Rheumatism according to ICD 10 is autoimmune disease associated with the appearance of circulating immune complexes after contact of the body with group A hemolytic streptococcus. It develops with the congenital similarity of the antigenic structure of the connective tissue and streptococcus, affects the valvular apparatus of the heart, large joints and the central nervous system. It is divided into forms of the disease with the formation of heart defects and without them.

This pathology can occur after suffering a sore throat. In modern times, rheumatism is much less common, the massive use of antibiotics does not allow the development of autoimmune processes.

The incidence of the disease in developed countries among the adult population is up to 0.9%, and in childhood- not less than 0.6%. With the development of rheumatism from a young age to adulthood (30-40), about 80-90% do not survive.

Rheumatism according to the registry microbial 10 is a systemic autoimmune disease. Its classification is based on damage to the joints, heart valves, central nervous system, stages and severity of the disease.

For a complete list of this pathology, the international classification of diseases of the 10th revision is used. According to ICD - 10, each disease has its own encoding. Rheumatism code starts with latin letter I which refers to all diseases of the circulatory system. The code for rheumatism and rheumatic fever is 00-09.

Acute rheumatic fever (ARF - ICb 10 rheumatic fever code I00-I02).

I 00 Rheumatic fever without effect on heart disease.

I 01 Rheumatic fever with influence on the appearance of heart disease.

I01.0 pericarditis;

I01.1 endocarditis;

I01.2 myocarditis;

I01.8 Other acute rheumatic heart diseases.

I 02 Chorea.

Chronic rheumatic heart disease (code I05-I09):

I 05 Rheumatic diseases of the mitral valve.

I05.0 mitral stenosis;

I05.1 mitral insufficiency;

I05.2 Mitral stenosis with mitral insufficiency.

I 06 Rheumatic diseases of the aortic valves.

I 07 Rheumatic diseases of the tricuspid valve.

I 08 Multiple valvular lesions.

I 09 Other rheumatic affections of the heart.

I09.0 Rheumatic myocarditis;

I09.1 chronic endocarditis, valvulitis;

I09.2 Chronic pericarditis

Classification of rheumatism

Clinicians and theorists distinguish two forms of rheumatism - active and inactive. Some separate progressive, fading, and relapsing phases. This pathology may be chronic stage with valvular and myocardial involvement. Palindromic (recurring) rheumatism was described as early as 1891.

In medicine, rheumatism is classified according to two criteria: according to clinical manifestations and the degree of disease activity.

Clinical manifestations of acute rheumatic fever:

Classification of rheumatism according to the degree of activity:

First degree. The minimum degree, which has mild symptoms. Differs in minor symptoms or their absence.

The second degree or the average degree of activity. May be associated with fever and carditis. It is characterized by an increase in ESR, leukocytes and a number of other indicators of a blood test.

Third degree (maximum). It is distinguished by the appearance of fever with fluid effusion in the cavity (polyarthritis, serositis). IN biochemical analysis the content of proteins - inflammation (CRP, a-globulins, seromukoid) and enzymes is sharply increased.

When diagnosed, damage to the central nervous system, heart, joints and other organs occurs. Often professors characterize the disease with the expression "rheumatism kisses the brain, licks the joints and bites the heart."

Such a disease is quite difficult to treat, but with proper and timely examination, treatment, a complete recovery occurs.

Causes and risk factors

The main cause of such a disease is infection with a group A bacterium, only beta-hemolytic streptococcus contains a rheumatogenic factor that determines the development of rheumatism. The second reason is the similarity of antigens of the microbe and cartilage tissue. Together, these reasons can cause the development of auto-aggression. immune system against the connective tissue of the body.

Risk factors for developing rheumatic disease:

• the presence of a characteristic streptococcus that causes hemolysis (a provoking factor);
• genetic predisposition of the immune status;
• inflammatory factors.

The course and prognosis of the disease

Rheumatism proceeds in 3 stages:

1. Autoimmune (the appearance of immune antigen-antibody compounds and the production of autoantibodies occur in it).
2. Vascular (pathology of the microvasculature and blood coagulation system, leading to the formation of blood clots).
3. Inflammatory (exudative reactions of connective tissue).

The course of ARF and rheumatism:

In 75% of patients, attacks of rheumatism subside no more than 6 weeks, in 95% of patients within 12 weeks there is a complete recovery. And only 5% of the course of the disease can exceed six months. Such patients are characterized by all clinical manifestations in a severe and neglected form. The frequency of exacerbations depends on the degree of re-infection with the bacterium, the presence of lesions of cardio-vascular system and duration of the remission stage.

Carditis develops in almost all patients. In the absence of coarse noises over the apex of the heart, a favorable prognosis of rheumatism should be judged.

In the International Classification musculoskeletal system and connective tissue are given a separate place for juvenile arthritis. He was assigned the code M08-M09.

There are also separate subspecies of this type of arthritis of the joints. These include arthritis rheumatoid, seronegative, pauciarticular, unspecified, psoriatic, with ulcerative colitis and Crohn's disease, with a systemic onset, ankylosing spondylitis, etc.

Studies have shown that approximately 294,000 children suffer from JA. Genetic and environmental factors are involved in the development of the disease. If one of the twins has such a disease, then it is possible that in the near future signs of pathology will appear in the second child. A lot of research is currently being done to better understand the causes of this type of arthritis. Common symptoms of all types of juvenile arthritis:

• puffiness;
• pain;
• redness;
• fever;
• morning stiffness.

The need to create a unified classification

According to the International Classification of Diseases 10 revision, rheumatoid arthritis is seropositive and seronegative. These two species also have their own classification and each subspecies of the disease has its own code.

Seronegative RA, ICD-10 code - M-06.0:

• Still's disease in adults- M-06.1;
• bursitis - M-06.2;
• rheumatoid nodule - M-06.3;
• inflammatory polyarthropathy - M-06.4;
• other specified RA - M-06.8;
• seronegative RA, unspecified - M-06.9.

Seropositive RA, ICD-10 code - M-05:

• Felty's syndrome - M-05.0;
• rheumatoid lung disease- M-05.1;
• vasculitis - M-05.2;
• rheumatoid arthritis involving other organs and systems - M-05.3;
• other seropositive RA - M-05.8;
• unspecified RA - M-05.9.

The International Statistical Classification of Diseases (abbreviated as ICD) is the fruit of a joint effort of doctors from different countries, statistical institutes and healthcare organizations, which allows the use of common designations for specialists from different medical schools who use the terminology adopted in a particular country and who are carriers of different linguistic bases.

The use of terminology, which poses certain difficulties for a physician from another country, makes it difficult to exchange information, statistics and scientific achievements that could alleviate the condition and improve the quality of life of thousands of patients.

Creation international classification- this is a great achievement in the process of interaction between doctors, which allows in the age of information technology to facilitate and improve the exchange of medical information.

Achievements in medicine, the emergence of new data and methods, cause a permanent update of the classifier, the introduction of new information into it, and new diseases.

This is done every 10 years, and currently the world medical community is already using the 10th International Classification, called ICD-10 or ICD-10.

This is the document that testifies to the optimization of the process of exchange of scientific and medical information on an international scale, and allows:

• ensure the unity of methodological approaches;
• ensure international comparability of materials;
• convert an imperfect verbal formulation into an alphanumeric code;
• facilitate the exchange of information within a single information space;
• to unify the terminology of different schools and different world languages.

Currently, 12,255 diseases are included in the microbial disease, and each disease has its own code.

The numbers and letters in the medical card next to the diagnosis are the classification designation (microbial code) of a certain disease, for statistical and scientific research, and their facilitation.

The emergence of a single information space has made it necessary to use universal alphanumeric codes to overcome the information and language barrier between its users.

Signs and conditions of occurrence of psoriatic arthropathies (M07)

Psoriatic arthritis of the knee, hip or any other joint is a chronic progressive inflammation. In ICD 10, psoriatic arthropathies have the M07 code. Clinical manifestations include:

• conjunctivitis;
• lower back pain;
• reduced range of motion;
• swelling of fingers and toes.
• swelling;
• stiffness.

Symptoms of rheumatoid arthritis

The signs of JRA are diverse. The disease can be acute or subacute. The acute course is more typical for children of preschool and younger school age. In the absence of therapy, the prognosis is poor. The main symptoms in this case will be:

• involvement in the process of joints;
• slight increase in body temperature;
• the appearance of a rash on the body;
• lymphadenopathy;
• an increase in the size of the liver or spleen.

In the acute course of the disease, bilateral joint damage is observed. The knee, elbow, and hip joints are more susceptible to inflammation. An acute onset is observed in the presence of a systemic and generalized type of arthritis.

The classical picture of the disease is typical. There is a systemic inflammatory process.

Rheumatoid arthritis has a progressive course. But sometimes there are remissions - periods of temporary improvement.

Types of symptoms:

The code M10 is put on a person’s personal medical card if he complains about the following symptoms related to gouty arthritis:

• soreness;
• metabolic disease;
• redness;
• nocturnal acute pain thumb legs;
• renal dysfunction.

Attacks can last from several days to several weeks, then remission occurs. It is necessary to consult a doctor even if the signs of gout have disappeared, because after a while the attack will recur again.

Over time, gout damages tendons and other tissues. Gouty arthritis begins to develop due to high levels of uric acid in the blood.

Due to its too high content in the blood, hard crystals begin to form in the joints, which disrupt blood circulation and cause specific symptoms.

Treatment of gouty type of arthritis with the ICD code - M10, begins with the use of NSAIDs. It is very important to start therapy on time to avoid complications.

Such arthritis may be in the group of reactive arthritis according to microbial 10, if there are additional symptoms in the signs that are characteristic of this particular type of disease:

• conjunctivitis
• colitis
• urethritis, cervicitis
• swollen lymph nodes

Such arthritis can be classified as gouty arthritis according to microbial 10. This will happen if the following is found in the medical history and during the tests:

• general metabolic disorders
• renal dysfunction
• system failures water-salt balance
• polyarthritis

If there is a diagnosis correctly made by a qualified specialist, the prognosis for a speedy recovery is always high.

Gouty arthritis according to ICD 10 and its symptoms

The main thing is to contact medical institutions, undergo all prescribed examinations, take all recommended tests and take prescribed medications strictly according to the scheme prescribed by the attending physician.

How to treat the disease?

Biological agents are proteins that are designed in a way genetic engineering. Based on human genes.

This method of treatment is aimed at suppressing inflammation in the disease. What differences do biological agents have without producing side effects? Proteins act on a number of specific components of human immunity, while excluding further complications.

What drugs does the doctor prescribe for the treatment of the disease? As a rule, the use of traditional anti-inflammatory drugs helps to reduce pain, swelling, and increase the functioning of the joints.

How much drug is required to treat rheumatoid arthritis? As a rule, a reduced dose is used.

It is also possible to use analgesics, which also help to eliminate pain.

Today, medicine has a lot of drugs that contribute to the treatment of rheumatoid arthritis (ICD-10 code). These include:

Sulfasalazine

Sulfasalazine is banned in some American countries. In our country, Sulfasalazine is the most safe means which can slow down the progression of the disease.

It should be noted that Sulfasalazine can cause a number of side effects. So, it is forbidden to use the drug Sulfasalazine with individual intolerance.

As a rule, Sulfasalazine is started at 500 mg / day, and after 14 days the dose is increased. The maintenance dose of the drug is 2 g / day.

Sulfasalazine is divided into two doses per day. For children, Sulfasalazine is divided into four doses.

As a rule, the effectiveness of the drug Sulfasalazine comes to the beginning - the end of the third month of treatment. Sulfasalazine can cause the following negative effects: the manifestation of nausea, loss of appetite, agranulocytosis.

Methotrexate

Methotrexate is widely used in oncology. So, thanks to him, inhibition of the division of cancer cells occurs. But methotrexate has found its use in rheumatoid arthritis.

Only a doctor is able to prescribe the correct dosage of Methotrexate.

Basically, Methotrexate leads to improvement 6 months after its use. It must be remembered that the frequency of taking the drug Methotrexate contributes to rapid treatment.

Wobenzym

Wobenzym helps to reduce side effects, as well as reducing the dosage of basic drugs. Wobenzym also helps to reduce the dosage of non-steroidal anti-inflammatory drugs.

The drug Wobenzym can be prescribed by a doctor with a mild degree of the disease. Wobenzym is also prescribed for contraindications to immunosuppressive therapy.

Metipred

Metipred belongs to the group of corticosteroids. In other words, Metipred is referred to as methylprednisolone.

In the case of rheumatoid arthritis, Metipred helps to eliminate painful manifestations, as well as improve general condition with illness.

Metipred has its own side effects. That is why apply this drug required by doctor's prescription.

Turmeric

Turmeric is not a medicine at all, but rather folk method treatment.

Turmeric is popularly known as a seasoning for many dishes. In addition to this property, turmeric is famous for its medicinal properties. So, turmeric helps to relieve painful manifestations, as well as swelling on the inflamed joint.

Preparing a healing mixture is not at all difficult. To do this, you need to mix chopped turmeric and olive oil. Miracle mix to use in the amount of 2 teaspoons with food.

