L88 Rheumatoid/seropositive arthritis (ICD-10:M06.9)

Introduction

Rheumatoid arthritis (RA), also known as seropositive arthritis, is a chronic autoimmune disease that primarily affects the joints^[1]. It is characterized by inflammation, pain, and stiffness in the affected joints, which can lead to joint deformity and disability if left untreated^[2]. The aim of this guide is to provide a comprehensive overview of the symptoms, causes, diagnostic steps, possible interventions, and lifestyle interventions for rheumatoid/seropositive arthritis.

Codes

• ICPC-2 Code: L88 Rheumatoid/seropositive arthritis
• ICD-10 Code: M06.9 Rheumatoid arthritis, unspecified

Symptoms

• Joint pain: Persistent pain and stiffness in the joints, typically affecting multiple joints symmetrically^[3].
• Joint swelling: Swelling and tenderness in the affected joints^[4].
• Morning stiffness: Stiffness and difficulty moving the joints, particularly in the morning or after periods of inactivity^[5].
• Fatigue: Generalized fatigue and lack of energy^[6].
• Rheumatoid nodules: Firm lumps under the skin, usually near the joints^[7].
• Joint deformity: Over time, joint deformities may develop, leading to loss of function and mobility^[8].

Causes

• Autoimmune response: Rheumatoid arthritis is believed to be caused by an autoimmune response, where the body’s immune system mistakenly attacks its own tissues, including the synovium (the lining of the joints)^[9].
• Genetic factors: Certain genetic factors may increase the risk of developing rheumatoid arthritis^[10].
• Environmental factors: Exposure to certain environmental factors, such as smoking, may increase the risk of developing rheumatoid arthritis.

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the duration, severity, and progression of joint pain and stiffness.
• Assess the patient’s medical history, including any previous diagnoses of autoimmune diseases or family history of rheumatoid arthritis.
• Inquire about any risk factors, such as smoking or exposure to environmental triggers.

Physical Examination

• Perform a thorough physical examination, focusing on the joints, to assess for signs of inflammation, swelling, tenderness, and deformity.
• Assess the patient’s range of motion and functional abilities.
• Look for the presence of rheumatoid nodules or other extra-articular manifestations.

Laboratory Tests

• Rheumatoid factor (RF) test: This blood test measures the presence of RF antibodies, which are often elevated in patients with rheumatoid arthritis.
• Anti-cyclic citrullinated peptide (anti-CCP) test: This blood test detects the presence of anti-CCP antibodies, which are highly specific for rheumatoid arthritis.
• Complete blood count (CBC): This test can help identify anemia, which is common in rheumatoid arthritis.
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) test: These tests measure the level of inflammation in the body.
• Joint fluid analysis: If joint swelling is present, a sample of the synovial fluid may be taken and analyzed for signs of inflammation and infection.

Diagnostic Imaging

• X-rays: X-rays can help assess the extent of joint damage and deformity.
• Ultrasound: Ultrasound can provide detailed images of the joints, allowing for the visualization of inflammation and joint damage.
• Magnetic resonance imaging (MRI): MRI can provide more detailed images of the joints, particularly in the early stages of rheumatoid arthritis.

Other Tests

• Bone density test: This test may be performed to assess for osteoporosis, which is common in patients with rheumatoid arthritis.
• Electromyography (EMG) and nerve conduction studies: These tests may be performed to assess for nerve involvement in cases of suspected nerve compression or entrapment.

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor disease progression, assess treatment effectiveness, and address any concerns or questions.
• Provide patient education on the nature of rheumatoid arthritis, including the chronic nature of the disease, the importance of adherence to treatment, and strategies for managing symptoms and improving quality of life.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Rheumatoid/Seropositive Arthritis:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Ibuprofen, Naproxen):
   • Cost: Generic versions can be $3-$20/month.
   • Contraindications: History of gastrointestinal bleeding, renal impairment.
   • Side effects: Upset stomach, heartburn, increased risk of cardiovascular events.
   • Severe side effects: Gastrointestinal bleeding, kidney damage, cardiovascular events.
   • Drug interactions: Anticoagulants, corticosteroids.
   • Warning: Prolonged use may increase the risk of gastrointestinal bleeding and cardiovascular events.
2. Disease-modifying antirheumatic drugs (DMARDs) (e.g., Methotrexate, Sulfasalazine):
   • Cost: Generic versions can be $10-$50/month.
   • Contraindications: Pregnancy, liver disease, severe infections.
   • Side effects: Nausea, vomiting, hair loss.
   • Severe side effects: Liver toxicity, bone marrow suppression.
   • Drug interactions: NSAIDs, immunosuppressants.
   • Warning: Regular monitoring of liver function and blood counts is required.
3. Biologic response modifiers (e.g., Adalimumab, Etanercept):
   • Cost: Brand-name versions can range from $1,000 to $5,000/month.
   • Contraindications: Active infections, history of malignancy.
   • Side effects: Injection site reactions, increased risk of infections.
   • Severe side effects: Serious infections, malignancies.
   • Drug interactions: Live vaccines, immunosuppressants.
   • Warning: Increased risk of infections and malignancies.
4. Corticosteroids (e.g., Prednisone, Methylprednisolone):
   • Cost: Generic versions can be $3-$20/month.
   • Contraindications: Active infections, uncontrolled diabetes.
   • Side effects: Weight gain, increased appetite, mood changes.
   • Severe side effects: Osteoporosis, adrenal suppression.
   • Drug interactions: NSAIDs, anticoagulants.
   • Warning: Long-term use may lead to significant side effects.
5. Janus kinase (JAK) inhibitors (e.g., Tofacitinib, Baricitinib):
   • Cost: Brand-name versions can range from $2,000 to $4,000/month.
   • Contraindications: Active infections, history of malignancy.
   • Side effects: Increased risk of infections, headache, diarrhea.
   • Severe side effects: Serious infections, malignancies, cardiovascular events.
   • Drug interactions: Live vaccines, immunosuppressants.
   • Warning: Increased risk of infections, malignancies, and cardiovascular events.

