Aka chronic polyarthritis / articular rheumatism.
Arthritis is a generic term for all problems with muscles, tendons, joints, and bones - the "motor apparatus" of the body. If the joints are chronically swollen, it is almost always a case of joint suffererings in which the immune system is involved.
They are called auto-immune diseases because the immune system is wrongly coded and attacks its own tissues - in this case the synovial membranes. The most common suffering is probably osteoarthritis - but also in psoriasis and gastro-intestinal diseases, there can be attacks on the synovial membranes and joints, e.g. in bleeding colitis, Crohn's disease, and salmonella- and yersinia infections.
Rheumatoid arthritis is a chronic suffering in several of the bodily systems, but most characteristic is the sustained inflammation in the synovial membranes, especially in the joints of arms and legs. This is not an inflammation caused by bacteria or vira, but a condition in which the body's immune system mistakes the cells of the synovial membranes for being foreign cells and therefore attacks them in order to destroy them.
In time, damage of cartilage and bones will occur. The course of the disease, however, can vary a lot from individual to individual - from mild cases which quickly cease to severe, long-lasting disabling cases in which joints are damaged.
The prevalence of this disease is approximately 1% of the population and women are affected three times more frequently than men. The prevalence increases with age, but it is possible to be affected by articular rheumatism while still in childhood; in Still's disease. There is a hereditary predisposition connected with the disease. Genetically predisposed individuals who work with motor oils and hydraulic oils, for example, seem to have an increased risk of developing rheumatoid arthritis, but inheritance is not the only factor involved in this disease.
It is still not known what triggers the disease and makes the immune system attack the synovial membranes, but microorganisms like vira, mycoplasmas, and bacteria are under suspicion. In all circumstances, a number of immune system cells are involved in the disease.
From the beginning, there are often uncharacteristic symptoms such as tiredness, loss of appetite, general weakening, and mild symtoms from muscles and bones before visible, swollen joints appear - especially of the hands, wrists, knees, and feet. In the hands, especially the metacarpophalangeal- and proximal interphalangeal joints of the fingers are attacked while swelling and pain in the distal interphalangeal joints are indications of osteoarthritis.
Pains which are worsened by strain occur - often along with morning stiffness and stiffness after breaks from work. If the morning stiffness lasts for more than one hour, articular rheumtism should always come to mind as a possibility. In time, reductions in mobility of the affected joints occur along with the risk of them in time being destroyed with malalignments as a result - especially if no treatment is initiated in time.
Besides symptoms from the joints, symptoms from other places in the body can occur. These can be arthritic swellings under the skin and inflammation-like changes in the blood vessels, plus signs of nervous damage. Also the pleurae and the lungs can be attacked causing increased formation of connective tissue and difficulties absorbing oxygen from the lungs.
In case of long-lasting disease, problems with enlargement of the spleen, too few white blood cells of the kind that fights off bacteria, and in some cases anaemia and a lack of blood platelets can occur. This is called Felty's syndrome. Osteoporosis is also a common disease and it can be worsened if treated with adrenocortical hormone. The heart might also be damaged as time goes by.
No blood test can state with certainty that you are affected by articular rheumatism, but there are a number of blood tests that can point in that direction, e.g. the rheumatoid factor (RF - a particular antibody). If active articular arthritis is in question, there is almost always an increased erythrocyte sedimentation rate and an increased level of C-reactive protein - CRP - which is eliminating the blood sedimentation. The elevated level most often relates to the activity of the disease.
Doctor Pekka Helin has described three small, fast methods for detecting articular rheumatism at an early stage.
- If it hurts in the knuckles when the person is given a firm handshake.
- If the person has difficulties in holding onto a pencil that is pressed between the three most distal joints of the finger (except the thumb) while the pencil is being lightly pulled.
- If the person cannot hold onto a piece of paper which is pressed between the index finger and the thumb when the paper is being pulled.
The course of articular rheumatism varies a lot from patient to patient, but after 10 - 12 years only 1/5 of the people affected will have no changes in joints or reduced mobility. In three years, as many as 70% of X-ray pictures show signs of joint damage and more than half of these already display the signs in the first year. The people who are most severely struck have a moderately reduced life expectancy time, and it is said that the medical treatment might be contributory to this. The mortality has increased mostly on account of infections and bleedings from the gastro-intestinal canal.
There are different goals when treating articular arthritis:
- To reduce pain.
- To suppress the inflammatory reaction.
- To protect the joints.
- To maintain functions and mobility.
- To control the effect of the articular rheumatism in other places of the body.
In the medical analgesic treatment, primarily acetylsalicylic acid, paracetamol, and ibuprofen rheumatic tablets are used - the so-called NSAID substances.
When the inflammatic reaction is being suppressed, the pain is gradually relieved. In light cases when acetylsalicylic acid and ordinary rheumatic tablets do not work, often similar substances or a small dose of adrenocortical hormones will be tried out.
Often, treatment with substances which specifically counteract the process of inflammation in articular rheumatism is used. Earlier, treatments with gold salts (gold cure) were used which often made the articular rheumatism cease, but they, unfortunately, had negative effects on the kidneys. Gold is still used, just like D-penicillamine, malaria remedies, and sulphasalazine which is also used against intestinal inflammation. These substances are called DMARD = disease modifying anti-rheumatic drugs.
They all come with a lot of side effects, so the treatment should be closesly monitored, e.g. with examination of blood, urine, and liver function. It is difficult to know which of the substances to use first, and often it is a matter of proceeding by the method of trial and error. The substance of methotrexate which is cell inhibiting and used in cancer treatment may be effective. It works faster than the other DMARDs but it is possible that the substance only suppresses the symptoms. Other cytocidal substances can also be used, but their side effects are quite toxic and can later increse the risk of cancer.
Treatment with adrenocortical hormones can also be used, especially in small doses, and it has been shown that it is capable of detaining the destruction of bones and suppressing the symptoms. If using adrenocortical hormones, it is important always to counteract osteoporosis by taking a supplement of calcium and vitamin D.
The most recent progress is treatment with the substance of leflunomide (Arava R) which suppresses quick cell growth in the immune system, for example, by inhibiting a specific enzyme. Among other things, it can affect the liver, bone marrow, and it has a number of side effects.
Surgically, new joints can be provided in order to relieve; especially shoulder-, hip-, and knee joints. If only a few joints are attacked, the synovial membrane of the joints can be removed. This relieves symptoms but apparently does not stop further degeneration of the joints.