Turmeric is useful as a seasoning that must be added to food at least 2 times in 7 days.

And the most important rule - unauthorized treatment will only aggravate the course of the disease.

A person who became interested in the classification of rheumatoid arthritis according to the ICD has already clearly seen the code designation of the disease in his medical record.

At the initial stage, rheumatoid arthritis does not yet cause significant concern, but the longer systematic treatment and medical consultations are delayed, the more serious the manifestations of pathology become.

Osteo-articular inflammation and degenerative changes in the composition of bone and cartilage tissue is the disease of the present century.

It is the result of using harmful products and ignoring the useful components that the body needs for normal life, lack of physical activity, and prolonged static loads, improper sleep, and oxygen starvation, bad habits and unfavorable ecology.

At the slightest problem with the joints and their activity, you should definitely contact for medical assistance, and start necessary treatment. Otherwise, it will be too late to do anything.

Treatment is carried out only after diagnosis. It is required to exclude such diseases as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, Reiter's syndrome, systemic lupus erythematosus, tumor, ankylosing spondylitis.

In the presence of rheumatic diseases in children, treatment should be comprehensive.

Treatment of juvenile rheumatoid arthritis includes restriction of motor activity, avoidance of insolation, use of NSAIDs to eliminate pain and inflammation, immunosuppressants, exercise therapy, physiotherapy.

Symptomatic drugs(painkillers from the NSAID group and glucocorticoids) are prescribed during an exacerbation of arthritis. Of the NSAIDs, Indomethacin, Diclofenac, Nimesulide, Naproxen are most often used.

Of the glucocorticoids - "Betamethasone" and "Prednisolone". The group of basic drugs in the treatment of rheumatoid arthritis includes: Methotrexate, Sulfasalazine, Cyclosporine, Hydroxychloroquine.

Treatment with these drugs can last for years.

These medicines are prescribed for a long course. With their help, it is possible to achieve a long-term remission, improve the prognosis for health, slow down the process of destruction of bone and cartilage tissue.

These are drugs pathogenetic therapy. Treatment involves massage, diet, and additional vitamin intake.

The diet should include foods containing vitamins and minerals (calcium, phosphorus). Of the physiotherapeutic methods, UVI, phonophoresis, and laser therapy are used.

If contractures develop, skeletal traction may be required.

In the later stages of the disease, with the development of ankylosis, arthroplasty (replacement of the joint with an artificial one) can be performed. Thus, juvenile rheumatoid arthritis is an incurable disease and, in the absence of pathogenetic therapy, can lead to disability.

Therapy for rheumatoid arthritis should begin immediately, without waiting for complications and irreversible consequences. Today there are international standards for the treatment of this pathology.

Basic principles of recovery:

1. When choosing a treatment course, the specialist takes into account the duration of the disease, features pain. On early stages active monitoring is established to monitor the patient's health status. The patient should regularly visit a rheumatologist, take the necessary tests. If necessary, once a year, a liver puncture is done in order to check its condition.
2. First, one drug is used. Basic antirheumatic drugs, non-steroidal anti-inflammatory drugs are used. Voltaren, Naproxen, Ibuprofen, Ortofen, Indomethacin can relieve inflammation.
3. If first-line drugs do not help, during the acute phase, the doctor prescribes steroids - hormones. This allows you to keep the inflammatory process at a very low level.
4. To save the patient from constant steroid therapy, immunosuppressants are used as prescribed by the doctor. These drugs modify the disease. They prevent abnormal immune cells from destroying body tissues. Most often, doctors prescribe Methotrexate, since its effectiveness has been fully proven today. Plaquenil is used as an immunosuppressant.
5. After achieving remission, the doctor recommends switching to a maintenance dose of drugs.
6. In severe cases, the patient has to replace the joints, put prostheses.

Illness is always a big problem for a person. When an ailment is detected, the patient is not so much interested in the subgroup and font of the disease in the international classification of diseases as a positive outcome.

Medicine is developing rapidly. Such a classification is an example of the fact that doctors keep up with the times, improve their methods, and improve their approach to patient care.

megan92 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the consequence, and not with the cause ... Nifiga does not help!

Daria 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. Such are the things

megan92 13 days ago

Daria 12 days ago

megan92, so I wrote in my first comment) Well, I'll duplicate it, it's not difficult for me, catch - link to professor's article.

Sonya 10 days ago

Tags:

Application tactics

Arthritis classification according to ICD 10

(according to the presence of RF): seropositive, seronegative

A distinction was made according to the following types of etiological relationship: a) direct infection of the joint, in which microorganisms invade the synovial tissue and microbial antigens are found in the joint; b) indirect infection, which can be of two types: “reactive arthropathy”, when microbial infection of the body is established, but neither microorganisms nor antigens are detected in the joint; and "post-infectious arthropathy", in which the microbial antigen is present, but the recovery of the organism is incomplete and there is no evidence of local reproduction of the microorganism.

Cyclophosphamide (200 mg ampoules), endoxan - 50 mg tablets

physiotherapy procedures;

Reactive Arthritis Symptoms

Puffiness

Second degree - the pain intensifies, the restriction of motor activity is such that it leads to a decrease in working capacity and limitation of self-service.

1. The symptom complex of the disease included: symmetrical damage to the joints, the formation of deformities, contractures and ankylosis in them; anemia, an increase lymph nodes, liver and spleen, sometimes the presence of febrile fever and pericarditis. Subsequently, in the 30-40s of the last century, numerous observations and descriptions of Still's syndrome revealed much in common between rheumatoid arthritis in adults and children, both in clinical manifestations and in the nature of the course of the disease. However, rheumatoid arthritis in children was still different from the disease of the same name in adults. In this regard, in 1946, the term "juvenile (juvenile) rheumatoid arthritis" was proposed by two American researchers Koss and Boots. Nosological separation of juvenile rheumatoid arthritis and adult rheumatoid arthritis was subsequently confirmed by immunogenetic studies.
2. This type of rheumatoid arthritis includes Still and Wieseler-Fanconi syndrome. Still's syndrome is more commonly diagnosed in preschoolers. It is distinguished by the following features:
3. Juvenile rheumatoid arthritis is a pathology that develops in children and adolescents under 16 years of age, in which not only the joints, but also other organs can be affected. A doctor can make a similar diagnosis if a child has arthritis that lasts more than 6 weeks. The disease does not occur very often. International statistics says that JRA is detected in 0.05-0.6% of children. Children under 2 years of age suffer from this disease extremely rarely. There are gender differences in the incidence among children. Arthritis is diagnosed more often in girls. The disease is steadily progressing.

NSAIDs Patients at risk of developing gastropathy and gastrointestinal bleeding (age over 75 years, history of gastrointestinal ulcers, simultaneous use of low doses of acetylsalicylic acid and HA, smoking) can be prescribed selective or specific COX-2 inhibitors, either (subject to high individual effectiveness) non-selective COX inhibitors in combination with misoprostol 200 mcg 2-3 times / day or proton pump inhibitors (omeprazole 20-40 mg / day) In patients with impaired renal function, NSAIDs should be treated with extreme caution If there is a risk of thrombosis, patients receiving selective COX-2 inhibitors should continue to take small doses of acetylsalicylic acid at the same time.

Diagnosis and treatment of the disease

Downstream:

Alkylating cytostatic; forms alkyl radicals with DNA, RNA and proteins, disrupting their function; has an antiproliferative effect.

Pronounced edema from the very beginning of the disease

In the third degree - the impossibility of self-service, a significant loss of mobility in the joint (joints).

What causes juvenile rheumatoid arthritis?

MoiSustav.ru

Learning to live with a diagnosis according to ICD 10 - rheumatoid arthritis

acute onset;

Causes and symptoms of rheumatoid arthritis

​If treatment is not started early, there is a high risk that the child will become disabled.​

The World Health Organization (WHO) has developed a special medical coding for the diagnosis and definition of medical diseases. ICD 10 code - coding for the international classification of diseases of the 10th revision as of January 2007.​

​GK Systemic application. It is recommended to use low< 10 мг/сут) дозы ГК, что позволяет адекватно « контролировать» ревматоидное воспаление, но должно обязательно сочетаться с базисной терапией Локальная терапия ГК имеет вспомогательное значение. Предназначена для купирования активного синовита в 1 или нескольких суставах. Повторные инъекции ГК в один и тот же сустав необходимо производить не чаще 1 раза в 3 мес. Противопоказания к проведению локальной терапии: гнойный​ rapidly progressive, slowly progressive (assessment of the rate of development of destructive changes in the joint during long-term follow-up)

Staphylococcal arthritis and polyarthritis

How to treat rheumatoid arthritis?

RA with systemic manifestations (vasculitis, nephropathy).

massage;

Edema appears when inflammation is attached

According to the nature of occurrence in medicine, several forms of arthritis are distinguished:

The pathogenesis of juvenile rheumatoid arthritis is being intensively studied in last years. The development of the disease is based on the activation of both cellular and humoral immunity.

moderate fever;

The primary incidence rate is from 6 to 19 cases per 100,000 children. It is important that the prognosis for health largely depends on the age at which the disease began. The older the child, the worse the prognosis. Still's disease is a type of rheumatoid arthritis. The disease is very severe, with severe fever, joint syndrome, damage to the lymphatic system and sore throat. This pathology also occurs in adults.

There are currently 21 disease classes, each containing subclasses with disease and condition codes. Rheumatoid arthritis ICD 10 belongs to the XIII class "Diseases of the musculoskeletal system and connective tissue". Subclass M 05-M 14 "Inflammatory processes of polyarthropathy".​

Rheumatoid arthritis: we treat folk methods

arthritis

By activity:

200 mg IM 2-3 times a week until a total dose of 6-8 g per course is reached; combined pulse therapy; endoxan at a dose of 100-150 mg / day, maintenance dose - 50 mg / day. Methods of operative surgery (injections into the articular cavity).

artrozmed.ru

Etiology and treatment of juvenile rheumatoid arthritis

Redness of the joint

Features of the disease

reactive - a complication that occurs with untreated (undertreated) infections; The pathogenesis of juvenile chronic arthritis

polyarthritis involving small joints in the process;

Etiological factors

Juvenile arthritis can occur for a variety of reasons. The exact reason has not yet been established.​

Reactive arthritis of the knee is the most common rheumatic disease. The disease is characterized by a non-purulent inflammatory formation in the bone structure. In some cases, the disease occurs as a response to infectious diseases. gastrointestinal tract(GI tract), urinary tract and organs of the reproductive system.

• , unspecified nature
• I - low, II - moderate, III - high activity
• Pneumococcal arthritis and polyarthritis
• Hemorrhagic cystitis, myelosuppression, activation of foci of infection.
• Of the medications, NSAIDs, cytostatics, hormonal agents, antibiotics, etc. are prescribed. The set of medications directly depends on the type and etiology of arthritis. Table 2 lists the treatment regimens for rheumatoid arthritis.​
• Yes, but it may not be right away
• Rheumatoid - is a consequence of rheumatic diseases;

The main clinical manifestation of the disease is arthritis. Pathological changes in the joint are characterized by pain, swelling, deformities and limitation of movement, increased skin temperature over the joints. In children, large and medium joints are most often affected, in particular, knee, ankle, wrist, elbow, hip, less often small joints of the hand. Typical for juvenile rheumatoid arthritis is the defeat of the cervical spine and maxillotemporal joints, which leads to underdevelopment of the lower, and in some cases, upper jaw and the formation of the so-called "bird's jaw."

Forms of the disease

Enlargement and soreness of the lymph nodes;

Possible etiological factors are:

• The development of arthritis occurs a month after infection, however, the provocative infection that caused this disease does not manifest itself in the human body. Men over the age of 45 are most at risk. Sexually transmitted infections (gonorrhea, chlamydia, and others) can contribute to the progression of the disease. Women are less likely to suffer from this disease.
• arthritis
• Radiological stage:

Clinical symptoms

Chlorbutin (leukeran) - tablets of 2 and 5 mg

• drug
• Yes, but in the later stages of redness may not be
• Acute - develops after bruises, fractures, strong physical exertion;
• Symptoms of juvenile chronic arthritis
• hepatosplenomegaly;

the presence of a viral or bacterial infection;

If the carrier of the infection has entered the body with food, reactive arthritis can equally develop in both men and women.

