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Treatment of rheumatoid arthritis

Rheumatoid arthritis is a serious illness, to struggle with which man has from the moment of diagnosis the rest of your life.

Treatment is complex and involves a number of drugs and techniques:

Let's start our conversation with basic therapy, as it is, as the name implies, is the basis of treatment of rheumatoid arthritis and have to deal with each patient in this serious disease.


Basic therapy of rheumatoid arthritis

Why the title appears the word "basic"? Not primarily because it is the main method of treatment, but because the drugs of this group affect the very essence of rheumatoid arthritis, that is his "basis". They do not cause alleviate health after a few days or even weeks after starting. These drugs provide a pronounced effect not sooner than a few months, and take them in the hope to slow the disease, but better – to drive RA in complete remission.

The long wait for results – not the only disadvantage of the basic treatment. Each of the constituent drugs in its effective. But the reaction of different patients different ways, therefore when planning the treatment of a rheumatologist is necessary to rely not only on health statistics. The need to include their medical intuition and evaluate each patient as an individual.

Modern basic therapy includes drugs five groups:

Let us consider in detail the pros and cons of each of the five basic components of therapy and try to figure out how to achieve the best efficiency and good tolerability in the treatment of rheumatoid arthritis.


Eurotherapy: treatment of gold

Beautiful word "eurotherapy" call receiving gold salts inside with curative intent. This techniquevery old – she's known since 1929, and for the treatment of patients with rheumatoid arthritis use for almost 75 years. By the way, until about the beginning of the 21st century it is the preparations of gold were the basis of basic therapy of rheumatoid arthritis, but other, more effective and safe means (especially methotrexate), aerotherapy faded into the background. However, aerotherapy not have surrendered at all, because there are patients having that same methotrexate is simply not helping.

To begin reception of preparations of gold better at the very early stage of RA. They are most effective in the treatment of acute, rapidly developing disease with severe pain and early degenerative changes in the joints. To appoint preparations of gold should be especially if the patient does not bring relief NSAIDs.

Another reason for the immediate commencement of aerotherapy can be called early appearance on x-ray bone erosions (uzur) and detection in the patient's blood titers of RF. In other words, the preparations of gold are almost always highly effective in the treatment of seropositive RA, but almost useless in the treatment of seronegative RA.

Benefits of gold preparations

Gold salts if taken for a long period of time inhibits the formation uzur and cysts in the joints in patients with seropositive rheumatoid arthritis. Particular success include cases where eurotherapy improves the General condition of the bone tissue, increases salinity levels, and sometimes even heals of an already existing bone Uzury in the small joints of the patient (hands, feet).

Gold drugs clearly recommended in patients with severe complications on the background of the RA: with Felty and Sjogren syndrome. They do not eliminate the so-called "dry syndrome", but greatly reduce its unpleasant symptoms. Also eurotherapy always prescribed for children and adolescents seropositive rheumatoid arthritis, since gold drugs able to inhibit the development of the disease.

Perhaps the main advantage of aerotherapy before the methotrexate is that gold drugs can be taken even when related inflammatory diseases and malignant tumors. In addition, in clinical trials it was found that gold salts inhibit the growth of fungi and some bacteria, including Helicobacter culprits of gastritis and peptic ulcer disease.

The effectiveness of aerotherapy in rheumatoid arthritis

Statistics show that eurotherapy effective in roughly 75% of cases of seropositive rheumatoid arthritis. Soon it becomes clear only after 2-3 months after the beginning of reception of preparations of gold. If even after 4-5 months of no progressthere, so eurotherapy not approached the patient, and its time to cancel. Well, a pronounced and persistent positive effects of this group of drugs is usually observed about a year after the start of therapy.

Over the years the use of autotherapy in the practice of the treatment of rheumatoid arthritis, the doctors found some gold, pardon the tautology, the rule is that the course must be finished when the total received sick in the course of treatment the amount of gold reaches the value of 1 gram. At this point, all possible benefit from eurotherapy be extracted, and to continue her nothing.

However, many patients some time after the end of treatment gold develop severe recurrent disease. And then there is the issue of re-appointment of preparations of gold. But, alas, all subsequent "gold attack" for rheumatoid arthritis end up in total surrender. If we are receiving gold salts is started, it should not be interrupted as long as possible. That is why modern surgeons put their patients on eurotherapy for years, if it does not entail serious complications.

