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Rheumatoid arthritis or carpal tunnel: Carpal Tunnel Syndrome vs. Arthritis: What’s the Difference?

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Carpal Tunnel Syndrome vs. Arthritis: What’s the Difference?

You’ve been experiencing pain in your wrists. At first you might chalk it up sleeping funny, or an overuse injury from your yoga class. But if the pain endures, and depending on the specific mix of your symptoms, you may be wondering whether it could it be carpal tunnel, a form of arthritis, or something else.

For some people, however, it’s often not an either-or situation. Having arthritis raises your risk of developing carpal tunnel, so you could have both conditions at the same time.

In this article, we’ll explain why arthritis may be a cause of carpal tunnel and share information about carpal tunnel symptoms, diagnosis, and treatment.

Arthritis vs. Carpal Tunnel Syndrome

While both arthritis and carpal tunnel can affect the wrists, hands, and fingers, the causes for the symptoms differ.

Rheumatoid arthritis is an autoimmune disease, which means your body’s own immune system attacks the joints, causing inflammation, pain, and swelling. Here are other common symptoms of rheumatoid arthritis.

Osteoarthritis is the “wear-and-tear” type that occurs when cartilage that cushions joints wears away. Here are other common osteoarthritis symptoms.

Carpal tunnel syndrome occurs when a major nerve in the hand — the median nerve — becomes compressed in the carpal tunnel, a narrow passageway on the palm side of your wrist that also houses the tendons that bend the fingers.

The floor and sides of this inch-wide tunnel are formed by small wrist bones called carpal bones, which are linked together by a ligament that overlies the top of the carpal tunnel. (The word carpal comes from the Latin “carpus,” which means wrist.)

Repetitive hand motions, such as those that occur when someone works on an assembly line, often contribute to carpal tunnel syndrome. With excessive motion, the tendons of the fingers can get swollen or inflamed and squeeze the median nerve. Despite common thinking that typing causes CTS, even heavy computer use did not make people more likely to develop it, according to one study.

A number of health problems can also cause swelling of this area. Arthritis is one, but diabetes and thyroid issues are also associated with carpal tunnel syndrome, as are hormonal changes that occur during pregnancy. Injuries, such as a wrist fracture, can contribute to the onset of carpal tunnel syndrome.

How Arthritis Can Cause Carpal Tunnel Syndrome

“It’s very common to have carpal tunnel syndrome when you have rheumatoid arthritis, especially if you have rheumatoid arthritis of the wrist,” says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and medical advisor for CreakyJoints.

If you have rheumatoid arthritis, chances are it does affect your wrists — research shows they’re the most common site for RA in the upper body and that 75 percent of people with RA have wrist involvement.

Though its impact isn’t usually as great as RA, even osteoarthritis (OA), the wear-and-tear type of arthritis, increases the risk of carpal tunnel too. OA in the wrist can cause swelling and bony changes that crowd the carpal tunnel.

“The wrist is a very small area and if it gets inflamed for any reason, it can cause pressure on the nerve that leads to carpal tunnel syndrome,” says Robert Gotlin, DO, a sports and spine physician in New York City and an associate professor of rehabilitation medicine and orthopedics at the Icahn School of Medicine at Mount Sinai.

Interestingly, carpal tunnel, like rheumatoid arthritis, is three times more likely to affect women than men, possibly because the carpal tunnel itself may be smaller in women than in men. The dominant hand is usually affected first and produces the most severe pain.

Like OA, carpal tunnel is more likely to occur with age; more than three-quarters of people develop symptoms between the ages of 40 and 70.

Luckily, despite some similarities in symptoms between carpal tunnel syndrome and arthritis, doctors usually don’t have much trouble telling the two conditions apart. Even better, there’s some overlap between treatments for both conditions.

Telltale Symptoms of Carpal Tunnel Syndrome

When carpal tunnel develops, it has a typical pattern, says Dr. Gotlin. Some key signs, which can help differentiate carpal tunnel from different kinds of arthritis, include:

1. Numbness and/or tingling in the first three fingers (thumb, index finger, and middle finger)

The median nerve provides sensation to these fingers, as well as to half of the ring finger (the pinky typically isn’t affected). It also provides strength to some of the muscles at the base of the thumb. Initially, numbness and tingling symptoms come and go, but as the condition worsens, they may become chronic.

2. Hand weakness

This may cause you to drop things or leave you unable to perform everyday tasks. “The thumb side of the hand provides precision grip, which is important when you want to do things like use a screwdriver or hold something carefully,” Dr. Gotlin explains. As carpal tunnel progresses, people may say their fingers feel useless or swollen, even though there’s no swelling. In the most severe cases, the muscles at the base of the thumb experience “gross atrophy,” which means they shrink in size.

3. Nighttime pain

Carpal tunnel tends to be especially painful at night. Blood pools because your hand isn’t moving, which creates swelling in the wrist. Many people also sleep with their wrists bent, which can also cause more pain at night.

4. ‘Flicking’ provides pain relief

Another tipoff it’s carpal tunnel is that in the early stages, people are usually able to relieve symptoms by shaking their hands rapidly (the “flick sign” in medicalese). “This gets the blood flowing again and reduces swelling, so the pain goes away,” says Dr. Gotlin.

Get more information here about how symptoms of arthritis affect the hands.

How Carpal Tunnel Syndrome Is Diagnosed

Your health care provider can diagnose carpal tunnel by taking a medical history and conducting a physical exam. He or she may tap the inside of your wrist to see if you feel pain or a shocking sensation (the Tinel test) or ask you to bend your wrist down for a minute to see if it causes symptoms (the Phalen test).

Lab tests and X-rays may be used to reveal problems like arthritis, diabetes, and fractures. Your doctor may also employ electromyography (EMG), a test that measures electrical activity of the nerve, to help confirm the carpal tunnel diagnosis.

How Carpal Tunnel Syndrome Is Treated

In most people, carpal tunnel gets worse over time, so early treatment is important. Ignoring symptoms can lead to permanent damage to the nerve and muscles, which can lead to loss of feeling, hand strength, and even the ability to distinguish hot and cold. It may also increase the need for surgery. Luckily, many people get better after first-step treatments, which include:

  • Immobilization: Wearing a wrist splint provides support and braces your wrist in a straight, neutral position that takes pressure off the median nerve. A splint can be worn just at night or 24 hours a day.
  • Rest: For people with mild carpal tunnel, avoiding activities or taking frequent breaks from repetitive-motion tasks that provoke symptoms may be all you need. If your wrist is red, warm, and swollen, applying cool packs can help.
  • Over-the-counter drugs: Nonsteroidal anti-inflammatory drugs (NSAIDS) like ibuprofen may provide short-term relief by calming swelling, but they haven’t been shown to treat CTS itself.
  • Prescription medication: In more severe cases, steroid injections are given to relieve pressure on the median nerve. Steroid injections usually aren’t effective in the long term, but research suggests improvement lasts 10 weeks to more than a year. Caution: If you have diabetes, be aware that long-term corticosteroid use can make it hard to regulate insulin levels.
  • Alternative therapies: Yoga poses that emphasize opening, stretching, and strengthening the joints of the upper body were shown in one preliminary study to reduce pain and improve grip strength in those with CTS. People in one study who got acupuncture reported improvement in symptoms and functionality. Chiropractic manipulation has also been shown to be beneficial. Be sure to talk with your doctor before trying any of these treatments to be sure they’re appropriate for you.

