[ad_1]
Provided “arthritis” we mean inflammation of the joints, manifested by pain, swelling (swelling) and stiffness of the joints, symptoms that usually worsen in the morning hours. Arthritis is a major symptom in most inflammatory rheumatic diseases.
These diseases are rheumatoid arthritis with a frequency of about 0.8%, psoriatic arthritis with a frequency of about 0.5%, h ankylosing spondylitis with a frequency of about 0.4%, o systemic lupus erythematosus with a frequency of about 0.35%, the Sjogren’s syndrome with approximately the same frequency, and other rarer diseases such as scleroderma, myositis, systemic vasculitis, etc.
Rheumatic diseases affect all ages. They can appear in young children, but also in the elderly. The main age of onset of rheumatoid arthritis is around 40-50 years, systemic lupus erythematosus 20-50 years, ankylosing spondylitis the 3rd and 4th decade of life, as well as psoriatic arthritis.
There are large differences in the distribution between the two sexes. Rheumatoid arthritis is more common in women by a ratio of 3 to 1, systemic lupus erythematosus by a ratio of 9 to 1 women/men, while ankylosing spondylitis is more common in men by a ratio of 7 to 1.
In addition to the joint damage, as described above, a very important symptom is the inflammatory pain in the lower back, which characterizes the diseases of the ankylosing spondylitis group. This pain differs from usual mechanical low back pain, as it is worse in the morning, accompanied by severe morning stiffness, worsens with rest and improves with movement, wakes the patient in the second half of the night, and “responds” remarkably to non-steroids anti-inflammatory drugs. Inflammatory rheumatic diseases may also have other symptoms, such as rashes (eg, psoriasis, lupus, angiitis), low-grade fever, feeling tired, dry mouth, dry eyes, anemia, low white or platelet counts, symptoms of the lungs, eye inflammation, etc.).
H rationale of rheumatic diseases remains largely unknown. Hereditary (genetic) factors, environmental (infections, pollution) factors, smoking and poor diet are blamed, but we don’t know exactly what starts the inflammatory process.
THE diagnosis of rheumatic diseases it is primarily clinical and relies on a detailed history and careful clinical examination. Laboratory tests are useful in confirming the diagnosis and investigating the general condition of the patient. No positive test alone (e.g. positive antinuclear antibodies or positive rheumatoid factor) can establish the diagnosis of rheumatic disease, but the specialist physician, the Rheumatologist, will assess the severity of the test according to the symptoms and the patient’s clinical picture.
THE osteoporosis is a silent disease, as its first symptom is exactly what we want to avoid, namely fracture. Osteoporotic fractures usually occur in the thoracolumbar spine, hip, or wrist, and are characterized as “low-energy” fractures, that is, without serious injury to warrant such damage. The main causes of osteoporosis are menopause in women, gonadal insufficiency in men, long-term cortisone intake, low body weight, smoking, and of course a family history of fracture in a parent. The diagnosis of osteoporosis is made with the history and the measurement of bone density, while the treatment with the use of bisphosphonates or specific monoclonal antibodies, with the simultaneous intake of calcium and vitamin D.
Biological agents and the newest targeted therapies
Of capital importance in rheumatic diseases is the early diagnosis and the initiation of the correct aggressive therapeutic treatment, with the aim of quickly combating the inflammation, fully restoring daily functionality and avoiding permanent damage and subsequent disability. In rheumatic diseases, permanent damage to joints and other organs occurs in the first 1-2 years from the onset of symptoms, which is why early diagnosis is so important. Nevertheless, very often patients delay visiting the specialist, for several months or even years.
Informing the public, with the actions of Patient Associations, but also of other medical specialties (general practitioners, pathologists, orthopaedics) with ongoing training, has led to a clear improvement in this matter. Any patient who has symptoms as described above, must immediately visit or be referred to the specialist doctor, which is the Rheumatologist.
THE Treatment of inflammatory arthritis initially includes the administration of small doses of cortisone to immediately combat the inflammation, and then the initiation of treatment with anti-rheumatic disease-modifying drugs, the main of which is methotrexate. In the last 20 years we have experienced a real therapeutic revolution in rheumatic diseases, with the discovery and use of biological agents and the newest targeted therapies. With these drugs, a large part of the patients are led to a remission of the disease or to a state of minimal activity. There are many classes of such drugs and a change can be made between them, until the one that will be most suitable for the specific patient is found (individualization of the treatment).
Correct and honest communication between doctor and patient is very important in rheumatic diseases. The patient must discuss with his doctor all the problems that concern him in his daily life, his work, his interpersonal relationships. The informed and empowered patient can better understand the disease and participate in the treatment decision (co-decision or informed consent).