Complications and side effects of drugs gold

Side effects during the supplementation of gold in varying degrees occur in almost one third of the patients. But curiously, as soon as eurotherapy gives complications it brings and the long-awaited effect: the state of the joints of the patient, finally, is significantly improved. After the abolition of the gold preparations side-effects come to naught the progress made in treatment is maintained, so even the likelihood of complications is not seen as a compelling reason for the failure of aerotherapy.

Often receiving gold salts is complicated by the so-called "gold dermatitis". It's a skin rash of small pink spots and blisters filled with clear fluid. Affected dermatitis region highly itchy. All these unpleasant symptoms usually disappear in 3-7 days after cessation of treatment gold. But sometimes itchy rash bothers the patient for months and even antihistamines do not bring relief.

Gold dermatitis is exacerbated by ultraviolet radiation, so if the patient developed this complication, it is contraindicated to be long in the sun. In severe cases of dermatitis, skin brown, and she a rash of bluish. This glittery gold, coming out through the skin. In medical practice there were even episodes of necrosis of small areas of the skin in patients that had not canceled eurotherapy. The patient should be carefully observed in orderto diagnose dermatitis gold and not to confuse it with the banal eczema or ringworm.

On the second place on the frequency of complications on the background of aerotherapy are various inflammatory processes in the mucous membranes: mouth, eyes, vagina, throat and intestines. In third place – non-infectious hepatitis and jaundiced skin. All these problems are solved very quickly by eliminating eurotherapy and the appointment of prednisolone.

But there are really terrible side effect – the "Golden nephropathy". This complication can lead to complete kidney failure. Therefore, the preparations of gold do not include in the basic therapy of rheumatoid arthritis, if the patient in the urine were found red blood cells and protein. Accordingly, if the bad tests obtained during treatment with gold preparations, and it is urgently stopped.

Precautions when eurotherapy

Complications and side effects against the background of aerotherapy or manifest almost immediately (2-3 months) or do not occur in the patient at all, although, of course, there are exceptions. The attending physician is closely monitoring his patient at the initial stage of gold therapy: examines the skin, throat and eyes, regularly takes blood and urine tests (at least once a month). If a rash, mouth sores, red blood cells and protein in the urine – products of gold cancel. Bad blood (reduction in the number of erythrocytes, thrombocytes, hemoglobin, neutrophils) also serves as a reason for the cancellation of aerotherapy.

Why, with such an impressive list of possible complications preparations of gold are still relevant? First of all, because their efficiency is higher on average than other components of the basic treatment of RA. In addition, eurotherapy is a proven method that was tested for years on thousands of patients. From the well forgotten old is always difficult to give up in favor of not familiar new.


Cytotoxic agents: drugs that suppress the immune system

The shorter word "drugs" is usually called drugs from the group of immunosuppressants (Remicade, arava, methotrexate, cyclosporine, azathioprine, cyclophosphamide and many others). All of these drugs inhibit cellular activity, including the activity of the immune cells. As you know, rheumatoid arthritis is an autoimmune nature, it is not surprising that he is being treated with cytostatics. And the method was adopted from the rheumatologists oncologists who are struggling withcytostatics with another terrible threat – cancer.

What cytotoxic agents, primarily methotrexate, he pushed a gold with leadership positions in the treatment of RA. Immunosuppressants treated successfully not only rheumatoid, but also psoriatic arthritis. Drugs in this group currently form the basis of the basic treatment of RA. This fact often scares patients because it is almost completely deprived of immunity is terrible. But keep in mind that in rheumatology are used much smaller doses of drugs than in cancer, so the fear of such terrible side-effects, which are observed in cancer patients, it is not necessary.

The advantages and disadvantages of immunosuppressive drugs

The first advantage of cytostatics is their high efficiency at relatively low dosage. Patients of rheumatoid arthritis administered in 5-20 times smaller dose of immunosuppressants than patients with cancer, but almost 80% of cases this is sufficient to achieve excellent therapeutic effect. Best of all cytotoxic agents have proven themselves in the treatment of severe forms of rheumatoid arthritis with a high rate of disease progression.

The second undeniable advantage of receiving cytostatic drugs – low frequency and small severity of side effects. Only a fifth of patients complaining of unpleasant symptoms:

  • Skin rash;

  • Loose stools or constipation;

  • Difficulty urinating;
  • The feeling on the skin "run creepy".