If you’re diagnosed with both carpal tunnel syndrome and arthritis, the two conditions can be treated at the same time — and sometimes the treatment is even the same. For instance, NSAIDs can help relieve the pain of RA and OA as well as carpal tunnel. The same is true for corticosteroids. In addition to immobilizing the wrist to relieve symptoms of CTS, wearing a splint can provide rest and support for arthritis in the wrist, hand, and fingers.

The Last Resort: Surgery for Carpal Tunnel

When carpal tunnel symptoms are severe and/or don’t respond to these conservative measures, surgery may be required. It’s a very common surgery, performed more than 400,000 times each year.

The outpatient procedure, known as carpal tunnel release surgery, involves making one or more small incisions in the wrist or palm and cutting (“releasing”) the ligament that’s compressing the carpal tunnel to enlarge the area. “It’s no longer a tunnel, but more like a convertible car — the roof is gone,” explains Dr. Gotlin.

Following surgery, the ligaments usually grow back together and allow more space than before. Symptoms are usually relieved immediately after surgery, but full recovery can take up to a year. Recurrence of carpal tunnel following surgery is rare, though, according to Dr. Domingues, it’s more common in people with active rheumatoid arthritis. Be aware that fewer than half of people report that their hand(s) ever feel completely normal post-op. Some residual numbness or weakness is common. Still, it’s comforting to know that the surgery has a high success rate, providing a lasting, good outcome in up to 90 percent of cases in one study.

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The Difference Between Carpal Tunnel and Rheumatoid Arthritis

Rheumatoid arthritis or RA, is actually an autoimmune disorder associated with chronic inflammation of the joints. Typically, RA affects your smaller joints in your hands and feet. The pain you feel with RA comes from your own immune system attacking your body’s tissue. This causes pain, stiffness and swelling in the lining of your joints. You may feel sick, tired and suffer from fevers if you are experiencing RA.

There are many specific symptoms indicative of RA. These may include: stiffness in the morning that can last for hours, swollen joints, tender joints, firm bumps of tissue under the skin of your arms, fever, fatigue and weight loss. RA can affect any and all of your joints, but typically starts with the smaller joints in your hands and feet.

The cause of RA can be difficult to determine. Anybody is subject to the disease, but doctors are not entirely able to pinpoint the root of RA. Likely, RA is caused by genetics, the environment or hormones.

Unfortunately there is no cure for RA. Treatment of RA might include drugs like nonsteroidal anti-inflammatories, steroids, antirheumatic drugs and biological agents. Other treatment options include therapy, surgery and alternative medicine. Once again, getting an early diagnosis can lead to quicker treatment and relief.

As you can see, carpal tunnel syndrome and RA have similarities, but they also have distinct differences. They both cause pain and tenderness in your hand and RA can actually lead to carpal tunnel syndrome. An important difference is that if you are suffering from RA, you will have pain in other joints of your body other than your hand. Pain from carpal tunnel syndrome is particularly distinctive in that your pinky finger will be less painful than the rest of your fingers, repetitive motion will make the pain more noticeable and it extends up your forearm.

It is also important to note that pain in your hand may not be caused by either carpal tunnel syndrome or RA. Pain in your hand or wrist could just be the result of an injury to the tendon, ligament, bone or even a nerve problem. If you are experiencing pain in your hand or wrist, you should always have it examined by a trusted medical professional for a proper diagnosis and treatment plan.

In the end, both carpal tunnel syndrome and rheumatoid arthritis do get confused for one another and it is easy to see why. They both cause uncomfortable pain in your hand and or wrist. Having a medical professional diagnose your pain is essential for receiving the proper medical treatment and having the best outcome.

Distinguishing Rheumatoid Arthritis From Carpal Tunnel

Rheumatoid arthritis and carpal tunnel syndrome are often misidentified as one another when linked to symptoms of joint pain in the hands. However, the distinction is extremely important in order for the most appropriate treatment to be pursued.

These are the key differences between rheumatoid arthritis and carpal tunnel syndrome and why the timing of diagnosis and treatment is so important for these two painful conditions.

Understanding Rheumatoid Arthritis Pain in the Hands

Rheumatoid arthritis is a chronic inflammatory disorder that is caused by the body’s own immune system. 1This autoimmune disorder occurs in the hands when the body’s immune system attacks its own bodily tissues by mistake. It has a painful impact on the lining of the joints, causing swelling, bone erosion, and even joint deformities in severe cases.

Rheumatoid arthritis in the hands feels like swelling and stiffness, with joints that are tender and warm to the touch.2,3,4,5 Symptoms typically occur on both sides of the body and get worse over time with pain that comes and goes. Over-the-counter medications like JointFlex are effective in treating the painful symptoms of rheumatoid arthritis, providing powerful and fast-acting arthritis relief without a prescription.

Understanding Carpal Tunnel Pain in the Hands

Conversely, carpal tunnel syndrome is caused as a result of compression of the median nerve and wear and tear over time.6,8 This nerve extends from the forearm through the wrist and into the hand. 7 Repetitive work, a wrist fracture, and chronic diseases like diabetes are risk factors for developing carpal tunnel syndrome.8,9 Inflammatory conditions, such as rheumatoid arthritis, can lead to carpal tunnel syndrome as well.10

Carpal tunnel syndrome feels like numbness and tingling in the hands that can be described as a “pins and needles sensation.”6,7,8This condition gets worse with use, especially while gripping objects or bending the wrist. Symptoms may be felt in either one hand or both hands and symptoms tend to be worse at night. Nonsurgical therapies for treatment include nonsteroidal anti-inflammatory drugs and wrist splinting.7,11 Surgery may be required for severe cases to relieve pressure on the median nerve.

The Important of Timely Diagnosis and Treatment

Both rheumatoid arthritis and carpal tunnel syndrome have long-term implications if they are not addressed quickly and correctly. That’s why this distinction between the two conditions must be made and well-understood.

People who suffer from rheumatoid arthritis often have joint pain in other regions of the body in addition to the hands.5 Carpal tunnel syndrome pain, however, is typically restricted to the hand, forearm, and shoulder.12 The tingling and numbness of carpal tunnel syndrome distinguish themselves from rheumatoid arthritis pain because it often doesn’t affect the pinky finger as badly, it’s triggered by repetitive motion, and it extends up the forearm.

Hand and wrist pain may also be attributed to an injury of the tendon, ligament, or bone or even a nerve problem in the fingers or neck.13 It is important to consult a trusted medical professional to properly diagnose and recommend treatment for the precise hand and joint pain condition that one suffers from.

