Pseudorheumatism

Description:

The pseudorheumatism is the general autoimmune disease which is characterized damage of joints with development in them destructive processes. The pseudorheumatism is quite widespread in the population – about 1% of people have this disease.
Distinctive feature of a pseudorheumatism is inflammatory process in small joints as polyarthritis.

Pseudorheumatism reasons:

At a research of etiological aspects at revmatoidnodny arthritis genetic predisposition to defect of immunoresistance is established. There is feedforward between development of this disease and existence of histocompatibility antigens. DR and DW antigens define an immune response of an organism owing to what reaction on the arrived infectious agents is exposed to treason. Heredity of a pseudorheumatism consists in the increased incidence on the family line. Also development of a pseudorheumatism is promoted by accession of an infection, first of all Epstein-Burra's virus and the T-lymphotropic virus  of the person, herpes virus, causative agents of measles, mycoplasmosis and some other. This theory found confirmation in immunological researches: at 80% of patients with a pseudorheumatism the increased level of antibodies to a virus Epstein-Burra comes to light. Besides, the virus Epstein-Burra promotes formation of a rhematoid factor. The role of mycobacteria at the moment found laboratory confirmation in experiments with animals.
The following risk factors for a pseudorheumatism are marked out:
- the age is more senior than 45 years
- hereditary burdeness
- female
- identification of certain genes of histocompatability of DW and DR
- existence of associated diseases, especially congenitally bone and joint pathology.

Pathogeny:

As it was already noted, development of a pseudorheumatism is closely connected with immunity pathology. The circulating cell-bound immune complexes which part G and M immunoglobulin is form. Being in blood and being attached to synovial membranes, complexes begin to destroy cartilage cells. The synovitis is result the influences of lizosomalny enzymes  which are released from neutrophils phagocytes. On a synovial membrane granulyatsionny fabric forms that gradually destroys a cartilage. Circular cell-bound immune complexes, getting into other bodies, cause extraarticular defeats at a pseudorheumatism. In case of the inferiority of fermental systems which is descended there are family cases. A special role is played by disturbance in system of exchange of tyrosine, a histidine, tryptophane, phenylalanine.
The following stage of development of a pseudorheumatism – formation of specific rhematoid granulomas which represent the fibrinovidny necrosis surrounded with histiocytes. The joint cartilage erizirutsya, baring a bone tissue. Further osteoporosis, an anchylosis, the uzuration of joint surfaces characteristic of a pseudorheumatism develops. The bursitis and a tendinitis joins a synovitis.
The joint and visceral form of a pseudorheumatism is a sign of a severe disease and is diagnosed when involving in pathological process of parenchymatous bodies.
Immune disturbances lead also to a vasculitis which proceeds in various form, up to defeat of the vital bodies - kidneys (nephrite), an eye (an iridocyclitis or a uveitis), lungs (pneumonia). At late stages of a pseudorheumatism development of an amyloidosis of internals is possible.
The pseudorheumatism is the disease giving high percent of disability. Average age of the manifesto of a disease makes 20-45 years.
In a final stage the pseudorheumatism leads to full immobilization of joints.

Pseudorheumatism symptoms:

On disease allocate 3 forms of a pseudorheumatism: without essential progressing of a disease, slowly and quickly progressing forms. Out of remission allocate degrees of activity of pathological process – minimum, average and high. In an initial stage the pseudorheumatism shows the increased fatigue moderated by subfibrilny temperature reaction, sometimes – an inflammation of sialadens. Then the joint syndrome joins: inflammation and morbidity of joints, morning constraint. The patient feels some improvement at an exercise stress. A characteristic sign is damage of small symmetric joints: joints of brushes and feet, radiocarpal, ankle joints. Also shoulder, hip, intervertebral joints can be surprised. By sight joints are edematous, skin over them is hyperemic, hot. Limitation of movements in the injured joints is noted. The joint is increased in volume, its contours are maleficiated. Exudative and proliferative processes promote its defiguration. Due to formation of incomplete dislocations, ankiloz and contractures there is a deformation of joints. The joint syndrome is shown as polyarthritis, an oligoarthritis or monoarthritis.
Extraarticular manifestations of a pseudorheumatism include rhematoid small knots, a vasculitis, polyneuropathy. When progressing a pseudorheumatism the atrophy of muscles around the affected joint, disturbance of trophic processes in skin is shown. The hyperhidrosis of feet and palms, an erythema in palms is noted. About 1/3 diseased have visceral manifestations of a pseudorheumatism. Changes in heart are shown in the form of myocarditis, a miokardiodistofiya, a pericardis, an endocarditis. Involvement of kidneys leads to an amyloidosis, focal nephrite, formation of a renal failure. Pneumonia and a pneumofibrosis is also possible. Manifestations from a liver include hepatitises, a liver failure, a liver amyloidosis.
The pseudorheumatism can proceed separately or in combination with other diseases of connecting fabric, the deforming osteoarthrosis, juvenile arthritis.

Diagnosis:

The laboratory and tool program of diagnosis of a pseudorheumatism includes: general blood test, determination of level of S-reactive protein, SOE, ultrasonography, MRT level of joints, rentgenobsledovaniye of joints, detection of a rhematoid factor, research of synovial fluid. Besides, the most specific is definition of an antibody to cyclic tsitrulinirovanny peptide (Anti-SSR).

Treatment of the Pseudorheumatism:

Treatment of a pseudorheumatism assumes a medikamentozna therapy, physiotreatment, LFK and even an operative measure.
The following groups of drugs are applied:
1. Group of non-steroidal anti-inflammatory drugs – an ibuprofen, sodium diclofenac, TsOG inhibitors. Slenut to remember that long uses of these medicines are led by development of complications from digestive tract and cardiovascular system.
2. Imunnodepressivny drugs. Drugs of this group are basic in treatment of a pseudorheumatism. The methotrexate, azathioprine, Mercaptopurinum, etc. are most widespread. Therapy by imunnosupressant demands constant control of laboratory indicators of blood and urine.
3. Glucocorticosteroids are also capable to reduce edematous and inflammatory process in joints.
4. Antimalarial drugs are also used in treatment of a pseudorheumatism. Their appointment is reasonable in a combination with imunnosupressor. Usually the effect of antimalarial therapy occurs not earlier than in several months.
5. Biological therapy of a pseudorheumatism assumes influence on the defective links of immunity causing development of a disease. Biological therapy is carried out by subcutaneous or intravenous injections.  For this purpose apply inhibitors of a factor of a necrosis of tumors (адалимумаб and инфликсимаб), modulators of lymphocytes (абатацепт and ритуксимаб), inhibitors interleykina-6 (тоцилизумаб). These drugs have high performance in fight against a pseudorheumatism, however degree of an exacerbation of psoriasis, development of infectious diseases and leukemia is high.
At the expressed joint deformation it is reasonable to carry out surgical treatment. An operative measure assumes removal of the destroyed joint capsule (synovectomy) or prosthetics of a joint.
Among physiotherapy it should be noted magnetotherapy, ультрофонофорез, электорофорез.