As soon as the drugs cancel or adjust the dosage, these side effects disappear by themselves. For prevention once a month the patient take blood and urine tests to spot the problem. Possible failures in the functioning of the kidneys, liver and blood oppression. But usually the drugs well tolerated, and a month after the start of therapy visible improvement of the patient with rheumatoid arthritis.

For the treatment of rheumatoid arthritis, modern rheumatology use three immunosuppressant: methotrexate, arava and Remicade. Let's look at the advantages and disadvantages of each of the drugs.

Methotrexate

We have already several times mentioned methotrexate, it is not surprising, because this cytostatic is a recognized leader in basic therapy of RA. Make it very comfortable: once a week the patient should drink one capsule at a dosage of 10 mg. is Usually the doctor and the patient agree on what day of the week they have now for many months "methotrexate". For example, on Mondays or Thursdays, the patient will now have to take these pills, so that confused or forgottenhard.

About the improvement of health, you can usually tell within 4-6 weeks from start of treatment, and a steady and marked progress in the treatment after 6-12 months. There is one important note: "methotrexate" you can't take NSAIDs, which are also in most cases included in the standard treatment of RA. Any other day of the week, you can safely continue treatment with nonsteroidal anti-inflammatory drugs.

Arava (Leflunomide)

Arava is considered to be a very promising immunosuppressant, and many rheumatologists are shifting their patients on this new drug. But there are doctors who believe arava heavier with the worst drug compared to methotrexate and tolerability. In General we can say that arava prescribed as alternatives to methotrexate if the latter caused the patient side effects.

Arava recommended for patients with a very rapid current and the rapid development of rheumatoid arthritis, when in the first year of illness there are serious problems with the joints, even to loss of mobility. About a month after the start of the reception is usually the first visible positive changes, and six months sustained improvement of the bones.

Remicade (infliximab)

Another novelty in the Arsenal of rheumatologists – Remicade.

It differs from methotrexate, arava and other immunosuppressants two features:

  • Amazing performance;
  • A very high cost.

Given the latter feature, Remicade is usually something of a lifeline for patients with severe rapidly progressing rheumatoid arthritis, which is absolutely not help methotrexate and other affordable drugs. Two more reasons for the replacement of methotrexate by Remicade – poor tolerability and the need for urgent reduction in the dose of corticosteroids, which is also a part of basic therapy of RA. As you can see, reason for appointment Remicade enough, but sometimes all of them outweighs the high cost of the drug.

High efficiency and speed action Remicade has a reverse side: this medicine has many side effects and contraindications. Before you start taking the drug, you should carefully examine the patient and to heal absolutely everything discovered inflammatory processes, even hidden and creeping. Otherwise, after the start of therapy in conditions of depressed immunity all these infections "raise your head" and will lead to serious problems, including sepsis.

Possible side effects, including itchy rash, it is recommended preventivelyto deal with the help of antihistamines. Women, it is very important to use protection while taking Remicade, since pregnancy and breast-feeding is absolutely impossible in this period. Moreover, to think about motherhood after at least six months after the end of treatment Remicade.

Other cytotoxic agents

Of course, there are other immunosuppressants, including more affordable:

  • Cyclosporine;
  • The chlorambucil;
  • Azathioprine;
  • Cyclophosphamide.

But all of these drugs during clinical trials showed itself not with the best hand a very high incidence of side effects, though complications tend to be more serious than during the reception of the same methotrexate. Therefore, the rejection of three of the most popular in the basic therapy of RA drugs is expedient only in case if they have no effect or poorly tolerated.


Treatment of rheumatoid arthritis antimalarial drugs

Drugs delagil (resochin, chloroquine, hingamin) and plaquenil (hydrochloric, gidroksilamin) is very long been used in medicine as remedies against tropical diseases – malaria. But and here is rheumatoid arthritis, you ask. The fact that in the middle of the last century, scientists searching for any new and effective medicine for the treatment of RA and have tried almost all types of anti-inflammatory drugs, because rheumatoid arthritis has long been considered just a special kind of infection. One such study brought good news, delagil and plaquenil for RA slow down and reduce the severity of its manifestations.

However, anti-malarial drugs in modern basic therapy of RA is probably the most humble place, because they have only one advantage – good tolerability. And lacking one, though very serious – they act very slowly (the improvement comes only after six months or a year) and even if successful, give a weak therapeutic effect.

Why can't the doctors refused anti-malarial therapy?