REFERENCES for ARTHRITIS VS. CARPAL TUNNEL

1. Kontzias, A. (2017 July). Rheumatoid Arthritis (RA). The Merck Manual: Consumer Version. Retrieved October 19, 2018 from https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/joint-disorders/rheumatoid-arthritis-ra.
2. Arthritis of the hand. American Academy of Orthopaedic Surgeons. Retrieved October 17, 2018 from https://orthoinfo.aaos.org/en/diseases–conditions/arthritis-of-the-hand/.
3. What makes my joints stiff in the morning? Harvard Health Publishing. Retrieved October 18, 2018 from https://www.health.harvard.edu/pain/what-makes-my-joints-stiff-in-the-morning.
4. Scott, J. T. (1960). Morning Stiffness in Rheumatoid Arthritis. Annals of Rheumatic Diseases, 19, 361-368. Retrieved October 18, 2018 from https://ard.bmj.com/content/annrheumdis/19/4/361.full.pdf.
5. Ezerioha, M. (2016). RA Symptoms: How Do You Diagnose Rheumatoid Arthritis? Rheumatoid Arthritis Support Network. Retrieved October 18, 2018 from https://www.rheumatoidarthritis.org/ra/symptoms/.
6. Steinberg, D. R. (2018 August). Carpal tunnel syndrome. The Merck Manual: Consumer Version. Retrieved October 17, 2018 from https://www.merckmanuals.com/home/bone,-joint,-and-muscle-disorders/hand-disorders/carpal-tunnel-syndrome.
7. Carpal tunnel syndrome. American Academy of Orthopaedic Surgeons. Retrieved October 18, 2018 from https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/.
8. Carpal tunnel syndrome fact sheet. National Institute of Neurological Disorders and Stroke. Retrieved October 18, 2018 from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Carpal-Tunnel-Syndrome-Fact-Sheet#3049_4.
9. Carpal Tunnel Syndrome. American College of Rheumatology. Retrieved October 18, 2018 from https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Carpal-Tunnel-Syndrome.
10. Chamberlain, M. A. & Corbett, M. (1970). Carpal tunnel syndrome in early rheumatoid arthritis. Annals of the Rheumatic Diseases, 29, 149-152. Retrieved October 18, 2018 from https://ard.bmj.com/content/annrheumdis/29/2/149.full.pdf.
11. Don’t delay treatment for carpal tunnel syndrome. Harvard Health Publishing. Retrieved October 18, 2018 from https://www.health.harvard.edu/diseases-and-conditions/dont-delay-treatment-for-carpal-tunnel-syndrome.
12. DeVries, C. (2013 March 22). Is My Hand Pain Caused by Arthritis or Carpal Tunnel Syndrome? Veritas Health. Retrieved October 19, 2018 from https://www.arthritis-health.com/blog/your-hand-pain-caused-carpal-tunnel-syndrome.
13. Wrist pain. MedlinePlus. Retrieved October 20, 2018 from https://medlineplus.gov/ency/article/003175.htm.

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Carpal Tunnel Syndrome

Carpal tunnel syndrome is possibly the most common nerve disorder experienced today. The carpal tunnel is located at the wrist on the palm side of the hand just beneath the skin surface (palmar surface). Eight small wrist bones form three sides of the tunnel, giving rise to the name carpal tunnel. The remaining side of the tunnel, the palmar surface, is composed of soft tissues, consisting mainly of a ligament called the transverse carpal ligament. This ligament stretches over the top of the tunnel.

The median nerve and nine flexor tendons to the fingers pass through the carpal tunnel. Flexor tendons help flex or bend the fingers. When the median nerve in the wrist is squeezed (by swollen tissues, for example), it slows or blocks nerve impulses from travelling through the nerve. Because the median nerve provides muscle function and feeling in the hand, this causes symptoms ranging from mild occasional numbness to hand weakness, loss of feeling and loss of hand function.

Usually carpal tunnel syndrome affects only one hand, but can affect both at the same time, causing symptoms in the thumb and the index, middle and ring fingers. In addition to numbness, patients with carpal tunnel syndrome may experience tingling, a pins and needle sensation or burning of the hand occasionally extending up to the forearm.

Frequently, symptoms appear in the morning after a person wakes up, but they can also happen during the night and interrupt their sleep. Symptoms can occur with certain activities such as driving, holding a book or other repetitive activity with the hands, especially activities that require a person to grasp something for long periods of time or bend their wrist. Activities that require use of the hands, such as buttoning a shirt, may become difficult, and carpal tunnel sufferers may drop things more easily. Individuals will often shake their hands trying to obtain relief and may feel that their hand is swollen when no swelling is present.

Because numbness and tingling may be mild and occur only periodically, many do not seek medical help. However, the disease can progress to more persistent numbness and burning. In some severe and chronic cases of carpal tunnel syndrome, loss of muscle mass occurs at the base of the thumb on the palm side of the hand. In these instances, especially when untreated, individuals can experience hand weakness, impaired use of the hand, and loss of sensation in their hand due to permanent nerve and muscle damage.

Does Arthritis Cause Carpal Tunnel Syndrome?

Question: For a few years I have had arthritis in my left wrist, and lately I have been experiencing numbness in my fingers and thumb. It is difficult to pick things up or even turn the pages of a book. Is there anything I can do to get the feeling back in these fingers?

A: Numbness in thumb and fingers is a classic symptom of carpal tunnel syndrome, also known as CTS. Other symptoms include a burning pain or tingling in the hand. 
 
To understand CTS, you must first understand the wrist’s anatomy. The bones of the wrist are called the carpal bones and, along with a ligament, they form a tunnel through which the median nerve and several tendons run. The median nerve is the one that supplies sensation to the thumb side of the hand. If the nerve becomes compressed within that tunnel, numbness in the thumb and fingers can occur. 
 
Several factors may have caused your median nerve to become compressed. Your longstanding arthritis could have caused spurs to form on the carpal bones, trapping the nerve and resulting in numbness. Any inflammation from your disease may also cause swelling within the carpal tunnel, which compresses the nerve. In fact, arthritis-related diseases, such as rheumatoid arthritis, gout and pseudogout, are common causes of CTS. 

If you have one of these diseases, the way to treat carpal tunnel syndrome is to treat that underlying disease process. Often, however, CTS occurs in the absence of underlying disease. Sometimes, the cause of carpal tunnel syndrome is simply overuse of the wrist. 

Treatment of carpal tunnel syndrome can include using wrist braces, especially at night; having periodic injections of steroids to reduce swelling; and avoiding activities that aggravate the symptoms. Although these measures generally work for a while and may offer lasting relief in some cases, more severe cases require surgery. An operation that releases the median nerve from entrapment can often relieve the symptoms. 

The best thing you can do is discuss your symptoms and possible treatment options with your physician. 
 
Tim Lambert, MD 

Family Practitioner 

Garland, Texas 

Do I Have Carpal Tunnel Or Something Else?

Carpal tunnel syndrome is a common term that we hear from family and friends when we complain of numbness or pain in the wrist. It’s the one condition that seems the most likely cause because it’s quite well known. However, just because carpal tunnel syndrome is well-known does not mean it is the only condition that causes wrist pain and numbness.

It is important to understand the symptoms of other common conditions that relate to the hand and wrist, as well as carpal tunnel syndrome, to rule out other possibilities.

In this article, we will cover common conditions that cause numbing, tingling, pain, or numbness in the fingers and wrists as well as what you should do if you believe you have one of these conditions.

