Rheumatoid Arthritis: Signs And Causes, Treatment

Content

• Rheumatoid arthritis - causes and mechanisms of development.
• Risk factors.
• Complaints in rheumatoid arthritis.
• Extra-articular symptoms of rheumatoid arthritis.
• Diagnosis of rheumatoid arthritis.
• Treatment of rheumatoid arthritis, diet therapy and lifestyle changes.
• Nutrition for rheumatoid arthritis
• What foods should be included in the diet
• Physical activity for rheumatoid arthritis

Rheumatoid arthritis - causes and mechanisms of development

Rheumatoid arthritis is a chronic inflammatory disease of the joints of an autoimmune nature, the occurrence of which depends on many factors and leads to severe deformity of the musculoskeletal system with the development of disability.

This is the most commonly diagnosed systemic inflammation of the joints - it is very common and is considered one of the global problems of the world health system. The risk group more often includes women and the elderly of any gender, the peak incidence is observed in patients 30–50 years old. Among the reasons may be hereditary predisposition (the strongest genetic risk factor for the development of the disease is a specific peptide sequence in the major histocompatibility complex: MHCII).

It should be noted that immunological changes occur long before the first manifestation of symptoms and the development of a characteristic clinical picture. Many foreign sources even distinguish a separate phase - prerheumatoid arthritis. Moreover, inflammation, as the results of new studies show, does not begin with the joints, but with the mucous membranes of the oral cavity, with the lungs and the gastrointestinal tract.

Risk factors

Despite the complexity of fully understanding the mechanisms of development of rheumatoid arthritis, predisposing factors are reliably known:

• Smoking can increase oxidative stress in the body, triggering various morphological, physiological, biochemical and enzymatic changes that lead to impaired antibacterial defenses, cellular regulatory activity and inflammatory responses.
• The risk of developing rheumatoid arthritis, according to statistics, in men who smoke is about 2 times higher than in women - 1.3 times (compared to non-smokers).
• Pollutants released into the air during the combustion of fossil fuels and as a by-product of the chemical industry, agriculture. They are able to directly damage the alveoli - the most important part of the respiratory system, where, in fact, gas exchange occurs. Signaling molecules entering the bloodstream, produced in large quantities in response to damage, are an important factor in the destruction of cartilage tissue and the subsequent development of rheumatoid arthritis.
• Obesity, an elevated body mass index (BMI), and an enlarged waist circumference are known risk factors for the development of any autoimmune disease. This is due to the release of white adipose tissue, which can be considered as an “endocrine organ”, as well as pro-inflammatory mediators and a number of hormone-like substances, the increased production of which creates a favorable environment for the development of autoimmunity (attack of organs by their own immune cells).

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• The consumption of gluten-containing foods - gliadin and glutenin, a mixture of proteins present in wheat grains, cause changes in the immunological response.
• Recent studies show that in patients with pre-existing rheumatoid arthritis, adherence to a gluten-free diet for one year was associated with a significant reduction in specific autoantibodies (which will be discussed below) and a decrease in the aggressiveness of the course of the disease itself.
• Excessive consumption of red meat - the saturated fats and nitrites contained in it contribute to the development of inflammatory processes, and overload due to incoming iron increases oxidative damage to the cells of the synovial membrane of the joints.
• Excessive salt intake increases the harmful effects of other environmental factors, in particular smoking, causes increased production of pro-inflammatory molecules and increases auto-aggression.
• The abundance of dairy products in the diet supports systemic inflammation due to the implementation of the immune response against cow's milk proteins.
• Vitamin D deficiency, which has an immunomodulatory effect and prevents the development of autoaggression.
• Intestinal dysbacteriosis leads to an imbalance between anti-inflammatory and pro-inflammatory reactions and leads to dysregulation of immune defenses.
• Infections caused by campylobacter, chlamydia, mycoplasmas, clostridia, salmonella and a number of other bacteria can directly increase the activity of immunocompetent cells and release pro-inflammatory signaling molecules.
• Diseases of the endocrine and reproductive systems in women - early menopause, polycystic ovary syndrome, preeclampsia - are taken out as independent risk factors for the development of rheumatoid arthritis. It is known that female sex hormones may play a protective role in rheumatoid arthritis.
• Viral infections can act as a trigger for the development of autoaggression (the role of the Epstein-Barr virus and parvovirus is especially well known in this).

