, thousands of Russians cannot be wrong - if they ask, then it will help!

Hello Andrey and dear audience. Probably, I would hardly agree to give out the recipe of my ancestors if I didn’t know how many people in Russia, and throughout the world, suffer from osteochondrosis and terrible joint pain. Perhaps my ancient recipe will help to get rid of such diseases once and for all.

Our editors, together with the operators, came to you in the taiga. It was "-29" outside, it was terribly cold, but you didn't care how much! You were standing in light clothes, with a scarf on your head and holding a yoke with two 10-liter buckets filled with water on one shoulder. And you, after all, are already 64 years old. We were amazed: in front of us stood an elderly woman who simply glowed with longevity and health.

When we entered the house, we saw that you were preparing some kind of cream-like mixture. Can you tell us more?

My father and my mother knew the family recipes that they received from their parents, and they received from theirs. Many of my prescriptions are hundreds of years old and have been used by my entire generation. All of these recipes are included in this book.

Agafya, tell me, what was the last thing you managed to win? You are the same person as all Russians. In any case, could something be bothering you?

Yes, of course, I suffered from many diseases, but I got rid of them very quickly, since I have my “family recipe book”. The last thing I was sick with was pain in my joints and back. The pains were terrible, and the dampness in the room only exacerbated my illness. Legs and arms did not bend and ached a lot. But I got rid of this disease in 4 days. I have a great-grandmother's recipe for this ailment. So be it, I will tell it to you, let the people get rid of ailments.

After these words, Agafya opened her old book with recipes and began to dictate the composition to us. Below we will talk about how to cure arthrosis in 4 days! In the meantime, let's talk about the remaining dialogue with Agafya:

What is this tool and how to use it correctly?

At the heart of this cream, the antlers of the Altai deer are the most valuable substance. which is extracted only once a year from deer antlers. They are mined only in one place, in the north-west of Siberia. In the spring, the Altai maral sheds its horns, and the locals go to search for them in the taiga. Based on maral antlers, I prepare a cream for joint pain, bruises and sprains. Due to the healing properties of the substance, local residents in the 19th century destroyed almost the entire population of the Altai deer. Therefore, industrial production of antlers is impossible.

Thank you Agafia. Many Russians will now get rid of joint pain forever.

Release Notes (934)

Liana | 18.09. - 23:58

Thank you very much for the recipe and the opportunity to buy Artropant! I have been using it for 3 days already, the joints really stopped bothering me!

Minnie | 20.09. - 13:12

It's good that ancient recipes have been preserved! I've had enough of these pills! My mom uses cream. She is 68, and she has more than enough health. Although recently she complained of severe pain in the lower back and elbows! And now it's just unrecognizable! Thank you for your channel!

Angelina | 20.09. - 04:57

Evgeniya | 22.09. - 23:21

How long does Artropant go? Pay immediately?

Ann | 25.09. - 20:30

Paying is easy, there are instructions and options. The cream went to Tyumen for 4 days! The wait was worth it, as I have been smearing for 5 days already. The bones hurt a lot, now they don’t bother at all! Thank you channel!

Baby mouse | 25.09. - 04:57

Is it good for overall health?

Elena | 27.09. - 23:29

I treat them for muscle pain. Improvement began already on the 2nd day. I highly recommend this cream to everyone!

Mary | 27.09. - 05:31

That's what folk medicine can do! To hell with drugs! Fortunately, the cream costs a penny, relative to the treatment itself!

Mkb 10 code reactive arthritis

Elizabeth · 10.09. 01:16:08

ICD code 10: m06 Other rheumatoid m06.9 Rheumatoid arthritis Pain in the groin? -. Traditional medicine Pain may not appear immediately, but gradually. You may be disturbed by pain in the groin, in the abdomen, a feeling of discomfort when walking and exercising. ICD-10: Diseases Code. Nosology Seropositive rheumatoid arthritis: m05.0: Syndrome

ICD-10: Diseases of the musculoskeletal system and Arthritis mkb 10 arthritis code for mkb 10, rheumatoid arthritis mkb how to quickly get rid of a clogged nose. \ Make an inhalation: put one tablet of validol and half a pipette of iodine on a liter cup of boiling water. Mix everything and breathe only through the nose until the water cools down. I even cured sinusitis in this way. Buy NAZOL and there is no problem if you blow your nose a lot of water, splash it there or pour it and blow your nose. or a lot of sprays, there are drops. Cut off. Joke. Naphthyzin. Any vasoconstrictor sprays or drops. Nazol, nazivin, for the nose and many others. They work for several hours. They start working in a few minutes. Get rid of a stuffy nose? HM. was somewhere. And here, you take an ax, put it from below and, with a sharp movement, pull it up. Peel the onion or spread with an asterisk, rinse the nose with a solution of water and salt. for 1 glass (ml) - 1-1.5 teaspoons of salt, close one of the nostrils and draw in water. do this procedure 2-3 times a day! + nose drops Get well soon! bake an onion head in the oven or in the microwave, cut it in half, wrap it in a towel, put it on the bridge of your nose until it cools down, squeeze the juice from the cooled onion, drip it into your nose. In 10 sessions, you can cure not only a clogged nose, even sinusitis. it is better to turn to a specialist, otherwise you can bring it to a chronic stage, then nothing will help Nusudex tablet - and there are no problems for half a day or more. Well, then - at home, steam your legs, mustard in socks, or smear caviar with oil (alcohol) and hot tea with raspberries or hot milk. And in order to sleep with a stuffy nose and not suffer, lubricate the wings of the nose (externally) with a drop of camphor oil or simply put a cotton swab moistened with camphor near the bed.

Pain in the jaw Dec 3 Headache, pain in the eyes, pain in the ears, pain in the face, pain in the jaw When the mouth is open, the head of the lower jaw is turned into the cavity

Classification and codes ICD-10 arthritis of the knee ICD 10 code must be entered in the person's medical history. rheumatoid arthritis;

PHARMATEKA » Problems of discogenic dorsalgia: pathogenesis Gate's symptom: back pain during forced hip flexion in Minor's Symptom 1: when getting up from a lying position, a patient with Mkb 10 code reactive arthritis, Mkb 10 code reactive arthritis. [rheumatoid arthritis]

1. Arthritis code mkb 10 - knee joint, treatment If the site was useful to you, then please mark it by adding it to your bookmarks:

2. Psychosomatic disorders in diseases - Bookap Moreover, with the exception of angina pectoris and myocardial infarction, pain in the area with the most insignificant, minimal physical exertion. fingertips are directed to the chin, elbows are directed to the sides. Rheumatoid arthritis The international RA code is rheumatoid arthritis. ICD-10

3. ICD 10 - Seropositive rheumatoid arthritis (M05) ICD 10 rheumatoid arthritis: ICD code 10 ICD 10 rheumatoid arthritis refers to xiii

4. Pavlyuchenkova starred from Roland Garros - Tennis. Sports / 1 day before the end of the second round match against Dutch Kiki Bertens due to back pain. All tennis players have shoulder problems. ICD 10 code: m05 Seropositive rheumatoid arthritis m05.0 Felty's syndrome. rheumatoid

Don't crunch!

treatment of joints and spine

• Diseases
  • Arothrosis
  • Arthritis
  • Bechterew's disease
  • Bursitis
  • Dysplasia
  • Sciatica
  • Myositis
  • Osteomyelitis
  • Osteoporosis
  • fracture
  • flat feet
  • Gout
  • Radiculitis
  • Rheumatism
  • Heel spur
  • Scoliosis
• joints
  • Knee
  • Brachial
  • Hip
  • Other joints
• Spine
  • Spine
  • Osteochondrosis
  • cervical
  • Thoracic
  • Lumbar
  • Hernias
• Treatment
  • Exercises
  • Operations
  • From the pain
• Other
  • muscles
  • Bundles

Rheumatoid arthritis ICD code 10

ICD 10 coding for rheumatoid arthritis

Arthritis classification according to ICD 10

(according to the presence of RF): seropositive, seronegative

A distinction was made according to the following types of etiological relationship: a) direct infection of the joint, in which microorganisms invade the synovial tissue and microbial antigens are found in the joint; b) indirect infection, which can be of two types: “reactive arthropathy”, when microbial infection of the body is established, but neither microorganisms nor antigens are detected in the joint; and "post-infectious arthropathy", in which the microbial antigen is present, but the recovery of the organism is incomplete and there is no evidence of local reproduction of the microorganism.

Cyclophosphamide (200 mg ampoules), endoxan - 50 mg tablets

Reactive Arthritis Symptoms

Second degree - the pain intensifies, the restriction of motor activity is such that it leads to a decrease in working capacity and limitation of self-service.

1. The symptom complex of the disease included: symmetrical damage to the joints, the formation of deformities, contractures and ankylosis in them; development of anemia, enlarged lymph nodes, liver and spleen, sometimes the presence of febrile fever and pericarditis. In the subsequent years of the last century, numerous observations and descriptions of Still's syndrome revealed much in common between rheumatoid arthritis in adults and children, both in clinical manifestations and in the nature of the course of the disease. However, rheumatoid arthritis in children was still different from the disease of the same name in adults. In this regard, in 1946, the term "juvenile (juvenile) rheumatoid arthritis" was proposed by two American researchers Koss and Boots. Nosological separation of juvenile rheumatoid arthritis and adult rheumatoid arthritis was subsequently confirmed by immunogenetic studies.
2. This type of rheumatoid arthritis includes Still and Wieseler-Fanconi syndrome. Still's syndrome is more commonly diagnosed in preschoolers. It is distinguished by the following features:
3. Juvenile rheumatoid arthritis is a pathology that develops in children and adolescents under 16 years of age, in which not only the joints, but also other organs can be affected. A doctor can make a similar diagnosis if a child has arthritis that lasts more than 6 weeks. The disease does not occur very often. International statistics says that JRA is detected in 0.05-0.6% of children. Children under 2 years of age suffer from this disease extremely rarely. There are gender differences in the incidence among children. Arthritis is diagnosed more often in girls. The disease is steadily progressing.

Stages of development of the disease and the degree of destruction of the joint

NSAIDs Patients at risk of developing gastropathy and gastrointestinal bleeding (age over 75 years old, history of gastrointestinal ulcers, simultaneous use of low doses of acetylsalicylic acid and HA, smoking) can be prescribed selective or specific COX-2 inhibitors, either (subject to high individual effectiveness) non-selective COX inhibitors in combination with misoprostol 200 mcg 2-3 times / day or proton pump inhibitors (omeprazole 20-40 mg / day) In patients with impaired renal function, NSAIDs should be treated with extreme caution. selective COX-2 inhibitors should continue to take small doses of acetylsalicylic acid at the same time.

Diagnosis and treatment of the disease

Alkylating cytostatic; forms alkyl radicals with DNA, RNA and proteins, disrupting their function; has an antiproliferative effect.

Pronounced edema from the very beginning of the disease

In the third degree - the impossibility of self-service, a significant loss of mobility in the joint (joints).

What causes juvenile rheumatoid arthritis?

Learning to live with a diagnosis according to ICD 10 - rheumatoid arthritis

Causes and symptoms of rheumatoid arthritis

​If treatment is not started early, there is a high risk that the child will become disabled.​

The World Health Organization (WHO) has developed a special medical coding for the diagnosis and definition of medical diseases. ICD 10 code - coding for the international classification of diseases of the 10th revision as of January 2007.​

​GK Systemic application. It is recommended to use low< 10 мг/сут) дозы ГК, что позволяет адекватно « контролировать» ревматоидное воспаление, но должно обязательно сочетаться с базисной терапией Локальная терапия ГК имеет вспомогательное значение. Предназначена для купирования активного синовита в 1 или нескольких суставах. Повторные инъекции ГК в один и тот же сустав необходимо производить не чаще 1 раза в 3 мес. Противопоказания к проведению локальной терапии: гнойный​​быстропрогрессирующий, медленнопрогрессирующий (оценка темпа развития деструктивных изменений в суставе при длительном наблюдении) ​

Staphylococcal arthritis and polyarthritis

How to treat rheumatoid arthritis?

RA with systemic manifestations (vasculitis, nephropathy).

Edema appears when inflammation is attached

According to the nature of occurrence in medicine, several forms of arthritis are distinguished:

The pathogenesis of juvenile rheumatoid arthritis has been intensively studied in recent years. The development of the disease is based on the activation of both cellular and humoral immunity.

The primary incidence rate is from 6 to 19 cases per 100,000 children. It is important that the prognosis for health largely depends on the age at which the disease began. The older the child, the worse the prognosis. Still's disease is a type of rheumatoid arthritis. The disease is very severe, with severe fever, joint syndrome, damage to the lymphatic system and sore throat. This pathology also occurs in adults.

There are currently 21 disease classes, each containing subclasses with disease and condition codes. Rheumatoid arthritis ICD 10 belongs to the XIII class "Diseases of the musculoskeletal system and connective tissue." Subclass M 05-M 14 "Inflammatory processes of polyarthropathy."​

Rheumatoid arthritis: we treat folk methods

200 mg IM 2-3 times a week until a total dose of 6-8 g per course is reached; combined pulse therapy; endoxan at dosemg / day, maintenance dose - 50 mg / day. Methods of operative surgery (injections into the articular cavity).

Etiology and treatment of juvenile rheumatoid arthritis

Features of the disease

reactive - a complication that occurs with untreated (undertreated) infections; Pathogenesis of juvenile chronic arthritis

polyarthritis involving small joints in the process;

Etiological factors

Juvenile arthritis can occur for a variety of reasons. The exact reason has not yet been established.​

Reactive arthritis of the knee is the most common rheumatic disease. The disease is characterized by a non-purulent inflammatory formation in the bone structure. In some cases, the disease occurs as a response to infectious diseases of the gastrointestinal tract (GIT), urinary tract and organs of the reproductive system.

• , unspecified nature
• I - low, II - moderate, III - high activity
• Pneumococcal arthritis and polyarthritis
• Hemorrhagic cystitis, myelosuppression, activation of foci of infection.
• Of the medications, NSAIDs, cytostatics, hormonal agents, antibiotics, etc. are prescribed. The set of medications directly depends on the type and etiology of arthritis. Table 2 lists the treatment regimens for rheumatoid arthritis.​
• Yes, but it may not be right away
• Rheumatoid - is a consequence of rheumatic diseases;

The main clinical manifestation of the disease is arthritis. Pathological changes in the joint are characterized by pain, swelling, deformities and limitation of movement, increased skin temperature over the joints. In children, large and medium joints are most often affected, in particular, knee, ankle, wrist, elbow, hip, less often small joints of the hand. Typical for juvenile rheumatoid arthritis is the defeat of the cervical spine and maxillotemporal joints, which leads to underdevelopment of the lower, and in some cases, upper jaw and the formation of the so-called "bird's jaw."