Carpal Tunnel Syndrome

Carpal tunnel syndrome happens when pressure is applied to your median nerve by the carpal bones. When swelling happens in your wrist, the carpal tunnel constricts the median nerve causing symptoms to appear. These symptoms could be radiating pain from the forearm to the shoulder, numbness, burning, or tingling starting at the thumb, pinky, or felt within the forearm.  

The symptoms of carpal tunnel syndrome typically start slow and are felt mostly at night. This is due to sleeping positions that cause restriction within the wrists. How to tell is if you feel the need to shake your wrist to regain feeling. As the condition worsens, you will begin to feel symptoms during the day while driving, typing, or talking on the phone.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is another condition that is easily mistaken with carpal tunnel syndrome (CTS) in the early stages. This condition causes hand pain and numbness, but what differentiates this condition from CTS is how the pain is distributed. Along with the hand pain and numbness, RA causes pain within the larger knuckles and wrist joints. If the condition is RA, you will not feel pain along the nerve path. Typically you will feel the pain simultaneously in the right and left hand.

Cervical Radiculopathy

Cervical radiculopathy is less common but is something worth ruling out. Cervical radiculopathy is caused by an existing condition within the cervical spine. The cervical spine is compiled of the seven vertebrae that make up the neck. This is where the nerves of the arms, wrists, and hands begin. When irritation happens to these vertebrae, you will experience neurological symptoms that include pain, numbness, and tingling of the arms and hands.

Conditions that cause cervical radiculopathy include herniated discs, spinal stenosis, degenerative disc disease, and osteoarthritis of the cervical spine. These conditions can cause similar symptoms as CTS and are difficult to self-diagnosis. However, If you experience mild ache, sharp or stabbing pain, there is the possibility that the cause is cervical radiculopathy. Another way to rule out CTS is the location of the symptoms. If you only feel the pain in the hands and wrist, it is more likely to be CTS and not cervical radiculopathy.

What Should You Do Next?

If you believe that you have one of these conditions, the next step is to get a confirmation from a medical professional. We recommend seeing a doctor as soon as you feel early symptoms of any of these conditions for early treatment. This will help treat the symptoms before they affect everyday tasks. 

Disclaimer: Going without treatment will cause the symptoms to worsen and possibly lead to surgery. If you suspect that you have one of these conditions, don’t wait. Speak to a medical professional as soon as possible.

If your carpal tunnel has been confirmed by your doctor you may want to consider doing hand exercises to help manage and prevent pain. Check out these carpal tunnel exercises approved by CORE hand specialist Dr. Raymon Metz below.

How is carpal tunnel syndrome (CTS) treated in rheumatoid arthritis (RA)?

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  • Luqmani R, Hennell S, Estrach C, et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years). Rheumatology (Oxford). 2009 Apr. 48(4):436-9. [Medline].

  • Goksel Karatepe A, Gunaydin R, Turkmen G, Kaya T. Effects of home-based exercise program on the functional status and the quality of life in patients with rheumatoid arthritis: 1-year follow-up study. Rheumatol Int. 2011 Feb. 31(2):171-6. [Medline].

  • Kamioka H, Tsutani K, Okuizumi H, Mutoh Y, Ohta M, Handa S. Effectiveness of aquatic exercise and balneotherapy: a summary of systematic reviews based on randomized controlled trials of water immersion therapies. J Epidemiol. 2010. 20(1):2-12. [Medline].

  • Katz P, Margaretten M, Gregorich S, Trupin L. Physical Activity to Reduce Fatigue in Rheumatoid Arthritis: A Randomized, Controlled Trial. Arthritis Care Res (Hoboken). 2017 Apr 5. [Medline].

  • Lemmey AB, Marcora SM, Chester K, Wilson S, Casanova F, Maddison PJ. Effects of high-intensity resistance training in patients with rheumatoid arthritis: a randomized controlled trial. Arthritis Rheum. 2009 Dec 15. 61(12):1726-34. [Medline].

  • O’Brien ET. Surgical principles and planning for the rheumatoid hand and wrist. Clin Plast Surg. 1996 Jul. 23(3):407-20. [Medline].

  • Macedo AM, Oakley SP, Panayi GS, Kirkham BW. Functional and work outcomes improve in patients with rheumatoid arthritis who receive targeted, comprehensive occupational therapy. Arthritis Rheum. 2009 Nov 15. 61(11):1522-30. [Medline].

  • Williams SB, Brand CA, Hill KD, Hunt SB, Moran H. Feasibility and outcomes of a home-based exercise program on improving balance and gait stability in women with lower-limb osteoarthritis or rheumatoid arthritis: a pilot study. Arch Phys Med Rehabil. 2010 Jan. 91(1):106-14. [Medline].

  • [Guideline] Combe B, Landewe R, Daien CI, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis. 2016 Dec 15. [Medline]. [Full Text].

  • Nordberg LB, Lillegraven S, Lie E, Aga AB, Olsen IC, Hammer HB, et al. Patients with seronegative RA have more inflammatory activity compared with patients with seropositive RA in an inception cohort of DMARD-naïve patients classified according to the 2010 ACR/EULAR criteria. Ann Rheum Dis. 2017 Feb. 76 (2):341-345. [Medline].

  • Ahlmen M, Svensson B, Albertsson K, Forslind K, Hafstrom I, BARFOT Study Group. Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage. Ann Rheum Dis. 2010 Jan. 69(1):230-3. [Medline].

  • Kineret [package insert] [package insert]. Amgen. Personal communication with Kijung Sung-Thay, PharmD. 2008.

  • Axelsen MB, Eshed I, Horslev-Petersen K, et al; OPERA study group. A treat-to-target strategy with methotrexate and intra-articular triamcinolone with or without adalimumab effectively reduces MRI synovitis, osteitis and tenosynovitis and halts structural damage progression in early rheumatoid arthritis: results from the OPERA randomised controlled trial. Ann Rheum Dis. 2015 May. 74(5):867-75. [Medline].

  • Callhoff J, Weiss A, Zink A, Listing J. Impact of biologic therapy on functional status in patients with rheumatoid arthritis–a meta-analysis. Rheumatology (Oxford). 2013 Dec. 52(12):2127-35. [Medline].

  • Chambers CD, Johnson DL, Luo Y, Xu R, Jones KL. Pregnancy outcomes in women exposed to adalimumab: an update on the OTIS Autoimmune Diseases in Pregnancy project. American College of Rheumatology. Available at http://acrabstracts.org/abstract/pregnancy-outcome-in-women-treated-with-adalimumab-for-the-treatment-of-rheumatoid-arthritis-an-update/. 2014 ACR/ARHP Annual Meeting.Abstract Number: 821; Accessed: April 6, 2017.

  • [Guideline] Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020 Feb 23. [Medline]. [Full Text].

    • Carpal tunnel syndrome – treatment, symptoms, causes, diagnosis

    Karpalny – this word comes from the Greek Karpos, which means “wrist”. The wrist is surrounded by bundles of fibrous tissue, which normally acts as a supporting function for the joint. The limited space between these fibrous strips of fibrous tissue and the bony structures of the wrist is called the carpal tunnel. The median nerve, which runs through the wrist, provides sensitivity to the thumb, index, and middle fingers of the hand.Any condition that causes swelling or tissue repositioning in the wrist can compress and irritate the median nerve. Irritation of the median nerve, in such cases, results in tingling and numbness in the thumb, index, and middle fingers, a condition known as carpal tunnel syndrome.

