According to ICD 10 rheumatoid arthritis belongs to the class of M: inflammatory polyarthropathy. In addition to it, this includes JRA (juvenile or juvenile rheumatoid arthritis), gout and others. The causes of this disease are still not fully elucidated. There are several theories about its development, but consensus has not yet formed. Assume that the infection causes a disruption in the regulation of the immune system in people who are predisposed. The result is the formation of molecules, which destroy the tissues of the joints. Against this theory is evidenced by the fact that rheumatoid arthritis (code according to ICD - 10 M05), bad treated with antibacterial drugs.
Rheumatoid arthritis – 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 is found with 123 of our era. People with the characteristic symptoms of the disease were depicted in the paintings of Rubens.
As a nosological unit rheumatoid arthritis first described a doctor the Landr-Beauvais in the early nineteenth century and called it "asthenic gout". Its present name the disease got half a century later, in 1859, while mentioning in the treatise on the nature and treatment of rheumatic gout. For every hundred thousand people identify fifty patients, most of them women. By 2010 in the world from RA died over forty nine thousand people.
RA - so common disease that has allocated to it a separate Chapter in ICD 10. Rheumatoid arthritis, like other diseases of the joints, the cause of the following factors:
1. Heredity:
- the tendency to autoimmune diseases in the family;
- the presence of a certain class of histocompatibility antibodies.
2. Infection:
- measles, mumps (mumps), respiratory syncytial infection;
hepatitis b
- all the family of herpes viruses, CMV (cytomegalovirus), Epstein-Barr;
- retroviruses.
3. Trigger factor:
hypothermia
intoxication
- stress, medication, hormonal disruption.
The Pathogenesis of the disease is abnormal reaction of immune cells to the presence of antigens. Lymphocytes produce antibodies against tissues of the body, instead of destroying bacteria or viruses.
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According to the ICD 10 rheumatoid arthritis develops in three stages. In the first stage there is swelling of the articular handbags, which causes pain, fever and the shape of the joints. At the second stage the cells of the tissue that covers the joint from the inside, starting to quickly share. Therefore, the synovium becomes thick and rigid. In the third stage, the inflammatory cells release enzymes that destroy joint tissue. This causes difficulty with voluntary movements and leads to physical defects.
Rheumatoid arthritis (ICD 10 - M05) has a gradual onset. Symptoms appear gradually, it may take months. In extremely rare cases, the process may begin as acute or subacute. What articular syndrome (pain, defigure and local increase in temperature) is not pathognomonic symptom much more difficult to diagnose the disease. Usually morning stiffness (inability to produce motion in the joints) takes about an hour, and it increases when you try active movements. A harbinger of the disease is the pain in joints when weather changes and overall weather sensitivity.
There are several variants of the disease that should lead a physician at the clinic.
1. the Classic when joint damage occurs symmetrically, the disease progresses slowly and has all of its forerunners.
2. the Oligoarthritis exclusively with the defeat of the large joints, usually the knee. It starts sharp, and all manifestations are reversible within six months from the onset of the disease. Pain in the joints are volatile in nature, on the radiograph no pathological changes, and treatment NPRC (non-steroidal anti-inflammatory drugs) gives a positive effect.
3. the Felty's Syndrome is diagnosed if joint disease with enlargement of the spleen with a characteristic pattern of changes in the blood.
4. the Juvenile rheumatoid arthritis (code according to ICD 10 – М08). A characteristic feature is that it affects children up to 16 years. There are two forms of this disease:
- allergisation syndrome;
- articular-visceral form, which includes vasculitis (inflammation of joints), loss of the heart valves, kidneys and digestive tract, as well as damage to the nervous system.
As with other nosologic units, reflected in the ICD 10 rheumatoid arthritis has several classifications.
1. According to clinical manifestations:
very early when the symptoms last up to six months;
early if the disease lasts up to year;
- unfolded – up to 24 months;
- late - in the durationdisease more than two years.
2. Radiographic stages:
First. Has thickened and seal soft tissue, isolated foci of osteoporosis.
Second. the Process of osteoporosis captures the entire epiphysis of the bone, joint space narrowing, cartilage erosion appear;
Third. deformity of the epiphyses of the bones, habitual dislocations and subluxations;
Fourth. Ankylosis (complete absence of the joint space).
3. Immunologic characteristics:
Rheumatoid factor
- seropositive rheumatoid arthritis (ICD 10 - M05.0). This means that in the blood of the patient revealed a rheumatoid factor.
- seronegative rheumatoid arthritis.
Citrullinemia antibodies to cyclic peptide (Anti-CCP):
- seropositive rheumatoid arthritis;
- seronegative rheumatoid arthritis (ICD 10 - M06).
4. Functional class:
Juvenile rheumatoid arthritis ICD 10 allocates in a separate category - as an autoimmune disease of young children. Most often, children get sick after a severe infection, vaccination, or trauma of the joints. The synovium develops aseptic inflammation, which leads to excessive accumulation of fluid in the cavity of the joint, pain and, eventually, the wall thickening of the joint capsule and sticking it to the cartilage. After some time, the cartilage is destroyed, and the child becomes disabled.
The clinic distinguish mono -, oligo - and polyarthritis. When struck by only one joint, it is, accordingly, monoartrit. If pathological changes subject to up to four joints it is oligoarthritis. Arthritis diagnosed with the defeat of almost all joints. There are also systemic rheumatoid arthritis when it affects the skeleton and other organs.
In order to make a diagnosis, must be properly and fully collect the anamnesis, to carry out biochemical tests of blood, make x-rays of the joints, as well as serodiagnostic.
The blood test, the doctor draws attention to the erythrocyte sedimentation rate, rheumatoid factor, number of blood corpuscles. The most progressive at the moment is the detection of anti-CCP, which was dedicated in 2005. This is a highly specific indicator, which is almost always present in the blood of patients, unlike rheumatoid factor.
If the patient has suffered infection or she is in the middle, he shown specific antibacterial therapy. In the selection of drugs pay attention to the severity of articular syndrome. As a rule, begin with non-steroidal anti-inflammatory drugs while inside the joint injected corticosteroids. Moreover, since RA-is an autoimmune disease, the patient needs plasmavores to eliminate all of immune complexes from the body.
The Treatment is usually lengthy and can drag on for years. This is because the drug needs to accumulate in the tissues. One of the key moments of the therapy is the treatment of osteoporosis. For this the patient is asked to follow a special diet with a high calcium content (dairy products, almonds, walnuts, hazelnuts), as well as take calcium and vitamin D.
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Alin Trodden - author of the article, editor
"Hi, I'm Alin Trodden. I write texts, read books, and look for impressions. And I'm not bad at telling you about it. I am always happy to participate in interesting projects."
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