A natural question, because there are drugs that act faster and work better. But medicine is one of those branches of science where a very strong prejudices and basic inertia. Even thirty years ago, the basic therapy of RA was based on this principle: first, delagil and plaquenil, then gold, if nothing helps – D-penicillamine or immunosuppressive drugs, and if nothinghelps corticosteroids. That is, selected from the harmless to potentially dangerous. But if you think about it, this principle of construction the basic treatment is criminal against the patient.

Suppose, a person of acute, rapidly developing rheumatoid arthritis with severe pain and rapidly degraded joints. Is it reasonable to wait for six months until the act anti-malarial drugs (the question is still – will work?) if you can assign a stronger and more effective medication? Even if there are side effects, it's better than just watching the person suffers, and as a condition of his joints catastrophically deteriorating with each passing day.

But there are, nevertheless, cases where anti-malarial drugs, are still relevant:

  • The patient very badly to all other drugs of basic therapy of RA;
  • Considered more effective medicines would have no effect;
  • Rheumatoid arthritis is very soft and develops slowly, so there is no need to resort to the most powerful but dangerous tools.

Treatment for rheumatoid arthritis drugs the group of sulfonamides

Salazopiridazin and sulfasalazine – two drugs from the group of sulfonamides, which are successfully used in the treatment of rheumatoid arthritis.

If you try to create a hit parade of the degree of effectiveness among the drugs of basic therapy of RA, it will look like this:

  • In the first place – methotrexate;
  • The second gold salt;
  • The third – sulfonamides and D-penicillamine;
  • The fourth – an antimalarial drugs.

Thus, sulfonamides can be regarded as among the leaders in efficiency, but they have huge advantages:

  • Well tolerated (incidence of side effects – 10-15%);
  • The low severity of complications, if any;
  • Affordable price.

The lack of sulfonamides only one, but significant – they are slow. The first improvements are visible only three months after the start of treatment, and persistent progress is usually observed in a year.


Treatment for rheumatoid arthritis D-penicillamine

D-penicillamine (distamine, kuprenil, artemin, trololol, metalcaptase) is almost never included in the standard treatment of RA, if the patient tolerates methotrexate and aerotherapy. It is somewhat lessthe listed drugs in effectiveness, but greatly exceeds the number of possible side effects, frequency of occurrence and severity of complications. So the only reason for the appointment of D-penicillamine – the lack of progress in the treatment of gold and methotrexate, or poor tolerance.

D-penicillamine – a highly toxic substance that causes adverse reactions in almost half of cases of seropositive rheumatoid arthritis, eve-third of cases, the treatment of seronegative RA. Why is it, however, still use doctors?

Because sometimes just no choice. Eurotherapy and cytostatics tried, no result. Or had to cancel due to poor tolerability. And the disease progresses quickly. Then the rheumatologist in the Arsenal there is only one, though dangerous, but in fact, the only strong drug D-penicillamine. This is the situation where the end justifies the means. If there is a negative reaction, cure is always possible to cancel. Therefore, it is better still to assign, than to do nothing at all.

Have with D-penicillamine and ACE in the hole – this drug helps the patients in whom RA gave complications in the heart, kidneys or lungs, for example, developed amyloidosis. If satisfactory tolerability of D-penicillamine take 3-5 years, then make a break for a couple of years and repeat the course. In this case, the medication loses its effectiveness, such as gold salts, which are better not to cancel for a long period. Unfortunately, a small portion of patients (approximately 10%) after a temporary improvement of health occurs a sharp deterioration.


Basic therapy: main findings

We reviewed the pros and cons of all five groups of drugs included in the list of so-called basic therapy of rheumatoid arthritis. In this story, so often flashed phrases about complications, side effects and dangers that involuntarily I want to ask – what kind of binding treatment of rheumatoid arthritis, if it is on the one hand treats (and not always), and on the other hand cripples (almost always)?

This question, of course, attends the heads of all patients with rheumatoid arthritis immediately after placing a disappointing diagnosis. Many sit on the medical forums and listening to angry rebuke, the essence of which can be formulated in one sentence: "I was the victim of a medical error, and in General, doctors do not know how to treat rheumatoid arthritis". This statement is not far from the truth in the part where it talks about ignorance.Because you know how to cure people from serious illness unexplained nature, can know except the Lord God.

On the selection of drugs for basic therapy for each specific patient with rheumatoid arthritis takes about six months. To find the most appropriate remedy for a shorter period of time is almost impossible, no matter how professional was the rheumatologist, and no matter how brutal instinct he may possess. And to predict how they will be transported drugs, generally not given to anyone.