    Reasons for the development of carpal tunnel syndrome

    Given the limited space in the carpal tunnel, any swelling in this area can put pressure on the median nerve, causing symptoms of carpal tunnel syndrome.There are many different reasons leading to the development of this syndrome, but often the exact cause cannot be determined. Some people initially have an anatomically narrower carpal tunnel, which makes them more at risk of developing carpal tunnel syndrome. It is believed that this tendency may be genetically determined, and if there are cases of this syndrome in the family, then the likelihood of pressure on the median nerve is significantly increased. You are also more likely to develop carpal tunnel syndrome if you are overweight, smoke or drink too much alcohol.Age is also a risk factor – the older the person, the higher the likelihood of developing carpal tunnel syndrome. Women are more prone to this syndrome than men because of the narrower carpal tunnel. There is also a greater tendency to develop carpal tunnel syndrome if there was a wrist injury (rupture or sprain) or there are diseases such as:

    • diabetes mellitus
    • osteoarthritis
    • rheumatoid arthritis
    • hypothyroidism

    It is possible that hormones play a role in the development of carpal tunnel syndrome, as some women develop the syndrome during pregnancy or menopause.Hormones produced during pregnancy can lead to fluid retention, which in turn can cause swelling in the wrist. It is noted that the performance of certain types of activities can lead to the development of this syndrome. People who do a lot of heavy manual work or repetitive wrist movements, such as on an assembly line or work with their hands in cold temperatures, also have a greater risk of developing carpal tunnel syndrome. But the probability increases significantly if the loads are combined with the presence of systemic diseases.

    Symptoms of carpal tunnel syndrome

    Patients with carpal tunnel syndrome initially feel numbness and tingling in the hand along the innervation of the median nerve (thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can even lead to awakening from sleep. Symptoms that worsen at night may be due to flexion of the wrist during sleep and / or accumulation of fluid around the wrist and hand while it is in a horizontal position.Carpal tunnel syndrome can be a temporary condition that goes away completely on its own, or symptoms can persist and progress.

    As the syndrome progresses, patients may develop a burning sensation and / or hand cramping and weakness. Decreased grip strength can lead to frequent dropping of objects from the hand. Sometimes, sharp shooting pains may be felt in the forearm as well. Chronic carpal tunnel syndrome can also lead to muscle atrophy of the hand, especially the muscles at the base of the thumb on the palmar surface.

    Diagnostics

    The diagnosis of carpal tunnel syndrome can be made on the basis of symptoms and characteristic numbness zones in the hand. But at the same time, it is often necessary to exclude other possible causes of symptoms that simulate carpal tunnel syndrome. These can be neck, shoulder, or elbow problems. A doctor examines the wrist to look for swelling, localized fever, tenderness, and discoloration. Sometimes pressing on the front of the wrist can produce a tingling sensation in the hand and this is called the Tinel sign, characteristic of carpal tunnel syndrome.Symptoms can also be reproduced from time to time with forward flexion of the wrist (called Phalen symptom), but the final diagnosis can be made with ENMG. As a rule, with carpal tunnel syndrome, there is a slowdown in the conduction of a nerve impulse after the nerve passes through the wrist.

    Limb muscle testing, an electromyogram, is sometimes performed to rule out or detect other conditions that may mimic carpal tunnel syndrome.

    Laboratory tests can be performed in order to diagnose diseases associated with tunnel syndrome. These tests include thyroid hormone tests, general blood tests, blood sugar levels, etc. An X-ray of the hand may also be done to check for bony changes (abnormalities in the bones and joints of the wrist). MRI is necessary in cases where it is necessary to visualize changes in ligaments, cartilage.

    Treatment of carpal tunnel syndrome

    The choice of treatment for carpal tunnel syndrome depends on the severity of the symptoms and the underlying condition that may be causing the symptoms.

    At the first stage, treatment usually includes rest, immobilization of the wrist in a brace, and sometimes local cold. If the patient’s profession is associated with a load on the wrist, then it is necessary to change the activity for a while. In addition, it is possible to improve the ergonomics of the workplace, for example, it is possible to adjust the computer keyboard and chair height and optimize the load on the hands. These measures, as well as occasional rest periods and wrist stretching exercises, can actually prevent the onset of carpal tunnel syndrome symptoms, which are caused by repetitive excessive movements in the wrist.If there are systemic diseases or injuries, then individual treatment of these diseases is carried out. Fractures may require orthopedic correction (plaster cast, orthosis). Overweight patients should be advised to lose weight. In rheumatoid arthritis, specific treatment of the inflammatory autoimmune process is performed. Swelling in the wrist, which may be associated with pregnancy, disappears after the baby is born.

    Drug treatment

    Several types of medications can be used to treat carpal tunnel syndrome.Vitamin B6 (pyridoxine) is often prescribed for the treatment of tunnel syndrome and, although the mechanism of therapeutic action is not entirely clear, nevertheless, many doctors note a certain effect of using this drug. Non-steroidal anti-inflammatory drugs may also be helpful in reducing inflammation and pain. But these drugs have side effects and therefore it is necessary to take this into account when prescribing them. It is also possible to use corticosteroids. They can be given orally or by injection into the affected wrist joint.Corticosteroids can lead to a rapid decrease in symptoms, but the side effects of these drugs prevent them from being prescribed for a long time and in the presence of certain conditions (for example, in diabetes mellitus, their use can lead to a worsening of the condition). They should also not be prescribed for infections. In addition to drug treatment, physical therapy and acupuncture also have a certain therapeutic effect. Most patients with carpal tunnel syndrome can be treated with conservative therapy.But sometimes chronic pressure on the median nerve can lead to persistent numbness and weakness. In such cases, surgical treatment may be recommended to avoid serious and persistent nerve and muscle damage. Surgical intervention consists in excision of tissues that exert pressure on the median nerve. This surgical procedure is called “carpal tunnel release”. Currently, such an operation can be performed using endoscopic techniques, which allows minimizing tissue trauma and achieving rapid restoration of nerve conduction.After surgical treatment, it is necessary to use exercise therapy to restore the function of the hand.

    Prediction of carpal tunnel syndrome

    Complications of carpal tunnel syndrome are rare and include muscle wasting and weakness at the base of the thumb. This can become a persistent violation if not treated on time. This atrophy impairs the motor skills of the hand and the performance of certain movements. As a rule, the prognosis for carpal tunnel syndrome is positive and can be cured conservatively or promptly.

    About carpal syndrome (numbness of the fingers)

    6 September 2017

    About carpal syndrome (numbness of fingers)

    Carpal tunnel syndrome is a neurological disorder that causes prolonged pain and numbness in the fingers of the hand due to compression in the carpal tunnel. It often occurs in women aged 40-50 years. Various concomitant diseases and health problems (diabetes mellitus, hypothyroidism, rheumatoid arthritis, gout, hormonal changes during pregnancy, infectious diseases, trauma and fractures of the wrist bones, lymphostasis, etc.) can lead to the development of carpal tunnel syndrome.).

