According to ICD 10, rheumatoid arthritis belongs to class M: inflammatory polyarthropathies. In addition to it, this includes Jura (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 a consensus has not yet been formed. It is believed that infection causes disturbances in the regulation of the immune system in people who are predisposed to this. 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 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 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 doctor Landre-Beauvais in the early nineteenth century and called it "asthenic gout." The disease got its current name after half a century, in 1859, when it was mentioned in the treatise on the nature and treatment of rheumatic gout. For every one hundred thousand people, fifty sick people are identified, most of them women. By 2010, more than forty-nine thousand people had died from RA in the world.
Etiology and pathogenesis
RA is such a common disease that it has been given a separate chapter in ICD 10. Rheumatoid arthritis, like other joint pathologies, 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:
- subcooling;
- intoxication;
- stress, medication, hormonal disruptions.
The pathogenesis of the disease is the abnormal reaction of 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 bags 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 rapidly divide. Therefore, the synovial membrane becomes dense and rigid. In the third stage, inflammatory cells release enzymes that destroy joint tissues. This causes difficulties with arbitrary 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 sub-scale. The fact that articular syndrome (pain, configuration and local temperature increase) is not a pathognomonic symptom, significantly complicates the diagnosis of the disease. As a rule, morning stiffness (inability to make movements in the joints) lasts about half an hour, and it intensifies when trying active movements. A harbinger of the disease is joint pain when the weather changes and general weather sensitivity.
Clinical options
There are several options for the course of the disease, which should be guided by the doctor in the clinic.
1. Classic , when joint damage occurs symmetrically, the disease progresses slowly and there are all its precursors.
2. Oligoarthritis with damage to exclusively large joints, as a rule, of the knee. It begins acutely, and all manifestations are reversible within a month and a half from the onset of the disease. At the same time, joint pains are volatile, there are no pathological changes on the radiograph, and treatment with NSAIDs (non-steroidal anti-inflammatory drugs) gives a positive effect.
3. Felty's syndrome is diagnosed if an enlarged spleen with a characteristic pattern of blood change joins the joint disease .
4. Juvenile rheumatoid arthritis (ICD code 10 - M08). A characteristic feature is that they are ill for children under 16 years of age. There are two forms of this disease:
- with allergic septic syndrome;
- 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 with other nosological units 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;
- detailed - up to 24 months;
- late - with a disease duration of more than two years.
2. X-ray stages:
- The first one. There is a thickening and compaction of the soft tissues of the joint, single foci of osteoporosis.
- The second one. The process of osteoporosis captures the entire pineal gland, the joint gap narrows, erosion appears on the cartilage;
- The third. Deformation of the pineal gland, habitual dislocation and subluxation;
- The fourth. Ankyloses (complete absence of joint space).
3. Immunological characteristics:
According to the 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-PCP):
- seropositive rheumatoid arthritis;
- seronegative rheumatoid arthritis (ICD 10 - M06).
4. Functional class:
- The first - all types of activities are preserved.
- Second - professional activity is violated.
- Third - the ability to self-service is maintained.
- Fourth - all activities are violated.
Rheumatoid Arthritis in Children
ICD 10 distinguishes juvenile rheumatoid arthritis in a separate category - as an autoimmune disease in young children. Most often, children become ill after a serious infectious disease, vaccination or joint injuries. 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 joint capsule and its adhesion to the cartilage. After some time, the cartilage is destroyed, and the child becomes disabled.
The clinic distinguishes mono -, oligo - and polyarthritis. When only one joint is affected, it is, accordingly, monoarthritis. If up to four joints are susceptible to pathological changes at the same time, then this is oligoarthritis. Polyarthritis is diagnosed with damage to almost all joints. Systemic rheumatoid arthritis is also distinguished, when in addition to the skeleton other organs are affected.
Diagnostics
In order to make a diagnosis, it is necessary to correctly and fully collect an anamnesis, conduct biochemical blood tests, do x-rays of the joints, as well as serodiagnosis.
In a blood test, the doctor draws attention to the erythrocyte sedimentation rate, rheumatoid factor, the number of blood cells. The most progressive at the moment is the detection of anti-PCP, which was isolated in 2005. This is a highly specific indicator that is almost always present in the blood of patients, in contrast to the rheumatoid factor.
Treatment
If the patient has suffered an infection or is in full swing, he is shown specific antibiotic therapy. When choosing drugs, pay attention to the severity of the articular syndrome. As a rule, they begin 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 plasmophoresis to eliminate all immune complexes from the body.
Treatment is usually lengthy and can be delayed for years. This is due to the fact that drugs must accumulate in the tissues. One of the key points of therapy is the treatment of osteoporosis. For this patient, they are asked to follow a special diet with a high content of calcium (dairy products, almonds, walnuts, hazelnuts), as well as take calcium and vitamin D.