Rheumatoid arthritis is a chronic inflammatory rheumatism which manifests itself by swollen and painful joints, and which evolves by push. This pathology is two to three times more frequent in women than men, and reaches a peak around 45 years.
With about 180,000 people affectedthere rheumatoid arthritis Chronic inflammatory rheumatism is the most frequent. “”It is an autoimmune disease that affects part of the joint called the synovial membrane“, Complete Professor Aleth Perderiger, Rheumatology Service Chef of Rennes University Hospital.
The synovial membrane is a structure that lines tendons and ligaments. In patients with rheumatoid arthritis, this membrane is attacked by white blood cells, which causes significant inflammation and thickening of the synovial tissue. Consequently, the joint is gradually destroyed: the cartilage erodes, the bone demineralizes and the tendons and ligaments threaten to break.
There rheumatoid arthritis is associated with a deregulation of the immune system which leads to the destruction of the joints. The exact causes of this immune dysfunction are unknown. However, we know that there are predisposition genes. “It is estimated that genetics counts for 30%,” said Professor Aleth Perdieriger. A set of environmental factors is also pointed out. These include:
- tobacco (rheumatoid arthritis is more frequent, more serious and less sensitive to treatments in smokers),
- sex (4 women for a man)
- age (peak of appearance after 45 years),
- of the place of life,
- Infectious agents have also been implicated, such as the Epstein Barr virus or the bacterium P. Gingivalis. However, the involvement of these pathogens is not found in all patients.
The term polyarthritis means that several joints are affected (at least 4). In patients with rheumatoid arthritis, all joints can be inflammmed and can gradually be destroyed (hands, elbow, cervical, hip, foot, etc.). The first signs of the disease are an enraid and painful swelling of several jointsespecially the wrists, hands and fingers. Generally pain appears at night and morning. Little by little, inflammation weakens cartilage, bone and tendons, which promotes the appearance of disabling deformations. More rarely, inflammation can also affect organs such as the heart or lungs. Patients in rheumatoid arthritis are therefore more at risk of cardiovascular pathologies (myocardial infarction, stroke).
Rheumatoid arthritis of the finger joints of the hand (normal left, on the right, with rheumatoid arthritis)
To make the diagnosis, the doctor relies on the patient’s interrogation, clinical examination and medical imaging examinations and biological analyzes. “”We will look the presence of arthritis which manifests itself by an inflammatory involvement of the joint who wakes up at night and gets fucked during the day when you move“, describes Professor Aleth Perdieriger.”You should also know if this inflammation affects several joints, and if the attacks are bilateral, and more or less symmetrical, that is to say that they concern the two wrists or fingers of both hands. We will also question the patient to find out if the pain has been there for more than 6 weeks, if it is the case, it will be said that the pain is chronic“.
A radiological assessment Allows you to search for erosion or joint pinch. The radios Asked are in particular an x -ray of the hands and wrists from the front, an x -ray of the feet from the front and 3/4 in normal size and any affected joint. Joint ultrasound is often useful for showing the inflammation of the joint. Finally, to assert the diagnosis of rheumatoid arthritis, doctors will also prescribe a blood test In order to seek the presence of specific antibodies called anti-acpa antibodies, as well as rheumatoid factors. If these antibodies are not found, then the patient certainly suffers from another polyarthritis than rheumatoid arthritis. It can for example be a lupus.
It does not exist today No treatment capable of curing rheumatoid arthritis. Management aims to slow down the progression of the disease and effectively relieve patients. And it is all the more effective, if it is started early. Thus doctors prescribe background treatment as soon as possible to regulate the immune system and make a normal appearance to the synovial membrane. These background treatments can be Immunosuppressants (methotrexate) or inhibitors of inflammation (anti-TNF alpha). “”But these drugs have a delayed action period which can take several weeks. So while waiting for them to be effective, the pain of patients must be relieved with analgesics such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs) or small doses of cortisone “underlines the specialist, before adding: “When the patient can reduce his doses of analgesics without seeing the pain reappear, it is because the background treatment works.“However, it happens that analgesics do not make, or more, effect. In this case, the rheumatologist can offer patients local infiltration of corticosteroids.
In parallel with this drug management, patients are strongly advised to do physical activity because it reduces inflammation and provides mobility to the joints. Of the physiotherapy sessions or occupational therapy are generally prescribed. Port of splints, called orthotics, can also relieve pain by immobilizing the joint, or by correcting or preventing a deformation.
Surgery Can also be a therapeutic solution for patients, in particular to prevent the appearance of a handicap. Surgery allows for example to prevent cartilage or tendon destruction, to remove a part or the entire synovial membrane, to repair tendons or to replace a joint destroyed by a prosthesis.
Being with rheumatoid arthritis does not mean that it is impossible to be pregnant. However, it is essential to immediately prevent his rheumatologist When a pregnancy project takes shape. It will inform you of the need or not to interrupt treatment before the design of the child or as soon as the pregnancy is diagnosed. Pregnancy improves symptoms of rheumatoid arthritis in 3 women out of 4. This almost total disappearance of manifestations begins at the end of the 1st trimester to be more important at the end of pregnancy. Pregnancy and childbirth take place completely normally. The signs of pathology will surface after the birth of the baby.
Thank you to Professor Aleth Perdriger, Rheumatology Service of the Rennes University Hospital, for its details and its validation.