    Diagnosis of carpal tunnel syndrome consists mainly of clinical manifestations: • Nocturnal paresthesia (painful sensations, reduced by changing position, shaking, hand massage). Often patients cannot describe it at first. • Often the pain radiates to the forearm and shoulder. • In advanced cases, atrophy and weakness of the hand muscles develop. In the initial stages of the disease, conservative treatment is possible, which includes a change in the motor stereotype, orthoses, exercise therapy, physiotherapy, medications, injections of corticosteroids into the carpal tunnel.

    In later stages, surgical treatment is indicated, while it is possible to carry out an operation in an open way and endoscopic. At the FEFU Medical Center, treatment of carpal tunnel syndrome is carried out mainly using endoscopic technology.
    In our clinic, surgery is performed through a small incision in the wrist and hand. An endoscope is inserted into the canal of the median nerve, after which, under video endoscopic control, the surgeon crosses the transverse ligament using special instruments.After surgery, a pressure bandage is placed on the hand, which is usually removed the next day.

    In the first 4-6 weeks after the operation, it is recommended to exclude the load on the arm, while it is necessary to move the fingers, developing the hand. In most patients, in the first days after the operation, pain in the hand is significantly reduced or stopped. In the case of prolonged compression of the nerve, sensitivity is restored slowly.

    Let us remind you that you can make an appointment with a neurosurgeon at the clinic of the FEFU MC by calling +7 (423) 223 00 00 or on the website https: // www.dvfu.ru/med/recording-when/ in the section “Appointment”.

    Brush

    CHRONIC REPEATED VOLTAGE INJURY

    (in Western literature Repetitive Strain Injury, RSI)

    When working with a computer keyboard, the user makes minor physical efforts and, it would seem, they can in no way cause the disease. Nevertheless, the hands are under considerable strain. Constant tension of the upper limbs when typing and moving the computer mouse can cause – RSI (chronic injury of the hands – repetitive strain injury).RSI is a typical occupational disease of programmers, office workers and all those who spend a long time at the computer. Serious neuromuscular disorders underlie RSI. Western insurance medicine has combined all chronic pathologies of the upper limb into this group:

    Neurovascular syndrome is a collective term that combines numerous manifestations of compression of the brachial plexus and subclavian vein when they exit the chest. It occurs quite often, and mainly adults with a complex of chronic diseases become typical patients.

    WRIST CHANNEL SYNDROME (ENGLISH CARPAL TUNNEL SYNDROME, CTS)

    Carpal tunnel syndrome is a condition caused by compression of the median nerve at the level of the wrist and is the most common compression neuropathy of the upper limb.

    CAUSES OF WRIST SYNDROME

    • Activities that require repetitive flexion / extension of the hand or are accompanied by vibration (for example, assembling equipment).
    • Edema or trauma of any kind (eg fractures) that compresses the median nerve.
    • Compression of the median nerve with edema in pregnant women or women taking contraceptives.
    • There is a consistent relationship between overweight and carpal tunnel syndrome. In addition, people of short stature are more prone to the disease.
    • Acromegaly, rheumatoid arthritis, gout, tuberculosis, renal failure, decreased thyroid function, the early period after menopause (as well as after removal of the ovaries), amyloidosis, a possible connection with diabetes mellitus.
    • The syndrome is characterized by a genetic predisposition, in particular due to many inherited characteristics (for example, square wrist, transverse ligament thickness, complexion).

    The carpal tunnel is the narrowest point on the path of the median nerve from the brachial plexus to the fingers, so compression most often occurs at this level.

    The canal is formed by the bones of the wrist and the palmar ligament, 20 mm long and 20/10 mm wide at its narrowest point, it contains 10 important anatomical structures: 8 flexors of the fingers (4 deep and 4 superficial), the long flexor of the thumb and the median nerve.Quite a lot for such a narrow tunnel.

    SYMPTOMS Characteristic symptoms are numbness, tingling sensation, burning sensation, goose bumps in the fingers. The median nerve is responsible for the sensitive innervation of the thumb, index and middle fingers, but unpleasant sensations do not always arise in these fingers, options are possible. Symptoms can appear at night, with exertion and hard work.

    As the disease progresses, numbness can become permanent, weakness joins, objects can fall out of the hands.Some complain about the inability to fasten buttons, take small things from the table, the need to shake their hand, massage their fingers. With prolonged compression, the muscles of the hand begin to suffer – the eminence of the thumb (thenar) sinks.

    Stenosing Tenosynovitis De Kerven

    The muscles working on the hand are long and start on the forearm just below the elbow. The contractile part of the muscle (abdomen) is located on the forearm, and the tendon (a thin cord that connects the muscle to the bone) passes by the wrist in special osteo-fibrous canals.For the extensor muscles, there are six of them. The first is the most sensitive to tendonitis on the wrist, the long muscle that abducts the first finger and the short extensor of the first finger pass through it. With excessive load, chronic inflammation occurs and the canal becomes tight for the tendon to slip freely, which causes pain.

    De Quervain’s tendonitis is one of the most common causes of wrist pain and is easy to diagnose and treat. The main symptom of the disease is pain when the thumb is loaded slightly above its base.Since the painful point is located in the projection of the styloid process of the radius (in Latin – styloid), you can also find the term “styloiditis of the wrist joint.” This does not change the essence of the problem.

    90,000 Rheumatoid monoarthritis of the wrist: rare case

    case presentation

    A 70-year-old patient presented to the polyclinic with complaints of pain in the left wrist in the last 6 months and limitation of range of motion in the wrist in the last 4 months.Examination revealed diffuse swelling of the left wrist. The feeling of heat and soreness in the joint was absent. Back flexion and palmar flexion were limited to 40 and 20 degrees, respectively. Abduction and adduction were limited to 10 degrees compared to the right wrist. The metacarpophalangeal and proximal interphalangeal joints were normal. There were no spinal disorders. No skin lesions were noted.

    Radiographs showed lytic lesions in the distal radius and wrist bones, concentric reduction in carpal joint space, and periarticular osteoporosis.Erythrocyte sedimentation rate and C-reactive protein levels were increased. No rheumatoid factor was detected. The uric acid level was normal. Articular aspirate culture was negative. The test result for antibodies to cyclic citrulline peptide was strongly positive.

    Most likely diagnosis

    • Gout
    • Osteoarthritis
    • Carpal tunnel syndrome
    • Rheumatoid arthritis
    case history

    The patient had no history of this wrist injury.The other large joints were not affected, and pain and limitation of the small joints of both hands were not observed. The patient denied weight loss or coughing up sputum. There was no contact with patients with tuberculosis.

    EXPERTISE AND LABORATORY STUDIES

    Radiography of the left wrist and hand revealed lytic lesions in the distal radius and wrist bones.There was subchondral sclerosis in the distal radius. Periarticular osteoporosis was observed. The total white blood cell count and uric acid levels were normal. The erythrocyte sedimentation rate was high (36 mm) and the C-reactive protein assay was positive (24 mg / L). The RF test result was negative.