Forms of the disease

Enlargement and soreness of the lymph nodes;

Possible etiological factors are:

• The development of arthritis occurs a month after infection, however, the provocative infection that caused this disease is in the human body does not manifest itself. Men over the age of 45 are most at risk. Sexually transmitted infections (gonorrhea, chlamydia, and others) can contribute to the progression of the disease. Women are less likely to suffer from this disease.
• arthritis
• Radiological stage:

Clinical symptoms

Chlorbutin (leukeran) - tablets of 2 and 5 mg

• drug
• Yes, but in the later stages of redness may not be
• Acute - develops after bruises, fractures, strong physical exertion;
• Symptoms of juvenile chronic arthritis
• hepatosplenomegaly;

the presence of a viral or bacterial infection;

If the carrier of the infection entered the body with food, reactive arthritis can equally develop in both men and women.

• , any changes in the skin near the puncture site, tuberculosis of the joint, tabes of the spinal cord, aseptic bone necrosis, intra-articular fracture, subluxation of the joint. The following drugs are used (a full dose of drugs is injected into large joints, 50% into medium-sized joints, 25% into small ones): Methylprednisolone 40 mg Hydrocortisone 125 mg Betamethasone in the form of injections (celeston, flosteron, diprospan) Pulse therapy methylprednisolone leads to a rapid but short-term effect (3-12 weeks); not affecting the rate of progression of the process In order to prevent osteoporosis, people receiving GCs are prescribed calcium (1500 mg / day) and cholecalciferol (400-800 IU / day), and in the absence of their effectiveness - bisphosphonates and calcitonin (see Osteoporosis). ​
• I - periarticular osteoporosis, II - the same + narrowing of the interarticular spaces + single erosions, III - the same + multiple erosions, IV - the same + ankylosis H
• Other streptococcal arthritis and polyarthritis
• Alkylating cytostatic; forms alkyl radicals with DNA, RNA and proteins, disrupting their function; has an antiproliferative effect
• ​Operating principle​

Other manifestations

infectious - caused by viruses or a fungal infection that enters the joint with the blood stream, or through an unsterile surgical instrument, often leads to the development of purulent inflammation of the knee joint;

• In the systemic variant of juvenile rheumatoid arthritis, leukocytosis (up to a thousand leukocytes) is often detected with a neutrophilic shift to the left (up to 25-30% of stab leukocytes, sometimes up to myelocytes), an increase in ESR domm / h, hypochromic anemia, thrombocytosis, an increase in the concentration of C-reactive protein , IgM and IgG in blood serum.
• anemia;
• traumatic joint injury;
• A characteristic feature of the course of the disease is the symmetry of joint damage
• ​Basic Therapy​
• Availability of functional ability:

• High RA activity with systemic manifestations, generalized lymphadenopathy, splenomegaly.
• ​Operating principle​
• Observed in the case of an autoimmune nature of the disease
• Reiter's syndrome is a type of reactive arthritis;
• Diagnosis of juvenile chronic arthritis
• myocardial damage;
• increased insolation;
• Reactive arthritis is severe. In the first week, the patient has a fever, disorders of the gastrointestinal tract (GIT), acute intestinal malaise, general weakness. In the future, the symptoms of arthritis progresses and is of a classic nature. At this stage of development, the disease can be divided into 3 types.
• ​Basic therapy should be given to all patients with reliable RA.​

​0 - retained, I - professional ability retained, II - professional ability lost, III - self-service ability lost.​

Diagnostic measures

​Arthritis and polyarthritis due to other specified bacterial pathogens If necessary, to identify the bacterial agent, use an additional code (​

6-8 mg / day, maintenance dose - 2-4 mg / day.

• Destination schemes
• No
• Arthritis in Bechterew's disease, gout (rare);
• Suppression of the inflammatory and immunological activity of the process.

Inflammation of the mucous membrane of the eyes occurs (may develop conjunctivitis).

Treatment tactics

Methotrexate remains the "gold standard" of basic therapy for RA, which has the best ratio of efficacy/toxicity. Assign to patients with active RA or those with risk factors for poor prognosis (see above) at a dose of 7.5-15 mg per week. The term of the effect is 1-2 months. Among side effects methotrexate - hepatotoxicity, myelosuppression, therefore, the control of KLA and transaminases should be performed monthly. An increase in the level of liver enzymes is a signal to reduce the dose of the drug or completely cancel it. A persistent increase in liver enzymes after discontinuation of the drug is an indication for a liver biopsy. Taking into account the antifolate mechanism of action, folic acid 1 mg / day is indicated, except for the days of methotrexate use.

Frequency - 1% in the general population. The predominant age is 22–55 years. The predominant gender is female (3:1). Incidence: 23.4 population in 2001

Possible side effects

Juvenile rheumatoid arthritis

Symptoms of a stuck joint

psoriatic arthritis (occurs in 10-40% of patients with psoriasis)

ICD-10 code

• Relief of systemic manifestations and articular syndrome.
• An increase in ESR in the UAC.
• ingestion of protein components;
• Pain in the joints becomes stronger, while motor activity decreases. In the affected areas, noticeable redness and swelling appear.
• Hydroxychloroquine (200 mg 2 r / day or 6 mg / kg / day) is a frequent component of combination therapy for active, especially "early" RA. Monotherapy with hydroxychloroquine does not slow radiological progression. The term of the effect is 2-6 months. At long-term treatment an annual ophthalmological examination, examination of visual fields is required.​
• unknown. Various exogenous (viral proteins, bacterial superantigens, etc.), endogenous (type II collagen, stress proteins, etc.) and nonspecific (trauma, infection, allergy) factors can act as "arthritogenic" factors.​
• Due to the fact that the RA treatment regimens indicated in the table are not always effective, several combinations of basic drugs are used in practice, among which the combinations of methotrexate with sulfasalazine, methotrexate and delagil are the most common. Currently, the treatment regimen in which methotrexate is combined with anticytokines is considered the most promising.

Epidemiology of juvenile chronic arthritis

Quinoline drugs (delagil - tablets of 0.25 g)

Classification of juvenile chronic arthritis

Reiter's syndrome (according to ICD-10 code 02.3) can develop in two forms - sporadic (causative agent - C. Trachomatis) and epidemic (Shigella, Yersinia, Salmonella).

Preservation of the functional ability of the joints.

Causes of juvenile chronic arthritis

In the subacute course of the disease, the symptoms are less pronounced. First, one joint is affected. Most often it is the ankle or knee joint. Both 1 joint and several can be affected. In the oligoarticular form of the disease, 2-4 joints are affected. Pain syndrome may not be. During a medical examination, swelling and dysfunction of the joint are determined. The movement of a sick child is difficult. The liver and spleen are of normal size. The subacute course proceeds more favorably and is better amenable to therapy.

The organs of the genitourinary system become inflamed.

The pathogenesis of juvenile chronic arthritis

Sulfasalazine is especially indicated in seronegative RA, when differential diagnosis with seronegative spondyloarthropathies is difficult. The starting dose is 0.5 g/day with a gradual increase in dose to 2-3 g/day in 2 divided doses after meals. Taking into account the myelotoxicity of the drug with its long-term use, it is necessary to control the OAC every 2-4 weeks for the first 2 months, then every 3 months.

​70% of RA patients have HLA - DR4 Ag, the pathogenetic significance of which is associated with the presence of a rheumatoid epitope (section b - the chain of the HLA molecule - DR4 with a characteristic amino acid sequence from the 67th to the 74th position). The effect of the “gene dose” is discussed, that is, the quantitative-qualitative relationship between the genotype and clinical manifestations. The combination of HLA - Dw4 (DR b10401) and HLA - Dw14 (DR b1*0404) significantly increases the risk of developing RA. On the contrary, the presence of antigen defenders, for example HLA - DR5 (DR b1 * 1101), HLA - DR2 (DR b1 * 1501), HLA DR3 (DR b1 * 0301) significantly reduces the likelihood of RA.

Symptoms of juvenile chronic arthritis

In medical practice, there are often cases of lack of effect from treatment (for example, with reactive arthritis, inflammation is not relieved even when taking antibiotics in combination with NSAIDs), when patients remain disease active and the rapid progression of articular deformities.

Diagnosis of juvenile chronic arthritis

Stabilization of lysosomal membranes, inhibition of phagocytosis and neutrophil chemotaxis, inhibition of cytokine synthesis.

Treatment goals for juvenile chronic arthritis

• The clinical picture differs from other types of arthritis, since concomitant signs of the disease are lesions of the mucous membranes oral cavity, prostatitis (in men), vaginitis and cervicitis (in women). A common symptom is inflammation of the eyes (conjunctivitis, iridocyclitis), which manifests itself in reddening of the sclera, the appearance of purulent discharge, swelling of the eyelids.
• ​Prevention or slowdown of joint destruction, disability of patients.​
• It is necessary to know not only the causes and symptoms of juvenile rheumatoid arthritis, but also the methods of its diagnosis. In the early stages of the disease, the symptoms may be mild, so the diagnosis is often difficult.
• Dysfunction of the immune system.
• Initially, the disease can affect only one knee joint, but later it can spread to other joints. A pronounced clinic can be insignificant or very strong, depending on the person's immune system. In the future, it is possible to develop rheumatoid arthritis, which affects the larger joints of the lower extremities and toes. Back pain occurs with the most severe form of the disease.
• Leflunomide is a new cytostatic drug with an antimetabolic mechanism of action, developed specifically for the treatment of RA. Apply at a dose of 10-20 mg / day. The effect develops after 4-12 weeks. Monitoring of toxicity involves monitoring the level of liver enzymes and TAC.​
• The pathological process in RA is based on generalized immunologically conditioned inflammation. In the early stages of the disease, Ag is detected - specific activation of CD4 + - T - lymphocytes in combination with hyperproduction of pro-inflammatory cytokines (tumor necrosis factor, IL - 1, IL - 6, IL - 8, etc. .) against the background of a deficiency of anti-inflammatory mediators (IL-4, a soluble antagonist of IL-1). IL - 1 plays an important role in the development of erosion. IL - 6 stimulates B - lymphocytes to the synthesis of RF, and hepatocytes - to the synthesis of proteins of the acute phase of inflammation (C - reactive protein, etc.). TNF-a causes the development of fever, pain, cachexia, is important in the development of synovitis (it promotes the migration of leukocytes into the joint cavity by enhancing the expression of adhesion molecules, stimulates the production of other cytokines, induces the procoagulant properties of the endothelium), and also stimulates the growth of pannus (granulation tissue penetrating into the cartilage from the synovial tissue and destroying it). An important prerequisite is the weakening of the endogenous synthesis of HA - hormones. In the late stages of RA, under conditions of chronic inflammation, tumor-like processes are activated due to somatic mutation of fibroblast-like synovial cells and defects in apoptosis.​

Forecast

Doctors make a conclusion about the need to change the therapy program if the patient has been treated for six months using at least three basic drugs.

The initial stage of RA.

​Laboratory research methods​

Arthritis of the knee joint should be differentiated from other pathological processes, the most common of which are arthrosis and bursitis. Bursitis, which is an inflammation in the synovial bag, can be easily distinguished from arthritis by an experienced specialist at the first appointment.

Prevention of juvenile chronic arthritis

The main diagnostic methods are:

Causes, symptoms, diagnosis and treatment of knee arthritis

From viral infections the most dangerous are those caused by the Epstein-Barr virus, parvovirus and retroviruses. The mechanism of the development of the disease is associated with autoimmune disorders. When exposed to any adverse factor in the body of a child, special immunoglobulins are formed. In response to this, the synthesis of rheumatoid factor occurs. Joint damage occurs. In this case, the synovial membranes and blood vessels, cartilage tissue are affected. Not only the joints, but also the marginal parts of the bones (epiphyses) can be destroyed. The resulting circulating immune complexes are carried through the blood vessels to various bodies. At the same time, there is a risk of developing multiple organ failure.

Etiology

In rare cases, the disease may affect the central nervous system, give complications to the organs of the cardiovascular system.

Gold salts (eg, sodium aurothiomalate) are used to treat seropositive RA. Trial dose 10 mg IM, then 25 mg weekly, then 50 mg weekly. As the total dose of 1000 mg is reached, they gradually switch to a maintenance regimen of 50 mg 1 time in 2-4 weeks. The effect develops in 3–6 months. Among the side effects are myelosuppression, thrombocytopenia, stomatitis, proteinuria, therefore OAC and OAM are recommended to be carried out 1 time in 2 weeks.

Evidence of the ineffectiveness of therapy is the negative dynamics of laboratory tests, the preservation of the focus of inflammation. In this case, you need an alternative solution on how to treat knee arthritis. Medical statistics confirm the positive dynamics in the use of pulse therapy using hormonal drugs(methylprednisolone intravenously, isotonic solution for three days - three courses are repeated after one month). Methylprednisolone is prescribed with caution in combination with cyclophosphamide due to the high toxicity of the drugs.

2 tab. per day for the first 2-4 weeks, then 1 table. per day for a long time.

Arthritis in children

Firstly, with bursitis, the mobility of the knee is slightly limited, and secondly, the area of ​​articular inflammation has clear contours. On palpation, the doctor quickly determines the boundaries of the inflammatory focus. As for arthrosis, it is more difficult to differentiate, since these diseases, which have completely different etiologies, have many similar signs.

Improving the quality of life of patients.

Symptoms of the disease

JRA classification according to ICD 10 takes into account the type of joint damage. Allocate polyarthritis and oligoarthritis. ICD 10 divides arthritis into acute and subacute. There is a classification that takes into account the clinical symptoms of the disease.

Today, to confirm whether a patient really has reactive arthritis, a whole range of laboratory tests is needed. Various specialists are involved in the examination of the patient. It is necessary to be examined by a gynecologist, urologist and therapist. The attending physician will indicate the need for examination by other medical specialists. After collecting the results of laboratory tests, anamnesis data, identifying clinical manifestations, the use of certain drugs is prescribed.