Alternative Drugs:

• Hydroxychloroquine: An antimalarial drug that can be used in combination with other DMARDs.
• Leflunomide: A DMARD that inhibits pyrimidine synthesis.
• Tocilizumab: A biologic agent that targets interleukin-6 receptors.
• Abatacept: A biologic agent that inhibits T-cell activation.
• Rituximab: A biologic agent that targets B cells.

Surgical Procedures:

• Joint replacement surgery: In cases of severe joint damage and disability, joint replacement surgery may be considered to improve function and reduce pain. Cost: $20,000 to $40,000 per joint.

Alternative Interventions

• Acupuncture: May help reduce pain and improve joint function. Cost: $60-$120 per session.
• Massage therapy: Can help relieve muscle tension and improve circulation. Cost: $50-$100 per session.
• Yoga: May improve flexibility, strength, and overall well-being. Cost: Varies depending on the location and instructor.
• Tai chi: A mind-body practice that combines gentle movements and deep breathing. Cost: Varies depending on the location and instructor.
• Supplements: Some supplements, such as omega-3 fatty acids and turmeric, may have anti-inflammatory properties. Cost: Varies depending on the specific supplement.

Lifestyle Interventions

• Regular exercise: Engaging in regular physical activity can help improve joint flexibility, strengthen muscles, and reduce pain. Cost: Varies depending on the chosen activity (e.g., gym membership, fitness classes).
• Healthy diet: Consuming a balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help support overall health and manage weight. Cost: Varies depending on individual food choices.
• Stress management: Practicing stress management techniques, such as meditation or deep breathing exercises, can help reduce stress and improve overall well-being. Cost: Varies depending on the chosen technique (e.g., meditation classes, relaxation apps).
• Heat and cold therapy: Applying heat or cold to the affected joints can help reduce pain and inflammation. Cost: Varies depending on the chosen method (e.g., heating pad, ice pack).

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions. It is recommended to consult with healthcare professionals for personalized treatment options and cost estimates.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – L88 Rheumatoid/seropositive arthritis (ICD-10:M06.9)

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Use the Mirari Cold Plasma device to treat Rheumatoid/seropositive arthritis effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Rheumatoid/seropositive arthritis. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Smolen, J. S., Aletaha, D., & McInnes, I. B. (2016). Rheumatoid arthritis. The Lancet, 388(10055), 2023-2038.
2. Scott, D. L., Wolfe, F., & Huizinga, T. W. (2010). Rheumatoid arthritis. The Lancet, 376(9746), 1094-1108.
3. Grassi, W., De Angelis, R., Lamanna, G., & Cervini, C. (1998). The clinical features of rheumatoid arthritis. European journal of radiology, 27, S18-S24.
4. Heidari, B. (2011). Rheumatoid arthritis: early diagnosis and treatment outcomes. Caspian journal of internal medicine, 2(1), 161.
5. Yazici, Y., Pincus, T., Kautiainen, H., & Sokka, T. (2004). Morning stiffness in patients with early rheumatoid arthritis is associated more strongly with functional disability than with joint swelling and erythrocyte sedimentation rate. The Journal of rheumatology, 31(9), 1723-1726.
6. Pollard, L. C., Choy, E. H., Gonzalez, J., Khoshaba, B., & Scott, D. L. (2006). Fatigue in rheumatoid arthritis reflects pain, not disease activity. Rheumatology, 45(7), 885-889.
7. Ziff, M. (1990). The rheumatoid nodule. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 33(6), 761-767.
8. Pincus, T., & Callahan, L. F. (1992). Rheumatology function tests: grip strength, walking time, button test and questionnaires document and predict longterm morbidity and mortality in rheumatoid arthritis. The Journal of rheumatology, 19(7), 1051-1057.
9. Choy, E. (2012). Understanding the dynamics: pathways involved in the pathogenesis of rheumatoid arthritis. Rheumatology, 51(suppl_5), v3-v11.
10. MacGregor, A. J., Snieder, H., Rigby, A. S., Koskenvuo, M., Kaprio, J., Aho, K., & Silman, A. J. (2000). Characterizing the quantitative genetic contribution to rheumatoid arthritis using data from twins. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 43(1), 30-37.