    A Mantoux skin test was performed to exclude tuberculosis of the wrist, which was negative. CT showed lytic lesions in the distal radius and carpus with synovial thickening.Microscopic examination of the synovial fluid to detect crystals gave negative results. An open biopsy of the left wrist was inconclusive. A working diagnosis of single-articular RA was made and an anti-CCP antibody test was performed. The analysis showed a sharply positive result (115.23 μ / ml).

    control

    The patient received disease-modifying antirheumatic drugs (DMPD).The patient noted a marked relief of symptoms 2 months after the start of treatment.

    discussion

    Common causes of monoarthritis are infection, trauma, crystal deposition disorders (gout and pseudogout), psoriasis, RA, and neoplasms (pigmented villennodular synovitis). The development of these conditions often has an acute onset with the presence of fever, pain and joint swelling. 2 RA affects 1% of the world population. RA is characterized by chronic inflammation of the synovial joints with progressive erosion and destruction of the joint. RA can affect any joints (even the cricoid joint), but most often affects the proximal interphalangeal and metacarpophalangeal joints, as well as the metatarsophalangeal joints of the legs, knee joints, and joints of the upper extremities. 4 Monoarthritis due to RA is rare and often affects the hip and knee joints.RF and IgM antibodies against a constant portion of IgG antibodies are found in 70-80% of patients with RA. RF is absent in 15-20% of patients with RA. 5 The anti-CCP antibody test is an effective method for differentiating RA from other disorders with manifestations of arthritis. Citrulline is an unusual autoantibody formed by post-translational modification of arginine residues. In RA, autoantibodies to citrulline peptide, such as filaggrin, are found. Variants of synthetic CCP react with autoantibodies to filaggrin and act as a substrate for detecting antibodies to CCP in a serological test. 6 The sensitivity of antibodies to CCP is about 74%, the specificity is 96-98%, while the sensitivity and specificity of rheumatoid factor are only 69.7 and 81%, respectively.

    studying:

    In our case, the classical manifestations of RA were absent.Single joint involvement in RA is rare, and isolated wrist involvement is even less common. This should be taken into account in the differential diagnosis of single-joint arthritis. In cases of doubt, an anti-CCP antibody test should be performed to diagnose rheumatoid arthritis.

    Recommendations
    1. Grassi W, De Angelis R, Lamanna G, Cervini C.The clinical features of rheumatoid arthritis. Eur J Radiol. 1998 May; 27 (Suppl 1): S18-24.
    2. Scutellari PN, Orzincolo C, Castaldi G, Franceschini F. Monoarthritis. Radiol Med. 1995 Dec; 90 (6): 689–98.
    3. Khosla P, Shankar S, Duggal L. AntiCCP antibodies in rheumatoid arthritis. J Indian Rheumatol Assoc. 2004; 12: 143-6.
    4. Scutellari PN, Orzincolo C. Rheumatoid arthritis: sequences. Eur J Radiol. 1998 May; 27 (Suppl 1): S31–38.
    5. Swedler W, Wallman J, Froelich CJ, Teodorescu M.Routine measurement of IgM, IgG, and IgA rheumatoid factors: high sensitivity, specificity, and predictive value for rheumatoid arthritis. J Rheumatol. 1997 June; 24 (6): 1037–44.
    6. Mimori T. Clinical significance of antiCCP antibodies in rheumatoid arthritis. Intern Med. 2005 Nov; 44 (11): 1122–6.
    7. Sauerland U, Becker H, Seidel M, Schotte H, Willeke P, Schorat A, et al. Clinical utility of the anti-CCP assay: experiences with 700 patients. Ann N Y Acad Sci. 2005 Jun; 1050: 314–8

    Marina Sergeevna Marchenkova – Clinic M53

    rheumatologist, doctor of the highest qualification category

    Specialization
    • inflammatory diseases of the joints and spine (rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, undifferentiated arthritis)
    • reactive arthritis
    • degenerative diseases of the joints and spine
    • pathology of periarticular tissues
    • gout
    • systemic connective tissue diseases (systemic scleroderma, systemic lupus erythematosus, systemic vasculitis, Sjogren’s disease, Behcet’s disease, polymyalgia rheumatica, mixed connective tissue diseases)
    • idiopathic inflammatory myopathies
    • management of patients undergoing treatment with genetically engineered biological preparations
    • ultrasound examination – diagnostics of joints and periarticular tissues
    • paravertebral blockade, intraarticular and periarticular injections (piriformis muscle block, carpal tunnel syndrome, epicondylitis, trochanteritis, bursitis of various localizations, subacromial syndrome), joint irrigation
    • reading and interpretation of radiographs, spondylograms, MRI, MSCT gram, ultrasound results – joints
    • application in clinical practice ECMOC – carrying out plasmapheresis, pulse and program methods of treatment
    • implementation of continuity in treatment – planning of hospitalization of patients with rheumatological pathology (in the presence of high clinical and laboratory activity of the disease) to the department of rheumatology
    Bibliography

    Author of 5 publications in various editions.

    Education, trainings and refresher courses
    • In 2000, she graduated with honors from the medical faculty of the Irkutsk State Medical University with a degree in General Medicine.
    • In 2000-2002. She underwent individual training in clinical residency at the Department of Internal Diseases Propedeutics of ISMU in the specialty “therapy”, after completing primary specialization (600 hours) in 2003 she received a certificate in the specialty “rheumatology”.
    • In 2004, she passed refresher courses at the State Educational Institution of Higher Professional Education MMA named after IM Sechenov of the Ministry of Health of Russia (Moscow) on the cycle “Topical issues of rheumatology” (144h)
    • In 2005, she passed the TU in rheumatology on the basis of the Russian Medical Academy of Postgraduate Education of Roszdrav, Moscow (216 hours).
    • In 2006 – completed refresher courses at the State Institution of the Institute of Rheumatology of the Russian Academy of Medical Sciences (Moscow) under the program “Ultrasound examination of joints in rheumatological diseases”.
    • In 2008 she passed the TU “Modern standards for the diagnosis and treatment of rheumatic diseases” on the basis of the Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow.
    • In 2009, she underwent professional retraining at GOU DPO ISIUV under the program “Rheumatology” (576 hours).
    • In 2014, at the Irkutsk Irkutsk State Medical University, she completed advanced training courses under the program “Selected Issues of Rheumatology” in the amount of 144 hours, confirmed the certificate of a rheumatologist.
    • 11-12.12.15 was a participant in the Interregional Scientific and Practical Conference “Topical Issues of Rheumatology of the Siberian Federal District”, Krasnoyarsk.
    • In 01.2017, completed refresher courses under the program “Organization of activities of centers for genetic engineering biological therapy” on the basis of Irkutsk State Medical University.
    Work experience in the specialty “rheumatology” is 15 years.
    • In 2009 she was awarded the first qualification category in the specialty “rheumatology”, confirmed the first category at 01.2014 Certificate of a rheumatologist 2014
    • From October 2003 to the present time he has been working as a rheumatologist at the rheumatology department of the OGAUZ IGKB No. 1 in Irkutsk.
    • From 02.2012 to the present time he has been working as a part-time doctor in the Irkutsk Regional Diagnostic Center.
    • He is a member of the Association of Rheumatologists of Russia, a participant and lecturer at monthly meetings of the Irkutsk branch of the Association.
    • Is a regular participant and lecturer of Schools for patients with rheumatic diseases (conducted on the basis of OGAUZ IGKB No. 1).