Cyclosporine is rarely used in the treatment of RA, only in cases of refractory to other drugs. The dose is 2.5–4 mg/kg/day. The effect develops in 2–4 months. Side effects are serious: arterial hypertension, impaired renal function.

Pyogenic arthritis, unspecified. Infectious arthritis NOS

Degrees of dysfunction

A new direction in the treatment of rheumatoid arthritis is therapy involving the use of so-called biological agents (biologic agents). The action of the drugs is based on the inhibition of the synthesis of cytokines (TNF-α and IL-1β).

Dyspeptic phenomena, skin itching, dizziness, leukopenia, retinal damage.

Do not reveal specific abnormalities

Arthrosis is a degenerative process in cartilage and bone tissue that occurs when there is a metabolic disorder, not associated with an inflammatory component. The main group of patients is the elderly (by the age of 60, most people are diagnosed with dystrophic changes in the joints).

Types of arthritis

Minimizing the side effects of therapy.

• external examination of the child;
• In this case, the following forms of juvenile arthritis are distinguished:
• It is necessary to begin treatment of reactive arthritis with the destruction of the infectious focus, that is, the causative agents of the original disease. To do this, you need to undergo a comprehensive examination of the whole organism. After determining the pathogen, sensitivity to drugs is established. A bacterial infection is treated with antibiotics.​
• Azathioprine is used at a dose of 50–150 mg/day. The effect develops in 2-3 months. Laboratory monitoring is required (OAC every 2 weeks, then every 1–3 months).​
• Fatigue, subfebrile condition, lymphadenopathy, weight loss. 2.​
• Excludes: arthropathy in sarcoidosis (​
• It has been reliably established that in 60% of patients with active rheumatoid articular syndrome, even with the third degree of the disease, there is a decrease (or absence) of the progression of articular changes during maintenance therapy with Remicade. However, the use of this form of treatment is justified if the basic therapy did not give the expected effect.

Sulfa drugs (sulfasalazine, salazopyridazine) - 500 mg tablets

Instrumental research methods

Differential Diagnosis

Arthritis is always inflammation, which over time, with the progression of the disease (with an autoimmune nature), spreads to the entire body. That is why there are many accompanying signs in autoimmune arthritis - this is fever, subfebrile temperature, and headache and general malaise. With rheumatoid arthritis, the cardiovascular system is seriously affected.

Treatment of juvenile chronic arthritis

The use of antibacterial drugs is recommended at the initial, most acute stage of the disease. In the future, their use becomes less effective. In some cases, symptomatic treatment is prescribed, in which non-steroidal drugs are used, for example, ibuprofen. "Anti-cytokine" therapy for RA is based on the suppression of the main pro-inflammatory cytokines: TNF-a and IL-1. Registered in Russia, infliximab is a monoclonal antibody to TNF - a. Infliximab is used at a dose of 3 mg/kg IV every 2, 6, and then every 8 weeks. The onset of the effect is from several days to 4 months. Articular syndrome

Diagnosis of arthritis of the knee

Mortality in juvenile arthritis is low. Most deaths are associated with the development of amyloidosis or infectious complications in patients with a systemic variant of juvenile rheumatoid arthritis, often resulting from long-term glucocorticoid therapy. In secondary amyloidosis, the prognosis is determined by the possibility and success of treating the underlying disease.

Treatment is carried out only after diagnosis. It is required to exclude such diseases as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, Reiter's syndrome, systemic lupus erythematosus, tumor, ankylosing spondylitis. In the presence of rheumatic diseases in children, treatment should be comprehensive.

involvement in the process of joints;

The 10th international classification of diseases (ICD 10) lists varieties of pathologies of the joints and connective tissues under the codes M05 (seropositive), M06 (seronegative) and M08 (juvenile) rheumatoid arthritis. Rheumatoid polyarthritis is classified, which in the ICD is under the M13.0 code, like other arthritis, depending on the presence of rheumatoid factor in the blood.

Long-term outpatient observation.

Tendosynovitis in the area of ​​the wrist joint and hand Bursitis, especially in the area of ​​the elbow joint Damage to the ligamentous apparatus with the development of hypermobility and deformities Muscle damage: muscle atrophy, myopathies, more often medicinal (steroid, as well as against the background of taking penicillamine or aminoquinoline derivatives). 4.​

Balneological therapy is a very effective procedure in a comprehensive program for the treatment of arthritis of the knee joint. However, this direction of rehabilitation is indicated for those patients who do not have serious illnesses cardiovascular system, neoplasms of a malignant nature, and there were no previous heart attacks or strokes. All procedures using therapeutic biological components are prescribed with great care.​

Inhibition of the functional activity of macrophages and neutrophils, inhibition of the production of immunoglobulins and RF.

Treatment

Due to the fact that the etiology of juvenile rheumatoid arthritis is unknown, primary prevention is not carried out.

Treatment of juvenile rheumatoid arthritis includes restriction of motor activity, avoidance of insolation, use of NSAIDs to eliminate pain and inflammation, immunosuppressants, exercise therapy, physiotherapy.

• a slight increase in body temperature;
• Polyarthritis is understood as systemic multiple lesions of the joints, in which not only almost all types of joints become inflamed and destroyed, simultaneously or sequentially, but also other organ systems. Sometimes the result of a neglected form of polyarthritis can be disability. Rheumatoid polyarthritis can act as an independent disease as an infectious-nonspecific rheumatoid arthritis, and sometimes it is a consequence of other diseases - sepsis, gout, rheumatism. Even those who have bad teeth should be wary of the disease, but the word "dentistry" is unacceptable in the lexicon.
• Observation is carried out jointly with a specialist - a rheumatologist and a district (family) doctor. The competence of a rheumatologist includes making a diagnosis, choosing a treatment strategy, teaching the patient the correct regimen, and conducting intra-articular manipulations. General practitioners are responsible for organizing the systematic management of the patient; they also carry out clinical monitoring. During each visit, the patient is assessed: the severity of pain in the joints on a point scale, the duration of morning stiffness in minutes, the duration of malaise, the number of swollen and painful joints, functional activity.
• Systemic manifestations
• A39.8

Since there are many varieties of arthritis and joint pathologies, it is necessary to consult a doctor at the first signs of the disease. The sooner the causes of the inflammatory process are determined, the more likely it is to cure the disease completely.

Anemia, an increase in ESR, an increase in CRP levels correlate with RA activity Synovial fluid is turbid, with low viscosity, leukocytosis is above 6000 / μl, neutrophilia (25-90%) RF (AT to IgG class IgM) is positive in 70-90% of cases ANAT, AT to Ro / La OAM (proteinuria as part of the nephrotic syndrome caused by amyloidosis of the kidneys or drug-derived glomerulonephritis) are detected in Sjögren's syndrome. An increase in creatinine, blood serum urea (assessment of renal function, a necessary stage in the selection and control of treatment).

The disease is not limited by age, but middle-aged women are diagnosed with this diagnosis somewhat more often than the representatives of the stronger half. An exception is infectious reactive arthritis, which is diagnosed mainly in older men (more than 85% of patients with reactive arthritis are carriers of the HLA-B27 antigen).

Depending on the type of classification, the disease has the following names: juvenile arthritis (ICD-10), juvenile idiopathic arthritis (ILAR), juvenile chronic arthritis (EULAR), juvenile rheumatoid arthritis (ACR).

Often, the joints in the cervical spine are involved in the process. Articular syndrome is characterized by:

New methods

This disease is difficult to treat. The only thing that patients can hope for is a long-term remission, when the hospital does not become a second home. In the early stages, this can often be achieved, but in most cases, the symptoms recur and even worsen.

​Assess and infer rate of improvement (20%, 50%, 70%) using scores swollen joint scores tender joint scores of at least 3 out of 5 scores overall activity score according to the patient overall activity score according to the clinician patient score pain acute phase blood counts (ESR, CRP) disability (quantified using standardized questionnaires).​

Arthritis and movement. Gordon N.F.​

Rehabilitation programs

Suppression of collagen synthesis, inhibition of the activity of type I T-helpers and B-lymphocytes, destruction of the CEC

Arthritis of the knee joint can be diagnosed at home if you carefully examine the symptoms of the disease. Regardless of the etiology, symptoms such as swelling, redness in the joint area, general malaise, external signs of deformation of the articular tissue appear.

​Unlimited (any age)​

It is worth dwelling in more detail on rheumatoid arthritis (RA), which is an autoimmune disease with an unclear etiology. The disease is a common pathology - about 1% of the population suffers. Very rarely there are cases of self-healing, in 75% of patients there is a stable remission; in 2% of patients, the disease leads to disability.​

M08. Juvenile arthritis.

Stiffness in the morning lasting up to 1 hour or more;

1. The goal of therapy for rheumatoid arthritis is to reduce rheumatic pain, reduce inflammation, improve joint mobility and prevent complete immobility of the patient. The basic principles that guide any clinic that treats rheumatoid arthritis are complexity and consistency. Well-proven spa treatment through therapeutic mud.
2. Rehabilitation.
3. American Rheumatological Association (1987)

ICD 10. Class XIII (M00-M25) | Medical practice - modern medicine of diseases, their diagnosis, etiology, pathogenesis and methods of treatment of diseases

Peripheral joints and systemic inflammatory lesions of internal organs.

2 Shoulder Humerus Elbow Bone

High clinical and laboratory activity of RA

However, one should not wonder how to treat arthritis of the knee joint on their own, especially using dubious recipes of folk medicine. This can lead to irreversible consequences. The decision on how to treat knee arthritis is made only after a comprehensive examination.​

As a rule, older

With this disease, the inner surface of the joints (cartilage, ligaments, bones) is destroyed and replaced by scar tissue. The rate of development of rheumatoid arthritis is not the same - from several months to several years. Peculiarities clinical picture one or another type of inflammation of the joints makes it possible to suspect the disease and prescribe the necessary examinations to confirm the diagnosis. In accordance with ICD-10, RA is classified as seropositive (code M05), seronegative (code M06), juvenile (code MO8)

M08.0. Juvenile (juvenile) rheumatoid arthritis (seropositive or seronegative).​

swelling in the joint area;

The first stage is the suppression of the autoimmune process, which actually leads to the destruction of tissues, pain, loss of the ability to move. This is followed by anti-inflammatory treatment, complete cleansing of the body from toxic metabolic products. During the period of remission, they restore blood circulation, increase the efficiency of joints, and normalize metabolism. All these stages combine both medical and physiotherapeutic methods of treatment.​

INFECTIOUS ARTHROPATHY (M00-M03)

Physical therapy plays an important role. Sanatorium - resort treatment is recommended during the period of minimal activity or remission. In order to correct deformities, orthoses are used - individual orthopedic devices made of thermoplastic, worn at night. At least 4 of the following Morning stiffness > 1 hour International Classification of Diseases Code ICD-10: 3 - bone, ulna Initial dose of 250 mg / day with a gradual increase to 500-1000 mg / day; maintenance dose - 150-250 mg / day

M00 Pyogenic arthritis

Physicians must determine the nature of the disease in order to prescribe adequate treatment. Orthopedic traumatologists, surgeons, rheumatologists give directions for laboratory and instrumental studies. The treatment regimen is developed by a specialized specialist (it can be a phthisiatrician, a dermatologist-venereologist, a cardiologist and other doctors). Nature of the process Some types of arthritis affect only children and adolescents, so they should be singled out in a separate row. M08.1. Juvenile (juvenile) ankydotic spondylitis. Painfulness; The basic treatment is the suppression of the autoimmune process through such drugs: methotrexate, sulfasalazine and leflunomide. In terms of minimizing side effects, the latter differs, this should be taken into account from the position that they all require long-term (at least six months) use. Features in pregnant women Arthritis M06 - 4 Hand Wrist, Joints between these fingers, bones, metacarpus Skin rash, dyspepsia, cholestatic hepatitis, myelosuppression code M08) affects children after bacterial and viral infections. As a rule, one knee or other large joint becomes inflamed. The child has pain with any movement, swelling in the joint area. Children limp, hardly get up in the morning. In the absence of treatment, joint deformity gradually develops, which is no longer possible to correct.

M08.2. Juvenile (juvenile) arthritis with a systemic onset, a change in gait; non-steroidal anti-inflammatory drugs (NSAIDs) also have an analgesic effect. But they should also be used for a long time, so the doctor must choose the one that is best tolerated by the patient. Among non-steroids, diclofenac, ibuprofen, nimesulide are widely used. All of them affect the gastrointestinal tract to a greater or lesser extent. Pregnancy improves the course of RA, however, after delivery, a relapse always occurs due to hyperprolactinemia. NSAIDs in the first trimester of pregnancy and 2 weeks before delivery are undesirable (in the first trimester - the risk of a teratogenic effect, before childbirth - the threat of developing weakness of labor, bleeding, early closure of the ductus arteriosus in the fetus). Gold salts, immunosuppressants are contraindicated for pregnant women. There is evidence of the relative safety of the use of aminoquinoline drugs and sulfasalazine, however, the expected effect should be correlated with the possible risk. 3 joints or more

​Other rheumatoid arthritis​​5 Pelvic Gluteal Hip joint, region and thigh region, sacroiliac, femoral joint, bone, pelvis Methotrexate (tablets 2.5 mg, ampoules 5 mg) Second stage - laboratory tests blood (with inflammation, there is an increase in ESR, leukocytosis, an inflammatory marker CRP, and other specific reactions).

Arthritis rheumatoid, Diseases and treatment of folk and medicinal products. Description, application and healing properties of herbs, alternative medicine

• Always chronic

Arthritis rheumatoid: Brief description

Reactive childhood arthritis (ICD-10 code MO2) manifests itself two weeks after an intestinal infection. If the process develops in the knee joint, then external signs are clearly visible: the skin turns red, swelling without pronounced boundaries is visible under the patella. The child often has a fever, which is reduced by antipyretic drugs, but pain in the knee area remains. M08.3. Juvenile (juvenile) polyarthritis (seronegative). Dysfunction of the affected area of ​​the body. It happens that non-steroidal drugs are not able to alleviate the suffering of the patient, so the clinic decides on the use of glucocorticosteroid (GCS) drugs - hormones that can be injected directly into affected joint. GCS have a lot of side effects, but they are prescribed in short courses, which significantly reduces the risk.