• , any skin changes near the puncture site, joint tuberculosis, dry patches spinal cord, aseptic bone necrosis, intra-articular fracture, subluxation of the joint. use the following drugs(a full dose of drugs is injected into large joints, 50% into medium-sized ones, 25% into small ones): Methylprednisolone 40 mg Hydrocortisone 125 mg Betamethasone in the form of injections (celeston, flosterone, diprospan) Pulse - therapy with methylprednisolone leads to fast, but short-term effect (3-12 weeks); not affecting the rate of progression of the process In order to prevent osteoporosis, people receiving GCs are prescribed calcium (1500 mg / day) and cholecalciferol (400-800 IU / day), and in the absence of their effectiveness - bisphosphonates and calcitonin (see Osteoporosis). ​
• I - periarticular osteoporosis, II - the same + narrowing of the interarticular spaces + single erosions, III - the same + multiple erosions, IV - the same + ankylosis H
• Other streptococcal arthritis and polyarthritis
• Alkylating cytostatic; forms alkyl radicals with DNA, RNA and proteins, disrupting their function; has an antiproliferative effect
• ​Operating principle​

Symptoms of intoxication

Other manifestations

infectious - caused by viruses or a fungal infection that enters the joint with the blood stream, or through an unsterile surgical instrument, often leads to the development of purulent inflammation of the knee joint;

• In the systemic variant of juvenile rheumatoid arthritis, leukocytosis (up to 30-50 thousand leukocytes) is often detected with a neutrophilic shift to the left (up to 25-30% of stab leukocytes, sometimes up to myelocytes), an increase in ESR up to 50-80 mm / h, hypochromic anemia, thrombocytosis, an increase in the concentration of C-reactive protein, IgM and IgG in the blood serum.
• anemia;
• traumatic joint injury;
• A characteristic feature of the course of the disease is the symmetry of joint damage
• ​Basic Therapy​
• Availability of functional ability:

• High RA activity with systemic manifestations, generalized lymphadenopathy, splenomegaly.
• ​Operating principle​
• Observed in the case of an autoimmune nature of the disease
• Reiter's syndrome is a type of reactive arthritis;
• Diagnosis of juvenile chronic arthritis
• myocardial damage;
• increased insolation;
• Reactive arthritis is severe. During the first week, the patient has fever, disorders of the gastrointestinal tract (GIT), acute intestinal malaise, general weakness. In the future, the symptoms of arthritis progresses and is of a classic nature. At this stage of development, the disease can be divided into 3 types.
• ​Basic therapy should be given to all patients with reliable RA.​

​0 - retained, I - professional ability retained, II - professional ability lost, III - self-service ability lost.​

Diagnostic measures

​Arthritis and polyarthritis caused by other specified bacterial pathogens Use an additional code if necessary to identify the bacterial agent (​

6-8 mg / day, maintenance dose - 2-4 mg / day.

• Destination schemes
• No
• Arthritis in Bechterew's disease, gout (rare);
• Suppression of the inflammatory and immunological activity of the process.

polyserositis;

hypothermia;

Inflammation of the mucous membrane of the eyes occurs (may develop conjunctivitis).

Treatment tactics

Methotrexate remains the "gold standard" of basic therapy for RA, which has the best ratio of efficacy/toxicity. Assign to patients with active RA or those with risk factors for poor prognosis (see above) at a dose of 7.5-15 mg per week. The term of the effect is 1-2 months. Among the side effects of methotrexate are hepatotoxicity, myelosuppression, so the control of KLA and transaminases should be performed monthly. An increase in the level of liver enzymes is a signal to reduce the dose of the drug or completely cancel it. A persistent increase in liver enzymes after discontinuation of the drug is an indication for a liver biopsy. Taking into account the antifolate mechanism of action, the reception is shown folic acid 1 mg/day except on days of methotrexate use.​

Frequency - 1% in the general population. The predominant age is 22–55 years. The predominant gender is female (3:1). Incidence: 23.4 per 100,000 population in 2001

Myelosuppression.

Possible side effects

SpinaZdorov.ru

Juvenile rheumatoid arthritis

Symptoms of a stuck joint

psoriatic arthritis (occurs in 10-40% of patients with psoriasis)

ICD-10 code

• Relief of systemic manifestations and articular syndrome.
• An increase in ESR in the UAC.
• ingestion of protein components;
• Pain in the joints becomes stronger, while motor activity decreases. In the affected areas, noticeable redness and swelling appear.
• Hydroxychloroquine (200 mg 2 r / day or 6 mg / kg / day) is a frequent component of combination therapy for active, especially "early" RA. Monotherapy with hydroxychloroquine does not slow radiological progression. The term of the effect is 2-6 months. With long-term treatment, an annual ophthalmological examination, examination of visual fields is necessary.
• unknown. Various exogenous (viral proteins, bacterial superantigens, etc.), endogenous (type II collagen, stress proteins, etc.) and nonspecific (trauma, infection, allergy) factors can act as "arthritogenic" factors.​
• Due to the fact that the RA treatment regimens indicated in the table are not always effective, several combinations of basic agents are used in practice, among which the combinations of methotrexate with sulfasalazine, methotrexate and delagil are the most common. Currently, the treatment regimen in which methotrexate is combined with anticytokines is considered the most promising.

Epidemiology of juvenile chronic arthritis

Quinoline drugs (delagil - tablets of 0.25 g)

Classification of juvenile chronic arthritis

Reiter's syndrome (according to ICD-10 code 02.3) can develop in two forms - sporadic (causative agent - C. Trachomatis) and epidemic (Shigella, Yersinia, Salmonella).

Preservation of the functional ability of the joints.

Causes of juvenile chronic arthritis

In the subacute course of the disease, the symptoms are less pronounced. First, one joint is affected. Most often it is the ankle or knee joint. Both 1 joint and several can be affected. In the oligoarticular form of the disease, 2-4 joints are affected. Pain syndrome may not be. During a medical examination, swelling and dysfunction of the joint are determined. The movement of a sick child is difficult. The liver and spleen are of normal size. The subacute course proceeds more favorably and is better amenable to therapy.

hereditary predisposition;

The organs of the genitourinary system become inflamed.

The pathogenesis of juvenile chronic arthritis

Sulfasalazine is especially indicated in seronegative RA, when differential diagnosis with seronegative spondyloarthropathies. The starting dose is 0.5 g/day with a gradual increase in dose to 2-3 g/day in 2 divided doses after meals. Taking into account the myelotoxicity of the drug with its long-term use it is necessary to control the KLA every 2-4 weeks for the first 2 months, then every 3 months.​

​70% of RA patients have HLA - DR4 Ag, the pathogenetic significance of which is associated with the presence of a rheumatoid epitope (section b - the chain of the HLA molecule - DR4 with a characteristic amino acid sequence from the 67th to the 74th positions). The effect of the “gene dose” is discussed, that is, the quantitative-qualitative relationship between the genotype and clinical manifestations. The combination of HLA - Dw4 (DR b10401) and HLA - Dw14 (DR b1*0404) significantly increases the risk of developing RA. On the contrary, the presence of antigen defenders, for example HLA - DR5 (DR b1 * 1101), HLA - DR2 (DR b1 * 1501), HLA DR3 (DR b1 * 0301) significantly reduces the likelihood of RA.

Symptoms of juvenile chronic arthritis

In medical practice, there are often cases of lack of effect from treatment (for example, with reactive arthritis, inflammation is not relieved even when taking antibiotics in combination with NSAIDs), when patients remain disease active and the rapid progression of articular deformities.

Diagnosis of juvenile chronic arthritis

Stabilization of lysosomal membranes, inhibition of phagocytosis and neutrophil chemotaxis, inhibition of cytokine synthesis.

Treatment goals for juvenile chronic arthritis

• The clinical picture differs from other types of arthritis, since concomitant signs of the disease are lesions of the mucous membranes oral cavity, prostatitis (in men), vaginitis and cervicitis (in women). A common symptom is inflammation of the eyes (conjunctivitis, iridocyclitis), which manifests itself in reddening of the sclera, the appearance of purulent discharge, swelling of the eyelids.
• ​Prevention or slowdown of joint destruction, disability of patients.​
• It is necessary to know not only the causes and symptoms of juvenile rheumatoid arthritis, but also the methods of its diagnosis. In the early stages of the disease, the symptoms may be mild, so the diagnosis is often difficult.
• Dysfunction of the immune system.
• Initially, the disease can affect only one knee joint, but later it can spread to other joints. A pronounced clinic can be insignificant or very strong, depending on the person's immune system. In the future, the development of rheumatoid arthritis, which affects larger joints, is possible. lower extremities and toes. Back pain occurs with the most severe form of the disease.
• Leflunomide is a new cytostatic drug with an antimetabolic mechanism of action, developed specifically for the treatment of RA. Apply at a dose of 10-20 mg / day. The effect develops after 4-12 weeks. Monitoring of toxicity involves monitoring the level of liver enzymes and TAC.​
• The pathological process in RA is based on generalized immunologically determined inflammation. In the early stages of the disease, Ag is detected - specific activation of CD4 + - T - lymphocytes in combination with hyperproduction pro-inflammatory cytokines(tumor necrosis factor, IL - 1, IL - 6, IL - 8, etc.) against the background of a deficiency of anti-inflammatory mediators (IL - 4, soluble antagonist of IL - 1). IL - 1 plays an important role in the development of erosion. IL - 6 stimulates B - lymphocytes to the synthesis of RF, and hepatocytes - to the synthesis of proteins of the acute phase of inflammation (C - reactive protein, etc.). TNF-a causes the development of fever, pain, cachexia, is important in the development of synovitis (it promotes the migration of leukocytes into the joint cavity by enhancing the expression of adhesion molecules, stimulates the production of other cytokines, induces the procoagulant properties of the endothelium), and also stimulates the growth of pannus (granulation tissue penetrating into the cartilage from the synovial tissue and destroying it). An important prerequisite is the weakening of the endogenous synthesis of HA - hormones. In the late stages of RA, under conditions of chronic inflammation, tumor-like processes are activated due to somatic mutation of fibroblast-like synovial cells and defects in apoptosis.​

Forecast

Doctors make a conclusion about the need to change the therapy program if the patient has been treated for six months using at least three basic drugs.

The initial stage of RA.

​Laboratory research methods​

Arthritis of the knee joint should be differentiated from other pathological processes, the most common of which are arthrosis and bursitis. Bursitis, which is an inflammation in the synovial bag, can be easily distinguished from arthritis by an experienced specialist at the first appointment.

Achieving remission.

Prevention of juvenile chronic arthritis

The main diagnostic methods are:

ilive.com.ua

Causes, symptoms, diagnosis and treatment of knee arthritis

From viral infections the most dangerous are those caused by the Epstein-Barr virus, parvovirus and retroviruses. The mechanism of the development of the disease is associated with autoimmune disorders. When exposed to any adverse factor in the body of a child, special immunoglobulins are formed. In response to this, the synthesis of rheumatoid factor occurs. Joint damage occurs. In this case, the synovial membranes and blood vessels, cartilage tissue are affected. Not only the joints, but also the marginal parts of the bones (epiphyses) can be destroyed. The resulting circulating immune complexes are distributed throughout blood vessels to various organs. At the same time, there is a risk of developing multiple organ failure.

Etiology

In rare cases, the disease may affect the central nervous system, give complications to the organs of the cardiovascular system.

Gold salts (eg, sodium aurothiomalate) are used to treat seropositive RA. Trial dose 10 mg IM, then 25 mg weekly, then 50 mg weekly. As the total dose of 1000 mg is reached, they gradually switch to a maintenance regimen of 50 mg 1 time in 2-4 weeks. The effect develops in 3–6 months. Among the side effects are myelosuppression, thrombocytopenia, stomatitis, proteinuria, therefore OAC and OAM are recommended to be carried out 1 time in 2 weeks.

Evidence of the ineffectiveness of therapy is the negative dynamics of laboratory tests, the preservation of the focus of inflammation. In this case, you need an alternative solution on how to treat knee arthritis. Medical statistics confirm the positive dynamics in the use of pulse therapy using hormonal drugs(methylprednisolone intravenously, isotonic solution for three days - three courses are repeated after one month). Methylprednisolone is prescribed with caution in combination with cyclophosphamide due to the high toxicity of the drugs.

2 tab. per day for the first 2-4 weeks, then 1 table. per day for a long time.

Arthritis in children

Detect changes

Firstly, with bursitis, the mobility of the knee is slightly limited, and secondly, the area of ​​articular inflammation has clear contours. On palpation, the doctor quickly determines the boundaries of the inflammatory focus. As for arthrosis, it is more difficult to differentiate, since these diseases, which have completely different etiologies, have many similar signs.

Improving the quality of life of patients.

collection of anamnesis;

Symptoms of the disease

JRA classification according to ICD 10 takes into account the type of joint damage. Allocate polyarthritis and oligoarthritis. ICD 10 divides arthritis into acute and subacute. There is a classification based on clinical symptoms diseases.​

Today, to confirm whether a patient really has reactive arthritis, a whole range of laboratory tests is needed. Various specialists are involved in the examination of the patient. It is necessary to be examined by a gynecologist, urologist and therapist. The attending physician will indicate the need for examination by other medical specialists. After collecting the results of laboratory tests, anamnesis data, identifying clinical manifestations, the use of certain drugs is prescribed.

Cyclosporine is rarely used in the treatment of RA, only in cases of refractory to other drugs. The dose is 2.5–4 mg/kg/day. The effect develops in 2–4 months. Side effects are serious: arterial hypertension, impaired renal function.

General symptoms:

Pyogenic arthritis, unspecified. Infectious arthritis NOS

Degrees of dysfunction

A new direction in the treatment of rheumatoid arthritis is therapy involving the use of so-called biological agents (biologic agents). The action of the drugs is based on the inhibition of the synthesis of cytokines (TNF-α and IL-1β).

dyspepsia, pruritus, dizziness, leukopenia, retinal damage.

