Rheumatoid Arthritis
Introduction
Introduction to rheumatoid arthritis Rheumatoid arthritis, also known as rheumatoid arthritis (RA), is a chronic systemic inflammatory disease whose etiology is not yet known. Rheumatoid arthritis is currently recognized as an autoimmune disease. May be related to differences in endocrine, metabolism, nutrition, geography, occupation, psychology and social environment, bacterial and viral infections and genetic factors, with chronic, symmetrical, multiple synovial arthritis and extra-articular lesions as the main clinical Performance, belonging to autoimmune inflammatory diseases. basic knowledge The proportion of illness: 0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: joint dislocation
Cause
Cause of rheumatoid arthritis
Bacterial factors (30%):
Experimental studies have shown that group A streptococci and peptidoglycan may be a persistent stimulator of RA. Group A streptococci have long-lasting antigens in the body, stimulating the body to produce antibodies and immunopathological damage. The disease-causing, mycoplasmal animal model of arthritis is similar to human RA, but does not produce rheumatoid factor (RF) specific to human RA, and has never been found in synovial fluid and synovial tissue of RA patients. Or bacterial antigenic material, suggesting that bacteria may be involved in the onset of RA, but lacks direct evidence.
Virus factor (25%):
The relationship between RA and viruses, especially EB virus, is one of the problems that scholars at home and abroad pay attention to. Studies have shown that arthritis caused by EB virus infection is different from RA, and RA patients have strong reactivity with EB virus than normal people. There is a persistently high level of anti-EBV-membrane antigen antibody in serum and synovial fluid of RA patients, but so far no Epstein-Barr virus nuclear antigen or capsid antigen antibody has been found in the serum of RA patients.
Genetic factors (20%):
The disease has a high incidence in some families. In the population survey, human leukocyte antigen (HLA)-DR4 was found to be associated with RF-positive patients. HLA studies found that DW4 is associated with the onset of RA, and 70% of patients are HLA-DW4-positive. The patient has a susceptibility gene at that point, so heredity may play an important role in the pathogenesis.
Sex hormones (20%):
Studies have shown that the incidence of RA is between 1:2 and 4, the condition is reduced during pregnancy, and the incidence of contraceptives is reduced. Animal models show that LEW/n females have high sensitivity to arthritis, and males have low incidence. After castration or treatment with -estradiol, the arthritis of the rats is the same as that of the female mice, indicating that sex hormones play a role in the pathogenesis of RA.
Cold, damp, fatigue, malnutrition, trauma, mental factors, etc., are often the predisposing factors of this disease, but most patients often have no obvious incentives.
Prevention
Rheumatoid arthritis prevention
Because rheumatoid arthritis is good or bad, there is no cure method that can only control temporary conditions. Therefore, special attention should be paid to health care in diet and life. The following points are suggestions for diet and exercise:
(1) Diet should choose foods that are easy to digest. The cooking method should be light and refreshing, and eat less spicy, greasy and cold food.
(B) Eat more appetizing foods such as jujube, coix seed, etc., especially coix seed has the effect of dehumidifying hurricane, boiled into coix porridge or cooked with mung bean is a good choice.
(C) to reduce the intake of fat as much as possible, the source of calories should be based on sugar and protein, if the weight exceeds the standard, gradually reduce weight.
(4) If the body is hot, eat more mung beans, watermelon and other foods; if it is cold, you should eat sheep or beef, but the intake should not be too much.
(5) If you take aspirin, you must take it after a meal because it is easy to cause damage to the stomach and is prone to iron deficiency anemia.
(6) Appropriately supplement vitamin A, C, D, E or mineral foods containing calcium, iron, copper, zinc, selenium, etc. to enhance the immunity of the group and prevent tissue oxidation or anemia.
(7) If taking steroids is likely to cause an increase in appetite, sodium retention and osteoporosis, it is necessary to control the intake of food to avoid a rapid increase in body weight, while seasonings and processed foods with high salt content are minimized and eaten. Calcium-containing foods such as skim milk, traditional tofu, etc.
(8) Reduce the bedtime for a long time, and should not be intense during exercise. You can choose to sit or stay in bed for exercise. If you are sitting, you can straighten your right leg, raise your calf and foot, and leave the ground 30 centimeters or more. After five seconds, put down, the left foot is repeated with the same action, and can be done several times a day, with the principle of energy load.
(9) Pay attention to heat preservation when getting up in the morning in winter. You can do some warm-up exercises. The movements are as follows: straighten your hands forward, palm down, down, and stretch the water backwards, or raise your hands up to Face, palm facing the face, after inhaling, hands up, stretch out, then slowly put down.