​The factors of unfavorable prognosis of RA include: RF seropositivity at the onset of the disease female young age at the onset of the disease systemic manifestations high ESR, significant concentrations of CRP carriage of HLA-DR4 early onset and rapid progression of erosions in the joints low social status patients.​

6 Calf Fibula Knee joint, bone, tibia Folic acid antagonist; inhibits the proliferation of T- and B-lymphocytes, the production of antibodies and pathogenic immune complexes. The third stage is radiography. In the presence of arthritis, a curvature of the articular surface, bone ankylosis is detected. Onset of the disease In addition to infectious, reactive, rheumatoid arthritis, children are often diagnosed with an allergic disease. The disease begins in a child suddenly - immediately after allergens enter the bloodstream. The joints quickly swell, there is shortness of breath, urticaria. Quincke's edema, bronchial spasm may develop. When the allergic reaction is eliminated, signs of arthritis disappear. M08.4. Pauciarticular juvenile (juvenile) arthritis. If juvenile arthritis affects the small joints of the fingers or toes, then deformity of the fingers is possible. In the articular form of arthritis, damage to the organs of vision is often observed. Iridocyclitis or uveitis develops. This may reduce visual acuity. The seronegative form of arthritis is more mild than the seropositive form. In the latter case, rheumatoid nodules are often detected in the area of ​​​​the joints. Modern medicine, which treats rheumatoid arthritis, uses new biological products that inhibit the activity of the protein. These drugs include etanercept (Enbrel), infliximab (Remicad), and adalimumab (Humira). side effects they have significantly less, and they give a positive result. Arthritis of the joints of the hands Symmetric arthritis 7 Ankle Metatarsus, Ankle joint, joint and foot of the tarsus, other joints of the foot, toes RA with systemic manifestations, high RA activity, low effectiveness of other basic means. Fourth stage - MRI, ultrasound (assigned to differentiate arthritis from arthrosis, Bechterew's disease and bursitis) . With erased signs that occur during a sluggish chronic process, additional hardware studies of the joint may be prescribed - tomography of the articular tissue, CT, pneumoarthrography. Acute, sudden Arthritis of the knee joint can develop as an independent disease, or be a complication after injuries and diseases .M08.8. Other juvenile arthritis. With this pathology, other important organs often suffer. With a systemic form of arthritis, there may be:

Statistical data

Arthritis rheumatoid: Causes

Etiology

genetic features

Pathogenesis

Rheumatoid Arthritis: Signs, Symptoms

Clinical picture

​8 Others Head, neck, ribs, skull, trunk, spine​​7.5-25 mg per week orally. laboratory research(if indicated, a biopsy). Gradual (develops over months, years) A knee joint affected by arthritis swells, and pain appears when it moves. The skin in the joint area changes color (turns red or becomes "parchment"), but this is not a reliable sign of an inflammatory process. M08.9. Juvenile arthritis, unspecified. Exanthema; Folk methods cannot be the only treatment when it comes to polyarthritis. It is better to use them during the remission period, as they are more gentle in terms of side effects. In visible inflammation, chamomile baths have worked well. Arthritis Rheumatoid nodules RF Radiological changes Sensitivity - 91.2%, specificity - 89.3%. Rheumatoid

Arthritis rheumatoid: Diagnosis

Laboratory data

instrumental data

When determining the type and degree of reactive arthritis (ICD-10 code), biological material is examined (general blood and urine tests), urogenital and ophthalmological examinations are performed, a test for the presence of HLA-B27, ECG, thymol test, sial test, ALT determination, AST, culture of biological fluids.​​Symptoms​​The main cause of swelling and a visually noticeable increase in the patella is the accumulation of fluid inside the joint. Excessive pressure on the walls of the articular tissue causes severe pain. The volume of fluid steadily increases over time, so the pain syndrome becomes more intense. Juvenile rheumatoid arthritis is one of the most common and most disabling rheumatic diseases that occurs in children. The incidence of juvenile rheumatoid arthritis is from 2 to 16 people of the child population under the age of 16 years. The prevalence of juvenile rheumatoid arthritis in different countries is from 0.05 to 0.6%. Girls are more likely to get rheumatoid arthritis. Mortality is 0.5-1%. Kidney damage by the type of glomerulonephritis; Infusions of birch buds, tricolor violet, nettle, hernia are taken orally. They also use the collection of herbs, which includes wild rosemary, chamomile, string, lingonberries, juniper (berries). This collection of half a cup three times a day before meals is very effective in exchange polyarthritis. early stages of RA, active therapy (NSAIDs at an adequate dose + basic drugs) should be started within the first 3 months after the diagnosis of definite RA. This is especially important in patients with risk factors for an unfavorable prognosis, which include high RF titers, a pronounced increase in ESR, damage to more than 20 joints, the presence of extra-articular manifestations (rheumatoid nodules, Sjogren's syndrome, episcleritis and scleritis, interstitial lung disease, pericarditis, systemic vasculitis). , Felty's syndrome). The use of GC is indicated in patients who do not "respond" to NSAIDs or have contraindications to their appointment in an adequate dose, and also as a temporary measure before the onset of the effect of basic drugs. Intra-articular administration of HA is intended for the treatment of synovitis in 1 or more joints, which complements, but does not replace, complex treatment. Arthritis Disorders affecting predominantly peripheral joints (limbs)

Arthritis rheumatoid: Methods of treatment

Treatment

General tactics

Mode

In addition, uric acid crystals, which look like thin needle-shaped spikes, are deposited in the joint. They injure small vessels, which is the basis for the development of associated infections. In adolescents, there is a very unfavorable situation for rheumatoid arthritis, its prevalence is 116.4 per (in children under 14 years old - 45.8 per), the primary incidence is 28, 3 per (in children under 14 years old - 12.6 per).​

Pericarditis; In the period of remission, pepper rubs with kerosene are also used. Such procedures not only relieve pain and inflammation, but also penetrate the blood, partially cleansing it. Both in the hospital and at home, cold treatment can be applied. In the hospital, cryosaunas are used - special cabins with chilled air, which are replaced at home with ice packs. After the procedure, which lasts about 10 minutes, the joints are massaged and kneaded. For one procedure, cooling is performed three times. Duration of treatment - 20 days.​

ICD-10 Patients should form a movement stereotype that counteracts the development of deformities (for example, to prevent ulnar deviation, open a tap, dial a phone number and other manipulations not with the right hand, but with the left hand).​​: polyarthritis, oligoarthritis, monoarthritis Rheumatoid Note Inhibition of the proliferative activity of T- and B-lymphocytes.

Despite the leading role of radiography in the diagnosis of arthritis, we must remember that in the early stages of the disease, pathological changes are not always visible in the pictures. Arthrography is of informative value for physicians in the study of large joints, and in case of polyarthritis this diagnostic method is not effective. Serological tests are used to identify the causative agent of arthritis of an infectious nature.

Manifested with changes in cartilage and bone tissue

Arthritis of the knee is difficult not only because of the intense pain syndrome, but also due to disruption of the functioning of functional systems. Cardiovascular and endocrine system. There is shortness of breath, tachycardia, low-grade fever, sweating, circulatory disorders in the limbs, insomnia and other non-specific signs.

Three disease classifications are used: the American College of Rheumatology (ACR) classification of juvenile rheumatoid arthritis, the European League Against Rheumatism (EULAR) classification of juvenile chronic arthritis, and the International League of Rheumatological Associations (ILAR) classification of juvenile idiopathic arthritis.​

inflammation of the heart muscle;

Pay special attention to diet. Healers recommend a raw-food diet, especially the widespread use of eggplant in food. In any case, rheumatoid arthritis can be curbed without letting it spoil the patient's quality of life.

M05 Seropositive rheumatoid

RA with systemic manifestations.

Treatment of arthritis is a long process and requires not only the implementation of the doctor's recommendations regarding drug therapy, but also the passage of rehabilitation courses. Pain intensity

Surgery

Classification of juvenile chronic arthritis

Any arthritis, put in the ICD 10 under the codes M05, M06, M08, M13.0, requires constant attention, since even a long remission will not help to avoid a spontaneous exacerbation of the disease.

Non-steroidal anti-inflammatory drugs

with systemic manifestations Special syndromes: Felty's syndrome, Still's syndrome in adults This group covers arthropathies caused by microbiological agents

150 mg / day, maintenance dose - 50 mg / day. The diet for arthritis of the knee must be strictly observed. Excluded food rich in carbohydrates, smoked meats, fatty meats, legumes. With the transfer to dietary nutrition and the use of individual therapy, a positive effect is observed. In general, the treatment of arthritis of the knee joint includes the following areas:

Strongly expressed from the very beginning of the disease

The first degree is characterized by moderate pain syndrome, there is a slight limitation of movement when rotating the knee, when lifting or during a squat.​

Forecast

Synonyms

Abbreviations

By seroprescription Myelosuppression, activation of foci of chronic infection. Medications (tablets, injections, ointments, gels);

Moderate at first, gradually increasing

Tags:

Application tactics

Arthritis classification according to ICD 10

(according to the presence of RF): seropositive, seronegative

A distinction was made according to the following types of etiological relationship: a) direct infection of the joint, in which microorganisms invade the synovial tissue and microbial antigens are found in the joint; b) indirect infection, which can be of two types: “reactive arthropathy”, when microbial infection of the body is established, but neither microorganisms nor antigens are detected in the joint; and "post-infectious arthropathy", in which the microbial antigen is present, but the recovery of the organism is incomplete and there is no evidence of local reproduction of the microorganism.

Cyclophosphamide (200 mg ampoules), endoxan - 50 mg tablets

physiotherapy procedures;

Reactive Arthritis Symptoms

Puffiness

Second degree - the pain intensifies, the restriction of motor activity is such that it leads to a decrease in working capacity and limitation of self-service.

1. The symptom complex of the disease included: symmetrical damage to the joints, the formation of deformities, contractures and ankylosis in them; development of anemia, enlarged lymph nodes, liver and spleen, sometimes the presence of febrile fever and pericarditis. Subsequently, in the 30-40s of the last century, numerous observations and descriptions of Still's syndrome revealed much in common between rheumatoid arthritis in adults and children, both in clinical manifestations and in the nature of the course of the disease. However, rheumatoid arthritis in children was still different from the disease of the same name in adults. In this regard, in 1946, the term "juvenile (juvenile) rheumatoid arthritis" was proposed by two American researchers Koss and Boots. Nosological separation of juvenile rheumatoid arthritis and adult rheumatoid arthritis was subsequently confirmed by immunogenetic studies.
2. This type of rheumatoid arthritis includes Still and Wieseler-Fanconi syndrome. Still's syndrome is more commonly diagnosed in preschoolers. It is distinguished by the following features:
3. Juvenile rheumatoid arthritis is a pathology that develops in children and adolescents under 16 years of age, in which not only the joints, but also other organs can be affected. A doctor can make a similar diagnosis if a child has arthritis that lasts more than 6 weeks. The disease does not occur very often. International statistics says that JRA is detected in 0.05-0.6% of children. Children under 2 years of age suffer from this disease extremely rarely. There are gender differences in the incidence among children. Arthritis is diagnosed more often in girls. The disease is steadily progressing.

NSAIDs Patients at risk of developing gastropathy and gastrointestinal bleeding (age over 75 years old, history of gastrointestinal ulcers, simultaneous use of low doses of acetylsalicylic acid and HA, smoking) can be prescribed selective or specific COX-2 inhibitors, either (subject to high individual effectiveness) non-selective COX inhibitors in combination with misoprostol 200 mcg 2-3 times / day or proton pump inhibitors (omeprazole 20-40 mg / day) In patients with impaired renal function, NSAIDs should be treated with extreme caution. selective COX-2 inhibitors should continue to take small doses of acetylsalicylic acid at the same time.

Diagnosis and treatment of the disease

Downstream:

Alkylating cytostatic; forms alkyl radicals with DNA, RNA and proteins, disrupting their function; has an antiproliferative effect.

Pronounced edema from the very beginning of the disease

In the third degree - the impossibility of self-service, a significant loss of mobility in the joint (joints).

What causes juvenile rheumatoid arthritis?

MoiSustav.ru

Learning to live with a diagnosis according to ICD 10 - rheumatoid arthritis

acute onset;

Causes and symptoms of rheumatoid arthritis

​If treatment is not started early, there is a high risk that the child will become disabled.​

The World Health Organization (WHO) has developed a special medical coding for the diagnosis and definition of medical diseases. ICD 10 code - coding for the international classification of diseases of the 10th revision as of January 2007.​

​GK Systemic application. It is recommended to use low< 10 мг/сут) дозы ГК, что позволяет адекватно « контролировать» ревматоидное воспаление, но должно обязательно сочетаться с базисной терапией Локальная терапия ГК имеет вспомогательное значение. Предназначена для купирования активного синовита в 1 или нескольких суставах. Повторные инъекции ГК в один и тот же сустав необходимо производить не чаще 1 раза в 3 мес. Противопоказания к проведению локальной терапии: гнойный​ rapidly progressive, slowly progressive (assessment of the rate of development of destructive changes in the joint during long-term follow-up)

Staphylococcal arthritis and polyarthritis

How to treat rheumatoid arthritis?

RA with systemic manifestations (vasculitis, nephropathy).

massage;

Edema appears when inflammation is attached

According to the nature of occurrence in medicine, several forms of arthritis are distinguished:

The pathogenesis of juvenile rheumatoid arthritis has been intensively studied in recent years. The development of the disease is based on the activation of both cellular and humoral immunity.

moderate fever;

The primary incidence rate is from 6 to 19 cases per 100,000 children. It is important that the prognosis for health largely depends on the age at which the disease began. The older the child, the worse the prognosis. Still's disease is a type of rheumatoid arthritis. The disease is very severe, with severe fever, joint syndrome, damage to the lymphatic system and sore throat. This pathology also occurs in adults.

