The hand. This anatomically complicated part of the human body has an amazing number of bones.
There are 8 bones in the wrist and they all create joints.
Furthermore, metacarpal bones create a set of joints with proximal phalanges.
Proximal phalanges create a set of joints with middle phalanges and middle phalanges
create a set of joints with distal phalanges. We have so many joints in our hands because
we perform so many functions with our hands. It is extremely important to keep our hands
and our fingers healthy, but dangerous conditions such as rheumatoid arthritis
can affect one of those joints or more of those joints without producing significant symptoms.
That is exactly what we have to explain. A clear diagnosis. How do we know whether a patient suffers
from rheumatoid arthritis or not? Furthermore, we have to explain mysterious symptoms that might
indicate that some deeper underlying issue is causing the symptoms. And of course, we have to
explain the therapy options according to the guidelines. There are different types of arthritis
and we’ll get to that in a minute. But first, let’s focus on rheumatoid arthritis. Where does
it all go wrong? This which you can see here are the B and T immune cells of the human body.
The B cells can produce the so-called rheumatoid factor. Rheumatoid factor is an antibody
that can create complexes with other antibodies and then deposit in the joints and contribute
to the chronic inflammation of the joints. The T cells of the immune system will not produce
antibodies and rheumatoid factor, but they can produce cytokines. Cytokines are pro-inflammatory
molecules that cause inflammation and destruction of the tissue and the joints. Now, if we would
open my chest like this, we could see a small organ here called the thymus. It is responsible
for teaching these cells not to attack our own body, but clearly in rheumatoid arthritis,
something is wrong here. So what exactly goes wrong is not known yet, but sadly, we do know
that additional immune cells called macrophages come to this region and they release enzymes
into the joints and ultimately cause damage. They can also activate fibroblasts and fibroblasts
are supposed to repair the damage, but they cannot do it in the right way or in the right spot.
And so, the permanent damage to the joint is done and this can have serious consequences
for the life quality and health of the patient in the future. These dangerous developments
not always cause symptoms and therefore they can be hard to recognize. A lot of people suffer
from rheumatoid arthritis, but they are not yet aware of it. So what can be done about it
and how can we easily diagnose it before serious damage has been caused? But before I explain this,
I have to ask you something. You see, we have a problem here. We created this channel to help
people suffering from rheumatoid arthritis and other conditions and then we get hundreds and
hundreds of comments posted by someone called Dr. Osaiye. Honestly, I doubt that this person
is even a doctor. He claims that he has some magical treatment that can cure all diseases
and they spam our channel. We get hundreds of comments just, you know, flat out lying
to the people that they can cure the diseases. I find their channel and they have more views
than we do. They have more subscribers than we do. I don’t know what YouTube and other
social platforms are doing with their algorithms, but we need to find a way to tell YouTube
and other platforms that we’re legit and these guys are a scam. Think about how immoral that is
to find people suffering in pain and to scam them out of their money. You know they’re suffering
and you know that what you’re offering them does not work. So there are three things you can do
and we can also do one thing for you. Three things are you can share this video. Just grab the link
and share it on your platform, on your accounts or social media with your friends and then you
can come back here to this video and just like it and subscribe. And then when you subscribe you
have to click that bell button because YouTube will still not offer you our videos unless
you click that bell button. It’s not going to suggest you our videos and then you can like the
video so that’s what you can do for us. What we can do for you is we can you have a question
about this condition. You have a question. You have a question about rheumatoid arthritis.
Ask the question in the comment section. We reply within 24 hours, but now back to our joints.
How to treat it? Well the treatment of rheumatoid arthritis depends a lot on the underlying activity
of these cells and the molecules they produce. There are three specific things I’d like to
highlight when it comes to treatment of rheumatoid arthritis. First and foremost, we know that exercise
and physical therapy help but the first line treatment for rheumatoid arthritis is typically
non-steroidal anti-inflammatory drugs. These wildly used non-steroidal anti-inflammatory drugs such as
ibuprofen are not the only drugs we use for rheumatoid arthritis. There are biologicals.
Those are given by injection. Jack inhibitors are the newest drugs for rheumatoid arthritis
and DMARTS stand for disease modifying anti-rheumatic drugs. Steroids cannot only get
rid of the pain, they can also reduce stiffness and inflammation in the joint. The mechanisms
through which these cells cause damage to the joints are diverse, but so are the mechanisms
through which these drugs try to stop that. So one size fits all definitely does not work here.
The exact combination of medications will depend on other medical conditions but also on the
activity of rheumatoid arthritis. One combination of medications can do wonders for one patient
and cause nothing but side effects for the other. If it’s not enough to treat rheumatoid arthritis
with medication we can look at surgical options that are available but we have to go all the way
to the beginning where the inflammation starts. Now what is this over here? This is a bone which
with its head is articulating with another bone and this constitutes a joint. Now this part over
here is the joint capsule with the synovial membrane and that is exactly where the inflammation
and rheumatoid arthritis starts. But rheumatoid arthritis does not only cause inflammation of
the synovial membrane around the joints. If I were to open my hand like this you would be able to see
the synovial membrane over here as well wrapping around the tendons of the muscles of the hand. If
the rheumatoid arthritis causes an inflammation of the synovial membrane around the tendons it can
ultimately cause the tendon to rupture and this has to be quickly repaired. Furthermore, if it
causes the inflammation of the synovial membrane around the joint it can destroy the joint surfaces
and this too can be repaired by simply removing the synovial membrane and it can be done
arthroscopically or through an open surgical approach. Surgery basically means that we have to
go through the skin of the patient and that is invasive. So let’s first look at the diagnosis
and how can we make sure that the patient indeed suffers from rheumatoid arthritis. There is no
single clinical or lab test that can confirm the presence of this condition. So therefore we have
to look at these seven criteria over here in order to diagnose rheumatoid arthritis. If the
joint is severely damaged, it can be completely replaced but before we get to any surgeries
because they’re invasive, let’s make sure that the patient indeed suffers from rheumatoid arthritis.
In order to diagnose someone with rheumatoid arthritis we have to look at these seven criteria
and four out of these seven have to be positive. The first criteria here to diagnose someone with
rheumatoid arthritis is morning stiffness that lasts longer than one hour. Furthermore soft
tissue swelling of three or more joints and the third criteria in this list is basically swelling
of the proximal interphalangeal joints. Furthermore swelling of the metacarpophalangeal joints and
swelling of the wrist joints. The fourth criteria is symmetric swelling of the joints bilaterally
and these four first criteria have to be present longer than six weeks. The last three criteria for
the diagnosis of rheumatoid arthritis are the presence of rheumatoid nodules. For example here
subcutaneously, that means under the skin. Furthermore rheumatoid factor in blood tests
can be positive and radiological confirmation of the changes that are indicated in rheumatoid
arthritis can be helpful. In radiological imaging for patients who suffer from rheumatoid arthritis
sometimes it is possible to see mysterious signs such as Heberden’s nodes and Bouchard’s nodes.
These findings can indicate that the patient not only suffers from rheumatoid arthritis but
also from osteoarthritis and this is really hard to deal with and that might be an explanation
why an appropriate therapy that is in accordance with the guidelines still does not help. But both
of you doctors and patients we can all benefit from videos like these. If you’re a doctor and
you want to make video like this one then go to anatomski.com but if you have more questions
about osteoarthritis, rheumatoid arthritis just go to symptomsky.com/help/arthritis
and both doctors and patients can subscribe.
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