(10) In the cold winter, you should pay attention to keep warm. When you have joint pain, you can try hot water bath to relieve pain.
(11) Do not arbitrarily treat traditional joint pains such as massage, massage, cupping, etc., so as not to cause the disease to worsen, causing irreparable harm or delaying the golden timing of treatment.
(12) Patiently cooperate with the doctor for long-term treatment, regular medication, regular visits, and a designated professional rehabilitation practitioner to perform correct rehabilitation treatment. If any uncomfortable situation occurs, it should be immediately notified. Doctors.
Complication
Rheumatoid arthritis complications Complications, joint dislocation
(1) Pneumonia: Due to decreased immunity and bacterial infection, patients often have pneumonia.
(B) urinary tract infection: patients with rheumatoid arthritis, if not pay attention to daily life, or suffering from a cold, often prone to urinary tract infection.
(C) Cushing's syndrome: patients with hormones for too long, often due to inhibition of adrenal cortical function in the body and Cushing's syndrome, common symptoms are mainly full moon face, buffalo back, weight gain.
(4) Oral ulcers: Patients with rheumatoid arthritis often develop oral ulcers after taking immunosuppressive agents, and may also have adverse reactions such as nausea and vomiting, anorexia, rash, and loss of taste.
(5) Infectious diseases: Patients have been suffering from this disease for too long, and their autoimmune function has declined. When certain infectious diseases are prevalent in society, they are more susceptible to infection than normal people.
(6) In severe cases, abnormal bones may be present, and even joint dislocation may occur.
Symptom
Rheumatoid arthritis symptoms Common symptoms Powerless skin Tension hypertrophy Loss of elastic joint pain Joint swelling and pain Rheumatoid nodules Joint swelling Toe joint pain Finger stiffness Chest pain Breathing difficulty
1, its prominent clinical manifestations: recurrent, symmetrical, multiple small arthritis, with the palm of the hand, wrist, toe and other joints are most common.
2, early red, swollen, heat, pain and dysfunction, late joints can appear varying degrees of toughness and deformity, and bone and skeletal muscle atrophy, is a disease with a high disability rate.
3. From the perspective of pathological changes, rheumatoid arthritis is a major involvement of the synovial membrane (which can later affect the articular cartilage, bone tissue, joint ligament and tendon), followed by the serosa, heart, lung and eye. A broad inflammatory disease such as connective tissue. Therefore, in addition to the above symptoms of arthritis, patients may also have other systemic manifestations, such as fever, fatigue, weight loss, subcutaneous nodules, pericarditis, pleurisy, peripheral neuropathy, eye lesions, arteritis.
4, the disease and the course of the disease have individual differences, from transient, mild oligoarthritis to rapid progressive polyarthritis. The affected joints are most common in the proximal interphalangeal joint, metacarpophalangeal joint, wrist, elbow, shoulder, knee and toe joint; cervical vertebrae, temporomandibular joint, chest lock and acromioclavicular joint can also be affected, with limited mobility; Hip involvement is rare. Arthritis often manifests as symmetry, persistent swelling and tenderness, and morning stiffness often lasts for more than an hour. The most common joint deformities are the rigidity of the wrist and elbow joint, the subluxation of the metacarpophalangeal joint, the deviation of the finger to the ulnar side, and the "swan neck" and buttonhole pattern. In severe cases, the joints are fibrotic or skeletal, and the muscles around the joints are atrophied, and the joints lose their joint function, which makes them unable to take care of themselves. In addition to joint symptoms, extra-articular or visceral damage, such as rheumatoid nodules, heart, lung, kidney, peripheral nerves and eyes, may occur.
From this, it can be seen that the so-called rheumatoid arthritis is not only an inflammatory lesion in the joint but a generalized systemic lesion, which is extremely harmful to the human body.
Examine
Rheumatoid arthritis examination
1, blood cell sedimentation rate Most patients with increased blood cell sedimentation rate, especially in the acute phase.
2, hemoglobin content is slightly lower than normal, advanced cases may have mild anemia, hemoglobin content is mostly between 8 ~ 10g.
3, anti-streptolysin O (ASO), rheumatoid factor (RF) typical rheumatoid patients can appear anti-streptolysin O test positive, rheumatoid factor is mostly positive.
4, immunoglobulin test (IgM, IgG) About 70% of patients with rheumatoid disease can have IgM abnormalities, IgG is mostly positive.
5, joint fluid examination in the damaged joints of the joint fluid is more turbid, but no bacteria, joint fluid viscosity is lower than normal, microscopic examination showed no crystals in the joint fluid.