Do not reveal specific abnormalities

Arthrosis is a degenerative process in cartilage and bone tissue that occurs when there is a metabolic disorder, not associated with an inflammatory component. The main group of patients is the elderly (by the age of 60, most people are diagnosed with dystrophic changes in the joints).

Types of arthritis

Minimizing the side effects of therapy.

• external examination of the child;
• In this case, the following forms of juvenile arthritis are distinguished:
• It is necessary to begin treatment of reactive arthritis with the destruction of the infectious focus, that is, the causative agents of the original disease. To do this, you need to undergo a comprehensive examination of the whole organism. After determining the pathogen, sensitivity to medicines. bacterial infection treated with antibiotics.
• Azathioprine is used at a dose of 50–150 mg/day. The effect develops in 2-3 months. Laboratory monitoring is required (OAC every 2 weeks, then every 1–3 months).​
• Fatigue, subfebrile condition, lymphadenopathy, weight loss. 2.​
• Excludes: arthropathy in sarcoidosis (​
• It has been reliably established that in 60% of patients with active rheumatoid articular syndrome, even with the third degree of the disease, there is a decrease (or absence) of the progression of articular changes during maintenance therapy with Remicade. However, the use of this form of treatment is justified if the basic therapy did not give the expected effect.

Sulfa drugs (sulfasalazine, salazopyridazine) - 500 mg tablets

Instrumental research methods

Differential Diagnosis

Arthritis is always inflammation, which over time, with the progression of the disease (with an autoimmune nature), spreads to the entire body. That is why there are many accompanying signs in autoimmune arthritis - this is fever, subfebrile temperature, headache, and general malaise. With rheumatoid arthritis, the cardiovascular system is seriously affected.

Treatment of juvenile chronic arthritis

laboratory research;

articular;

The use of antibacterial drugs is recommended at the initial, most acute stage of the disease. In the future, their use becomes less effective. In some cases, symptomatic treatment is prescribed, in which non-steroidal drugs are used, for example, ibuprofen. "Anti-cytokine" therapy for RA is based on the suppression of the main pro-inflammatory cytokines: TNF-a and IL-1. Registered in Russia, infliximab is a monoclonal antibody to TNF - a. Infliximab is used at a dose of 3 mg/kg IV every 2, 6, and then every 8 weeks. The onset of the effect is from several days to 4 months. Articular syndrome

Diagnosis of arthritis of the knee

Mortality in juvenile arthritis is low. Most deaths are associated with the development of amyloidosis or infectious complications in patients with a systemic variant of juvenile rheumatoid arthritis, often resulting from long-term glucocorticoid therapy. In secondary amyloidosis, the prognosis is determined by the possibility and success of treating the underlying disease.

Treatment is carried out only after diagnosis. It is required to exclude such diseases as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, Reiter's syndrome, systemic lupus erythematosus, tumor, ankylosing spondylitis. In the presence of rheumatic diseases in children, treatment should be comprehensive.

involvement in the process of joints;

The 10th International Classification of Diseases (ICD 10) lists varieties of pathologies of the joints and connective tissues under the codes M05 (seropositive), M06 (seronegative) and M08 (juvenile) rheumatoid arthritis. Rheumatoid polyarthritis is classified, which in the ICD is under the M13.0 code, like other arthritis, depending on the presence of rheumatoid factor in the blood.

Long-term outpatient observation.

Tendosynovitis in the area of ​​the wrist joint and hand Bursitis, especially in the area of ​​the elbow joint Damage to the ligamentous apparatus with the development of hypermobility and deformities Muscle damage: muscle atrophy, myopathies, more often medicinal (steroid, as well as while taking penicillamine or aminoquinoline derivatives). 4.​

* Meningococcal arthritis (​

Balneological therapy is a very effective procedure in a comprehensive program for the treatment of arthritis of the knee joint. However, this direction of rehabilitation is indicated for those patients who do not have serious illnesses cardiovascular system, neoplasms of a malignant nature, and there were no previous heart attacks or strokes. All procedures using therapeutic biological components are prescribed with great care.​

Inhibition of the functional activity of macrophages and neutrophils, inhibition of the production of immunoglobulins and RF.

Medical treatment

Arthritis

Treatment

Due to the fact that the etiology of juvenile rheumatoid arthritis is unknown, primary prevention is not carried out.

Treatment of juvenile rheumatoid arthritis includes restriction of motor activity, avoidance of insolation, use of NSAIDs to eliminate pain and inflammation, immunosuppressants, exercise therapy, physiotherapy.

• a slight increase in body temperature;
• Polyarthritis is understood as systemic multiple lesions of the joints, in which not only almost all types of joints become inflamed and destroyed, simultaneously or sequentially, but also other organ systems. Sometimes the result of a neglected form of polyarthritis can be disability. Rheumatoid polyarthritis can act as an independent disease as an infectious-nonspecific rheumatoid arthritis, and sometimes it is a consequence of other diseases - sepsis, gout, rheumatism. Even those who have bad teeth should be wary of the disease, but the word "dentistry" is unacceptable in the lexicon.
• Observation is carried out jointly with a specialist - a rheumatologist and a district (family) doctor. The competence of a rheumatologist includes making a diagnosis, choosing a treatment strategy, teaching the patient the correct regimen, and conducting intra-articular manipulations. General practitioners are responsible for organizing the systematic management of the patient; they also carry out clinical monitoring. During each visit, the patient is assessed: the severity of pain in the joints on a 100-point scale, the duration of morning stiffness in minutes, the duration of malaise, the number of swollen and painful joints, functional activity.
• Systemic manifestations
• A39.8

Since there are many varieties of arthritis and joint pathologies, it is necessary to consult a doctor at the first signs of the disease. The sooner the causes that caused the inflammatory process are determined, the more likely it is to cure the disease completely.

​Age group​

The disease is not limited by age, but middle-aged women are diagnosed with this diagnosis somewhat more often than the representatives of the stronger half. An exception is infectious reactive arthritis, which is diagnosed mainly in men aged 20-40 years (more than 85% of patients with reactive arthritis are carriers of the HLA-B27 antigen).

Depending on the type of classification, the disease has the following names: juvenile arthritis (ICD-10), juvenile idiopathic arthritis (ILAR), juvenile chronic arthritis (EULAR), juvenile rheumatoid arthritis (ACR).

Often, the joints in the cervical spine are involved in the process. Articular syndrome is characterized by:

New methods

This disease is difficult to treat. The only thing that patients can hope for is a long-term remission, when the hospital does not become a second home. In the early stages, this can often be achieved, but in most cases, the symptoms recur and even worsen.

​Assess and infer rate of improvement (20%, 50%, 70%) using scores swollen joint scores painful joints scores of at least 3 out of 5 scores overall activity score according to patient overall activity score according to clinician patient score pain acute phase blood counts (ESR, CRP) disability (quantified using standardized questionnaires).​

arthritis

arthritis

Arthritis and movement. Gordon N.F.​

Rehabilitation programs

Suppression of collagen synthesis, inhibition of the activity of type I T-helpers and B-lymphocytes, destruction of the CEC

Arthritis of the knee joint can be diagnosed at home if you carefully examine the symptoms of the disease. Regardless of the etiology, symptoms such as swelling, redness in the joint area, general malaise, external signs articular tissue deformities.

​Unlimited (any age)​

It is worth dwelling in more detail on rheumatoid arthritis (RA), which is an autoimmune disease with unclear etiology. The disease is a common pathology - about 1% of the population suffers. Very rarely there are cases of self-healing, in 75% of patients there is a stable remission; in 2% of patients, the disease leads to disability.​

M08. Juvenile arthritis.

Stiffness in the morning lasting up to 1 hour or more;

1. The goal of therapy for rheumatoid arthritis is to reduce rheumatic pain, reduce inflammation, improve joint mobility and prevent complete immobility of the patient. The basic principles that guide any clinic that treats rheumatoid arthritis are complexity and consistency. Well established sanatorium spa treatment through therapeutic mud.
2. Rehabilitation.
3. American Rheumatological Association (1987)

SpinaZdorov.ru

ICD 10. Class XIII (M00-M25) | Medical practice - modern medicine of diseases, their diagnosis, etiology, pathogenesis and methods of treatment of diseases

peripheral joints and systemic inflammatory lesions internal organs.​

2 Shoulder Shoulder elbow joint bone

High clinical and laboratory activity of RA

However, one should not wonder how to treat arthritis of the knee joint on their own, especially using dubious recipes of folk medicine. This can lead to irreversible consequences. The decision on how to treat knee arthritis is made only after a comprehensive examination.​

Usually older than 50-60 years old

With this disease, the inner surface of the joints (cartilage, ligaments, bones) is destroyed and replaced by scar tissue. The rate of development of rheumatoid arthritis is not the same - from several months to several years. Features of the clinical picture of one or another type of inflammation of the joints make it possible to suspect the disease and prescribe the necessary examinations to confirm the diagnosis. In accordance with ICD-10, RA is classified as seropositive (code M05), seronegative (code M06), juvenile (code MO8)

M08.0. Juvenile (juvenile) rheumatoid arthritis (seropositive or seronegative).​

swelling in the joint area;

The first stage is the suppression of the autoimmune process, which actually leads to the destruction of tissues, pain, loss of the ability to move. This is followed by anti-inflammatory treatment, complete cleansing of the body from toxic metabolic products. During the period of remission, they restore blood circulation, increase the efficiency of joints, and normalize metabolism. All these stages combine both medical and physiotherapeutic methods of treatment.​

INFECTIOUS ARTHROPATHY (M00-M03)

Physical therapy plays an important role. Sanatorium - resort treatment is recommended during the period of minimal activity or remission. In order to correct deformities, orthoses are used - individual orthopedic devices made of thermoplastic, worn at night. ​At least 4 of the following Morning stiffness > 1 hour ​ Code according to the international classification of diseases ICD-10: 3 Forearm, radius, wrist joint - bone, ulna Initial dose of 250 mg / day with a gradual increase to 500-1000 mg / day; maintenance dose - 150-250 mg / day

M00 Pyogenic arthritis

Physicians must determine the nature of the disease in order to prescribe adequate treatment. Orthopedic traumatologists, surgeons, rheumatologists give directions for laboratory and instrumental studies. The treatment regimen is developed by a specialized specialist (it can be a phthisiatrician, dermatologist-venereologist, cardiologist and other doctors). Some types of arthritis affect only children and adolescents, so they should be singled out in a separate row. M08.1. Juvenile (juvenile) ankydotic spondylitis.​ soreness; The basic treatment is the suppression of the autoimmune process through such drugs: methotrexate, sulfasalazine and leflunomide. In terms of minimizing side effects, the latter differs, this should be taken into account from the position that they all require long-term (at least six months) use. Features in pregnant women Arthritis ​M06-​ 4 Hand Wrist, Joints between these fingers, bones, metacarpus Skin rash, dyspepsia, cholestatic hepatitis, myelosuppression The first stage for determining the disease (according to ICD 10) is a visual examination, anamnesis. Acute or chronic Juvenile rheumatoid arthritis (ICD-10 code M08) affects children after suffering bacterial and viral infections. As a rule, one knee or other large joint becomes inflamed. The child has pain with any movement, swelling in the joint area. Children limp, hardly get up in the morning. In the absence of treatment, joint deformity gradually develops, which is no longer possible to correct.

M08.2. Juvenile (juvenile) arthritis with systemic onset.​ change in gait; Non-steroidal anti-inflammatory drugs (NSAIDs) also have an analgesic effect. But they should also be used for a long time, so the doctor must choose the one that is best tolerated by the patient. Among non-steroids, diclofenac, ibuprofen, nimesulide are widely used. All of them affect the gastrointestinal tract to a greater or lesser extent. Pregnancy improves the course of RA, however, after delivery, a relapse always occurs due to hyperprolactinemia. It is undesirable to use NSAIDs in the first trimester of pregnancy and 2 weeks before delivery (in the first trimester - the risk of a teratogenic effect, before childbirth - the threat of developing weakness in labor, bleeding, early closure ductus arteriosus in the fetus). Gold salts, immunosuppressants are contraindicated for pregnant women. There is evidence of the relative safety of the use of aminoquinoline drugs and sulfasalazine, however, the expected effect should be correlated with the possible risk. 3 joints or more

Other rheumatoid arthritis 5 Pelvic Gluteal Hip joint, region and thigh region, sacroiliac, femoral joint, bone, pelvis Methotrexate (tablets 2.5 mg, ampoules 5 mg) The second stage is laboratory blood tests (with inflammation, an increase in ESR, leukocytosis, an inflammation marker CRP, and other specific reactions) are observed.

medpractik.ru

Arthritis rheumatoid, Diseases and treatment of folk and medicinal products. Description, application and healing properties of herbs, alternative medicine

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Rheumatoid arthritis codes in the International Classification of Diseases

The most important thing in the diagnosis and treatment of any disease is to make the correct diagnosis. Understanding the causes and knowing the symptoms helps the doctor assess the situation and make a decision on the tactics of therapy, which is especially important with a wide variety of diseases in humans. The International Classification of Diseases 10th Revision (ICD-10) is not only disease statistics, but also a real assistant to the doctor in daily work. Rheumatoid arthritis is classified under Arthropathy and is a type of disease that affects the peripheral joints. Various types There are a lot of pathological processes associated with inflammation. To easily navigate among this variety, the specialist uses a convenient and detailed classification that takes into account all the nuances of joint diseases.

