Добре дошли в сайта на д-р Севдалина Ламбова, дм, ревматолог




Rheumatoid arthritis

             Rheumatoid arthritis (RA) is a chronic inflammatory disorder, affecting small and middle-sized joints, but also larger joints, internal organs such as lung, vessels, haematopoetic system. The prevalence of RA is about 1% with some variation amongst ethnic population. The prevalence is two fold to fourfold more common in women.  


            The type of onset and the course of RA may vary in a wide range. The gradual and insidious onset with pain and stiffness in hand and feet joints is the most typical although in some cases the disease may start acutely with fever polyarthritis and extraarticular manifestations. In the latter case the condition should be differentiated from infectious disease.  


            Sicca symptoms from eyes and mouth (secondary Sjögren syndrome) is present in over 10% of RA patients and are markers of poorer prognosis. Scleritis and episcleritis are other eye complications in RA patients in the stages of disease activity. The main forms of pulmonary involvement in RA include pleuritis, interstitial pneumonitis and nodular lung disease.


            In the active phase of the disease, an increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), pathologic changes in peripheral blood count. In 80-85% of RA patients a positive test for rheumatoid factor (RF) is found. RF is a non-specific immunological marker, which may be found in a number of clinical conditions different from RA. An immunological marker for early diagnosis of RA are anti-citrullinated protein antibodies, that is currently routinely applied and recommended for diagnostic purposes.  


            Conventional radiographic examination of hands and feet are the gold standard for the diagnosis of RA. In cases of early arthritis X-rays of hands and feet does not reveal pathologic changes. Joint ultrasonography and magnetic resonance imaging may be used in these cases for detection of synovitis and joint erosions. It should be underlined that in the first months of the disease course there are no radiographic changes.


            On the other hand, there is evidence that early diagnosis of RA and early initiation of disease-modifying treatment prevents or slows the development of joint erosions and permanent structural damage in RA. Nowadays, it is postulated that disease-modifying antirheumatic drugs (DMARDs - cytotoxic drugs – methotrexate, leflunomide etc.; biologic drugs – adalimumab, etanercept, golimumab, certolizumab, tocilizumab, etc.) should be administered early, at the beginning of the disease, when the diagnosis of RA is established together with nonsteroidal anti-inflammatory drugs. If indicated oral or intraarticular corticosteroid are used in the therapeutic regimen.


            If there are indication for treatment with the above-mentioned DMARDs you will be screened with the necessary investigations for presence of contraindications for such treatment. In every individual case according to the disease activity the most appropriate therapeutic approach will be chosen. The needs for treatment modification according to the therapeutic effect and safety will be evaluated during the follow-up. You will be instructed for the necessity of follow-up and the possible adverse reactions in the course of treatment.


                                                                                  Dr Sevdalina Lambova, MD, PhD