So maybe not to start this basic therapy? Why torture the person? Well, let the disease develops as fast as possible to people early died, then certainly you will no longer suffer. Practice shows that if the basic therapy to start without delay, immediately after diagnosis, that is more than a decent chance to slow the disease or even achieve a stable remission. But where the patient with rheumatoid arthritis did not receive any treatment and all of a sudden got better, medicine is not know.

Think about it, if there's even a small chance to prolong your life or the life of a loved one, would you think about side effects? The disease itself will give you such side effects that the drugs did not dream, and very soon.


Treatment of rheumatoid arthritis non-steroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs we continue through the narrative, we will call the acronym NSAIDs, so convenient. This group includes:

  • Ibuprofen (Nurofen);
  • Diclofenac;
  • Ketoprofen (Ketorolac, Ketanov);
  • Indomethacin;
  • Phenylbutazone;
  • Piroxicam.

In the treatment of rheumatoid arthritis these drugs act as an ambulance when the pain in the joints. They reduce not only pain but also inflammation in joint and periarticular tissues, therefore, their method is appropriate in any case. Why we didn't include diclofenac or ibuprofen in a group of drugs of basic therapy of RA? Because they do not treat the disease itself and does not slow down its development. They act symptomatically, but at the same time improve the quality of life of patients with rheumatoid arthritis.

Of course, to take NSAIDs constantly, and with prolonged use rarely the drug has no side effects. That is why it is important to choose the right NSAID for a particular patient and it is reasonable to use the drug without exceeding the dosage. About how to do it, talk on.

Selection criteria NSAIDs

The first criterion the toxicity, therefore, is primarily prescribed to patients of RA the least toxic NSAIDs are quickly absorbed and quickly excreted from the body. Primarily is ibuprofen, Ketoprofen, and diclofenac, and selective anti-inflammatory drug Movalis, which we will discuss in detail below. Ketorolac, piroxicam and indomethacin are excreted from the body longer in addition, the latter can cause mental disorders in elderly patients. That's why these three drugs usually prescribed for young patients who do not have problems with liver, kidneys, stomach and heart. Then the probability of side effects and complications is small.

The second criterion is the effectiveness of NSAIDs, and it is all very subjective. The patient with rheumatoid arthritis usually takes every one of the doctor recommended medications within weeks to their feelings to evaluate the result. If a person says that diclofenac, everything hurts, but the ibuprofen helps, the doctor usually agrees with it.

Speaking of subjectivity, not to mention the power of suggestion, which has the usual instruction to the drug. So, many patients, after reading the abstract to diclofenac where honestly and openly painted with all its possible side effects, in horror, clutching his head and say that your pills will never be. Actually, diclofenac is not more dangerous than aspirin, which people drink for any occasion almost handfuls. Just aspirin no boxes nested inside with detailed instruction.

Summarizing, we say that the evaluation of the effectiveness of NSAIDs you need to take into consideration not only your feelings (it helps/doesn't help), but data from regular surveys that demonstrate the General condition of your body and the joints of patients in particular. If there is side effects (worsened the internal organs) and joints become inflamed all more strongly, it makes sense to switch to a different NSAID on the advice of a doctor.

Treatment of rheumatoid arthritis selective anti-inflammatory drugs

This group of drugs belongs Movalis is a relatively new medication that was designed specifically for long-term continuous use in order to minimize possible side effects. Returning to the subjectivity of the evaluations, say that most patients with arthritis find Movalis no less, and sometimes more effective analgesic. While Movalisvery well tolerated and rarely causes adverse reactions, which is not true about NSAIDs, the reception of which is often accompanied by digestive disorders.

Under the supervision of a doctor Movalis can take several months or even years if this is required. Very convenient and something to ease the pain of missing one pill that you drink either in the morning or before bedtime. There is also the Movalis in the form of rectal suppositories. If the pain is very intense, you can resort to the injection of Movalis. In the period of exacerbation of rheumatoid arthritis the patient often have the whole week to do the injections, and only then to go on the pill. But encouraged by the fact that Movalis, first, helps, almost all patients and secondly, almost no contraindications.


Treatment of rheumatoid arthritis with corticosteroids

Another "fireman" and the method of symptomatic relief of patients with rheumatoid arthritis receiving corticosteroid hormonal drugs (corticosteroids).

