According to the IBC 10 rheumatoid arthritis belongs to the classM: inflammatory polyarthropathies. In addition, it includes JRA (juvenile, or juvenile rheumatoid arthritis), gout and others. The causes of this disease have not yet been fully clarified. There are several theories about its development, but unanimity has not yet been formed. It is suggested that infection causes disturbances in the regulation of the immune system in people who are predisposed to it. As a result, molecules are formed that destroy the tissues of the joints. Against this theory is the fact that rheumatoid arthritis (the ICD code is 10 M05) is poorly treated with antibacterial drugs.
Ревматоидный артрит – древнее заболевание.The first cases of it were found in the study of skeletons of Indians, whose age was about four and a half thousand years. In the literature, the description of RA occurs from the year 123 AD. People with characteristic symptoms of the disease were imprinted on the canvases of Rubens.
As a nosological unit rheumatoid arthritisHe was first described by the doctor Landre-Beauvais in the early nineteenth century and called it "asthenic gout." The disease got its current name half a century later, in 1859, when the treatise mentions the nature and treatment of rheumatic gout. For every hundred thousand people, fifty people are diagnosed, most of them women. By 2010, more than forty-nine thousand people died in the world from Armenia.
RA is such a common disease that a separate chapter was allocated to it in the ICD 10. Rheumatoid arthritis, like other pathologies of the joints, is caused by the following factors:
1. Heredity:
- a tendency to autoimmune diseases in the family;
- the presence of a certain class of histocompatibility antibodies.
2. Infections:
- measles, mumps (mumps), respiratory syncytial infection;
- Hepatitis B;
- the whole family of herpes viruses, CMV (cytomegalovirus), Epstein-Barr;
- retroviruses.
3. Trigger factor:
- hypothermia;
- intoxication;
- stress, medication, hormonal disruptions.
The pathogenesis of the disease is abnormalthe reaction of immune cells to the presence of antigens. Lymphocytes produce immunoglobulins against body tissues, instead of destroying bacteria or viruses.
According to ICD 10, rheumatoid arthritis developsin three stages. In the first stage, there is swelling of the articular bags, 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 quickly divide. Therefore, the synovial membrane becomes dense and rigid. In the third stage, inflammatory cells release enzymes that destroy the tissues of the joint. This causes difficulties with voluntary movements and leads to physical defects.
Ревматоидный артрит (МКБ 10 - М05) имеет gradual start. Symptoms appear gradually, it can take months. In extremely rare cases, the process may begin acutely or subacutely. The fact that articular syndrome (pain, defiguration and local temperature rise) is not a pathognomonic symptom makes diagnosis of the disease much more difficult. As a rule, morning stiffness (inability to produce movements in the joints) lasts about half an hour, and it is aggravated when attempting active movements. The harbinger of the disease is pain in the joints when the weather changes and general meteosensitivity.
There are several options for the course of the disease, which should guide the doctor in the clinic.
1. Classicalwhen joint damage occurs symmetrically, the disease progresses slowly and there are all its precursors.
2. Oligoarthritis with a lesion of exceptionally large joints, likeusually knee. It begins acutely, and all manifestations are reversible within one and a half months from the onset of the disease. In this case, pains in the joints are volatile in nature, there are no pathological changes on the roentgenogram, and treatment of NSAIDs (nonsteroidal anti-inflammatory drugs) has a positive effect.
3. Felty's Syndrome it is diagnosed if an enlargement of the spleen joins the disease of the joints with a characteristic pattern of blood change.
4. Juvenile rheumatoid arthritis (ICD code 10 - M08). A characteristic feature is that they suffer from children under 16 years of age. There are two forms of this disease:
- with allergic syndrome;
- the articular-visceral form, which includes vasculitis (inflammation of the joints), damage to the valves of the heart, kidneys and the digestive tract, as well as damage to the nervous system.
As in the case of other nosological units, as reflected in 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;
- deployed - up to 24 months;
- Late - with a duration of illness of more than two years.
2. Radiological stages:
- The first. There are thickening and compaction of the soft tissues of the joint, single foci of osteoporosis.
- The second. The process of osteoporosis captures the entire epiphysis of the bone, the joint gap narrows, erosion appears on the cartilage;
- The third. Deformation of the epiphyses of bones, habitual dislocations and subluxations;
- Fourth. Ankylosis (complete absence of the joint space).
3. Immunological characteristics:
For rheumatoid factor:
- seropositive rheumatoid arthritis (ICD 10 - M05.0). This means that the patient’s rheumatoid factor is detected in the patient’s blood.
- Seronegative rheumatoid arthritis.
For antibodies to cyclic citrulline peptide (Anti-CCP):
- seropositive rheumatoid arthritis;
- Seronegative rheumatoid arthritis (ICD 10 - M06).
4. Functional class:
Juvenile rheumatoid arthritis ICD 10 highlights ina separate category - as an autoimmune disease of young children. Most often, children fall ill after a serious infectious disease, vaccination or injury to the joints. Aseptic inflammation develops in the synovial membrane, which leads to excessive accumulation of fluid in the joint cavity, pain, and ultimately - to a thickening of the wall of the joint capsule and sticking it 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 simultaneously affected by pathological changes, then this is oligoarthritis. Polyarthritis is diagnosed with the defeat of almost all joints. Systemic rheumatoid arthritis is also distinguished when, in addition to the skeleton, other organs are also affected.
In order to make a diagnosis, it is necessary to correctly and fully collect anamnesis, conduct biochemical blood tests, make X-rays of the joints, as well as serodiagnosis.
In a blood test, the doctor pays attention toerythrocyte sedimentation rate, rheumatoid factor, 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, which is almost always present in the blood of patients, in contrast to the rheumatoid factor.
If the patient has had the infection or is inthe height, then he was shown specific antibiotic therapy. In the selection of drugs pay attention to the severity of articular syndrome. As a rule, they start with nonsteroidal 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 prolonged and maydrag on for years. This is due to the fact that drugs must accumulate in the tissues. One of the key points of treatment is the treatment of osteoporosis. To do this, the patient is asked to follow a special diet with a high content of calcium (dairy products, almonds, walnuts, hazelnuts), as well as taking calcium and vitamin D.
