Rheumatoid Arthritis



Rheumatoid arthritis (RA) is a common disease that affects the joints and possibly other organs. Like most diseases called "rheumatic", the exact cause is unknown but some mechanisms have been elucidated. Eventually, the PR represents a significant proportion of disability.

Epidemiology: about 1% of the population is affected by rheumatoid arthritis, and women are affected 3-4 times more often than men. In the blood of sick patients, there is a certain antigen (HLA DR-4) in 70% of cases, however, a quarter of healthy subjects were also positive for this antigen.
Pathophysiological mechanisms: Rheumatoid Arthritis is one of those diseases is called "autoimmune" in the sense that the patient's immune cells react against components of his own body. In the case of RA, the lymphocytes (immune cells) will attack the components of the lining of the joints (synovium). This will lead to a slow and progressive destruction of articular cartilage.

Symptoms and diagnosis: RA patient will feel symptoms such as weight loss, sweating at night, muscle pain and possibly damage the nails. In addition, the joints will be affected: Typically, these are the first joints of the fingers are affected, and on both sides and simultaneously. Over time, the disease will eventually propagate to the hand, wrist, or other joints. Members are painful when they are mobilized and swollen, especially in the early morning. Inflammation of the tendons at the wrist can lead to carpal tunnel syndrome, that is to say, the compression of a nerve that innervates the hand (the median nerve). Over time, it may be noted deformation of the hands and fingers quite characteristic. Other organs may be affected optionally: the heart and lungs, even if no symptoms are detected most of the time, but also the eyes (inflammation of the cornea and conjunctiva = keratoconjunctivitis).

The diagnosis can be made based on the patient's history, the typical signs of the joints and the various reviews that will complement the balance sheet: X-ray, blood test dosing with "rheumatoid factor" and inflammation factors.

Treatment and care: the treatment of RA is based on several axes. We can offer the patient means "physical" as cryotherapy, massage and gymnastics, but also drugs that will act against the pain felt by the patient: anti-inflammatory "classical" selective substances Corticosteroids and anti-rheumatic (Methotrexate, Hydroxychloroquine). In recent years, we have developed antibodies (anti-TNF) acting at the level of molecules that cause inflammation. Finally, the injection of radio-active substances (radiosynoviorthèse) and surgery to remove the synovium have also proven themselves in difficult cases.