Arthropathy options

Articular diseases that mainly affect the limbs include the following types of pathology:

• infectious (in ICD-10 they have the code M00-M03);
• inflammatory pathology of the joints (M05-M14);
• arthrosis (M15-M19);
• other joint lesions (M20-M24).

Rheumatoid arthritis is included in the group "Inflammatory arthropathies", which indicates the nature of the disease and helps the doctor to correctly assess the causative factor of articular pathology.

Disease coding

The defeat of the joints by rheumatism manifests itself in a variety of ways, being the cause of diseases of the internal organs and forming complex syndromes. The doctor needs to select the correct code in ICD-10 in order to conduct effective treatment taking into account the possible damage not only to the joints, but also to other organs and systems human body. At the stage of preliminary examination, a specialist can use a code that does not accurately indicate a specific disease, but as new diagnostic information is received, the diagnosis is corrected.

Table. ICD-10 code for various variants of rheumatoid joint disease

In the ICD-10, codes M07-M14 encode numerous joint diseases caused by any factors other than rheumatism. Their use involves identifying the exact causes and detecting typical symptoms of pathology.

For any type of joint disease, the doctor can find the appropriate ICD-10 code. It is important to conduct a complete diagnosis and identify the underlying causative factor of the disease in order to accurately determine the code.

Significance of the ICD-10

The classification of diseases used by doctors all over the world makes it possible to accurately account for all cases of severe articular pathology associated with rheumatic disease. Thanks to this, specialists in different countries can learn and adopt the experience of other doctors, better understand the causes of inflammatory arthropathy and use advanced therapies. Rheumatoid arthritis requires a careful approach to examination and treatment, because this problem can become the basis for severe complications and disability of a person.

ICD-10 - generally accepted international classification of diseases

Having determined the diagnosis, the doctor will prescribe treatment. Rheumatoid arthritis should be treated comprehensively, providing a therapeutic effect with drugs, the action of which is aimed at removing pain and improving joint mobility. It is necessary to accurately and consistently follow the recommendations of a specialist in order to get rid of problems in the present and prevent complications in the future. This is especially important in the complicated course of articular disease, when there is damage to internal organs. The main factor of treatment is basic therapy prescribed for a long time. Be sure to use symptomatic treatment. The effectiveness of therapy will be much higher if you start medical measures as early as possible, before external changes in small joints. That is why timely examination and correct diagnosis in accordance with ICD-10 is the best way to prevent complicated forms of the disease.

Don't crunch!

treatment of joints and spine

• Diseases
  • Arothrosis
  • Arthritis
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Rheumatoid arthritis ICD code 10

ICD 10 coding for rheumatoid arthritis

Arthritis classification according to ICD 10

(according to the presence of RF): seropositive, seronegative

A distinction was made according to the following types of etiological relationship: a) direct infection of the joint, in which microorganisms invade the synovial tissue and microbial antigens are found in the joint; b) indirect infection, which can be of two types: “reactive arthropathy”, when microbial infection of the body is established, but neither microorganisms nor antigens are detected in the joint; and "post-infectious arthropathy", in which the microbial antigen is present, but the recovery of the organism is incomplete and there is no evidence of local reproduction of the microorganism.

Cyclophosphamide (200 mg ampoules), endoxan - 50 mg tablets

Reactive Arthritis Symptoms

Second degree - the pain intensifies, the restriction of motor activity is such that it leads to a decrease in working capacity and limitation of self-service.

1. The symptom complex of the disease included: symmetrical damage to the joints, the formation of deformities, contractures and ankylosis in them; development of anemia, enlarged lymph nodes, liver and spleen, sometimes the presence of febrile fever and pericarditis. In the subsequent years of the last century, numerous observations and descriptions of Still's syndrome revealed much in common between rheumatoid arthritis in adults and children, both in clinical manifestations and in the nature of the course of the disease. However, rheumatoid arthritis in children was still different from the disease of the same name in adults. In this regard, in 1946, the term "juvenile (juvenile) rheumatoid arthritis" was proposed by two American researchers Koss and Boots. Nosological separation of juvenile rheumatoid arthritis and adult rheumatoid arthritis was subsequently confirmed by immunogenetic studies.
2. This type of rheumatoid arthritis includes Still and Wieseler-Fanconi syndrome. Still's syndrome is more commonly diagnosed in preschoolers. It is distinguished by the following features:
3. Juvenile rheumatoid arthritis is a pathology that develops in children and adolescents under 16 years of age, in which not only the joints, but also other organs can be affected. A doctor can make a similar diagnosis if a child has arthritis that lasts more than 6 weeks. The disease does not occur very often. International statistics says that JRA is detected in 0.05-0.6% of children. Children under 2 years of age suffer from this disease extremely rarely. There are gender differences in the incidence among children. Arthritis is diagnosed more often in girls. The disease is steadily progressing.

Stages of development of the disease and the degree of destruction of the joint

NSAIDs Patients at risk of developing gastropathy and gastrointestinal bleeding (age over 75 years, history of gastrointestinal ulcers, simultaneous use of low doses of acetylsalicylic acid and HA, smoking) can be prescribed selective or specific COX-2 inhibitors, either (subject to high individual effectiveness) non-selective COX inhibitors in combination with misoprostol 200 mcg 2-3 times / day or proton pump inhibitors (omeprazole 20-40 mg / day) In patients with impaired renal function, NSAIDs should be treated with extreme caution If there is a risk of thrombosis, patients receiving selective COX-2 inhibitors should continue to take small doses of acetylsalicylic acid at the same time.

Diagnosis and treatment of the disease

Alkylating cytostatic; forms alkyl radicals with DNA, RNA and proteins, disrupting their function; has an antiproliferative effect.

Pronounced edema from the very beginning of the disease

In the third degree - the impossibility of self-service, a significant loss of mobility in the joint (joints).

What causes juvenile rheumatoid arthritis?

Learning to live with a diagnosis according to ICD 10 - rheumatoid arthritis

Causes and symptoms of rheumatoid arthritis

​If treatment is not started early, there is a high risk that the child will become disabled.​

The World Health Organization (WHO) has developed a special medical coding for the diagnosis and definition of medical diseases. ICD 10 code - coding for the international classification of diseases of the 10th revision as of January 2007.​

​GK Systemic application. It is recommended to use low< 10 мг/сут) дозы ГК, что позволяет адекватно « контролировать» ревматоидное воспаление, но должно обязательно сочетаться с базисной терапией Локальная терапия ГК имеет вспомогательное значение. Предназначена для купирования активного синовита в 1 или нескольких суставах. Повторные инъекции ГК в один и тот же сустав необходимо производить не чаще 1 раза в 3 мес. Противопоказания к проведению локальной терапии: гнойный​​быстропрогрессирующий, медленнопрогрессирующий (оценка темпа развития деструктивных изменений в суставе при длительном наблюдении) ​

Staphylococcal arthritis and polyarthritis

How to treat rheumatoid arthritis?

RA with systemic manifestations (vasculitis, nephropathy).

Edema appears when inflammation is attached

According to the nature of occurrence in medicine, several forms of arthritis are distinguished:

The pathogenesis of juvenile rheumatoid arthritis has been intensively studied in recent years. The development of the disease is based on the activation of both cellular and humoral immunity.

The primary incidence rate is from 6 to 19 cases per 100,000 children. It is important that the prognosis for health largely depends on the age at which the disease began. The older the child, the worse the prognosis. Still's disease is a type of rheumatoid arthritis. The disease is very severe, with severe fever, joint syndrome, damage to the lymphatic system and sore throat. This pathology also occurs in adults.

There are currently 21 disease classes, each containing subclasses with disease and condition codes. Rheumatoid arthritis ICD 10 belongs to the XIII class "Diseases of the musculoskeletal system and connective tissue." Subclass M 05-M 14 "Inflammatory processes of polyarthropathy."​

Rheumatoid arthritis: we treat folk methods

200 mg IM 2-3 times a week until a total dose of 6-8 g per course is reached; combined pulse therapy; endoxan at dosemg / day, maintenance dose - 50 mg / day. Methods of operative surgery (injections into the articular cavity).

Etiology and treatment of juvenile rheumatoid arthritis

Features of the disease

reactive - a complication that occurs with untreated (undertreated) infections; Pathogenesis of juvenile chronic arthritis

polyarthritis involving small joints in the process;

Etiological factors

Juvenile arthritis can occur for a variety of reasons. The exact reason has not yet been established.​

Reactive arthritis of the knee is the most common rheumatic disease. The disease is characterized by a non-purulent inflammatory formation in the bone structure. In some cases, the disease occurs as a response to infectious diseases of the gastrointestinal tract (GIT), urinary tract and organs of the reproductive system.

• , unspecified nature
• I - low, II - moderate, III - high activity
• Pneumococcal arthritis and polyarthritis
• Hemorrhagic cystitis, myelosuppression, activation of foci of infection.
• Of the medications, NSAIDs, cytostatics, hormonal agents, antibiotics, etc. are prescribed. The set of medications directly depends on the type and etiology of arthritis. Table 2 lists the treatment regimens for rheumatoid arthritis.​
• Yes, but it may not be right away
• Rheumatoid - is a consequence of rheumatic diseases;

The main clinical manifestation of the disease is arthritis. Pathological changes in the joint are characterized by pain, swelling, deformities and limitation of movement, increased skin temperature over the joints. In children, large and medium joints are most often affected, in particular, knee, ankle, wrist, elbow, hip, less often small joints of the hand. Typical for juvenile rheumatoid arthritis is the defeat of the cervical spine and maxillotemporal joints, which leads to underdevelopment of the lower, and in some cases, the upper jaw and the formation of the so-called "bird's jaw".

Forms of the disease

Enlargement and soreness of the lymph nodes;

Possible etiological factors are:

• The development of arthritis occurs a month after infection, however, the provocative infection that caused this disease does not manifest itself in the human body. Men over the age of 45 are most at risk. Sexually transmitted infections (gonorrhea, chlamydia, and others) can contribute to the progression of the disease. Women are less likely to suffer from this disease.
• arthritis
• Radiological stage:

Clinical symptoms

Chlorbutin (leukeran) - tablets of 2 and 5 mg

• drug
• Yes, but in the later stages of redness may not be
• Acute - develops after bruises, fractures, strong physical exertion;
• Symptoms of juvenile chronic arthritis
• hepatosplenomegaly;

the presence of a viral or bacterial infection;

If the carrier of the infection entered the body with food, reactive arthritis can equally develop in both men and women.

• , any changes in the skin near the puncture site, tuberculosis of the joint, tabes of the spinal cord, aseptic bone necrosis, intra-articular fracture, subluxation of the joint. The following drugs are used (a full dose of drugs is injected into large joints, 50% into medium-sized joints, 25% into small ones): Methylprednisolone 40 mg Hydrocortisone 125 mg Betamethasone in the form of injections (celeston, flosteron, diprospan) Pulse therapy methylprednisolone leads to a rapid but short-term effect (3-12 weeks); not affecting the rate of progression of the process In order to prevent osteoporosis, people receiving GCs are prescribed calcium (1500 mg / day) and cholecalciferol (400-800 IU / day), and in the absence of their effectiveness - bisphosphonates and calcitonin (see Osteoporosis). ​
• I - periarticular osteoporosis, II - the same + narrowing of the interarticular spaces + single erosions, III - the same + multiple erosions, IV - the same + ankylosis H
• Other streptococcal arthritis and polyarthritis
• Alkylating cytostatic; forms alkyl radicals with DNA, RNA and proteins, disrupting their function; has an antiproliferative effect
• ​Operating principle​

Other manifestations

infectious - caused by viruses or a fungal infection that enters the joint with the blood stream, or through an unsterile surgical instrument, often leads to the development of purulent inflammation of the knee joint;

• In the systemic variant of juvenile rheumatoid arthritis, leukocytosis (up to a thousand leukocytes) is often detected with a neutrophilic shift to the left (up to 25-30% of stab leukocytes, sometimes up to myelocytes), an increase in ESR domm / h, hypochromic anemia, thrombocytosis, an increase in the concentration of C-reactive protein , IgM and IgG in blood serum.
• anemia;
• traumatic joint injury;
• A characteristic feature of the course of the disease is the symmetry of joint damage
• ​Basic Therapy​
• Availability of functional ability:

• High RA activity with systemic manifestations, generalized lymphadenopathy, splenomegaly.
• ​Operating principle​
• Observed in the case of an autoimmune nature of the disease
• Reiter's syndrome is a type of reactive arthritis;
• Diagnosis of juvenile chronic arthritis
• myocardial damage;
• increased insolation;
• Reactive arthritis is severe. In the first week, the patient has a fever, disorders of the gastrointestinal tract (GIT), acute intestinal malaise, general weakness. In the future, the symptoms of arthritis progresses and is of a classic nature. At this stage of development, the disease can be divided into 3 types.
• ​Basic therapy should be given to all patients with reliable RA.​

​0 - retained, I - professional ability retained, II - professional ability lost, III - self-service ability lost.​

Diagnostic measures

​Arthritis and polyarthritis caused by other specified bacterial pathogens Use an additional code if necessary to identify the bacterial agent (​

6-8 mg / day, maintenance dose - 2-4 mg / day.

