Rheumatoid arthritis (RA) is a chronic immunological disease in which the cells of the human body's immune system misidentify some of the cells of their own body as foreign and start inflammatory processes that lead to their destruction. It is described as a systemic disease, because although it originally involves the synovium of the joints, pathological changes may affect not only the motor system but also many other systems (e.g. circulatory, excretory) and organs.
SYMPTOMS OF RAS
- morning stiffness of the joints lasting over 1 hour - a characteristic, often the first symptom of the disease, caused by exudate (inflammatory fluid), accumulating in the affected joints at night
- low-grade fever, weight loss, general weakness, muscle pain - often occur in the early stages of the disease as a general reaction of the body to the ongoing pathological process
- pain, swelling, increased temperature, pain during compression - a symptom of ongoing inflammation of the symmetrical joints and periarticular tissues of the hands and feet, and usually in the later stage of the disease also of "large" joints - knee, shoulder and elbow joints
- changes in tendons and ligaments, loss in interosseous muscles leading to damage in the musculoskeletal system
Symptoms of involvement of the musculoskeletal system depending on the location of the inflammatory process:
Joints of the hands and feet The disease usually affects the proximal interphalangeal joints, metacarpophalangeal joints, wrist joints and metatarsophalangeal joints Ulnar deflection of the arms is characteristic, as well as palpic palmar subluxations, changes in the appearance of fingers - so-called "telescopic" fingers, "buttonhole", "swan neck" look - caused by destruction of tendons and ligaments and shortening of the phalanges of the hands. Falling of fingers is often observed, or so-called "latching" fingers. In many cases, ganglion cysts are created filled with jelly-like content. There may be compression of the median nerve that runs in some of its sections in the narrow osteochondral channel, which gives the symptoms of the so-called carpal tunnel syndrome (numbness of the fingers from the thumb to the ring finger, mainly at night and in the morning). Involvement of carpal joints may lead to their immobilization (ankylosis). The disease process in the ankles and joints of the feet causes pain during compression, as well as swelling. Tendon ruptures may occur due to the formation of rheumatoid nodules and subluxation of the joints and deformation of the toes. Elbow joints Pain, limitation of extension, and gradually arising flexion contractures Shoulder joints Pain, swelling of the joints, gradual limitation of mobility Knee joints The first symptom may be atrophy of the quadriceps muscle of the thigh. There may occur joint swelling, flexion contractures, convexity of the external part of the joint, which increases with the compression of the patella. A common complication is the popliteal cyst (Baker’s cyst) resulting from excessive production of synovial fluid in the course of the inflammatory process and its leakage outside the synovial cavity through the damaged capsule. In the case of ruptured joint capsule, pain and swelling of the calf area occurs. Hip joints Pain in the groin area increasing when walking, limitation of mobility (mainly concerns internal rotation). The resulting changes lead to the positioning of the limb in flexion and external rotation. Spine joints The changes most often concern the cervical spine. There occurs reduction of its mobility (mainly turning to the side), pain, subluxation in the joints, micro-fractures, damage to the intervertebral discs and their prolapse. Temporomandibular joints The process of the disease leads to difficulties in opening the mouth and thus disturbs the speech and makes eating difficult. Extra-articular changes accompanying rheumatoid arthritis: They most often occur in patients with the presence of rheumatoid factor (RF) in the blood. They can involve many organs: sight, pericardium, kidneys and cause haematological disorders (mainly iron deficiency anaemia). Approximately 30% of patients have rheumatoid nodules, usually on erectile surfaces of the joints, in areas exposed to pressure. These are painless subcutaneous nodules, which are an expression of inflammation of small blood vessels in soft tissues. They often occur in the occipital area and joints of elbows and hands.
DIAGNOSTICS OF RHEUMATOID ARTHRITIS
Medical history and examination are essential. X-ray examination is necessary to assess the scale of destructive changes in the joints, ultrasound examination assessing the structure of joints, tendons and muscles, sometimes also magnetic resonance imaging. Laboratory tests are also performed: morphology with peripheral blood smear, ESR, determination of C-reactive protein level (CRP), serological test (rheumatoid factor - RF, anti-CCP antibodies), general urine examination, examination of synovial fluid.
TREATMENT OF RA
The treatment of rheumatoid arthritis should be comprehensive:
Farmakologiczne: Pharmacological: Drugs modifying the course of the disease and biological drugs - causative effect. Non-steroidal anti-inflammatory drugs (NSAIMs) and glucocorticoids - mainly relieving pain. Unfortunately, their use (especially long-term) is associated with the possibility of many adverse side effects such as: gastrointestinal disorders, allergic reactions, bone marrow disorders (which may result in, for example, anaemia), disorders of the nervous system (headaches and dizziness). Sometimes NSAIMs are the cause of gastrointestinal bleeding, as well as stomach and duodenal ulcers. Medications made from natural healing minerals used in health resort treatment (sulphide brine, peloid):
- bals sulphur (300g) anti-rheumatic sulphide gel based on sulphide brine from the Shaft of Solec Health Resort “Solec Zdrój” Sp. J. It allows the patient to use healing mineral (sulphide) waters at home, and in physical therapy facilities (iontophoresis or phonophoresis treatments - with bals sulphur gel).
- peloid ointment 60g) - anti-rheumatic medication for rubbing into the affected joints.
- reumogel (130g) for patting into aching muscles and joints, as well as for peloid iontophoresis and phonophoresis treatments (ultrasounds plus reumogel)
These medications have an anti-inflammatory, anti-swelling and pain relief properties. Because they do not have side effects, unlike other groups of medications, they can be used by all patients, also in long-term therapy. They can be bought in pharmacies and herbal medical stores throughout Poland.
Rehabilitation - the most effective in the context of health resort treatment. In the health resorts Solec - Zdrój and Busko - Zdrój, patients are effectively treated with sulphide waters (mineral baths) and peloid baths. Unfortunately, due to limitations related to contraindications for stimulus treatments (e.g. cardiovascular diseases), as well as limited time and financial possibilities of patients, health resort treatment is not available for every patient. An alternative is the use of treatments with medications based on aqueous peloid and sulphide brine extract.
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HEALTH RESORT AT HOME
PA PRODUCTS PROLONGING HEALTH RESORT TREATMENT AND FOR USE AT HOME
- Busko SPA sulphide – a unique health resort product from Busko-Zdrój. The only SPA sulphide produced from natural mineral sulphide brine. Sulphide bath in a bathtub or shower gel.
- Busko sulphide mask – for use in bath and shower, as well as for full and partial compresses. The mask is white, it does not contain yellow lanolin.
- peloid „plus”– contains microbiologically pure peloid strengthened with approx. 20% addition of concentrated aqueous peloid extract. For compresses, partial and total wraps.
- peloid–peloid treatment using peloid SPA lotion for baths, produced from microbiologically pure peloid, with a forest scent. Product based on a concentrated aqueous peloid extract.
- peloid butter– for rubbing and warming massages. The butter contains aquatic peloid extract - a concentrate of biologically active peloid ingredients. The use of peloid butter for classical massage strengthens its healing effect.