There are currently 21 disease classes, each containing subclasses with disease and condition codes. Rheumatoid arthritis ICD 10 belongs to the XIII class "Diseases of the musculoskeletal system and connective tissue". Subclass M 05-M 14 "Inflammatory processes of polyarthropathy".​

Rheumatoid arthritis: we treat folk methods

arthritis

By activity:

200 mg IM 2-3 times a week until a total dose of 6-8 g per course is reached; combined pulse therapy; endoxan at a dose of 100-150 mg / day, maintenance dose - 50 mg / day. Methods of operative surgery (injections into the articular cavity).

artrozmed.ru

Etiology and treatment of juvenile rheumatoid arthritis

Redness of the joint

Features of the disease

reactive - a complication that occurs with untreated (undertreated) infections; The pathogenesis of juvenile chronic arthritis

polyarthritis involving small joints in the process;

Etiological factors

Juvenile arthritis can occur for a variety of reasons. The exact reason has not yet been established.​

Reactive arthritis of the knee is the most common rheumatic disease. The disease is characterized by a non-purulent inflammatory formation in the bone structure. In some cases, the disease occurs as a response to infectious diseases of the gastrointestinal tract (GIT), urinary tract and organs of the reproductive system.

• , unspecified nature
• I - low, II - moderate, III - high activity
• Pneumococcal arthritis and polyarthritis
• Hemorrhagic cystitis, myelosuppression, activation of foci of infection.
• Of the medications, NSAIDs, cytostatics, hormonal agents, antibiotics, etc. are prescribed. The set of medications directly depends on the type and etiology of arthritis. Table 2 lists the treatment regimens for rheumatoid arthritis.​
• Yes, but it may not be right away
• Rheumatoid - is a consequence of rheumatic diseases;

The main clinical manifestation of the disease is arthritis. Pathological changes in the joint are characterized by pain, swelling, deformities and limitation of movement, increased skin temperature over the joints. In children, large and medium joints are most often affected, in particular, knee, ankle, wrist, elbow, hip, less often small joints of the hand. Typical for juvenile rheumatoid arthritis is the defeat of the cervical spine and maxillotemporal joints, which leads to underdevelopment of the lower, and in some cases, the upper jaw and the formation of the so-called "bird's jaw".

Forms of the disease

Enlargement and soreness of the lymph nodes;

Possible etiological factors are:

• The development of arthritis occurs a month after infection, however, the provocative infection that caused this disease is in the human body does not manifest itself. Men over the age of 45 are most at risk. Sexually transmitted infections (gonorrhea, chlamydia, and others) can contribute to the progression of the disease. Women are less likely to suffer from this disease.
• arthritis
• Radiological stage:

Clinical symptoms

Chlorbutin (leukeran) - tablets of 2 and 5 mg

• drug
• Yes, but in the later stages of redness may not be
• Acute - develops after bruises, fractures, strong physical exertion;
• Symptoms of juvenile chronic arthritis
• hepatosplenomegaly;

the presence of a viral or bacterial infection;

If the carrier of the infection entered the body with food, reactive arthritis can equally develop in both men and women.

• , any changes in the skin near the puncture site, tuberculosis of the joint, tabes of the spinal cord, aseptic bone necrosis, intra-articular fracture, subluxation of the joint. The following drugs are used (a full dose of drugs is injected into large joints, 50% into medium-sized joints, 25% into small ones): Methylprednisolone 40 mg Hydrocortisone 125 mg Betamethasone in the form of injections (celeston, flosteron, diprospan) Pulse therapy methylprednisolone leads to a rapid but short-term effect (3-12 weeks); not affecting the rate of progression of the process In order to prevent osteoporosis, people receiving GCs are prescribed calcium (1500 mg / day) and cholecalciferol (400-800 IU / day), and in the absence of their effectiveness - bisphosphonates and calcitonin (see Osteoporosis). ​
• I - periarticular osteoporosis, II - the same + narrowing of the interarticular spaces + single erosions, III - the same + multiple erosions, IV - the same + ankylosis H
• Other streptococcal arthritis and polyarthritis
• Alkylating cytostatic; forms alkyl radicals with DNA, RNA and proteins, disrupting their function; has an antiproliferative effect
• ​Operating principle​

Symptoms of intoxication

Other manifestations

infectious - caused by viruses or a fungal infection that enters the joint with the blood stream, or through an unsterile surgical instrument, often leads to the development of purulent inflammation of the knee joint;

• In the systemic variant of juvenile rheumatoid arthritis, leukocytosis (up to 30-50 thousand leukocytes) is often detected with a neutrophilic shift to the left (up to 25-30% of stab leukocytes, sometimes up to myelocytes), an increase in ESR up to 50-80 mm / h, hypochromic anemia, thrombocytosis, an increase in the concentration of C-reactive protein, IgM and IgG in the blood serum.
• anemia;
• traumatic joint injury;
• A characteristic feature of the course of the disease is the symmetry of joint damage
• ​Basic Therapy​
• Availability of functional ability:

• High RA activity with systemic manifestations, generalized lymphadenopathy, splenomegaly.
• ​Operating principle​
• Observed in the case of an autoimmune nature of the disease
• Reiter's syndrome is a type of reactive arthritis;
• Diagnosis of juvenile chronic arthritis
• myocardial damage;
• increased insolation;
• Reactive arthritis is severe. In the first week, the patient has a fever, disorders of the gastrointestinal tract (GIT), acute intestinal malaise, general weakness. In the future, the symptoms of arthritis progresses and is of a classic nature. At this stage of development, the disease can be divided into 3 types.
• ​Basic therapy should be given to all patients with reliable RA.​

​0 - retained, I - professional ability retained, II - professional ability lost, III - self-service ability lost.​

Diagnostic measures

​Arthritis and polyarthritis caused by other specified bacterial pathogens Use an additional code if necessary to identify the bacterial agent (​

6-8 mg / day, maintenance dose - 2-4 mg / day.

• Destination schemes
• No
• Arthritis in Bechterew's disease, gout (rare);
• Suppression of the inflammatory and immunological activity of the process.

polyserositis;

hypothermia;

Inflammation of the mucous membrane of the eyes occurs (may develop conjunctivitis).

Treatment tactics

Methotrexate remains the "gold standard" of basic therapy for RA, which has the best ratio of efficacy/toxicity. Assign to patients with active RA or those with risk factors for poor prognosis (see above) at a dose of 7.5-15 mg per week. The term of the effect is 1-2 months. Among the side effects of methotrexate are hepatotoxicity, myelosuppression, so the control of KLA and transaminases should be performed monthly. An increase in the level of liver enzymes is a signal to reduce the dose of the drug or completely cancel it. A persistent increase in liver enzymes after discontinuation of the drug is an indication for a liver biopsy. Taking into account the antifolate mechanism of action, folic acid 1 mg / day is indicated, except for the days of methotrexate use.

Frequency - 1% in the general population. The predominant age is 22–55 years. The predominant gender is female (3:1). Incidence: 23.4 per 100,000 population in 2001

Myelosuppression.

Possible side effects

SpinaZdorov.ru

Juvenile rheumatoid arthritis

Symptoms of a stuck joint

psoriatic arthritis (occurs in 10-40% of patients with psoriasis)

ICD-10 code

• Relief of systemic manifestations and articular syndrome.
• An increase in ESR in the UAC.
• ingestion of protein components;
• Pain in the joints becomes stronger, while motor activity decreases. In the affected areas, noticeable redness and swelling appear.
• Hydroxychloroquine (200 mg 2 r / day or 6 mg / kg / day) is a frequent component of combination therapy for active, especially "early" RA. Monotherapy with hydroxychloroquine does not slow radiological progression. The term of the effect is 2-6 months. With long-term treatment, an annual ophthalmological examination, examination of the visual fields is necessary.
• unknown. Various exogenous (viral proteins, bacterial superantigens, etc.), endogenous (type II collagen, stress proteins, etc.) and nonspecific (trauma, infection, allergy) factors can act as "arthritogenic" factors.​
• Due to the fact that the RA treatment regimens indicated in the table are not always effective, several combinations of basic drugs are used in practice, among which the combinations of methotrexate with sulfasalazine, methotrexate and delagil are the most common. Currently, the treatment regimen in which methotrexate is combined with anticytokines is considered the most promising.

Epidemiology of juvenile chronic arthritis

Quinoline drugs (delagil - tablets of 0.25 g)

Classification of juvenile chronic arthritis

Reiter's syndrome (according to ICD-10 code 02.3) can develop in two forms - sporadic (causative agent - C. Trachomatis) and epidemic (Shigella, Yersinia, Salmonella).

Preservation of the functional ability of the joints.

Causes of juvenile chronic arthritis

In the subacute course of the disease, the symptoms are less pronounced. First, one joint is affected. Most often it is the ankle or knee joint. Both 1 joint and several can be affected. In the oligoarticular form of the disease, 2-4 joints are affected. Pain syndrome may not be. During a medical examination, swelling and dysfunction of the joint are determined. The movement of a sick child is difficult. The liver and spleen are of normal size. The subacute course proceeds more favorably and is better amenable to therapy.

hereditary predisposition;

The organs of the genitourinary system become inflamed.

The pathogenesis of juvenile chronic arthritis

Sulfasalazine is especially indicated in seronegative RA, when differential diagnosis with seronegative spondyloarthropathies is difficult. The starting dose is 0.5 g/day with a gradual increase in dose to 2-3 g/day in 2 divided doses after meals. Taking into account the myelotoxicity of the drug with its long-term use, it is necessary to control the OAC every 2-4 weeks for the first 2 months, then every 3 months.

​70% of RA patients have HLA - DR4 Ag, the pathogenetic significance of which is associated with the presence of a rheumatoid epitope (section b - the chain of the HLA molecule - DR4 with a characteristic amino acid sequence from the 67th to the 74th position). The effect of the “gene dose” is discussed, that is, the quantitative-qualitative relationship between the genotype and clinical manifestations. The combination of HLA - Dw4 (DR b10401) and HLA - Dw14 (DR b1*0404) significantly increases the risk of developing RA. On the contrary, the presence of antigen defenders, for example HLA - DR5 (DR b1 * 1101), HLA - DR2 (DR b1 * 1501), HLA DR3 (DR b1 * 0301) significantly reduces the likelihood of RA.

Symptoms of juvenile chronic arthritis

In medical practice, there are often cases of lack of effect from treatment (for example, with reactive arthritis, inflammation is not relieved even when taking antibiotics in combination with NSAIDs), when patients remain disease active and the rapid progression of articular deformities.

Diagnosis of juvenile chronic arthritis

Stabilization of lysosomal membranes, inhibition of phagocytosis and neutrophil chemotaxis, inhibition of cytokine synthesis.

Treatment goals for juvenile chronic arthritis

• The clinical picture differs from other types of arthritis, since the accompanying signs of the disease are lesions of the mucous membranes of the oral cavity, prostatitis (in men), vaginitis and cervicitis (in women). A common symptom is inflammation of the eyes (conjunctivitis, iridocyclitis), which manifests itself in reddening of the sclera, the appearance of purulent discharge, swelling of the eyelids.
• ​Prevention or slowdown of joint destruction, disability of patients.​
• It is necessary to know not only the causes and symptoms of juvenile rheumatoid arthritis, but also the methods of its diagnosis. In the early stages of the disease, the symptoms may be mild, so the diagnosis is often difficult.
• Dysfunction of the immune system.
• Initially, the disease can affect only one knee joint, but later it can spread to other joints. A pronounced clinic can be insignificant or very strong, depending on the person's immune system. In the future, it is possible to develop rheumatoid arthritis, which affects the larger joints of the lower extremities and toes. Back pain occurs with the most severe form of the disease.
• Leflunomide is a new cytostatic drug with an antimetabolic mechanism of action, developed specifically for the treatment of RA. Apply at a dose of 10-20 mg / day. The effect develops after 4-12 weeks. Monitoring of toxicity involves monitoring the level of liver enzymes and TAC.​
• The pathological process in RA is based on generalized immunologically conditioned inflammation. In the early stages of the disease, Ag is detected - specific activation of CD4 + - T - lymphocytes in combination with hyperproduction of pro-inflammatory cytokines (tumor necrosis factor, IL - 1, IL - 6, IL - 8, etc. .) against the background of a deficiency of anti-inflammatory mediators (IL-4, a soluble antagonist of IL-1). IL - 1 plays an important role in the development of erosion. IL - 6 stimulates B - lymphocytes to the synthesis of RF, and hepatocytes - to the synthesis of proteins of the acute phase of inflammation (C - reactive protein, etc.). TNF-a causes the development of fever, pain, cachexia, is important in the development of synovitis (it promotes the migration of leukocytes into the joint cavity by enhancing the expression of adhesion molecules, stimulates the production of other cytokines, induces the procoagulant properties of the endothelium), and also stimulates the growth of pannus (granulation tissue penetrating into the cartilage from the synovial tissue and destroying it). An important prerequisite is the weakening of the endogenous synthesis of HA - hormones. In the late stages of RA, under conditions of chronic inflammation, tumor-like processes are activated due to somatic mutation of fibroblast-like synovial cells and defects in apoptosis.​

Forecast

Doctors make a conclusion about the need to change the therapy program if the patient has been treated for six months using at least three basic drugs.

The initial stage of RA.

​Laboratory research methods​

Arthritis of the knee joint should be differentiated from other pathological processes, the most common of which are arthrosis and bursitis. Bursitis, which is an inflammation in the synovial bag, can be easily distinguished from arthritis by an experienced specialist at the first appointment.

Achieving remission.

Prevention of juvenile chronic arthritis

The main diagnostic methods are:

ilive.com.ua

Causes, symptoms, diagnosis and treatment of knee arthritis

Of the viral infections, the most dangerous are those caused by the Epstein-Barr virus, parvovirus, and retroviruses. The mechanism of the development of the disease is associated with autoimmune disorders. When exposed to any adverse factor in the body of a child, special immunoglobulins are formed. In response to this, the synthesis of rheumatoid factor occurs. Joint damage occurs. In this case, the synovial membranes and blood vessels, cartilage tissue are affected. Not only the joints, but also the marginal parts of the bones (epiphyses) can be destroyed. The resulting circulating immune complexes are carried through the blood vessels to various organs. At the same time, there is a risk of developing multiple organ failure.

Etiology

In rare cases, the disease can affect the central nervous system, give complications to the organs of the cardiovascular system.

Gold salts (eg, sodium aurothiomalate) are used to treat seropositive RA. Trial dose 10 mg IM, then 25 mg weekly, then 50 mg weekly. As the total dose of 1000 mg is reached, they gradually switch to a maintenance regimen of 50 mg 1 time in 2-4 weeks. The effect develops in 3–6 months. Among the side effects are myelosuppression, thrombocytopenia, stomatitis, proteinuria, therefore OAC and OAM are recommended to be carried out 1 time in 2 weeks.