• Destination schemes
• No
• Arthritis in Bechterew's disease, gout (rare);
• Suppression of the inflammatory and immunological activity of the process.

Inflammation of the mucous membrane of the eyes occurs (may develop conjunctivitis).

Treatment tactics

Methotrexate remains the "gold standard" of basic therapy for RA, which has the best ratio of efficacy/toxicity. Assign to patients with active RA or those with risk factors for poor prognosis (see above) at a dose of 7.5-15 mg per week. The term of the effect is 1-2 months. Among the side effects of methotrexate are hepatotoxicity, myelosuppression, so the control of KLA and transaminases should be performed monthly. An increase in the level of liver enzymes is a signal to reduce the dose of the drug or completely cancel it. A persistent increase in liver enzymes after discontinuation of the drug is an indication for a liver biopsy. Taking into account the antifolate mechanism of action, folic acid 1 mg / day is indicated, except for the days of methotrexate use.

Frequency - 1% in the general population. The predominant age is 22–55 years. The predominant gender is female (3:1). Incidence: 23.4 population in 2001

Possible side effects

Juvenile rheumatoid arthritis

Symptoms of a stuck joint

psoriatic arthritis (occurs in 10-40% of patients with psoriasis)

ICD-10 code

• Relief of systemic manifestations and articular syndrome.
• An increase in ESR in the UAC.
• ingestion of protein components;
• Pain in the joints becomes stronger, while motor activity decreases. In the affected areas, noticeable redness and swelling appear.
• Hydroxychloroquine (200 mg 2 r / day or 6 mg / kg / day) is a frequent component of combination therapy for active, especially "early" RA. Monotherapy with hydroxychloroquine does not slow radiological progression. The term of the effect is 2-6 months. With long-term treatment, an annual ophthalmological examination, examination of visual fields is necessary.
• unknown. Various exogenous (viral proteins, bacterial superantigens, etc.), endogenous (type II collagen, stress proteins, etc.) and nonspecific (trauma, infection, allergy) factors can act as "arthritogenic" factors.​
• Due to the fact that the RA treatment regimens indicated in the table are not always effective, several combinations of basic agents are used in practice, among which the combinations of methotrexate with sulfasalazine, methotrexate and delagil are the most common. Currently, the treatment regimen in which methotrexate is combined with anticytokines is considered the most promising.

Epidemiology of juvenile chronic arthritis

Quinoline drugs (delagil - tablets of 0.25 g)

Classification of juvenile chronic arthritis

Reiter's syndrome (according to ICD-10 code 02.3) can develop in two forms - sporadic (causative agent - C. Trachomatis) and epidemic (Shigella, Yersinia, Salmonella).

Preservation of the functional ability of the joints.

Causes of juvenile chronic arthritis

In the subacute course of the disease, the symptoms are less pronounced. First, one joint is affected. Most often it is the ankle or knee joint. Both 1 joint and several can be affected. In the oligoarticular form of the disease, 2-4 joints are affected. Pain syndrome may not be. During a medical examination, swelling and dysfunction of the joint are determined. The movement of a sick child is difficult. The liver and spleen are of normal size. The subacute course proceeds more favorably and is better amenable to therapy.

The organs of the genitourinary system become inflamed.

The pathogenesis of juvenile chronic arthritis

Sulfasalazine is especially indicated in seronegative RA, when differential diagnosis with seronegative spondyloarthropathies is difficult. The starting dose is 0.5 g/day with a gradual increase in dose to 2-3 g/day in 2 divided doses after meals. Taking into account the myelotoxicity of the drug with its long-term use, it is necessary to control the OAC every 2-4 weeks for the first 2 months, then every 3 months.

​70% of RA patients have HLA - DR4 Ag, the pathogenetic significance of which is associated with the presence of a rheumatoid epitope (section b - the chain of the HLA molecule - DR4 with a characteristic amino acid sequence from the 67th to the 74th positions). The effect of the “gene dose” is discussed, that is, the quantitative-qualitative relationship between the genotype and clinical manifestations. The combination of HLA - Dw4 (DR b10401) and HLA - Dw14 (DR b1*0404) significantly increases the risk of developing RA. On the contrary, the presence of antigen defenders, for example HLA - DR5 (DR b1 * 1101), HLA - DR2 (DR b1 * 1501), HLA DR3 (DR b1 * 0301) significantly reduces the likelihood of RA.

Symptoms of juvenile chronic arthritis

In medical practice, there are often cases of lack of effect from treatment (for example, with reactive arthritis, inflammation is not relieved even when taking antibiotics in combination with NSAIDs), when patients remain disease active and the rapid progression of articular deformities.

Diagnosis of juvenile chronic arthritis

Stabilization of lysosomal membranes, inhibition of phagocytosis and neutrophil chemotaxis, inhibition of cytokine synthesis.

Treatment goals for juvenile chronic arthritis

• The clinical picture differs from other types of arthritis, since the accompanying signs of the disease are lesions of the mucous membranes of the oral cavity, prostatitis (in men), vaginitis and cervicitis (in women). A common symptom is inflammation of the eyes (conjunctivitis, iridocyclitis), which manifests itself in reddening of the sclera, the appearance of purulent discharge, swelling of the eyelids.
• ​Prevention or slowdown of joint destruction, disability of patients.​
• It is necessary to know not only the causes and symptoms of juvenile rheumatoid arthritis, but also the methods of its diagnosis. In the early stages of the disease, the symptoms may be mild, so the diagnosis is often difficult.
• Dysfunction of the immune system.
• Initially, the disease can affect only one knee joint, but later it can spread to other joints. A pronounced clinic can be insignificant or very strong, depending on the person's immune system. In the future, it is possible to develop rheumatoid arthritis, which affects the larger joints of the lower extremities and toes. Back pain occurs with the most severe form of the disease.
• Leflunomide is a new cytostatic drug with an antimetabolic mechanism of action, developed specifically for the treatment of RA. Apply at a dose of 10-20 mg / day. The effect develops after 4-12 weeks. Monitoring of toxicity involves monitoring the level of liver enzymes and TAC.​
• The pathological process in RA is based on generalized immunologically conditioned inflammation. In the early stages of the disease, Ag is detected - specific activation of CD4 + - T - lymphocytes in combination with hyperproduction of pro-inflammatory cytokines (tumor necrosis factor, IL - 1, IL - 6, IL - 8, etc. .) against the background of a deficiency of anti-inflammatory mediators (IL-4, a soluble antagonist of IL-1). IL - 1 plays an important role in the development of erosion. IL - 6 stimulates B - lymphocytes to the synthesis of RF, and hepatocytes - to the synthesis of proteins of the acute phase of inflammation (C - reactive protein, etc.). TNF-a causes the development of fever, pain, cachexia, is important in the development of synovitis (it promotes the migration of leukocytes into the joint cavity by enhancing the expression of adhesion molecules, stimulates the production of other cytokines, induces the procoagulant properties of the endothelium), and also stimulates the growth of pannus (granulation tissue penetrating into the cartilage from the synovial tissue and destroying it). An important prerequisite is the weakening of the endogenous synthesis of HA - hormones. In the late stages of RA, under conditions of chronic inflammation, tumor-like processes are activated due to somatic mutation of fibroblast-like synovial cells and defects in apoptosis.​

Forecast

Doctors make a conclusion about the need to change the therapy program if the patient has been treated for six months using at least three basic drugs.

The initial stage of RA.

​Laboratory research methods​

Arthritis of the knee joint should be differentiated from other pathological processes, the most common of which are arthrosis and bursitis. Bursitis, which is an inflammation in the synovial bag, can be easily distinguished from arthritis by an experienced specialist at the first appointment.

Prevention of juvenile chronic arthritis

The main diagnostic methods are:

Causes, symptoms, diagnosis and treatment of knee arthritis

Of the viral infections, the most dangerous are those caused by the Epstein-Barr virus, parvovirus, and retroviruses. The mechanism of the development of the disease is associated with autoimmune disorders. When exposed to any adverse factor in the body of a child, special immunoglobulins are formed. In response to this, the synthesis of rheumatoid factor occurs. Joint damage occurs. In this case, the synovial membranes and blood vessels, cartilage tissue are affected. Not only the joints, but also the marginal parts of the bones (epiphyses) can be destroyed. The resulting circulating immune complexes are carried through the blood vessels to various organs. At the same time, there is a risk of developing multiple organ failure.

Etiology

In rare cases, the disease can affect the central nervous system, give complications to the organs of the cardiovascular system.

Gold salts (eg, sodium aurothiomalate) are used to treat seropositive RA. Trial dose 10 mg IM, then 25 mg weekly, then 50 mg weekly. As the total dose of 1000 mg is reached, they gradually switch to a maintenance regimen of 50 mg 1 time in 2-4 weeks. The effect develops in 3–6 months. Among the side effects are myelosuppression, thrombocytopenia, stomatitis, proteinuria, therefore OAC and OAM are recommended to be carried out 1 time in 2 weeks.

Evidence of the ineffectiveness of therapy is the negative dynamics of laboratory tests, the preservation of the focus of inflammation. In this case, you need an alternative solution on how to treat knee arthritis. Medical statistics confirms the positive dynamics in the use of pulse therapy using hormonal drugs (methylprednisolone intravenously, isotonic solution for three days - three courses are repeated after one month). Methylprednisolone is prescribed with caution in combination with cyclophosphamide due to the high toxicity of the drugs.

2 tab. per day for the first 2-4 weeks, then 1 table. per day for a long time.

Arthritis in children

Firstly, with bursitis, the mobility of the knee is slightly limited, and secondly, the area of ​​articular inflammation has clear contours. On palpation, the doctor quickly determines the boundaries of the inflammatory focus. As for arthrosis, it is more difficult to differentiate, since these diseases, which have completely different etiologies, have many similar signs.

Improving the quality of life of patients.

Symptoms of the disease

JRA classification according to ICD 10 takes into account the type of joint damage. Allocate polyarthritis and oligoarthritis. ICD 10 divides arthritis into acute and subacute. There is a classification that takes into account the clinical symptoms of the disease.

Today, to confirm whether a patient really has reactive arthritis, a whole range of laboratory tests is needed. Various specialists are involved in the examination of the patient. It is necessary to be examined by a gynecologist, urologist and therapist. The attending physician will indicate the need for examination by other medical specialists. After collecting the results of laboratory tests, anamnesis data, identifying clinical manifestations, the use of certain drugs is prescribed.

Cyclosporine is rarely used in the treatment of RA, only in cases of refractory to other drugs. The dose is 2.5–4 mg/kg/day. The effect develops in 2–4 months. Side effects are serious: arterial hypertension, impaired renal function.

Pyogenic arthritis, unspecified. Infectious arthritis NOS

Degrees of dysfunction

A new direction in the treatment of rheumatoid arthritis is therapy involving the use of so-called biological agents (biologic agents). The action of the drugs is based on the inhibition of the synthesis of cytokines (TNF-α and IL-1β).

Dyspeptic phenomena, skin itching, dizziness, leukopenia, retinal damage.

Do not reveal specific abnormalities

Arthrosis is a degenerative process in cartilage and bone tissue that occurs when there is a metabolic disorder, not associated with an inflammatory component. The main group of patients is the elderly (by the age of 60, most people are diagnosed with dystrophic changes in the joints).

Types of arthritis

Minimizing the side effects of therapy.

• external examination of the child;
• In this case, the following forms of juvenile arthritis are distinguished:
• It is necessary to begin treatment of reactive arthritis with the destruction of the infectious focus, that is, the causative agents of the original disease. To do this, you need to undergo a comprehensive examination of the whole organism. After determining the pathogen, sensitivity to drugs is established. A bacterial infection is treated with antibiotics.​
• Azathioprine is used at a dose of 50–150 mg/day. The effect develops in 2-3 months. Laboratory monitoring is required (OAC every 2 weeks, then every 1–3 months).​
• Fatigue, subfebrile condition, lymphadenopathy, weight loss. 2.​
• Excludes: arthropathy in sarcoidosis (​
• It has been reliably established that in 60% of patients with active rheumatoid articular syndrome, even with the third degree of the disease, there is a decrease (or absence) of the progression of articular changes during maintenance therapy with Remicade. However, the use of this form of treatment is justified if the basic therapy did not give the expected effect.

Sulfa drugs (sulfasalazine, salazopyridazine) - 500 mg tablets

Instrumental research methods

Differential Diagnosis

Arthritis is always inflammation, which over time, with the progression of the disease (with an autoimmune nature), spreads to the entire body. That is why there are many accompanying signs in autoimmune arthritis - this is fever, subfebrile temperature, headache, and general malaise. With rheumatoid arthritis, the cardiovascular system is seriously affected.