These include:

  • Prednisone (medopred);
  • Methylprednisolone (medrol, depo-medrol, metipred);
  • Triamcinolon (triamcinolone, polcortolon, kenalog, kenacort);
  • Betamethasone (celeston, flosteron, diprospan);
  • Dexamethasone.

Corticosteroids are very popular in the West, where they assign nearly all patients with RA. But in our country doctors are divided into two opposing camps: some advocate taking hormones, while others vehemently reject this technique, calling it extremely dangerous. Accordingly, patients who wish to be informed of all news from the world of medicine, read an interview with the American and Russian rheumatologists and become confused: who to believe? We will try to understand.

Use of corticosteroids results in a rapid improvement of health in patients with RA: the pain goes away, disappears stiffness and chills in the morning. Of course, it can't please a man, and it automatically assigns the doctor the status of a "professional". The pills helped – the good doctor did not doctor bad, everything is clear. And in the West a sense of gratitude to the doctor is usually expressed in monetary terms. That's why "good"doctors there are much more than"bad".

In our country, in terms of free health insurance the doctor will think three times before you assign your patient hormones. Because it will take time, and this same physician is likely to suffer the consequences of such therapy.

The danger of hormone therapy

What is so dangerous corticosteroids? This stress hormones that have a powerful negativeimpact on all the organs. Until the person accepts them, he feels great, but once you stop, the disease aktiviziruyutsya with redoubled force. If before the joints would ache so that it was quite possible to endure, the hurt is unbearable and nothing helps.

So maybe to keep the patient on hormones all the time? It is absolutely impossible, because, first, they will bring less and less effect, and secondly, the negative impact on the internal organs will accumulate and add up, until it will lead to serious failure.

Here are just some of the likely consequences:

Terrible list, isn't it? Typically when you are prompted at least one serious side effect of corticosteroids immediately canceled, but here's the scary part – the body is protesting against the abolition. This is reflected in the fluctuating increase of the inflammatory process in joints and periarticular tissues and severe pain that nothing can relieve. Hormones trying to repeal gradually to avoid shock.

To drink or not to drink hormones?

But how to drink them if it threatens such dire consequences, you ask. Indeed, corticosteroids at some stage will cease to bring relief and begin to harm the patient. But there are times when several evils to choose the least. Sometimes the patient is now worse than ever, and though only hormones can alleviate his condition. We are talking about patients with still's syndrome, Felty's syndrome,rheumatic polymyalgia and other severe complications.

Intelligent and visionary, the specialist will prescribe hormones only to such patient whose rheumatoid arthritis is at a very high stage of activity, erythrocyte sedimentation rate exceeds the limit, the level of C-reactive protein in the blood beyond, though inflammation is not relieved with NSAIDs.

Conclusion: corticosteroids should be prescribed to the patient with rheumatoid arthritis in the case if the expected benefit from treatment exceeds the probable harm.


Physical and mechanical methods of treatment of rheumatoid arthritis

Such techniques include lymph drainage, lymphocytopenia, plasmavores and irradiation of lymphoid tissue. Each of these procedures are quite effective, but has several disadvantages. Let's consider them in detail.

Lymph drainage

For this procedure you need sophisticated medical equipment. Doctor using a drainage apparatus penetrates the thoracic lymph duct of a patient, pumping out all the lymph, puts it in a special centrifuge that spins and separates the contents into a clean lymph and cellular debris, waste products of microbes and other "junk". Fully cleaned lymph is pumped back into the thoracic duct.

A couple of weeks after this procedure the patient begins to feel much better, but this effect lasts only for a month. Then the purified lymph is once again filled with harmful impurities, because the disease has not disappeared. This is why lymph drainage is almost never used in modern practice, the treatment of rheumatoid arthritis. The procedure is complicated, expensive, but the effect of it remains at too modest a period of time.

Imposiciones

This procedure is also very expensive and carried high-tech medical equipment in large medical centers. The doctor as a kind of "bumps" in the circulating bloodstream of the patient, that the blood passed through a special centrifuge, and from there it was removed from the monocytes and lymphocytes. For four hours, during which there is an imposiciones, it is possible to remove from the bloodstream of the patient for about 12120 lymphocytes.

Why is it necessary and what it gives? Lymphocytes, or cells of the immune system – a satellite of the inflammatory process. That's why a rheumatologist is never happy to see the results of your bloodwork elevated lymphocytes. If at least part of these cells to remove from the bloodstream, healthpatients with RA will immediately improve. However, this effect, as in the previous case, will last only about a month. That's why lymphocytopenia is rarely used.