6, X-ray inspection on the X-ray film can find the following changes:
(1) Swelling of soft tissue: showing an increase in the shadow of the joint capsule.
(2) The joint space is narrowed: due to cartilage involvement and defects.
(3) Osteoporosis around the joint: It shows that the trabecular bone in the bone around the joint is reduced, atrophied and thinned.
7, other imaging examinations CT and MRI imaging techniques can be used as appropriate, especially for early cases.
Diagnosis
Diagnosis and diagnosis of rheumatoid arthritis
diagnosis:
1. The judgment of RA's diagnostic criteria, staging, function and activity.
(1) The RA classification criteria revised by the American College of Rheumatology in 1987 are as follows: 4 can confirm the diagnosis of RA.
1 morning stiffness for at least 1 hour ( 6 weeks).
23 or more joints were involved (6 weeks).
3 hand joints (wrist, MCP or PIP joints) were involved (6 weeks).
4 symmetric arthritis ( 6 weeks).
5 have rheumatoid subcutaneous nodules.
6X line changes.
7 serum rheumatoid factor positive (titer > 1:32).
(2) Stages of illness:
1 There is synovitis in the early stage, no cartilage damage.
2 The mid-term is between the upper and lower (inflammation, joint destruction, extra-articular manifestation).
3 advanced joint structure destruction, no progressive synovitis.
(3) Classification of joint function The level 1I function is in good condition, and it can complete normal tasks without any obstacles (can move freely). Class 2II can perform normal activities, but one or more joint activities are limited or uncomfortable (moderately restricted). Level 3III can only be used as part of a general professional task or self-care (significantly limited). Level 4 is mostly or completely incapacitated and requires long-term bed rest or wheelchair dependence, with little or no self-care (bed or wheelchair).
(4) The activity index has 1 joint pain 4. 2 morning stiffness > 30 minutes. 3ESR 30mm / h. 4CRP increased. 5 platelet (PLT) increased. 6 anemia. 7RF (+) 1:20 or more. 8 have extra-articular manifestations (fever, anemia, vasculitis, etc.).
Differential diagnosis:
1. Osteoarthritis
More common in middle and old age, the onset process is mostly slow. The hands, knees, hips, and spine joints are susceptible, while the palms, wrists, and other joints are less affected. The condition usually worsens with activity or is relieved by rest. The morning stiffness is less than half an hour. Heberden and Bouchard nodules can be seen when the hands are affected, and the knees can feel the friction. It is not accompanied by extra-articular manifestations such as subcutaneous nodules and vasculitis. Rheumatoid factor is mostly negative, and a small number of elderly patients may have low titer positive.
2. Psoriatic arthritis
The polyarthritic type of psoriatic arthritis is very similar to rheumatoid arthritis. However, patients with this disease have characteristic silver rash or nail lesions, or a family history of psoriasis. Frequent involvement of the distal interphalangeal joints, mostly in the early stage of asymmetric distribution, serum and rheumatoid factor and other antibodies are negative.
3, ankylosing spondylitis
The disease is more common in young men, mainly due to the involvement of the central axis joints such as hernia and spinal joints. Although there are peripheral joint lesions, it is mostly characterized by large joints of the lower extremities, which are asymmetrical swelling and pain, often accompanied by spinous processes. , the greater trochanter, the Achilles tendon, the rib joints and other tendons and ligaments attached to the point of pain. Extra-articular manifestations include iridocyclitis, heart block, and aortic insufficiency. X-ray films showed invasion, destruction or fusion of the ankle joint, and the patient's rheumatoid factor was negative, and most of them were positive for HLA-B27 antigen. The disease has a more pronounced family morbidity.
4, systemic lupus erythematosus
Patients with this disease may have arthritis of the hands or wrists early in the course of the disease, but patients often have fever, fatigue, oral ulcers, rash, cytopenia, proteinuria or antinuclear antibody positive lupus-specific, multi-system performance, Arthritis is milder than rheumatoid arthritis and there is no joint deformity. A variety of autoantibodies can be found in laboratory tests.
5, reactive arthritis
The disease is acute, and there is often a history of intestinal or urinary tract infection before the onset of the disease. The asymmetry of large joints (especially the lower extremity joints) is mainly involved, and there are generally no symmetry finger proximal interphalangeal joints, wrist joints and other small joints involved. May be associated with ophthalmia, urethritis, balanitis and fever, HLA-B27 can be positive and rheumatoid factor is negative, patients can have X-ray changes in asymmetrical arthritis.
