{"id":3691,"date":"2025-02-28T01:05:01","date_gmt":"2025-02-28T00:05:01","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=3691"},"modified":"2026-01-01T23:28:38","modified_gmt":"2026-01-01T22:28:38","slug":"polyarthrite-rhumatoide","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=3691","title":{"rendered":"Polyarthrite rhumato\u00efde"},"content":{"rendered":"\n<p><strong>Epid\u00e9miologie<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Maladie auto-immune la plus fr\u00e9quente chez l&rsquo;adulte<\/li>\n\n\n\n<li>4F\/1H<\/li>\n\n\n\n<li>\u00c2ge de d\u00e9but : 30 \u00e0 55 ans<\/li>\n\n\n\n<li>Souvent, \u00e9v\u00e9nement de vie d\u00e9clenchant : m\u00e9nopause, retraite<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Physiopathologie<\/strong><\/p>\n\n\n\n<p><strong>Facteurs d\u00e9clenchants<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Terrain g\u00e9n\u00e9tique<\/li>\n\n\n\n<li>Facteurs environnementaux : pollution, tabac<\/li>\n\n\n\n<li>Notion de d\u00e9lai entre la l\u00e9sion initiale et le d\u00e9clenchement de la maladie (jusqu&rsquo;\u00e0 15 ans)<\/li>\n<\/ul>\n\n\n\n<p><strong>Processus<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>1. L\u00e9sion initiale (premier sympt\u00f4me = douleur) : synovite, inflammation, membrane synoviale qui devient hypertrophique<\/li>\n\n\n\n<li>2. Production abondante de cytokine qui augmente l&rsquo;inflammation<\/li>\n\n\n\n<li>3. Activation des ost\u00e9oclastes qui d\u00e9truisent l&rsquo;articulation et entra\u00eenent des trous dans les os (g\u00e9odes)<\/li>\n\n\n\n<li>4. Activation chondrocytes : augmentation de la d\u00e9gradation de la matrice cartilagineuse entra\u00eenant un pincement de l&rsquo;interligne<\/li>\n\n\n\n<li>=> Destruction articulaire, terrain favorable aux infections, lymphomes (cancer des ganglions), complication cardio-vasculaire, ost\u00e9oporose et fragilisation des os \u00e0 cause de la diminution de l&rsquo;activit\u00e9 physique.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Signes cliniques<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Douleurs inflammatoires<\/strong><\/li>\n\n\n\n<li><strong>Synovites <\/strong>: gonflement au niveau des doigts, entre les articulation MP et disparition des plis de flexion des doigts<\/li>\n<\/ul>\n\n\n\n<p><strong>Atteinte <\/strong>cutan\u00e9e (vascularite mais rare), r\u00e9nale (n\u00e9phraopathie glom\u00e9rulaire mais se rar\u00e9fie) et atteinte pulmonaire (pneumopathie interstitielle<\/p>\n\n\n\n<p>Radiographie<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gonflement apparaissent pr\u00e9coc\u00e9ment<\/li>\n\n\n\n<li>Erosions (g\u00e9odes) apparaissent fr\u00e9quemment et pr\u00e9coc\u00e9ment<\/li>\n\n\n\n<li>Perte de congruence de l&rsquo;articulation : risque de luxation<\/li>\n<\/ul>\n\n\n\n<p><strong>Si \u00e9volution<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gonflement : articulation plus l\u00e2hce<\/li>\n\n\n\n<li>Fonte musculaire car sous-utilisation \u00e0 cause de la douleur<\/li>\n\n\n\n<li>D\u00e9formation (coup de vent cubital) : plus rare aujourd&rsquo;hui gr\u00e2ce aux traitements<\/li>\n\n\n\n<li>Luxation des articulations<\/li>\n\n\n\n<li>Douleurs<\/li>\n<\/ul>\n\n\n\n<p>=> <strong>Maladie rapidement destructrice <\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Crit\u00e8re diagnostic<\/strong><\/p>\n\n\n\n<p>\u00c9vocation du diagnostic si 2 signes sur 3 :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Au moins 2 articulations gonfl\u00e9es<\/li>\n\n\n\n<li>Atteinte des MTP et MCP au squeeze test (compression qui d\u00e9clenche la douleur)<\/li>\n\n\n\n<li>Raideur matinale sup\u00e9rieure \u00e0 30mn<\/li>\n<\/ul>\n\n\n\n<p><strong>Crit\u00e8res de classification