Plasmavores

Procedure plazmafereza lasts about six hours, during which a large volume of patient's blood is removed, the plasma containing the harmful components: mediators of inflammation and aggressive immune cells, rheumatoid factor, the waste of the bacteria. "Bad" is replaced with donor plasma or albulina. Just one treatment fails to removed from the body by 40 ml of plasma per kg of patient weight. Plasmavores held courses for 15-20 procedures, the treatment takes about one and a half months.

For the sake of such suffering? Plasmavores greatly reduces the performance of the SOE and ROE, reduces the amount of antibodies in the blood, and the patient begins to feel much better. However, possible negative consequences: edema, decreased hemoglobin, a deficiency of potassium. With the side effects it can be overcome, use of the procedure outweighs the risk.

The main disadvantages of plazmofereza – its high cost and short duration of therapeutic effect. A positive result persists for several months and then the course must be repeated. However, for plazmofereza resort often, especially when a sudden acute development of rheumatoid arthritis in the case when the choice of drugs for the basic treatment is delayed. It plasmavores gives the opportunity to the attending physician to gain time and to prevent fatal deterioration of the patient.

Irradiation of lymphoid tissue

The method of irradiation of lymphoid tissue was first used in 1980 and since then is actively used. Its essence is to be subjected to spot irradiation of the lymph nodes, spleen, and thymus of the patient. In one session the patient receives from 150 to 220 rad just for the course of treatment – 4000 rad. In almost all cases, treatment is effective and allows to reduce the dose of corticosteroids and NSAIDs, or even abandon them altogether. The effect lasts for a long time – 1-2 years.

As with any method of treatment associated with radiation, radiation of lymphoid tissue has no side effects. In some patients there is a General weakness, nausea, decrease in level of leukocytes in the blood. However, this procedure is successfully used for the treatment of rheumatoid arthritis, both in our country and in the West.


Local treatment of rheumatoid arthritis in active stage

To alleviate the condition of patients with rheumatoid arthritis inthe active stage by using hormone injections in the joint capsule, laser therapy, cryotherapy, special ointments and creams. Consider the advantages and disadvantages of each method.

Intra-articular injection of corticosteroids

The essence of the method consists in injecting into the joint cavity of the hormonal drugs from the group of corticosteroids (about which we talked above). It could be prednisone, celestone, hydrocortisone, depo-medrol, diprospan, kenalog or flosteron. After the procedure, a rapid and a pronounced positive effect: inflammation subsides, the pain decreases or even goes at all.

Corticosteroid injections – a "ambulance" for painful joints. Introduction of hormones directly into the joint do when the patient feel quite so bad, and no other measures, including the NSAIDs and Movalis, do not help to relieve pain and reduce inflammation. Usually after the injection the patient feels well during the month, but in severe cases the procedure must be repeated every 10 days. More often not, otherwise the corticosteroids will start harmful effects on the body as a whole.

In addition, the doctors highly recommend not to do hormone injections in the same joint more than eight times. It can cause destructive changes in the cartilage, ligaments and muscles around the joint. Turns out that for the temporary improvement of health, the patient will have to pay a prohibitively high price.

Laser therapy

The laser beam has a beneficial effect on the organism of a person suffering from rheumatoid arthritis in any stage of activity. If at the moment there is aggravation of the disease, laser is irradiated with the elbow of the patient. In this way improve the quality of the blood and improve the blood supply to the organs and tissues. It is believed that the laser beams also normalizes the immune status of patients with RA. This technique is successfully applied both independently and in conjunction with the basic treatment, about which we wrote above.

When the period of acute illness has passed, in the body of the patient is not observed acute inflammatory process, the body temperature is not increased, it is possible to irradiate the laser directly to the joints. In the first weeks after the procedures may be a temporary deterioration of health and increased pain. But then 80% of patients seeing an improvement, which persists for several months.

Treatment usually consists of 15-20 procedures, and conduct them at intervals of one day. Laser irradiation would be of little help to patients in the last stages of rheumatoid arthritis – a quadriplegic with gnarled joints. However, in the initial stages and in periods of remission, suchimpact very effectively and just as helpful.

To the laser irradiation, there are some important contraindications:

Cryotherapy

Cryotherapy, or cold therapy, is successfully used not only in the treatment of arthritis (rheumatoid, reactive, psoriatic), but also in the treatment of ankylosing spondylitis. This method is good both at the stage of exacerbation and periods of attenuation of disease. Almost 80% of patients with RA treated with cryotherapy, have noted a substantial improvement in health. The main thing is to be consistent and to undergo treatments regularly for a long time.