Rheumatoid arthritis: complaints

• pain and stiffness in several joints (and the joints of the wrist are most often affected, as well as interphalangeal and metacarpophalangeal joints);
• morning stiffness lasting more than an hour indicates the inflammatory nature of the disease;
• rapid weight loss;
• subfebrile temperature (37.1–38 ºС).

Extra-articular symptoms of rheumatoid arthritis

In rheumatoid arthritis, the joints are primarily affected: first small, then large. However, like any autoimmune disease, arthritis also manifests itself in a number of systemic reactions due to the involvement of extra-articular structures in the pathological process.

1. Skin manifestations are associated with the development of vasculitis (inflammation of the walls of blood vessels) and are manifested by rheumatoid nodules located in various areas of the body.
2. Pulmonary complications (pleural effusion, pulmonary fibrosis, interstitial lung disease and arteritis).
3. The risk of developing cardiovascular diseases (atherosclerosis, coronary arteritis, congestive heart failure, valvular disease, pericarditis) in patients with rheumatoid arthritis is 1.5–2 times higher than in people of the same age and gender from the general population. This excess risk is associated with systemic chronic inflammation, a hallmark of the disease.
4. Anemia. Inflammation leads to increased production by the liver of a specific protein - hepcidin, which inhibits not only the absorption of iron from food in the intestine, but also its release from cells into the systemic circulation. Moreover, a number of researchers argue that hepcidin may be a valuable prognostic biomarker in rheumatoid arthritis.
5. Gastrointestinal and hepatic diseases (as a rule, they are also autoimmune in nature).

Diagnosis of rheumatoid arthritis

Timely and accurate diagnosis of rheumatoid arthritis is critical for establishing a differential diagnosis, prescribing treatment, and preventing delayed complications.

Diagnostic criteria for rheumatoid arthritis:

1. Morning stiffness for one hour and longer for six weeks.
2. Swelling of three or more joints for at least six weeks.
3. Arthritis of the joints of the hand for at least six weeks.
4. Symmetric arthritis (eg, small joint involvement in both hands) for at least six weeks.
5. Rheumatoid nodules. Subcutaneous nodules on protruding areas of bones, extensor surfaces, or around joints.
6. Serum rheumatoid factor detected by any method.
7. Typical radiological changes.

The diagnosis of "Rheumatoid arthritis" is considered reliable in the presence of at least four criteria.

Since 2010, new diagnostic criteria have been used, which were proposed by the American College of Rheumatology. They include two different types of biomarkers:

• inflammation markers - C-reactive protein and ESR;
• markers of autoaggression (autoantibodies) - rheumatoid factor (RF) and antibodies to anticitrulline peptides (ACPA).

(Important note: The detection of rheumatoid factor increases with age and is found in 25% of people over 70 who do not have rheumatoid arthritis.)

In the classical version of the course, a number of features can be distinguished that are characteristic of rheumatoid arthritis and allow it to be distinguished from other pathologies of the musculoskeletal system:

• symmetrical, large and small joints are affected (with ankylosing spondylitis - only small joints, with psoriatic arthropathy - asymmetric localization of lesions);
• inflammation is more intense in rheumatoid arthritis than in osteoarthritis (a chronic disease that causes damage to cartilage and surrounding tissues);
• an increase in rheumatoid factor is associated mainly with rheumatoid arthritis (although it also occurs with Sjögren's syndrome and systemic lupus erythematosus);
• increased levels of antinuclear antibodies are more common in systemic lupus erythematosus than in rheumatoid arthritis;
• the most intense erosive changes on radiographs are found in rheumatoid arthritis.

But sometimes the differential diagnosis of rheumatoid arthritis with other inflammatory joint lesions is so difficult that it requires a biopsy.

To make an accurate diagnosis, it is also necessary to conduct instrumental diagnostic methods: ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).

Additional research methods include:

• the level of electrolytes in the blood serum;
• hepatic profile - ALT, AST, GGT, alkaline phosphatase;
• protein fractions of blood;
• creatinine and urea;
• analysis of feces for occult blood;
• general urine analysis.

Treatment of rheumatoid arthritis

Treatment of rheumatoid arthritis is designed to reduce inflammation and pain in the joints, improve their mobility, prevent the destruction of cartilage and the development of disability. Treatment regimens consist of combinations of pharmaceuticals, therapeutic exercises, physiotherapy and diet therapy.