Treatment of juvenile chronic arthritis

The use of antibacterial drugs is recommended at the initial, most acute stage of the disease. In the future, their use becomes less effective. In some cases, symptomatic treatment is prescribed, in which non-steroidal drugs are used, for example, ibuprofen. "Anti-cytokine" therapy for RA is based on the suppression of the main pro-inflammatory cytokines: TNF-a and IL-1. Registered in Russia, infliximab is a monoclonal antibody to TNF - a. Infliximab is used at a dose of 3 mg/kg IV every 2, 6, and then every 8 weeks. The onset of the effect is from several days to 4 months. Articular syndrome

Diagnosis of arthritis of the knee

Mortality in juvenile arthritis is low. Most deaths are associated with the development of amyloidosis or infectious complications in patients with a systemic variant of juvenile rheumatoid arthritis, often resulting from long-term glucocorticoid therapy. In secondary amyloidosis, the prognosis is determined by the possibility and success of treating the underlying disease.

Treatment is carried out only after diagnosis. It is required to exclude such diseases as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, Reiter's syndrome, systemic lupus erythematosus, tumor, ankylosing spondylitis. In the presence of rheumatic diseases in children, treatment should be comprehensive.

involvement in the process of joints;

The 10th International Classification of Diseases (ICD 10) lists varieties of pathologies of the joints and connective tissues under the codes M05 (seropositive), M06 (seronegative) and M08 (juvenile) rheumatoid arthritis. Rheumatoid polyarthritis is classified, which in the ICD is under the M13.0 code, like other arthritis, depending on the presence of rheumatoid factor in the blood.

Long-term outpatient observation.

Tendosynovitis in the area of ​​the wrist joint and hand Bursitis, especially in the area of ​​the elbow joint Damage to the ligamentous apparatus with the development of hypermobility and deformities Muscle damage: muscle atrophy, myopathies, more often medicinal (steroid, as well as while taking penicillamine or aminoquinoline derivatives). 4.​

Balneological therapy is a very effective procedure in a comprehensive program for the treatment of arthritis of the knee joint. However, this direction of rehabilitation is indicated for those patients who do not have serious diseases of the cardiovascular system, malignant neoplasms, and have not previously had heart attacks or strokes. All procedures using therapeutic biological components are prescribed with great care.​

Inhibition of the functional activity of macrophages and neutrophils, inhibition of the production of immunoglobulins and RF.

Treatment

Due to the fact that the etiology of juvenile rheumatoid arthritis is unknown, primary prevention is not carried out.

Treatment of juvenile rheumatoid arthritis includes restriction of motor activity, avoidance of insolation, use of NSAIDs to eliminate pain and inflammation, immunosuppressants, exercise therapy, physiotherapy.

• a slight increase in body temperature;
• Polyarthritis is understood as systemic multiple lesions of the joints, in which not only almost all types of joints become inflamed and destroyed, simultaneously or sequentially, but also other organ systems. Sometimes the result of a neglected form of polyarthritis can be disability. Rheumatoid polyarthritis can act as an independent disease as an infectious-nonspecific rheumatoid arthritis, and sometimes it is a consequence of other diseases - sepsis, gout, rheumatism. Even those who have bad teeth should be wary of the disease, but the word "dentistry" is unacceptable in the lexicon.
• Observation is carried out jointly with a specialist - a rheumatologist and a district (family) doctor. The competence of a rheumatologist includes making a diagnosis, choosing a treatment strategy, teaching the patient the correct regimen, and conducting intra-articular manipulations. General practitioners are responsible for organizing the systematic management of the patient; they also carry out clinical monitoring. During each visit, the patient is assessed: the severity of pain in the joints on a point scale, the duration of morning stiffness in minutes, the duration of malaise, the number of swollen and painful joints, and functional activity.
• Systemic manifestations
• A39.8

Since there are many varieties of arthritis and joint pathologies, it is necessary to consult a doctor at the first signs of the disease. The sooner the causes that caused the inflammatory process are determined, the more likely it is to cure the disease completely.

Anemia, an increase in ESR, an increase in CRP levels correlate with RA activity Synovial fluid is turbid, with low viscosity, leukocytosis is above 6000/µl, neutrophilia (25–90%) RF (AT to IgG class IgM) is positive in 70–90% of cases ANAT, AT to Ro / La OAM (proteinuria in the framework of nephrotic syndrome caused by amyloidosis of the kidneys or drug-derived glomerulonephritis) are detected in Sjögren's syndrome. An increase in creatinine, blood serum urea (assessment of renal function, a necessary stage in the selection and control of treatment).

The disease is not limited by age, but middle-aged women are diagnosed with this diagnosis somewhat more often than the representatives of the stronger half. An exception is infectious reactive arthritis, which is diagnosed mainly in older men (more than 85% of patients with reactive arthritis are carriers of the HLA-B27 antigen).

Depending on the type of classification, the disease has the following names: juvenile arthritis (ICD-10), juvenile idiopathic arthritis (ILAR), juvenile chronic arthritis (EULAR), juvenile rheumatoid arthritis (ACR).

Often, the joints in the cervical spine are involved in the process. Articular syndrome is characterized by:

New methods

This disease is difficult to treat. The only thing that patients can hope for is a long-term remission, when the hospital does not become a second home. In the early stages, this can often be achieved, but in most cases, the symptoms recur and even worsen.

​Assess and infer rate of improvement (20%, 50%, 70%) using scores swollen joint scores painful joints scores of at least 3 out of 5 scores overall activity score according to patient overall activity score according to clinician patient score pain acute phase blood counts (ESR, CRP) disability (quantified using standardized questionnaires).​

Arthritis and movement. Gordon N.F.​

Rehabilitation programs

Suppression of collagen synthesis, inhibition of the activity of type I T-helpers and B-lymphocytes, destruction of the CEC

Arthritis of the knee joint can be diagnosed at home if you carefully examine the symptoms of the disease. Regardless of the etiology, symptoms such as swelling, redness in the joint area, general malaise, external signs of deformation of the articular tissue appear.

​Unlimited (any age)​

It is worth dwelling in more detail on rheumatoid arthritis (RA), which is an autoimmune disease with an unclear etiology. The disease is a common pathology - about 1% of the population suffers. Very rarely there are cases of self-healing, in 75% of patients there is a stable remission; in 2% of patients, the disease leads to disability.​

M08. Juvenile arthritis.

Stiffness in the morning lasting up to 1 hour or more;

1. The goal of therapy for rheumatoid arthritis is to reduce rheumatic pain, reduce inflammation, improve joint mobility and prevent complete immobility of the patient. The basic principles that guide any clinic that treats rheumatoid arthritis are complexity and consistency. Well-proven spa treatment through therapeutic mud.
2. Rehabilitation.
3. American Rheumatological Association (1987)

ICD 10. Class XIII (M00-M25) | Medical practice - modern medicine of diseases, their diagnosis, etiology, pathogenesis and methods of treatment of diseases

Peripheral joints and systemic inflammatory lesions of internal organs.

2 Shoulder Humerus Elbow Bone

High clinical and laboratory activity of RA

However, one should not wonder how to treat arthritis of the knee joint on their own, especially using dubious recipes of folk medicine. This can lead to irreversible consequences. The decision on how to treat knee arthritis is made only after a comprehensive examination.​

As a rule, older

With this disease, the inner surface of the joints (cartilage, ligaments, bones) is destroyed and replaced by scar tissue. The rate of development of rheumatoid arthritis is not the same - from several months to several years. Features of the clinical picture of one or another type of inflammation of the joints make it possible to suspect the disease and prescribe the necessary examinations to confirm the diagnosis. In accordance with ICD-10, RA is classified as seropositive (code M05), seronegative (code M06), juvenile (code MO8)

M08.0. Juvenile (juvenile) rheumatoid arthritis (seropositive or seronegative).​

swelling in the joint area;

The first stage is the suppression of the autoimmune process, which actually leads to the destruction of tissues, pain, loss of the ability to move. This is followed by anti-inflammatory treatment, complete cleansing of the body from toxic metabolic products. During the period of remission, they restore blood circulation, increase the efficiency of joints, and normalize metabolism. All these stages combine both medical and physiotherapeutic methods of treatment.​

INFECTIOUS ARTHROPATHY (M00-M03)

Physical therapy plays an important role. Sanatorium - resort treatment is recommended during the period of minimal activity or remission. To correct deformities, orthoses are used - individual orthopedic devices made of thermoplastic, worn at night.​​At least 4 of the following Morning stiffness > 1 hour International Classification of Diseases Code ICD-10: 3 - bone, ulna Initial dose of 250 mg / day with a gradual increase to 500-1000 mg / day; maintenance dose - 150-250 mg / day

M00 Pyogenic arthritis

Physicians must determine the nature of the disease in order to prescribe adequate treatment. Orthopedic traumatologists, surgeons, rheumatologists give directions for laboratory and instrumental studies. The treatment regimen is developed by a specialized specialist (it can be a phthisiatrician, dermatologist-venereologist, cardiologist and other doctors). Nature of the process Some types of arthritis affect only children and adolescents, so they should be singled out in a separate row. M08.1. Juvenile (juvenile) ankydotic spondylitis. Painfulness; The basic treatment is the suppression of the autoimmune process through such drugs: methotrexate, sulfasalazine and leflunomide. In terms of minimizing side effects, the latter differs, this should be taken into account from the position that they all require long-term (at least six months) use. Features in pregnant women Arthritis M06 - 4 Hand Wrist, Joints between these fingers, bones, metacarpus Skin rash, dyspepsia, cholestatic hepatitis, myelosuppression code M08) affects children after bacterial and viral infections. As a rule, one knee or other large joint becomes inflamed. The child has pain with any movement, swelling in the joint area. Children limp, hardly get up in the morning. In the absence of treatment, joint deformity gradually develops, which is no longer possible to correct.

M08.2. Juvenile (juvenile) arthritis with a systemic onset, a change in gait; Non-steroidal anti-inflammatory drugs (NSAIDs) also have an analgesic effect. But they should also be used for a long time, so the doctor must choose the one that is best tolerated by the patient. Among non-steroids, diclofenac, ibuprofen, nimesulide are widely used. All of them affect the gastrointestinal tract to a greater or lesser extent. Pregnancy improves the course of RA, however, after delivery, a relapse always occurs due to hyperprolactinemia. NSAIDs in the first trimester of pregnancy and 2 weeks before delivery are undesirable (in the first trimester - the risk of a teratogenic effect, before childbirth - the threat of developing weakness of labor, bleeding, early closure of the ductus arteriosus in the fetus). Gold salts, immunosuppressants are contraindicated for pregnant women. There is evidence of the relative safety of the use of aminoquinoline drugs and sulfasalazine, however, the expected effect should be correlated with the possible risk. 3 joints or more

​Other rheumatoid arthritis​​5 Pelvic Gluteal Hip joint, area and thigh area, sacroiliac, femoral joint, bone, pelvis Methotrexate (tablets 2.5 mg, ampoules 5 mg) Second stage - laboratory tests blood (with inflammation, there is an increase in ESR, leukocytosis, an inflammatory marker CRP, and other specific reactions).

Arthritis rheumatoid, Diseases and treatment of folk and medicinal products. Description, application and healing properties of herbs, alternative medicine

• Always chronic

Arthritis rheumatoid: Brief description

Reactive childhood arthritis (ICD-10 code MO2) manifests itself two weeks after an intestinal infection. If the process develops in the knee joint, then external signs are clearly visible: the skin turns red, swelling without pronounced boundaries is visible under the patella. The child often has a fever, which is reduced by antipyretic drugs, but pain in the knee area remains. M08.3. Juvenile (juvenile) polyarthritis (seronegative). Dysfunction of the affected area of ​​the body. It happens that non-steroidal drugs are not able to alleviate the suffering of the patient, so the clinic decides on the use of glucocorticosteroid (GCS) drugs - hormones that can be injected directly into affected joint. GCS have a lot of side effects, but they are prescribed in short courses, which significantly reduces the risk.

​The factors for an unfavorable prognosis of RA include: seropositivity in the Russian Federation at the onset of the disease female gender young age at the onset of the disease systemic manifestations high ESR, significant concentrations of CRP carriage of HLA-DR4 early onset and rapid progression of erosions in the joints low social status of patients.