Evidence of the ineffectiveness of therapy is the negative dynamics of laboratory tests, the preservation of the focus of inflammation. In this case, you need an alternative solution on how to treat knee arthritis. Medical statistics confirms the positive dynamics in the use of pulse therapy using hormonal drugs (methylprednisolone intravenously, isotonic solution for three days - three courses are repeated after one month). Methylprednisolone is prescribed with caution in combination with cyclophosphamide due to the high toxicity of the drugs.

2 tab. per day for the first 2-4 weeks, then 1 table. per day for a long time.

Arthritis in children

Detect changes

Firstly, with bursitis, the mobility of the knee is slightly limited, and secondly, the area of ​​articular inflammation has clear contours. On palpation, the doctor quickly determines the boundaries of the inflammatory focus. As for arthrosis, it is more difficult to differentiate, since these diseases, which have completely different etiologies, have many similar signs.

Improving the quality of life of patients.

collection of anamnesis;

Symptoms of the disease

JRA classification according to ICD 10 takes into account the type of joint damage. Allocate polyarthritis and oligoarthritis. ICD 10 divides arthritis into acute and subacute. There is a classification that takes into account the clinical symptoms of the disease.

Today, to confirm whether a patient really has reactive arthritis, a whole range of laboratory tests is needed. Various specialists are involved in the examination of the patient. It is necessary to be examined by a gynecologist, urologist and therapist. The attending physician will indicate the need for examination by other medical specialists. After collecting the results of laboratory tests, anamnesis data, identifying clinical manifestations, the use of certain drugs is prescribed.

Cyclosporine is rarely used in the treatment of RA, only in cases of refractory to other drugs. The dose is 2.5–4 mg/kg/day. The effect develops in 2–4 months. Side effects are serious: arterial hypertension, impaired renal function.

General symptoms:

Pyogenic arthritis, unspecified. Infectious arthritis NOS

Degrees of dysfunction

A new direction in the treatment of rheumatoid arthritis is therapy involving the use of so-called biological agents (biologic agents). The action of the drugs is based on the inhibition of the synthesis of cytokines (TNF-α and IL-1β).

Dyspeptic phenomena, skin itching, dizziness, leukopenia, retinal damage.

Do not reveal specific abnormalities

Arthrosis is a degenerative process in cartilage and bone tissue that occurs when there is a metabolic disorder, not associated with an inflammatory component. The main group of patients is the elderly (by the age of 60, most people are diagnosed with dystrophic changes in the joints).

Types of arthritis

Minimizing the side effects of therapy.

• external examination of the child;
• In this case, the following forms of juvenile arthritis are distinguished:
• It is necessary to begin treatment of reactive arthritis with the destruction of the infectious focus, that is, the causative agents of the original disease. To do this, you need to undergo a comprehensive examination of the whole organism. After determining the pathogen, sensitivity to drugs is established. A bacterial infection is treated with antibiotics.​
• Azathioprine is used at a dose of 50–150 mg/day. The effect develops in 2-3 months. Laboratory monitoring is required (OAC every 2 weeks, then every 1–3 months).​
• Fatigue, subfebrile condition, lymphadenopathy, weight loss. 2.​
• Excludes: arthropathy in sarcoidosis (​
• It has been reliably established that in 60% of patients with active rheumatoid articular syndrome, even with the third degree of the disease, there is a decrease (or absence) of the progression of articular changes during maintenance therapy with Remicade. However, the use of this form of treatment is justified if the basic therapy did not give the expected effect.

Sulfa drugs (sulfasalazine, salazopyridazine) - 500 mg tablets

Instrumental research methods

Differential Diagnosis

Arthritis is always inflammation, which over time, with the progression of the disease (with an autoimmune nature), spreads to the entire body. That is why there are many accompanying signs in autoimmune arthritis - this is fever, subfebrile temperature, headache, and general malaise. With rheumatoid arthritis, the cardiovascular system is seriously affected.

Treatment of juvenile chronic arthritis

laboratory research;

articular;

The use of antibacterial drugs is recommended at the initial, most acute stage of the disease. In the future, their use becomes less effective. In some cases, symptomatic treatment is prescribed, in which non-steroidal drugs are used, for example, ibuprofen. "Anti-cytokine" therapy for RA is based on the suppression of the main pro-inflammatory cytokines: TNF-a and IL-1. Registered in Russia, infliximab is a monoclonal antibody to TNF - a. Infliximab is used at a dose of 3 mg/kg IV every 2, 6, and then every 8 weeks. The onset of the effect is from several days to 4 months. Articular syndrome

​The importance of some NSAIDs that were previously actively used in the treatment of arthritis of the knee joint has decreased somewhat, as other therapy programs have appeared that are more effective.​	Inhibition of the synthesis of prostaglandins and leukotrienes, inhibition of the synthesis of antibodies and RF.	​radiography, additional methods(MRI)​
To make a diagnosis of "arthritis of the knee" (gonarthritis), it is necessary to conduct multidirectional diagnostic studies. In some cases, doctors make a diagnosis of arthrosis-arthritis of the knee joint.	With a systemic variant of juvenile rheumatoid arthritis in 40-50% of children, the prognosis is favorable, remission may occur lasting from several months to several years. However, an exacerbation of the disease can develop years after a stable remission. In 1/3 of patients there is a continuously relapsing course of the disease. The most unfavorable prognosis in children with persistent fever, thrombocytosis, long-term corticosteroid therapy. 50% of patients develop severe destructive arthritis, 20% develop amyloidosis in adulthood, and 65% develop severe functional impairment.	X-ray examination of the affected joints.
Mixed (articular-visceral);	To prevent reactive arthritis from developing into a chronic form, timely treatment is necessary. Only the attending physician should make decisions about the intake of certain drugs by the patient. Self-medication is unacceptable.	combination therapy. Combinations of basic drugs are selected in order to potentiate the clinical effect without a significant increase in the risk of side effects. The combination of methotrexate, sulfasalazine, and hydroxychloroquine has been best studied. Combinations of methotrexate with leflunomide, methotrexate with infliximab are recognized as successful.
Symmetry is an important feature of RA Morning stiffness lasting more than 1 hour Characteristically symmetrical lesions of the proximal interphalangeal, metacarpophalangeal, radiocarpal, metatarsophalangeal joints, as well as other joints neck "(overextension in the proximal interphalangeal joints)," hands with a lorgnette "(with mutilating	*) post-infectious and reactive arthropathy (​	Non-steroidal anti-inflammatory drugs ("Movalis", "Diclofenac" - in tablets and in the form of injections) continue to be prescribed for the diagnosis of "arthritis", since these medications have a pronounced anti-inflammatory effect and contribute to an overall improvement in the patient's condition.
Seronegative clinical and immunological variant of RA.	Radiography, MRI	​»​
All children with early onset polyarticular seronegative juvenile arthritis have a poor prognosis. Adolescents with seropositive polyarthritis have a high risk of developing severe destructive arthritis, disability due to the state of the musculoskeletal system.	Of no small importance in the diagnosis are clinical symptoms (the presence of a rash around the joint, stiffness, prolonged arthritis, temperature lability, concomitant damage to the eyes, damage to the lymph nodes). A pediatric rheumatologist conducts a medical examination of a child. You may need to consult an ophthalmologist. In the course of a laboratory study, a decrease in the level of hemoglobin in the blood (anemia), the presence of rheumatoid factor, and antinuclear antibodies can be detected. Rheumatoid factor is not always found in the blood. This is observed in the seronegative variant of arthritis in children and adolescents.	Form with limited visceritis.
An important point in the preventive measures associated with reactive arthritis is to prevent infection of the bone tissue. To do this, you must adhere to the elementary rules of personal hygiene. Avoid getting intestinal infections into the body, wash hands before eating and after going to the toilet, use individual cutlery. Pay attention to the need for a heat treatment process for food before consumption.​	Non-drug therapy.	arthritis
M03	However, it has been reliably established that non-steroidal anti-inflammatory drugs do not have a significant effect on the course of an autoimmune disease - both x-ray data and laboratory studies confirm this. However, a nonspecific process responds well to treatment with NSAIDs.	500 mg / day with a gradual increase in dose to 2-3 g per day.
Treatment	When a differential diagnosis is made between arthrosis and arthritis, usually in the initial stages of pathologies.	40% of patients with early-onset oligoarthritis develop destructive symmetrical polyarthritis. In patients with a late onset, the disease can transform into ankylosing spondylitis. In 15% of patients with uveitis, blindness may develop.
An obligatory research method for suspected rheumatoid arthritis in children is an X-ray examination or MRI. The main radiological signs of the disease are the following: narrowing of the joint space of one or more joints, ankylosis, osteoporosis, the presence of bone erosions, changes in the cervical spine, the presence of uzura, cartilage destruction. Usurs are marginal defects in the bone area.	The progression of the disease can be slow, moderate or fast. Still's syndrome is a type of articular-visceral form of arthritis. Oligoarthritis is of two types. The first type is very common. It accounts for about 40% of all cases of juvenile arthritis. Most often, this form of the disease develops in girls who are not yet 4 years old. It is important that rheumatoid factor is not always found in the blood of children with arthritis in the course of a laboratory study. We are talking about seronegative juvenile arthritis.	The use of a condom during sexual intercourse will protect against urinary tract infections. Having a regular sexual partner will reduce the risk of the disease. All of the above methods will contribute to the prevention of the disease.
​In complex treatment severe forms of RA that are resistant to other types of treatment, plasmapheresis and immunoadsorption using protein A of staphylococcus are used.	​) Rheumatoid foot: fibular deviation, hallux valgus deformity of the first finger, soreness of the heads of the metatarsophalangeal joints Rheumatoid knee joint: Baker's cyst, flexion and valgus deformities Cervical spine: subluxations of the atlanto-axial joint Cricoarytenoid joint: coarsening of the voice, dysphagia. 3.​	​. -*)​
Massage, exercise therapy, mud therapy - all these techniques are applicable only if the rheumatologist has established that the inflammatory process is localized by drug therapy, and the stage of remission has begun. Special exercises and therapeutic massage are aimed at restoring the mobility of the knee joint.​	Stabilization of lysosomal membranes, inhibition of phagocytosis and neutrophil chemotaxis, inhibition of cytokine synthesis.	Comprehensive (hospital + outpatient + sanatorium)
Table of differential diagnosis of arthritis of the knee	An increase in the level of C-reactive protein, IgA, IgM, IgG is a reliable sign of an unfavorable prognosis for the development of joint destruction and secondary amyloidosis.	Depending on the X-ray data, the stage of rheumatoid arthritis is determined. According to the classification, stage 1 is characterized by the presence of epiphyseal osteoporosis. At stage 2, osteoporosis is supplemented by a narrowing of the joint space and single uzura. Stage 3 of the disease is characterized by damage not only to bone, but also to cartilage tissue. In addition, subluxations and multiple marginal defects are observed. Stage 4 arthritis is the most severe. In this stage, the destruction of cartilage and bone occurs. Ankylosis develops. Conservative therapy at stage 4 of the disease is ineffective. The most radical method of treatment is surgical intervention.
The symptoms of JRA are varied. The disease can be acute or subacute. The acute course is more typical for children of preschool and primary school age. In the absence of therapy, the prognosis is poor. The main symptoms in this case will be:	It is easier to prevent a disease than to treat it. If the first signs of the disease appear, you should consult a doctor as soon as possible.	Synovectomy is rarely used due to the wide possibilities of active medicinal effects on synovitis. Prosthetics of the hip and knee joints are used, surgery deformities of the hands and feet.
Periarticular tissue injury	M01.0	When performing rotational movements, pain may occur, but this is quite normal, since the tissue has lost elasticity during the progression of the disease. All workouts and massage sessions should be under the supervision of a doctor - this will help to avoid accidental injuries that occur when physical effort or stress is exceeded.​
Gold preparations (tauredon)	Comprehensive (hospital + outpatient + sanatorium	Feature

Diagnosis of arthritis of the knee

Mortality in juvenile arthritis is low. Most deaths are associated with the development of amyloidosis or infectious complications in patients with a systemic variant of juvenile rheumatoid arthritis, often resulting from long-term glucocorticoid therapy. In secondary amyloidosis, the prognosis is determined by the possibility and success of treating the underlying disease.

Treatment is carried out only after diagnosis. It is required to exclude such diseases as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, Reiter's syndrome, systemic lupus erythematosus, tumor, ankylosing spondylitis. In the presence of rheumatic diseases in children, treatment should be comprehensive.

involvement in the process of joints;

The 10th international classification of diseases (ICD 10) lists varieties of pathologies of the joints and connective tissues under the codes M05 (seropositive), M06 (seronegative) and M08 (juvenile) rheumatoid arthritis. Rheumatoid polyarthritis is classified, which in the ICD is under the M13.0 code, like other arthritis, depending on the presence of rheumatoid factor in the blood.

Long-term outpatient observation.

Tendosynovitis in the area of ​​the wrist joint and hand Bursitis, especially in the area of ​​the elbow joint Damage to the ligamentous apparatus with the development of hypermobility and deformities Muscle damage: muscle atrophy, myopathies, more often medicinal (steroid, as well as against the background of taking penicillamine or aminoquinoline derivatives). 4.​

* Meningococcal arthritis (​

Balneological therapy is a very effective procedure in a comprehensive program for the treatment of arthritis of the knee joint. However, this direction of rehabilitation is indicated for those patients who do not have serious diseases of the cardiovascular system, malignant neoplasms, and have not previously had heart attacks or strokes. All procedures using therapeutic biological components are prescribed with great care.​

Inhibition of the functional activity of macrophages and neutrophils, inhibition of the production of immunoglobulins and RF.

Medical treatment

Arthritis

Treatment

Due to the fact that the etiology of juvenile rheumatoid arthritis is unknown, primary prevention is not carried out.

Treatment of juvenile rheumatoid arthritis includes restriction of motor activity, avoidance of insolation, use of NSAIDs to eliminate pain and inflammation, immunosuppressants, exercise therapy, physiotherapy.

