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},
"code": "M06.9",
"name": "Ревматоидный артрит неуточненный",
"icd_name": "Ревматоидный артрит неуточненный",
"gender": 0,
"age_min": 45,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 3,
"slug": "m06.9_revmatoidnyy_artrit_neutochnennyy",
"lead": "хроническое воспалительное заболевание соединительной ткани, которое характеризуется повреждением суставов и системным поражением внутренних органов",
"description": "<p><span id=\"docs-internal-guid-aa8d1140-7fff-6bae-524c-3849a8e48b15\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ревматоидный артрит - это хроническое воспалительное заболевание суставов неизвестной этиологии, имеющее разнообразное клиническое течение, характеризующееся прогрессирующей деструкцией синовиальных суставов с деградацией хряща и кости.</span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Среди причин развития ревматоидного артрита выделяют:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наследственную предрасположенность;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">инфекционные заболевания (вирус герпеса, краснухи, гепатит В, Эпштейна-Барра и др).</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Провоцирующими факторами являются травмы, пищевая аллергия, хирургические вмешательства в анамнезе.</span></p>",
"pathogenesis": "<p><span id=\"docs-internal-guid-2f41e1e5-7fff-20e7-7085-598e189f031b\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В норме иммунная система человека продуцирует антитела (белки), которые помогают бороться организму, разрушать вирусы, бактерии и другие чужеродные вещества. При ревматоидном артрите иммунная система вырабатывает антитела против здоровых клеток и тканей собственного организма, они называются аутоантителами (\"ауто\" - свои собственные). При артрите возникает воспаление внутри сустава: синовиальная оболочка утолщается, что может привести к припуханию сустава. Припухшая синовиальная оболочка превращается в плотную массу, именуемую \"паннус\". По мере роста \"паннуса\" начинает повреждаться суставной хрящ, что приводит к ослаблению мышц, связок и сухожилий. На фоне сохраняющегося воспаления происходит разрушение костей, формирующих сустав. При тяжелом РА, дистальные отделы костей могут приходить в контакт и частично соединяться, вызывая так называемый анкилоз, при котором сустав начинает терять свою функцию.</span></span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Диагноз ставится врачом-ревматологом.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основанием для постановки такого диагноза являются следующие симптомы:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">жалобы пациента (на утреннюю скованность более 1 часа, характерный суставной синдром);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие припухлости суставов, которые сохраняются в течение 6 недель и более;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">данные лабораторных анализов (клинический анализ крови и СОЭ, титр С-реактивного белка, ревматоидного фактора, антител к циклическому цитрулиновому пептиду);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">данные УЗИ либо МРТ суставов (если это необходимо врачу на ранней стадии заболевания);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ренгенография суставов.</span></li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В основе терапии при ревматоидном артрите лежит назначение курса быстродействующих (противовоспалительных) и базисных (модифицирующих течение заболевания) препаратов, проведение эфферентной терапии, лечебной физкультуры. При необходимости выполняются хирургические вмешательства.</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Фармакотерапия. К группе быстродействующих относятся НПВС (диклофенак, ибупрофен, напроксен), кортикостероиды, купирующие воспаление и боль. Использование базисных препаратов (сульфасалазина, гидроксихлороквина метотрексата, лефлуномида) позволяет достичь ремиссии ревматоидного артрита и предотвратить/замедлить дегенерацию суставов.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гравитационная хирургия крови. Кроме приема медикаментов, при ревматоидном артрите показано проведение экстракорпоральной гемокоррекции – криоафереза, мембранного плазмафереза, экстракорпоральной фармакотерапии, каскадной фильтрации плазмы.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечебная физкультура. Пациентам с ревматоидным артритом рекомендуются занятия ЛФК, плавание.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ортопедические операции. С целью восстановление функции и структуры суставов применяются хирургические вмешательства – артроскопия, эндопротезирование разрушенных суставов.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для того, чтобы снизить риск развития или обострения ревматоидного артрита, врачи советуют следовать следующим рекомендациям:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выполнять лечебную физкультуру. Для поддержания объема движений в суставах достаточно выполнять легкие упражнения.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Массаж мышц. Назначается при наличии анкилозов (полной неподвижности сустава). Массаж позволяет поддерживать нормальный тонус и массу мышц.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Санаторно-курортное лечение. При ревматоидном артрите положительное воздействие оказывает бальнеотерапия. Однако, данный метод лечения рекомендуется при легком течении заболевания.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Прием назначенной терапии. При необходимости врач назначает метотрексат. Дозировка подбирается в индивидуальном порядке.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выполнять санацию хронических очагов инфекции. Подразумевает своевременное лечение ангины, пневмонии, пиелонефрита, синусита и других заболевания.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Использование ортопедических шин, поддерживающих устройств. Они позволяют предупредить дальнейшую деформацию сустава при его имеющейся нестабильности.</span></li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ревматоидный артрит – системное заболевание, при котором могут поражаться не только суставы, но и различные органы и системы. Выраженность клинической картины зависит от многих факторов: тяжести заболевания, наличия или отсутствия осложнений, локализации патологии. Согласно статистике, 70% случаев обострения ревматоидного артрита приходится на холодное время года.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заболевание поражает преимущественно мелкие суставы кистей, стоп. По мере прогрессирования в патологический процесс вовлекаются другие органы и системы. Скрытый период болезни выражается слабостью, усталостью, снижением массы тела, болями в мышцах, повышением температуры тела, потливостью.</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для ревматоидного артрита более характерно подострое начало. Оно сопровождается следующими симптомами:</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Боль в суставах. Ноющая, волнообразного течения. Купируется приемом противовоспалительных средств. Локализуется чаще в мелких суставах стоп, кистей, запястья, коленных и локтевых.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мышечные боли. Носят ноющий характер, сохраняются в течение длительного времени.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лихорадка. Уровень повышения температуры тела зависит от активности воспалительного процесса.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Утренняя скованность. Продолжается в течение 30-60 минут.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Внесуставные проявления ревматоидного артрита</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ревматоидный артрит поражает не только суставы, но и другие органы и системы:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кожа. Основными симптомами являются сухость и истончение кожных покровов, ломкость ногтей, небольшие подкожные кровоизлияния. Также для болезни характерны ревматоидные узелки – подкожные образования, диаметром до 2 см.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Желудочно-кишечный тракт. Выражается в снижении аппетита, появлении метеоризма, редко болей в животе, тяжести в области эпигастрия.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дыхательная система. Ревматоидный артрит поражает плевру и интерстициальную ткань. Это выражается сухим или экссудативным плевритом.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Сердечно-сосудистая система. Ревматоидный процесс может поражать все слои сердца.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мочевыделительная система. Поражение проявляется в виде гломерулонефрита.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нервная система. Ревматоидный процесс, распространившийся на нервную систему, выражается нарушением чувствительности, параличами, нарушением потоотделения, терморегуляции.</span></li>\r\n</ul>\r\n<p> </p>",
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}
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}