Nutrition for rheumatoid arthritis

Drawing up a correct and personalized protocol is of great importance as one of the therapeutic strategies for the prevention and treatment of rheumatoid arthritis.

A Western diet characterized by a high intake of red meat, saturated fats, and trans fats, a low ratio of omega-3 to omega-6 fatty acids, and a high intake of refined carbohydrates is associated with an increased risk of rheumatoid arthritis, mainly due to the occurrence of inflammatory processes, impaired carbohydrate metabolism and development of obesity.

In contrast, the Mediterranean diet is often recommended for patients with chronic inflammatory conditions due to its anti-inflammatory and antioxidant effects.

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What foods should be included in the diet

1. Sources of omega-3 polyunsaturated fatty acids: salmon, herring, sardines, tuna, anchovies. Studies show that omega-3 fatty acids have a protective effect on the body of patients predisposed to rheumatoid arthritis, reduce inflammation in cartilage and relieve pain.
2. Olive oil. The use of extra virgin olive oil helps to reduce the level of pro-inflammatory molecules in the systemic circulation (thromboxane 2 and leukotriene B4).
3. Black tea has an anti-inflammatory effect (due to the content of flavonoids), reduces the level of C-reactive protein, inhibits platelet aggregation (“clumping”) and leukocyte activation.
4. Green tea. Epigallocatechin-3-gallate (EGCG), the main biologically active substance in its composition, has a protective effect demonstrated in cardiovascular, inflammatory and neurodegenerative diseases, as well as in various types of cancer. Green tea has shown the ability to reduce inflammatory responses in mice models of arthritis, so we are waiting for confirmation from human studies.
5. Fruit reduces the risk of rheumatoid arthritis by providing nutrients with antioxidant properties that act as free radical scavengers to prevent cell damage.
6. Turmeric is a source of the pigment curcumin, which has a pronounced antioxidant and anti-inflammatory effect.
7. Soy is a source of genistein, an isoflavonoid that has antioxidant activity and suppresses the immune system by reducing the number of T cells. So, in a number of scientific works it was demonstrated that genistein has a beneficial effect on the course of rheumatoid arthritis.
8. Grapes, blueberries, raspberries, mulberries are rich in polyphenols such as resveratrol. It not only has antioxidant properties, but also significantly improves the course of arthritis in rats.
9. Cod liver contains vitamin D, which has a hormone-like effect and a pronounced immunomodulatory effect (in particular, it suppresses pro-inflammatory Th1 and Th17 cells and stimulates regulatory T cells, thereby preventing the development of autoaggression).
10. Foods rich in iron: organ meats, lentils, buckwheat, peas, chicken eggs, tofu, spinach. Iron plays an important role in maintaining normal immune function, and iron deficiency and anemia can disrupt the immune balance. Doctors emphasize: correction of anemia significantly improves physical activity and quality of life in patients with rheumatic diseases.

Physical activity for rheumatoid arthritis

The immune system quickly and actively responds to human physical activity. Mobilization of immune cells during exercise is due to many factors, including increased contractility of the heart, hormone production, changes in body temperature and the level of signaling molecules. Exercise promotes the recycling of protective antibodies and the production of anti-inflammatory cytokines.

1. Therapeutic exercise: dynamic exercises, stretching, aerobic exercise, swimming and routine daily activities. All this increases muscle endurance and improves the functions of the patient as a whole. Despite evidence of beneficial effects of physical activity on overall health and well-being, there are numerous barriers to the low level of physical activity in patients with arthritis: joint damage, pain, stiffness, and fatigue.
2. Massage improves flexibility, general well-being, helps relieve swelling from inflamed joints. In the treatment of rheumatoid arthritis, physiotherapeutic methods are also widely used: thermotherapy can be applied in the form of superficial hot compresses, infrared radiation and hydrotherapy. With the help of heat, anesthesia occurs, muscle spasm is relieved and elasticity of the periarticular structures is achieved; electrical stimulation is used in the treatment of patients with rheumatoid arthritis to relieve pain.

Thus, rheumatoid arthritis, being a complex and multifactorial disease, requires an integrated approach to treatment and preventive action. In this case, the main attention should be paid to the correction of nutrition, lifestyle changes and physical activity.