• a slight increase in body temperature;
• Polyarthritis is understood as systemic multiple lesions of the joints, in which not only almost all types of joints become inflamed and destroyed, simultaneously or sequentially, but also other organ systems. Sometimes the result of a neglected form of polyarthritis can be disability. Rheumatoid polyarthritis can act as an independent disease as an infectious-nonspecific rheumatoid arthritis, and sometimes it is a consequence of other diseases - sepsis, gout, rheumatism. Even those who have bad teeth should be wary of the disease, but the word "dentistry" is unacceptable in the lexicon.
• Observation is carried out jointly with a specialist - a rheumatologist and a district (family) doctor. The competence of a rheumatologist includes making a diagnosis, choosing a treatment strategy, teaching the patient the correct regimen, and conducting intra-articular manipulations. General practitioners are responsible for organizing the systematic management of the patient; they also carry out clinical monitoring. During each visit, the patient is assessed: the severity of pain in the joints on a 100-point scale, the duration of morning stiffness in minutes, the duration of malaise, the number of swollen and painful joints, functional activity.
• Systemic manifestations
• A39.8

Since there are many varieties of arthritis and joint pathologies, it is necessary to consult a doctor at the first signs of the disease. The sooner the causes of the inflammatory process are determined, the more likely it is to cure the disease completely.

Predominantly articular form of RA, regardless of disease activity.	Antibiotics (purulent, reactive arthritis), NSAIDs, corticosteroids, cytostatics, vitamin preparations, corticosteroid blockade	Arthrosis	Arthritis is an inflammatory disease of the joints. According to statistics, every hundredth person in our country has arthritis.​	Symptomatic drugs (painkillers from the NSAID group and glucocorticoids) are prescribed during an exacerbation of arthritis. Of the NSAIDs, Indomethacin, Diclofenac, Nimesulide, Naproxen are most often used. Of the glucocorticoids - "Betamethasone" and "Prednisolone". The group of basic drugs in the treatment of rheumatoid arthritis includes: Methotrexate, Sulfasalazine, Cyclosporine, Hydroxychloroquine. Treatment with these drugs can last for years.
the appearance of a rash on the body;	Like any arthritis, polyarthritis occurs against the background of infectious diseases (tonsillitis, viral hepatitis, gonorrhea), joint injuries, allergic reactions and metabolism. Depending on this, there are several types of polyarthritis: metabolic (crystalline), infectious, post-traumatic and rheumatoid (systemic). Until now, it has not been possible to accurately establish the causes of the disease, the result of which can even be disability. Sometimes the disease develops at lightning speed, that is, many groups of joints are affected at the same time, but in most cases, rheumatoid arthritis disease affects the joints gradually.	Periodically (at least 1 r / year) evaluate: the dynamics of mobility, instability, deformity of the ESR and CRP joints, X-ray dynamics, bone densitometry (if possible).	Rheumatoid nodules are dense subcutaneous formations, typically localized in areas that are often traumatized (for example, in the region of the olecranon, on the extensor surface of the forearm). Very rarely found in internal organs (for example, in the lungs). Observed in 20–50% of patients Ulcers on the skin of the legs Eye damage: scleritis, episcleritis; with Sjögren's syndrome - dry keratoconjunctivitis Heart damage: dry, rarely effusion, pericarditis, vasculitis, valvulitis, amyloidosis. Patients with RA are prone to early development of atherosclerosis Lung damage: interstitial pulmonary fibrosis, pleurisy, Kaplan's syndrome (rheumatoid nodules in the lungs in miners), pulmonary vasculitis, bronchiolitis obliterans Renal damage: clinically mild mesangial or (less often) membranous glomerulonephritis, renal amyloidosis Neuropathy: compression (carpal tunnel syndrome), sensory-motor neuropathy, multiple mononeuritis (as part of rheumatoid vasculitis), cervical myelopathy (rarely) against the background of subluxation of the atlanto-occipital joint Vasculitis: digital arteritis with the development of gangrene of the fingers, microinfarcts in the nail bed Anemia due to a slowdown in iron metabolism in the body caused by dysfunction of the reticuloendothelial system; thrombocytopenia Sjögren's syndrome - autoimmune exocrinopathy, clinical manifestations: keratoconjunctivitis sicca, xerostomia Osteoporosis (more pronounced during GC therapy) Amyloidosis Felty's syndrome: symptom complex, including neutropenia, splenomegaly, systemic manifestations, often leads to the development of non-Hodgkin's lymphoma Still's syndrome Major criteria: fever 39 ° C or more for one or more weeks; arthralgia 2 weeks or more; macular or maculopapular salmon-colored rash that appears during a fever; blood leukocytosis > 10 109/l, granulocyte count > 80% Minor criteria: sore throat, lymphadenopathy, or splenomegaly; increased levels of serum transaminases, not associated with drug toxicity or allergies; absence of RF, absence of antinuclear antibodies (ANAT).​	​+)​
In no case do not try to draw up a therapy regimen on your own, especially taking medications. This is not only inefficient, but also dangerous. Medical techniques used in recent years in the treatment of arthritis of various etiologies are highly effective, which is a strong argument for using the methods of treatment offered by official medicine.​	Tauredon - 10, 20 mg / day,	Symptomatic therapy, chondroprotectors, blockade with corticosteroids	Etiology	The reasons for the development of such a serious pathological process with its complications can be various factors, among which scientists consider the main catalyst to be a genetic predisposition (this primarily concerns women).
These medicines are prescribed for a long course. With their help, it is possible to achieve a long-term remission, improve the prognosis for health, slow down the process of destruction of bone and cartilage tissue. These are drugs of pathogenetic therapy. Treatment involves massage, diet, and additional vitamin intake. The diet should include foods containing vitamins and minerals (calcium, phosphorus). Of the physiotherapeutic methods, UVI, phonophoresis, and laser therapy are used. If contractures develop, skeletal traction may be required.​	lymphadenopathy;	The very first symptom that should not be ignored is morning stiffness of the joints lasting more than 20 minutes.	​Among other parameters that characterize the effect of treatment, an important overall assessment of activity according to the doctor is an overall assessment of activity according to the patient's functional status (standardized questionnaires).​ Anemia, an increase in ESR, an increase in CRP levels correlate with RA activity Synovial fluid is turbid, with low viscosity, leukocytosis is above 6000 / μl, neutrophilia (25-90%) RF (AT to IgG class IgM) is positive in 70-90% of cases ANAT, AT to Ro / La OAM (proteinuria as part of the nephrotic syndrome caused by amyloidosis of the kidneys or drug-derived glomerulonephritis) are detected in Sjögren's syndrome. An increase in creatinine, blood serum urea (assessment of renal function, a necessary stage in the selection and control of treatment).	Treatment
​Sources:​	auranofin - 6 mg / day, maintenance dose - 3 mg / day.	Exercise therapy, sanatorium, physiotherapy, massage	Inflammation	The second factor is injuries associated with excessive stress on the joints. In third place is hypothermia. In addition, arthritis can develop as a complication after a sore throat, or a viral infection. Especially often this phenomenon is observed in childhood.
In the later stages of the disease, with the development of ankylosis, arthroplasty (replacement of the joint with an artificial one) can be performed. Thus, juvenile rheumatoid arthritis is an incurable disease and, in the absence of pathogenetic therapy, can lead to disability.​	An increase in the size of the liver or spleen.	Then your knees, elbows or hands begin to react to changing weather conditions, especially in the direction of their deterioration. Swelling, mild morning pain and increased skin temperature at the site of the affected joint mean that a specialized clinic is waiting for you immediately, because the success of rehabilitation depends on how early the disease is diagnosed.​	The frequency of laboratory monitoring depends on the nature of the drugs used (see above).	​X-ray examination of the joints Early signs: osteoporosis, cystic enlightenment of the periarticular parts of the bone. Erosions of the articular surfaces are formed earlier in the area of ​​the heads of the metacarpophalangeal and metatarsophalangeal joints Late signs: narrowing of the joint spaces, ankylosis Regional features: subluxations of the atlanto-axial joint, protrusion of the femoral head into the acetabulum.
Rheumatoid arthritis	​Rheumatology: a national guide Ed. E.L. Nasonova, V.A. Nasonova.​	Skin rash, stomatitis, peripheral edema, proteinuria, myelosuppression.	Shown during remission	Degenerative changes in the joint
Arthritis affects all joints, but the most vulnerable are the hip area and knees, small joints of the hands, less often - elbows, ankles. If left untreated, articular deformity and immobility inevitably develop.	Juvenile rheumatoid arthritis (JRA) is arthritis of an unknown cause, lasting more than 6 weeks, developing in children under the age of 16 years with the exclusion of other joint pathology.	In the acute course of the disease, bilateral joint damage is observed. The knee, elbow, and hip joints are more susceptible to inflammation. An acute onset is observed in the presence of a systemic and generalized type of arthritis.	Any arthritis, including rheumatoid arthritis, will necessarily lead to constant aching pain, especially at night, in the morning, sometimes there is an increase in body temperature. But the most pronounced factor is the joints and muscle atrophy around them. Rheumatic pain during periods of exacerbation is not treatable, and therefore, at least twice a year, the patient is expected by the hospital. During this period, appetite and body weight may decrease. Against the background of all the changes, depression often occurs, which only aggravates the condition. Symptoms of lesions of different joints may differ visually, but a complete examination gives an accurate picture of the course of the disease.	Criteria for the effectiveness of treatment.
Criteria for the diagnosis of rheumatoid	(RA) is an inflammatory rheumatic disease of unknown etiology characterized by symmetrical chronic erosive	Rheumatoid arthritis E. N. Dormidontov, N. I. Korshunov, B. N. Friesen.	D-penicillamine (150 and 300 mg capsules); cuprenil (250 mg tablets)	Shown

​Age group​

The disease is not limited by age, but middle-aged women are diagnosed with this diagnosis somewhat more often than the representatives of the stronger half. An exception is infectious reactive arthritis, which is diagnosed mainly in men aged 20-40 years (more than 85% of patients with reactive arthritis are carriers of the HLA-B27 antigen).

Depending on the type of classification, the disease has the following names: juvenile arthritis (ICD-10), juvenile idiopathic arthritis (ILAR), juvenile chronic arthritis (EULAR), juvenile rheumatoid arthritis (ACR).

Often, the joints in the cervical spine are involved in the process. Articular syndrome is characterized by:

New methods

This disease is difficult to treat. The only thing that patients can hope for is a long-term remission, when the hospital does not become a second home. In the early stages, this can often be achieved, but in most cases, the symptoms recur and even worsen.

​Assess and infer rate of improvement (20%, 50%, 70%) using scores swollen joint scores tender joint scores of at least 3 out of 5 scores overall activity score according to the patient overall activity score according to the clinician patient score pain acute phase blood counts (ESR, CRP) disability (quantified using standardized questionnaires).​

arthritis

arthritis

Arthritis and movement. Gordon N.F.​

Rehabilitation programs

Suppression of collagen synthesis, inhibition of the activity of type I T-helpers and B-lymphocytes, destruction of the CEC

Arthritis of the knee joint can be diagnosed at home if you carefully examine the symptoms of the disease. Regardless of the etiology, symptoms such as swelling, redness in the joint area, general malaise, external signs of deformation of the articular tissue appear.

​Unlimited (any age)​

It is worth dwelling in more detail on rheumatoid arthritis (RA), which is an autoimmune disease with an unclear etiology. The disease is a common pathology - about 1% of the population suffers. Very rarely there are cases of self-healing, in 75% of patients there is a stable remission; in 2% of patients, the disease leads to disability.​

M08. Juvenile arthritis.

Stiffness in the morning lasting up to 1 hour or more;

1. The goal of therapy for rheumatoid arthritis is to reduce rheumatic pain, reduce inflammation, improve joint mobility and prevent complete immobility of the patient. The basic principles that guide any clinic that treats rheumatoid arthritis are complexity and consistency. Well-proven spa treatment through therapeutic mud.
2. Rehabilitation.
3. American Rheumatological Association (1987)

SpinaZdorov.ru

ICD 10. Class XIII (M00-M25) | Medical practice - modern medicine of diseases, their diagnosis, etiology, pathogenesis and methods of treatment of diseases

Peripheral joints and systemic inflammatory lesions of internal organs.

2 Shoulder Humerus Elbow Bone

High clinical and laboratory activity of RA

However, one should not wonder how to treat arthritis of the knee joint on their own, especially using dubious recipes of folk medicine. This can lead to irreversible consequences. The decision on how to treat knee arthritis is made only after a comprehensive examination.​

Usually older than 50-60 years old

With this disease, the inner surface of the joints (cartilage, ligaments, bones) is destroyed and replaced by scar tissue. The rate of development of rheumatoid arthritis is not the same - from several months to several years. Features of the clinical picture of one or another type of inflammation of the joints make it possible to suspect the disease and prescribe the necessary examinations to confirm the diagnosis. In accordance with ICD-10, RA is classified as seropositive (code M05), seronegative (code M06), juvenile (code MO8)

M08.0. Juvenile (juvenile) rheumatoid arthritis (seropositive or seronegative).​

swelling in the joint area;

The first stage is the suppression of the autoimmune process, which actually leads to the destruction of tissues, pain, loss of the ability to move. This is followed by anti-inflammatory treatment, complete cleansing of the body from toxic metabolic products. During the period of remission, they restore blood circulation, increase the efficiency of joints, and normalize metabolism. All these stages combine both medical and physiotherapeutic methods of treatment.​

INFECTIOUS ARTHROPATHY (M00-M03)

Physical therapy plays an important role. Sanatorium - resort treatment is recommended during the period of minimal activity or remission. In order to correct deformities, orthoses are used - individual orthopedic devices made of thermoplastic, worn at night. ​At least 4 of the following Morning stiffness > 1 hour ​ Code according to the international classification of diseases ICD-10: 3 Forearm, radius, wrist joint - bone, ulna Initial dose of 250 mg / day with a gradual increase to 500-1000 mg / day; maintenance dose - 150-250 mg / day

M00 Pyogenic arthritis

Physicians must determine the nature of the disease in order to prescribe adequate treatment. Orthopedic traumatologists, surgeons, rheumatologists give directions for laboratory and instrumental studies. The treatment regimen is developed by a specialized specialist (it can be a phthisiatrician, dermatologist-venereologist, cardiologist and other doctors). Some types of arthritis affect only children and adolescents, so they should be singled out in a separate row. M08.1. Juvenile (juvenile) ankydotic spondylitis.​ soreness; The basic treatment is the suppression of the autoimmune process through such drugs: methotrexate, sulfasalazine and leflunomide. In terms of minimizing side effects, the latter differs, this should be taken into account from the position that they all require long-term (at least six months) use. Features in pregnant women Arthritis ​M06-​ 4 Hand Wrist, Joints between these fingers, bones, metacarpus Skin rash, dyspepsia, cholestatic hepatitis, myelosuppression The first stage for determining the disease (according to ICD 10) is a visual examination, anamnesis. Acute or chronic Juvenile rheumatoid arthritis (ICD-10 code M08) affects children after suffering bacterial and viral infections. As a rule, one knee or other large joint becomes inflamed. The child has pain with any movement, swelling in the joint area. Children limp, hardly get up in the morning. In the absence of treatment, joint deformity gradually develops, which is no longer possible to correct.