6 Calf Fibula Knee joint, bone, tibia Folic acid antagonist; inhibits the proliferation of T- and B-lymphocytes, the production of antibodies and pathogenic immune complexes. The third stage is radiography. In the presence of arthritis, a curvature of the articular surface, bone ankylosis is detected. Onset of the disease In addition to infectious, reactive, rheumatoid arthritis, children are often diagnosed with an allergic disease. The disease in a child begins suddenly - immediately after allergens enter the bloodstream. The joints quickly swell, there is shortness of breath, urticaria. Quincke's edema, bronchial spasm may develop. When the allergic reaction is eliminated, signs of arthritis disappear. M08.4. Pauciarticular juvenile (juvenile) arthritis. If juvenile arthritis affects the small joints of the fingers or toes, then deformity of the fingers is possible. In the articular form of arthritis, damage to the organs of vision is often observed. Iridocyclitis or uveitis develops. This may reduce visual acuity. The seronegative form of arthritis is more mild than the seropositive form. In the latter case, rheumatoid nodules are often detected in the area of ​​​​the joints. Modern medicine treating rheumatoid arthritis uses new biological products that inhibit protein activity. These drugs include etanercept (Enbrel), infliximab (Remicad), and adalimumab (Humira). They have significantly fewer side effects, and they give a positive result. Arthritis of the joints of the hands Symmetrical arthritis 7 Ankle Metatarsus, Ankle joint, Tarsal joint and foot, other joints of the foot, toes RA with systemic manifestations , high activity of RA, low efficiency of other basic means. Fourth stage - MRI, ultrasound (assigned to differentiate arthritis from arthrosis, Bechterew's disease and bursitis). With erased signs that occur during a sluggish chronic process, additional hardware studies of the joint may be prescribed - tomography of the articular tissue, CT, pneumoarthrography. Acute, sudden Arthritis of the knee joint can develop as an independent disease, or be a complication after injuries and diseases .M08.8. Other juvenile arthritis. With this pathology, other important organs often suffer. With a systemic form of arthritis, there may be:

Statistical data

Arthritis rheumatoid: Causes

Etiology

genetic features

Pathogenesis

Rheumatoid Arthritis: Signs, Symptoms

Clinical picture

​8 Others Head, neck, ribs, skull, trunk, spine​​7.5-25 mg per week orally.​​At the same stage, puncture of the joint and collection of synovial fluid for laboratory examination (if indicated, biopsy) is indicated. Gradual (develops over months, years) Arthritis-affected knee joint swells, pain occurs when it moves. The skin in the joint area changes color (turns red or becomes "parchment"), but this is not a reliable sign of an inflammatory process. M08.9. Juvenile arthritis, unspecified. Exanthema; Folk methods cannot be the only treatment when it comes to polyarthritis. It is better to use them during the remission period, as they are more gentle in terms of side effects. In visible inflammation, chamomile baths have worked well. Arthritis Rheumatoid nodules RF Radiological changes Sensitivity - 91.2%, specificity - 89.3%. Rheumatoid

Arthritis rheumatoid: Diagnosis

Laboratory data

instrumental data

When determining the type and degree of reactive arthritis (ICD-10 code), biological material is examined (general blood and urine tests), urogenital and ophthalmological examinations are performed, a test for the presence of HLA-B27, ECG, thymol test, sial test, ALT determination, AST, inoculation of biological fluids.​​Symptoms​​The main cause of swelling and a visually noticeable increase in the patella is the accumulation of fluid inside the joint. Excessive pressure on the walls of the articular tissue causes severe pain. The volume of fluid steadily increases over time, so the pain syndrome becomes more intense. Juvenile rheumatoid arthritis is one of the most common and most disabling rheumatic diseases that occurs in children. The incidence of juvenile rheumatoid arthritis is from 2 to 16 people of the child population under the age of 16 years. The prevalence of juvenile rheumatoid arthritis in different countries is from 0.05 to 0.6%. Girls are more likely to get rheumatoid arthritis. Mortality is 0.5-1%. Kidney damage by the type of glomerulonephritis; Infusions of birch buds, tricolor violet, nettle, hernia are taken orally. They also use the collection of herbs, which includes wild rosemary, chamomile, string, lingonberries, juniper (berries). This collection of half a glass three times a day before meals is very effective in exchange polyarthritis. early stages of RA, active therapy (NSAIDs at an adequate dose + basic drugs) should be started within the first 3 months after the diagnosis of definite RA. This is especially important in patients with risk factors for an unfavorable prognosis, which include high RF titers, a pronounced increase in ESR, damage to more than 20 joints, the presence of extra-articular manifestations (rheumatoid nodules, Sjogren's syndrome, episcleritis and scleritis, interstitial lung damage, pericarditis, systemic vasculitis). , Felty's syndrome). The use of GC is indicated in patients who do not "respond" to NSAIDs or have contraindications to their appointment in an adequate dose, and also as a temporary measure before the onset of the effect of basic drugs. Intra-articular administration of HA is intended for the treatment of synovitis in 1 or several joints, which complements, but does not replace, complex treatment. Arthritis Disorders predominantly affecting peripheral joints (limbs)

Arthritis rheumatoid: Methods of treatment

Treatment

General tactics

Mode

In addition, uric acid crystals, which look like thin needle-shaped spikes, are deposited in the joint. They injure small vessels, which is the basis for the development of associated infections. In adolescents, there is a very unfavorable situation for rheumatoid arthritis, its prevalence is 116.4 per (in children under 14 years old - 45.8 per), the primary incidence is 28, 3 per (in children under 14 years old - 12.6 per).​

Pericarditis; In the period of remission, pepper rubs with kerosene are also used. Such procedures not only relieve pain and inflammation, but also penetrate the blood, partially cleansing it. Both in the hospital and at home, cold treatment can be applied. In the hospital, cryosaunas are used - special cabins with chilled air, which are replaced at home with ice packs. After the procedure, which lasts about 10 minutes, the joints are massaged and kneaded. For one procedure, cooling is performed three times. Duration of treatment - 20 days.​

ICD-10 Patients should form a movement stereotype that counteracts the development of deformities (for example, to prevent ulnar deviation, open a tap, dial a phone number and other manipulations not with the right hand, but with the left hand).​​: polyarthritis, oligoarthritis, monoarthritis Rheumatoid Note Inhibition of the proliferative activity of T- and B-lymphocytes.

Despite the leading role of radiography in the diagnosis of arthritis, it must be remembered that in the early stages of the disease, pathological changes are not always visible in the pictures. Arthrography is of informative value for physicians in the study of large joints, and in case of polyarthritis this diagnostic method is not effective. Serological tests are used to identify the causative agent of arthritis of an infectious nature.

Manifested with changes in cartilage and bone tissue

Arthritis of the knee is difficult not only because of the intense pain syndrome, but also due to disruption of the functioning of functional systems. The cardiovascular and endocrine systems are particularly affected. There is shortness of breath, tachycardia, low-grade fever, sweating, circulatory disorders in the limbs, insomnia and other non-specific signs.

Three classifications of the disease are used: the American College of Rheumatology (ACR) classification of juvenile rheumatoid arthritis, the European League Against Rheumatism (EULAR) classification of juvenile chronic arthritis, and the International League of Rheumatological Associations (ILAR) classification of juvenile idiopathic arthritis.

inflammation of the heart muscle;

Pay special attention to diet. Healers recommend a raw-food diet, especially the widespread use of eggplant in food. In any case, rheumatoid arthritis can be curbed without letting it spoil the patient's quality of life.

M05 Seropositive rheumatoid

RA with systemic manifestations.

Treatment of arthritis is a long process and requires not only the implementation of the doctor's recommendations regarding drug therapy, but also the passage of rehabilitation courses. Pain intensity

Surgery

Classification of juvenile chronic arthritis

Any arthritis, put in the ICD 10 under the codes M05, M06, M08, M13.0, requires constant attention, since even a long remission will not help to avoid a spontaneous exacerbation of the disease.

Non-steroidal anti-inflammatory drugs

with systemic manifestations Special syndromes: Felty's syndrome, Still's syndrome in adults This group covers arthropathies caused by microbiological agents

150 mg / day, maintenance dose - 50 mg / day. The diet for arthritis of the knee must be strictly observed. Excluded food rich in carbohydrates, smoked meats, fatty meats, legumes. With the transfer to dietary nutrition and the use of individual therapy, a positive effect is observed. In general, the treatment of arthritis of the knee joint includes the following areas:

Strongly expressed from the very beginning of the disease

The first degree is characterized by a moderate pain syndrome, there is a slight limitation of movement when rotating the knee, when lifting or while squatting.

Forecast

Synonyms

Abbreviations

By seroprescription Myelosuppression, activation of foci of chronic infection. Medications (tablets, injections, ointments, gels);

Moderate at first, gradually increasing

Belongs to class M: inflammatory polyarthropathies. In addition to it, this includes JRA (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 no consensus has yet been formed. The infection is thought to cause dysregulation of the immune system in predisposed individuals. 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 during the study of the skeletons of the Indians, whose age was about four and a half thousand years. In the literature, the description of RA is found from 123 AD. People with characteristic symptoms diseases were captured on the canvases of Rubens.

As a nosological unit, the doctor Landre-Bove was the first to describe at the beginning of the nineteenth century and called it "asthenic gout". The disease received its present name half a century later, in 1859, when it was mentioned in a treatise on the nature and treatment of rheumatic gout. For every one hundred thousand people, fifty cases are detected, most of them women. By 2010, more than forty-nine thousand people had died from RA worldwide.

Etiology and pathogenesis

RA is such a common disease that it has a separate chapter in ICD 10. Rheumatoid arthritis, like other joint pathologies, is caused by the following factors:

1. Heredity:

Predisposition 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;

All family of herpes viruses, CMV (cytomegalovirus), Epstein-Barr;

Retroviruses.

3. Trigger factor:

hypothermia;

Intoxication;

Stress, medication, hormonal disruptions.

The pathogenesis of the disease consists in an abnormal reaction of the 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 capsules 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 divide rapidly. Therefore, it becomes dense and rigid. In the third stage, inflammatory cells release enzymes that destroy joint tissues. This causes difficulty with voluntary 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 subacutely. The fact that the articular syndrome (pain, defiguration and local temperature increase) is not a pathognomonic symptom makes the diagnosis of the disease much more difficult. As a rule, morning stiffness (the inability to move the joints) lasts about half an hour, and it intensifies when active movements are attempted. A harbinger of the disease is pain in the joints when the weather changes and general meteosensitivity.

Variants of the clinical course

There are several options for the course of the disease, which the doctor in the clinic should be guided by.

1. Classical when the damage to the joints occurs symmetrically, the disease progresses slowly and there are all its precursors.

2. Oligoarthritis with damage to exclusively large joints, as a rule, the knee. It begins acutely, and all manifestations are reversible within one and a half months from the onset of the disease. At the same time, joint pains are volatile in nature, there are no pathological changes on the radiograph, and treatment with NSAIDs (non-steroidal anti-inflammatory drugs) has a positive effect.

3. Felty syndrome it is diagnosed if an enlargement of the spleen with a characteristic pattern of blood changes joins.

4. Juvenile rheumatoid arthritis(code according to ICD 10 - M08). A characteristic feature is that they are ill children under 16 years of age. There are two forms of this disease:

With allergic septic syndrome;

The articular-visceral form, which includes vasculitis, damage to the valves of the heart, kidneys and digestive tract, as well as damage to the nervous system.

Classification

As in the case of other nosological units reflected in the 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;

Expanded - up to 24 months;

Late - with a disease duration of more than two years.

2. X-ray stages:

-First. There is a thickening and compaction of the soft tissues of the joint, single foci of osteoporosis.

-Second. The process of osteoporosis captures the entire epiphysis of the bone, the joint space narrows, erosion appears on the cartilage;

- Third. Deformation of the epiphyses of bones, habitual dislocations and subluxations;

-Fourth. Ankylosis (complete absence of the joint space).

3. Immunological characteristics:

For rheumatoid factor:

Seropositive rheumatoid arthritis (ICD 10 - M05.0). This means that in the patient's blood

seronegative rheumatoid arthritis.

For antibodies to cyclic citrulline peptide (Anti-CCP):

Seropositive rheumatoid arthritis;

- (ICB 10 - M06).

4. Functional class:

• First- all types of activities are saved.
• Second- disrupted professional activity.
• Third- maintains the ability to self-service.
• Fourth- all kinds of activity are broken.

Rheumatoid arthritis in children

Juvenile rheumatoid arthritis ICD 10 distinguishes into a separate category - as an autoimmune disease of children younger age. Most often, children get sick after a severe infectious disease, vaccination or joint injury. 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 articular capsule and its adhesion to the cartilage. After some time, the cartilage is destroyed, and the child becomes disabled.

The clinic distinguishes between mono-, oligo- and polyarthritis. When only one joint is affected, it is, respectively, monoarthritis. If up to four joints are subject to pathological changes at the same time, then this is oligoarthritis. Polyarthritis is diagnosed when almost all joints are affected. Systemic rheumatoid arthritis is also distinguished, when other organs are affected in addition to the skeleton.

Diagnostics

In order to make a diagnosis, it is necessary to correctly and fully collect an anamnesis, conduct biochemical blood tests, make x-rays of the joints, as well as serodiagnosis.

In a blood test, the doctor pays attention to the erythrocyte sedimentation rate, rheumatoid factor, and the number of blood cells. The most progressive at the moment is the detection of anti-CCP, which was isolated in 2005. This is a highly specific indicator that is almost always present in the blood of patients, in contrast to rheumatoid factor.

Treatment

If the patient has had an infection or it is in full swing, then he is shown a specific antibiotic therapy. When choosing drugs, pay attention to the severity of the articular syndrome. As a rule, they start 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 plasmapheresis to eliminate all immune complexes from the body.

Treatment is usually lengthy and can take years. This is due to the fact that medicines should accumulate in the tissues. One of the key points of therapy is the treatment of osteoporosis. This patient is asked to follow a special diet with high content calcium (dairy products, almonds, walnuts, hazelnuts), as well as take calcium and vitamin D supplements.