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Poliartrita reumatoid.
Mna n poliartrita reumatoid.
Poliartrita reumatoid ( PR ) reprezint o afeciune a esutului conjunctiv cu manifestri
predominante la nivelul aparatuui locomotor.
Caracateristica bolii este inflamaia cronic infiltrativ- proliferativ a sinovialei
articulare a extremitilor, n special a articulaiilor mici. Fenomenele inflamatoare sunt frecvent
simetrice, persistente, centripete i duc n timp la deviaii, deformri i anchiloze. Boala este
progresiv evolutiv, prezentnd exacerbri i remisiuni.
Din totalul afeciunilor reumatismale, poliartrita reumatoid reprezint aproximativ 10 %,
fiind mai frecvent la femei.
Cauza poliartritei reumatoide este necunoscut.
Poliartrita reumatoid este o boal frecvent, cu evolu ie prelungit, determinrile
osteoarticulare cu caracter invalidant duc la infirmizarea bolnavului, ceea ce face din poliartrita
reumatoid o boal cu caracter social.
Se mai pot produce mici luxaii falangiene, cu devierea degetelor de la fiecare mn ctre
degetul mic. De asemenea, la nivelul articulaiilor tumefiate se pot produce compresii ale
nervilor din vecintate, cu apariia anesteziei sau paresteziei.
Semne i simptome
Rigididatea, edemul i durerea sunt simptome frecvente pentru toate formele de artrit a
minii. n cazul poliartritei reumatoide, unele articulaii pot fi mai inflamate dect altele.Adesea,
degetele capt o form fusiform.
Alte simptome ale poliartritei reumatoide sunt:
- nodulii de dimensiuni mici localizai pe faa dorsal a minii, care se mobilizeaz odat cu
tendoanele care ndreapt degetele,
- crepitaii n timpul micrii ,
- modificarea poziiei degetelor,
- inflamarea tendoanelor de la nivelul degetelor, aparnd crepitaiile i modificarea pozi iei la
flexiunea acestora, uneori cu amoreal i furnicturi locale ( sindromul de canal carpian),
- ruperea tendoanelor cu pierderea capacitii flexiunii i extensiunii degetelor,
- articulaii instabile,
- deformri, n care articulaiile mijlocii de la nivelul degetelor rmn ndoite n hiperextensiune
( deformarea n butonier),
- deformarea n gt de lebd.
Tratament
Tratamentul optim al bolii necesit un diagnostic precoce, precum i utilizarea la timp a agenilor
care reduc probabilitatea leziunilor articulare ireversibile. Este necesar precizarea corect a
diagnosticului de PR (uneori difi cil n stadiile incipiente), urmat de evaluarea periodic a
activitii bolii, a efi cienei programului terapeutic i a toxicitii medicamentoase, cu revizuirea
schemei de tratament n funcie de rezultatul acestor evaluri.
Este demonstrat c pacienii cu PR activ, poliarticular i seropozitiv, au o probabilitate de
peste 70% de a dezvolta eroziuni sau leziuni articulare n primii doi ani de la debutul bolii. Este
de asemenea demonstrat c aplicarea timpurie a unui tratament agresiv poate s amelioreze
evoluia n timp a bolii, motiv pentru care majoritatea centrelor reumatologice opiniaz n
prezent pentru o schem terapeutic precoce i agresiv
Dei scopul final al tratamentului PR este inducerea unei remisiuni complete, aceasta nu este
dect rareori posibil. Remisiunea se definete ca fiind absena:
durerii de tip inflamator i a simptomelor de inflamaie sinovial
redorii matinale;
asteniei;
modificrii reactanilor de faz acut (VSH i PCR);
progresiei leziunilor radiologice pe radiografii seriate.
n cazul n care tratamentul nu poate determina remisiunea complet, scopul tratamentului este
acela de a:
controla activitatea bolii;
reduce durerea i simptomele inflamaiei sinoviale;
menine capacitatea funcional de gestic uzual i munc;
menine calitatea vieii;
Articole
Un alt studiu ce analizeaza indicile de predictie a riscului de 10 ani a unui fatal eveniment
de boala cardiovasculara la 100 de pacienti cu poliartrita reumatoida de sex feminin comparativ
cu 100 de pacienti ce fac parte din grupul de control arata faptul ca prevalenta comorbitatilor
analizate a fost similara la pacientii cu poliartita reumatoida comparative cu grupul de control.