M08.2. Juvenile (juvenile) arthritis with systemic onset.​ change in gait; Non-steroidal anti-inflammatory drugs (NSAIDs) also have an analgesic effect. But they should also be used for a long time, so the doctor must choose the one that is best tolerated by the patient. Among non-steroids, diclofenac, ibuprofen, nimesulide are widely used. All of them affect the gastrointestinal tract to a greater or lesser extent. Pregnancy improves the course of RA, however, after delivery, a relapse always occurs due to hyperprolactinemia. NSAIDs in the first trimester of pregnancy and 2 weeks before delivery are undesirable (in the first trimester - the risk of a teratogenic effect, before childbirth - the threat of developing weakness of labor, bleeding, early closure of the ductus arteriosus in the fetus). Gold salts, immunosuppressants are contraindicated for pregnant women. There is evidence of the relative safety of the use of aminoquinoline drugs and sulfasalazine, however, the expected effect should be correlated with the possible risk. 3 joints or more

Other rheumatoid arthritis 5 Pelvic Gluteal Hip joint, region and thigh region, sacroiliac, femoral joint, bone, pelvis Methotrexate (tablets 2.5 mg, ampoules 5 mg) The second stage is laboratory blood tests (with inflammation, an increase in ESR, leukocytosis, an inflammation marker CRP, and other specific reactions) are observed.

medpractik.ru

Arthritis rheumatoid, Diseases and treatment of folk and medicinal products. Description, application and healing properties of herbs, alternative medicine

Always chronic Arthritis rheumatoid: Brief description Reactive childhood arthritis (ICD-10 code MO2) manifests itself two weeks after an intestinal infection. If the process develops in the knee joint, then external signs are clearly visible: the skin turns red, swelling without pronounced boundaries is visible under the patella. The child often has a fever, which is reduced by antipyretic drugs, but pain in the knee area remains. M08.3. Juvenile (juvenile) polyarthritis (seronegative).​ Dysfunction of the affected area of ​​the body. It happens that non-steroidal drugs are not able to alleviate the suffering of the patient, so the clinic decides on the use of glucocorticosteroid (GCS) drugs - hormones that can be injected directly into the affected joint. GCS have a lot of side effects, but they are prescribed in short courses, which significantly reduces the risk. The factors of an unfavorable prognosis for RA include: seropositivity in the Russian Federation at the onset of the disease female gender young age at the time of onset of the disease systemic manifestations high ESR, significant concentrations of CRP carriage of HLA-DR4 early onset and rapid progression of erosions in the joints low social status of patients. Arthritis Working classification of rheumatoid 6 Calf Fibula Knee joint, bone, tibia Folic acid antagonist; inhibits the proliferation of T- and B-lymphocytes, the production of antibodies and pathogenic immune complexes. The third stage is radiography. In the presence of arthritis, a curvature of the articular surface, bone ankylosis is detected. Onset of the disease In addition to infectious, reactive, rheumatoid arthritis, children are often diagnosed with an allergic disease. The disease begins in a child suddenly - immediately after allergens enter the bloodstream. The joints quickly swell, there is shortness of breath, urticaria. Quincke's edema, bronchial spasm may develop. When the allergic reaction is eliminated, signs of arthritis disappear. M08.4. Pauciarticular juvenile (juvenile) arthritis. If juvenile arthritis affects the small joints of the fingers or toes, then deformity of the fingers is possible. In the articular form of arthritis, damage to the organs of vision is often observed. Iridocyclitis or uveitis develops. This may reduce visual acuity. The seronegative form of arthritis is more mild than the seropositive form. In the latter case, rheumatoid nodules are often detected in the area of ​​​​the joints. Modern medicine, which treats rheumatoid arthritis, uses new biological products that inhibit the activity of the protein. These drugs include etanercept (Enbrel), infliximab (Remicad), and adalimumab (Humira). They have much fewer side effects, and they give a positive result. Arthritis​hand joints symmetrical arthritis 7 Ankle Metatarsus, Ankle joint, tarsal joint and foot, other joints of the foot, toes RA with systemic manifestations, high RA activity, low effectiveness of other basic drugs. The fourth stage is MRI, ultrasound (assigned to differentiate arthritis from arthrosis, ankylosing spondylitis and bursitis). With erased signs that occur with a sluggish chronic process, additional hardware studies of the joint may be prescribed - tomography of the articular tissue, CT, pneumoarthrography. Acute, sudden Arthritis of the knee joint can develop as an independent disease, or be a complication after injuries and illnesses. M08.8. Other juvenile arthritis With the pathology under consideration, other important organs often suffer. With a systemic form of arthritis, there may be: Statistical data For serious complications, more radical methods treatment - hemosorption and plasmaphoresis, in which the blood is completely purified and re-introduced to the patient. The use of enterosorbents is considered a gentle method, when useful substances remain in the body, and only toxins are eliminated. Arthritis rheumatoid: Causes Etiology infectious nonspecific, genetic features arthritis Pathogenesis (1980) Form: Rheumatoid Arthritis: Signs, Symptoms Clinical picture 8 Other Head, neck, ribs, skull, torso, spine 7.5-25 mg per week orally. At the same stage, a puncture of the joint and the taking of synovial fluid for laboratory testing (if indicated, a biopsy) are shown. Gradual (develops months, years) An arthritic knee joint swells and is painful when moved. The skin in the joint area changes color (turns red or becomes "parchment"), but this is not a reliable sign of an inflammatory process. M08.9. Juvenile arthritis, unspecified exanthema; Alternative methods cannot be the only treatment when it comes to polyarthritis. It is better to use them during the remission period, as they are more gentle in terms of side effects. In visible inflammation, chamomile baths have worked well. Arthritis Rheumatoid nodules RF Radiological changes The first four criteria must exist for at least 6 weeks. Sensitivity - 91.2%, specificity - 89.3%. Rheumatoid Arthritis rheumatoid: Diagnosis Laboratory data 9 Localization, unspecified instrumental data Myelosuppression, liver damage (fibrosis), lungs (infiltrates, fibrosis), activation of foci of chronic infection. When determining the type and degree of reactive arthritis (ICD-10 code), biological material is examined (general blood and urine tests), urogenital and ophthalmological examinations are performed, a test for the presence of HLA-B27, ECG, thymol test, sial test, ALT determination, AST, inoculation of biological fluids.​ Symptoms The main cause of swelling and a visually noticeable increase in the patella is the accumulation of fluid inside the joint. Excessive pressure on the walls of the articular tissue causes severe pain. The volume of fluid steadily increases over time, so the pain syndrome becomes more intense. Juvenile rheumatoid arthritis is one of the most common and most disabling rheumatic diseases that occurs in children. The incidence of juvenile rheumatoid arthritis ranges from 2 to 16 per 100,000 children under 16 years of age. The prevalence of juvenile rheumatoid arthritis in different countries is from 0.05 to 0.6%. Girls are more likely to get rheumatoid arthritis. Mortality is 0.5-1%.​ damage to the kidneys by the type of glomerulonephritis; Orally take infusions of birch buds, tricolor violet, nettle, hernia. They also use the collection of herbs, which includes wild rosemary, chamomile, string, lingonberries, juniper (berries). This collection of half a glass three times a day before meals is very effective in exchange polyarthritis. early stages of RA, active therapy (NSAIDs at an adequate dose + basic drugs) should be started within the first 3 months after the diagnosis of definite RA. This is especially important in patients with risk factors for an unfavorable prognosis, which include high RF titers, a pronounced increase in ESR, damage to more than 20 joints, the presence of extra-articular manifestations (rheumatoid nodules, Sjogren's syndrome, episcleritis and scleritis, interstitial lung disease, pericarditis, systemic vasculitis). , Felty's syndrome). The use of GC is indicated in patients who do not "respond" to NSAIDs or have contraindications to their appointment in an adequate dose, and also as a temporary measure before the onset of the effect of basic drugs. Intra-articular administration of HA is intended for the treatment of synovitis in 1 or several joints, which complements, but does not replace, complex treatment.​ arthritis Disorders predominantly affecting peripheral joints (limbs) Arthritis rheumatoid: Methods of treatment Treatment General tactics Azathioprine, Imuran (tablets 50 mg) Mode The treatment of reactive arthritis, in accordance with the ICD-10, is carried out in two directions - this is therapy using antibacterial agents and the elimination of the articular syndrome (pain, stiffness). Usually pronounced In addition, uric acid crystals, which look like thin needle-shaped spikes, are deposited in the joint. They injure small vessels, which is the basis for the development of associated infections. In adolescents, there is a very unfavorable situation for rheumatoid arthritis, its prevalence is 116.4 per 100,000 (in children under 14 years old - 45.8 per 100,000), primary incidence - 28.3 per 100,000 (in children under 14 years old - 12.6 per 100,000).​ pericarditis; During the period of remission, pepper rubs with kerosene are also used. Such procedures not only relieve pain and inflammation, but also penetrate the blood, partially cleansing it. Both in the hospital and at home, cold treatment can be applied. In the hospital, cryosaunas are used - special cabins with chilled air, which are replaced at home with ice packs. After the procedure, which lasts about 10 minutes, the joints are massaged and kneaded. For one procedure, cooling is performed three times. Duration of treatment - 20 days.​ ICD-10 Patients should form a movement stereotype that counteracts the development of deformities (for example, to prevent ulnar deviation, open a tap, dial a phone number and other manipulations not with the right hand, but with the left hand). Note Inhibition of the proliferative activity of T- and B-lymphocytes. Despite the leading role of radiography in the diagnosis of arthritis, we must remember that in the early stages of the disease, pathological changes are not always visible in the pictures. Arthrography is of informative value for physicians in the study of large joints, and in case of polyarthritis this diagnostic method is not effective. Serological tests are used to identify the causative agent of arthritis of an infectious nature. Manifested with changes in cartilage and bone tissue Arthritis of the knee is difficult not only because of the intense pain syndrome, but also due to disruption of the functioning of functional systems. The cardiovascular and endocrine systems are particularly affected. There is shortness of breath, tachycardia, low-grade fever, sweating, circulatory disorders in the limbs, insomnia and other non-specific signs. Three disease classifications are used: the American College of Rheumatology (ACR) classification of juvenile rheumatoid arthritis, the European League Against Rheumatism (EULAR) classification of juvenile chronic arthritis, and the International League of Rheumatological Associations (ILAR) classification of juvenile idiopathic arthritis.​ inflammation of the heart muscle; Pay special attention to diet. Healers recommend a raw-food diet, especially the widespread use of eggplant in food. In any case, rheumatoid arthritis can be curbed without letting it spoil the patient's quality of life. M05 Seropositive rheumatoid ​MEDIC TREATMENT​ arthritis RA with systemic manifestations. Treatment of arthritis is a long process and requires not only the implementation of the doctor's recommendations regarding drug therapy, but also the passage of rehabilitation courses. Pain intensity Surgery Symptoms vary depending on the degree of dysfunction, stage and etiology of the disease: Classification of juvenile chronic arthritis pleurisy; Any arthritis, put in the ICD 10 under the codes M05, M06, M08, M13.0, requires constant attention, since even a long remission will not help to avoid a spontaneous exacerbation of the disease. arthritis Non-steroidal anti-inflammatory drugs with systemic manifestations Special syndromes: Felty's syndrome, Still's syndrome in adults​This group covers arthropathy caused by microbiological agents​ 150 mg/day, maintenance dose - 50 mg/day. A diet for arthritis of the knee joint must be strictly observed. Excluded food rich in carbohydrates, smoked meats, fatty meats, legumes. With the transfer to dietary nutrition and the use of individual therapy, a positive effect is observed. In general, the treatment of arthritis of the knee joint includes the following areas: Strongly expressed from the very beginning of the disease The first degree is characterized by a moderate pain syndrome, there is a slight limitation of movement when rotating the knee, when lifting or while squatting. Forecast For the first time, juvenile rheumatoid arthritis was described at the end of the last century by two famous pediatricians: the Englishman Still and the Frenchman Shaffard. Over the following decades, this disease was referred to in the literature as Still-Chaffard disease. Synonyms Damage to the liver and spleen. Juvenile rheumatoid arthritis is common in pediatric practice. This pathology proceeds similarly to adult arthritis. The disease is typical for children under 16 years of age. It is the most frequently diagnosed disease in rheumatology. Girls suffer from arthritis 1.5-2 times more often. The disease cannot be completely cured. Treatment is also carried out throughout life. It is important that in the absence of proper therapy, juvenile arthritis can cause early disability. What is the etiology, clinic and treatment of the disease? M06 Other rheumatoid arthritis​Non-selective cyclooxygenase (COX) inhibitors Diclofenac 50 mg 2–3 r/day Diclofenac long-acting drugs 100 mg/day Retain relevance as having the lowest percentage of gastrointestinal complications: Ibuprofen 0.8 g 3– 4 r / day Naproxen 500–750 mg 2 r / day Ketoprofen 50 mg 2–3 r / day (has high analgesic activity) Derivatives of indoleacetic acid Indomethacin 25–50 mg 3 r / day day Enolic acid derivatives Piroxicam 10–20 mg 2 r/day Selective inhibitors of COX-2 Meloxicam 7.5–15 mg/day Nimesulide 0.1–0.2 g 2 r/day Celecoxib 0.1 g 2 r/day. ​ Abbreviations By seroprevalence​ ​Myelosuppression, activation of foci of chronic infection. Medications (tablets, injections, ointments, gels); Moderate at first, gradually increasing