Cryotherapy can be dry, this is when the body is exposed to dry air to very low temperatures, for example, in a special cryo. And there may be liquid cryotherapy – in this case, the patient is exposed to liquid nitrogen. Let's start with the second option.

On a diseased joint a high pressure jet of liquid nitrogen, which immediately evaporates, but at the same time deep tissue cooling. Inflammation they subside, blood circulation increases, swelling decreases and the pain goes away. Usually spend 8-12 such procedures every day or every other day to achieve lasting positive effect. Cryotherapy with liquid nitrogen has almost no contraindications, it may be resorted to even in the treatment of elderly patients with RA. Limitations only a few – Raynaud's syndrome, severe arrhythmia, recent myocardial infarction or stroke.

Now let's talk about dry cryotherapy. The patient fully undressed and placed in a cryo-sauna is a room filled with sverhdorogim dry air. The principle therapeutic action here is the same as when breathing liquid nitrogen, however, the cryosauna has a positive effect on the entire body, not just the individual joints. This procedure is carried out in specialized medical centers, usually private, so it is not cheap. In addition, for dry cryotherapy requires rare, expensive equipment, so even if cryosauna equipped public hospitals,it is unlikely their use would be free.

Read more about: cryotherapy as a particularly effective method of treatment

Medicated creams and ointments

Advertising promises us a wonderful deliverance from pain in the joints, but there are no miracles. In rheumatoid arthritis are recommended ointments and creams based on those same NSAIDs:

  • Butadiona ointment;
  • Of indometacin ointment;
  • Fastum gel;
  • Voltaren emulgel;
  • First days without.

If you spread a diseased joint, this drug through the pores of the skin will penetrate about 5-7% of the active substance. Bring it a big relief? Unlikely. However, if you take NSAIDs inside, like most patients with rheumatoid arthritis, the ointment can be used as a support, i.e., to enhance the effect. Have creams and ointments for joint pain there is only one undeniable advantage – they are almost harmless (I wanted to say, almost useless).


Physiotherapy treatment of rheumatoid arthritis

What if you have arthritis well that is unacceptable for arthritis, so physiotherapy and massage is prescribed only in periods of remission, when the acute inflammatory process. If the patient has a high fever and joints are literally burning what kind of massage or warming can be discussed?

But when the inflammation was able to arrest some gentle massages and physical therapy can help to improve blood flow to joints and restore their mobility.

In the treatment of rheumatoid arthritis into remission using the following physiotherapy treatments:

  • Diathermy;
  • Infrared radiation;
  • With an application of paraffin, ozokerite and mud;
  • Phonophoresis with hydrocortisone;
  • Radiotherapy.

Choose method treatment therapeutic effects have doctor. Absolutely unacceptable, when a patient with rheumatoid arthritis sent to a private SPA to enjoy the therapeutic mud. Tips different kinds of healers and natural healers to follow you should not. And the massage at home shall not be conducted by someone who does not have relevant qualifications, and not knowing how to treat joints affected by rheumatoid arthritis.


Dietary recommendations for patients with rheumatoid arthritis

Proper nutrition is justof great importance for patients with RA. Almost all patients reported that the use of some products that irritate the body, leads to a sharp deterioration of health, exacerbation of inflammation and increased pain. And as soon as a bad product is eliminated, the situation soon returns to normal.

What is this dangerous product? Here is the list:

  • Pork;
  • Citrus;
  • Some cereals (wheat, oats, corn, rye);
  • Milk and dairy products.

As you can see, in the black list are foods that are usually considered to be useful (except, perhaps, pork). But don't worry, in patients with rheumatoid arthritis have a good alternative:

  • Fish and seafood;
  • Vegetables and fruits (except citrus);
  • Chicken and quail eggs;
  • Buckwheat and barley porridge.

To cook food you need a healthy way: in the oven or steamer, you can boil or simmer. Recommended to eat more often: 5-6 times a day but small portions. Not to eat at night. It is desirable to exclude from the diet salt and sugar. Avoid meats and fried foods. Some patients with arthritis even have to obtain special advice from a dietitian to develop a customized diet to avoid complications triggered by improper nutrition.

Read more: Diet in rheumatoid arthritis


uravitsky Igor, the doctor-the rheumatologist