1.
trial. The reported PA classified patients as meeting or not meeting the World
Health Organization (WHO) PA guideline (cutoff: 150 minutes of
moderate-to-intense activity per week). Other measurements included the Disease
Activity Score (DAS). Since both treatment arms showed equal treatment effect,
these were analyzed as 1 group with simple before-after analyses and generalized
estimating equations (GEE).
RESULTS: In these analyses, 140 patients (86% of the trial population, 66% women,
mean age 52 years) with complete data were included. At entry, 69% of the
patients met the WHO PA guideline, increasing to 90% at week 13, and remaining
stable at 89% after 1 year (P < 0.001). Mean DAS improved from 4.0 to 1.8 during
the first year of treatment (P < 0.001). In GEE analyses, DAS decreases were
significantly associated with PA increases (P=0.008). Patients with clinically
relevant responses (expressed as DAS remission, European League Against
Rheumatism good response or American College of Rheumatology criteria for 70%
improvement response) showed higher PA levels compared to nonresponders,
regardless of the definition of response, for both the WHO and Dutch PA
guideline.
2.
OBJECTIVES: To evaluate the frequency of four serum biomarkers in RA patients and
their relatives and identify possible associations with clinical findings of the
disease.
RESULTS: A higher positivity for all antibodies was observed in RA patients when
compared to relatives and controls (p<0.0001). IgA-RF was more frequent in
relatives compared to controls (14.6% vs. 5.4%, p=0.03, OR=2.98; 95%CI=1.11-7.98)
whereas anti-CCP was the most common biomarker among RA patients (75.6%).
Concomitant positivity for the four biomarkers was more common in patients
(46.2%, p<0.0001). Relatives and controls were mostly positive for just one
biomarker (20.2%, p<0.0001 and 15.2%, p=0.016, respectively). No association was
observed between the number of positive biomarkers and age of disease onset,
functional class or tobacco exposure. In seronegative patients predominate
absence of extra articular manifestations (EAMs) (p=0.01; OR=3.25;
CI=1.16-10.66). Arthralgia was present in positive relatives, regardless the type
of biomarker.
3.
INTRODUCTION: Rheumatoid arthritis is an autoimmune disease that causes systemic
involvement and is associated with increased risk of cardiovascular disease.
METHODS: Case-control study with analysis of 100 female patients matched for age
and gender versus 100 patients in the control group. For the prediction of
10-year risk of a fatal cardiovascular disease event, the SCORE and modified
SCORE (mSCORE) risk indexes were used, as suggested by EULAR, in the subgroup
with two or more of the following: duration of disease 10 years, RF and/or
anti-CCP positivity, and extra-articular manifestations.
CONCLUSION: The SCORE risk index is similar in both groups, but with the
application of the mSCORE index, we recognized that RA patients have a higher
10-year risk of a fatal cardiovascular disease event, and this reinforces the
importance of factors inherent to the disease not measured in the SCORE risk
index, but considered in mSCORE risk index.
4.
5.
OBJECTIVES: To investigate the association of comorbidities with mobility
limitation and functional disability in patients with rheumatoid arthritis (RA)
and to identify which comorbidity indicator is the most appropriate to determine
this association.
Timed Up and Go Test (TUG) and Five Times Sit To Stand Test (FTSTS). Statistical
analysis was performed using a stepwise log-linear multiple regression with a
significance level of 5%.
RESULTS: In the final model, only comorbidity (FCI) was associated with mobility
limitation (FTSTS and TUG). The FCI score explained 19.1% of the variability of
the FTSTS (coefficient of determination [R(2)]=0.191) and 19.5% of the TUG
variability (R(2)=0.195). With regard to functional disability (HAQ), the
associated factors were comorbidity (FCI) and disease activity (DAS-28/ESR),
which together explained 32.9% of the variability of the HAQ score (adjusted
R(2)=0.329).