ACR<\/strong> (positif si 4 crit\u00e8res sur 7)<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Raideur matinale<\/li>\n\n\n\n<li>Arthrite d&rsquo;au-moins 3 articulations<\/li>\n\n\n\n<li>Arthrite touchant la main<\/li>\n\n\n\n<li>Arthrite sym\u00e9trique<\/li>\n\n\n\n<li>Nodule rhumato\u00efdes<\/li>\n\n\n\n<li>Facteurs rhumato\u00efdes dans le s\u00e9rum<\/li>\n\n\n\n<li>L\u00e9sions radiologiques<\/li>\n<\/ul>\n\n\n\n<p><strong>Nouveaux crit\u00e8res ACR\/EULAR2010<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"667\" height=\"385\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/02\/image-108-png.avif\" alt=\"\" class=\"wp-image-3698\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/02\/image-108-png.avif 667w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/02\/image-108-300x173.avif 300w\" sizes=\"auto, (max-width: 667px) 100vw, 667px\" \/><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>La fen\u00eatre d&rsquo;opportunit\u00e9 : les 3 premiers mois<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Traitement pr\u00e9coce : impact fonctionnel limit\u00e9 et r\u00e9versible<\/li>\n\n\n\n<li>Diagnostic et PEC pr\u00e9coces : meilleure r\u00e9mission<\/li>\n\n\n\n<li>Action dans les 3 premiers mois apr\u00e8s le d\u00e9but des sympt\u00f4mes : 1 patient sur 2 n&rsquo;aura plus de sympt\u00f4mes (au-del\u00e0 de 6 mois, 10% de r\u00e9mission seulement)<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Traitement<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Maladie inflammatoire <\/strong>: m\u00e9dicaments immunomodulateurs<\/li>\n\n\n\n<li><strong>Traitements symptomatique<\/strong> : antalgiques, AINS, cortico\u00efdes<\/li>\n\n\n\n<li><strong>Traitement de fond <\/strong>pour induire la r\u00e9mission et \u00e9viter les signes de la maladie : hydroxychloroquine, immunomodulateurs<\/li>\n<\/ul>\n\n\n\n<p><strong>Effets ind\u00e9sirables<\/strong> des immunosuppresseurs : provoque la diminution de l&rsquo;immunit\u00e9 donc risque accru de certains cancers (lymphomes, cancer de la peau, cancer du col d l&rsquo;ut\u00e9rus). N\u00e9cessit\u00e9 d&rsquo;expliquer au patient la notion de balance b\u00e9n\u00e9fices\/risques pour une adh\u00e9sion optimale.<\/p>\n\n\n\n<p><strong>Recommandation SFR 2018<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Importante de l&rsquo;activit\u00e9 physique, soutien psycho-sociale, accompagnement professionnel et action sur les facteurs de risque (tabac, vaccination)<\/li>\n\n\n\n<li>Prise en charge globale centr\u00e9e sur le patient<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Epid\u00e9miologie Physiopathologie Facteurs d\u00e9clenchants Processus Signes cliniques Atteinte cutan\u00e9e (vascularite mais rare), r\u00e9nale (n\u00e9phraopathie glom\u00e9rulaire mais se rar\u00e9fie) et atteinte pulmonaire (pneumopathie interstitielle Radiographie Si \u00e9volution => Maladie rapidement destructrice Crit\u00e8re diagnostic \u00c9vocation du diagnostic&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=3691\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0Polyarthrite rhumato\u00efde\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[361,364],"tags":[],"class_list":["post-3691","post","type-post","status-publish","format-standard","hentry","category-pathologie-poignet-main","category-pathologies-articulaires"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/3691","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3691"}],"version-history":[{"count":6,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/3691\/revisions"}],"predecessor-version":[{"id":3703,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/3691\/revisions\/3703"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}