    Diagnosis / Consultant Plus

    Making a diagnosis

    The diagnosis of RA should be made as early as possible, preferably within the first 1–3 months from the onset of the first symptoms of the disease [127–130].

    – It is recommended to take into account the RA classification criteria ACR / EULAR, 2010 [7, 131] when making a diagnosis. (see Appendix D1.)

    Evidence level – I, recommendation level of evidence – A

    Comments: There are three main factors to consider when making a diagnosis of RA:

    1.Identify at least one swollen joint in the patient on clinical examination.

    2. Eliminate other diseases that may manifest as joint inflammation.

    3. Score at least 6 points out of 10 possible in 4 positions characterizing joint damage and laboratory disorders typical for RA.

    The determination of the number of inflamed joints, which takes into account both swelling and painfulness of the joint, revealed during an objective examination, is of fundamental importance.

    – Assessment of the patient’s status is based on the allocation of 4 categories of joints:

    Exception joints:

    – Changes in the distal interphalangeal joints, the first carpometacarpal joints and the first metatarsophalangeal joints are not taken into account

    Large joints:

    – Shoulder, elbow, hip, knee, ankle

    Small joints:

    – Metacarpophalangeal, proximal interphalangeal, 2 – 5 metatarsophalangeal, interphalangeal joints of the thumbs, wrist joints

    Other joints:

    – Joints that can be affected in RA, but are not included in any of the groups listed above (for example, temporomandibular, acromioclavicular, sternoclavicular, etc.)

    There are four categories of patients with a high likelihood of developing RA, but who do not meet the criteria for a diagnosis of RA (ACR / EULAR, 2010) at the time of the initial examination:

    1. Patients in whom the X-ray examination reveals “typical” for RA erosions in the small joints of the hands and / or feet.

    2. Patients with advanced RA who previously met the classification criteria for this disease [132]

    3. Patients with an early stage of RA who, at the time of examination, do not fully meet the classification criteria for RA.In this case, the diagnosis of RA is based on the cumulative assessment of the clinical and laboratory signs of RA identified over the entire observation period.

    4. Patients with NDA, the nature of joint damage in which does not meet the criteria for RA (or any other disease) for a long time. In these patients, it is necessary to take into account the presence of risk factors for the development of RA, the main of which are the detection of RF and / or ACB.

    Examples of the wording of clinical diagnoses:

    – Seropositive rheumatoid arthritis (M05.8), advanced stage, activity II, erosive (X-ray stage II), with systemic manifestations (rheumatoid nodules), ACCP (-), FC II.

    – Seronegative rheumatoid arthritis (M06.0), early stage, activity III, non-erosive (X-ray stage I), ACCP (+), FC I.

    – Seropositive rheumatoid arthritis (M05.8), late stage, erosive (X-ray stage III), activity II, with systemic manifestations (rheumatoid nodules, digital arteritis), ACCP (? – not investigated), FC III, complications – carpal tunnel syndrome channel on the right, secondary amyloidosis with kidney damage.

    – Probable rheumatoid arthritis (M06.9), seronegative, early stage, activity II, non-erosive (X-ray stage I), ACCP (+), FC I.

    Treatment of rheumatoid arthritis GUNA-HANDFOOT

    If you are concerned about:

    • Persistent pain in the joints of the arms and legs
    • Pain in the joints of the extremities after removal of the cast
    • Carpal tunnel syndrome

    Time to start life without painkillers

    Rheumatoid arthritis today is one of the most common diseases.Most often, women get sick after 30 years. However, in recent years, cases of morbidity at an earlier age have become more frequent. This disease is expressed in inflammation of the joints, because of this, pain in the fingers, pain in the tendons, pain in the wrists can occur. Rheumatoid arthritis often develops as a complication after colds or sore throats.

    Causes of rheumatoid arthritis:

    • Impaired immune system
    • hypothermia, cold
    • stress, neuroses

      • injuries

    • infections

    Why this or that person gets sick with rheumatoid arthritis science is not yet known for certain.There is a risk group: most likely a hereditary factor plays a large role, and if your relative has rheumatoid arthritis, then it is quite possible that you will have it too.

    According to the doctors’ supervision, a strong shock is needed to activate the disease. This can be both physical trauma (this is why pain occurs after removing the cast, for example), and psychological shock – dismissal, divorce, death of a close relative, etc. It is worth remembering that rheumatoid arthritis is an autoimmune disease, that is, its essence lies in the fact that the body, as it were, rebelles against itself.Lymphocytes begin to destroy the cells of the human joints, mistaking them for cells of a different origin – viruses or bacteria.

    A huge role in the treatment of rheumatoid arthritis is played by the patient’s emotional state, which can and should be regulated by re-coding cells to defend the body, and not to attack. Such treatment should be carried out only under the supervision of competent specialists, otherwise the suffering from rheumatoid arthritis will continue until the end of life and may worsen.

    Benefits of GunaHandfoot treatment at Trubetskoy Clinic

    Every hundredth person on earth suffers from rheumatoid arthritis.Pain can push us to a lot: we start buying countless ointments, creams and gels. Without thinking about the consequences, we buy painkillers in pharmacies and consume them uncontrollably, we self-medicate. But even if you see a doctor, there is no guarantee that the right treatment will be selected for you: often the same pain relievers containing opiates are prescribed for arthritis, which can cause irreparable harm to our nervous system and gastrointestinal tract. Thus, the emotional state is aggravated: painkillers cause nausea, reduce performance.Each time, the dosage has to be increased, because the susceptibility to the drug decreases. But the most important thing is that conventional medications will not be able to cure you of arthritis, since they only relieve symptoms, and then for a while. In order to treat arthritis, it is necessary to determine its type, highlight the affected areas. An examination at the Trubetskoy clinic will help to clarify all this.

    GunaHandfoot is an Italian homeopathic medicine that doctors of the Trubetskoy clinic use in the treatment of rheumatoid arthritis.The Guna Method is an innovation in medicine – a “smart” medicine that determines the nature of your pain, whether it be hormonal disorders, damage to the immune system, or mental characteristics. The ancient method of Acupuncture was also taken into account when developing, thus, Guna-Handfoot activates your energy, stimulating your body to fight pain, including on its own! Few people know, but our body has unexplored resources that allow us not to think about pain, provided that some neurotransmitters are active.Guna-Handfoot wakes them up and thus relieves pain without causing harm. The drug has passed a long trial in a research center in Italy and its effectiveness has been confirmed.

    Guna-Handfoot better than other preparations:

    • quickly relieves pain
    • no side effects
    • 100% natural composition, vegetable origin
    • safe for pregnant and lactating women
    • can be combined with other drugs and treatments
    • can be used for a long period

    Only a doctor can cure you

    Rheumatoid arthritis is an infamous disease of our century.Living on painkillers all the time is not an option. Doctors of the clinic of Dr. Trubetskoy will help you to develop an individual treatment regimen. Patients with such a preliminary diagnosis need a thorough examination and a purely individual approach to treatment. The doctors of the clinic will accurately calculate the dosage of the drug and determine the necessary injection zones, taking into account the characteristics of your body. Usually, injections are given to painful points, as well as to biologically active points, including on the auricle. Guna therapy at the Trubetskoy clinic is carried out by specially trained doctors.

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