rheumatoid arthritis
Introduction
Introduction to rheumatoid arthritis Rheumatoid arthritis is an allergic disease and is one of the main manifestations of rheumatic fever. It is usually caused by acute fever and joint pain. It is usually mild or moderate fever, migratory polyarthritis, and most of the affected joints. Knee, ankle, shoulder, elbow, wrist and other large joints, often transferred from one joint to another, the lesions appear red, swollen, burning, severe pain, some patients also have several joints at the same time, atypical patients only Joint pain without other inflammatory manifestations, acute inflammation usually subsides in 2-4 weeks, leaving no sequelae, but often repeated attacks. If rheumatism affects the heart, then myocarditis can occur and even heart valve disease remains. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: pneumonia, oral ulcers
Cause
Causes of rheumatoid arthritis
Visceral yin and yang internal injuries (20%):
According to the view of the Chinese medicine yin and yang five elements, the five internal organs are the heart, liver, spleen, lung, kidney, heart main blood: liver main tendons; spleen main muscle; lung main fur; kidney main bone, rheumatism is mainly caused by liver, spleen and kidney injury, The kidney is the congenital, the essence of the marrow, the body is the strong official; the liver is the foundation of the ribs, the blood is thick, the spleen is the bones and joints; the spleen is the foundation of the day after tomorrow, the source of qi and blood biochemistry, the main Muscles of the limbs, the yin and yang of the human body must be balanced. If the yin and yang are not balanced, there will be partial stagnation and decay, and the evil will invade, so the symptoms of heat and cold of rheumatism occur.
Exogenous six kinky evil (24%):
Six sinister evil means wind, cold, department, wet, dry, fire. Six kinds of normal gas are too much. The gas that invades the body's body causes the disease to be called evil. Rheumatism is invaded by wind, cold and wet evil. The person who happens in the body, the winner of the wind is the shackle; the person who suffers from the cold is the pain; the winner of the moisture is the sputum, the wind, the cold and the dampness block the meridians and joints, and the pain is unreasonable, which causes the joints to swell and pain.
Turbid blood stasis (18%):
Turbidity and blood stasis are the pathological products of the human body under the influence of disease and evil. They can also act on the human body as a cause. Most of the rheumatism has a chronic process. If the disease is long, the disease will be in the form of light and heavy. It causes dysfunction of the viscera, and the result of dysfunction of the viscera produces turbidity and blood stasis. These are the root causes of the lingering and refractory rheumatism.
Camp gas and blood disorders (16%):
Chinese medicine talks about qi and blood, camping in the veins, outside the line, yin and yang, qi and blood, nutrition, limbs, viscera, meridians, camping and adjustment, Weiqi protects people's body surface, defensive evils invade the body The camp is not harmonious, the evil spirits take advantage of it, so the camp Wei is one of the important factors in the incidence of rheumatism.
Prevention
Rheumatoid arthritis prevention
Joint pain is the main symptom of patients with rheumatoid arthritis, and it is also one of the symptoms that make patients suffer. After joint pain, patients should pay attention to the following aspects:
1. Joint Brake: In the acute phase, the joint should be placed in a resting position to reduce exercise.
2, local massage: after the joint pain has been alleviated, you can massage around your own joints.
3, joint gymnastics exercises: practice different joint gymnastics for each different joint, each time 30 minutes, 2-3 times a day.
Complication
Rheumatoid arthritis complications Complications pneumonia mouth ulcers
Patients with rheumatoid arthritis during acute pain, due to prolonged bed rest, or taking hormones for too long, can cause the patient's immune function to be low, and some complications occur. The following are common:
1. Pneumonia: Due to decreased immunity and bacterial infection, patients often have pneumonia.
2, urinary tract infection: rheumatoid arthritis patients often do not pay attention to daily life, or suffering from a cold, often prone to urinary tract infections.
3, 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 take oral ulcers after taking immunosuppressive agents, in addition to nausea and vomiting, anorexia, rash, loss of taste and other adverse reactions.
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.
Symptom
Rheumatoid arthritis symptoms Common symptoms Wind, cold and wet joint pain, joint pain, leg pain, knee joint pain, joint stiffness, fever, joint swelling, joint swelling, joint fluid, exudation of limbs or trunk numbness
Rheumatoid arthritis is more acute, the affected joints are mainly large joints, and 85% of the joints that begin to invade the lower limbs. The knees and ankles are the most common, followed by the shoulders, elbows and wrists. The small joints of the hands and feet are rare. Joint lesions are multiple and migratory, local joint inflammation is obvious, manifested by redness, swelling, heat, pain, tenderness and limited mobility, duration is not long, often resolves within a few days, and the joint inflammation disappears without leaving a disability Recurrence is rare, in patients with acute arthritis, fever, sore throat, palpitation, increased erythrocyte sedimentation rate and increased C-reactive protein can be restored to normal after the condition improves.
Examine
Rheumatoid arthritis examination
Anti-chain O, anti-streptolysin O, is an antibody found in the serum of humans infected with group A hemolytic streptococcus, and 80% of patients with rheumatoid arthritis have an increase in chain O, often above 1:800. After the condition is restored, the antibody can gradually decrease.
In addition to the increase in anti-chain O in patients with rheumatoid arthritis, laboratory tests can also find the following abnormalities:
1, the peripheral blood white blood cell count increased, more than l0 × 109 / liter (that is, 10000 / cubic mm), the proportion of neutrophils also increased significantly, up to 80-90%, and some nuclear left shift phenomenon.
2. ESR and C-reactive protein are elevated. ESR and C-reactive protein are usually indicators of various inflammations. In the acute phase of rheumatoid arthritis patients, the ESR can reach 90 mm/hr or more, and C-reactive protein is also present. 30 mg / liter (30 g / ml) or more, after the acute period (about January to February) gradually returned to normal.
3, joint fluid examination, often exudate, light white blood cell count can be close to normal, heavy can reach 80 × l09 / liter (80000 / cubic millimeter) or more, most of them are neutrophils, bacterial culture is negative.
4. Both rheumatoid factor and antinuclear antibodies are negative.
Diagnosis
Diagnosis and diagnosis of rheumatoid arthritis
diagnosis
The diagnosis of this disease is mainly based on the history of hemolytic streptococcal infection 1-4 weeks before the onset, acute migratory arthritis, often accompanied by other manifestations of rheumatic fever such as myocarditis, ring erythema, subcutaneous nodules, etc. The agglutination titer of cocci hemolysin 0 was significantly increased, and the throat swab culture was positive and the white blood cells were increased.
Rheumatoid arthritis examination and diagnosis
The diagnosis of rheumatoid arthritis is mainly based on the history of hemolytic streptococcal infection 1-4 weeks before the onset, acute migratory arthritis, often accompanied by other manifestations of rheumatic fever such as myocarditis, ring erythema, subcutaneous nodules, etc., serum The anti-streptolysin hemolysin 0 agglutination titer is significantly increased, the throat swab culture is positive and the white blood cells are increased, and the anti-chain (anti-streptolysin) is present in the serum after the human group is infected with group A hemolytic streptococcus. An antibody, nearly 85% of patients with rheumatoid arthritis have anti-chain increase, usually above 1:800, of course, after the recovery of rheumatoid arthritis, this antibody can gradually decline, rheumatoid joints in addition to anti-chain increase In addition, laboratory tests can also find the following anomalies:
1, the peripheral blood white blood cell count increased, more than l0 × 109 / liter (that is, 10000 / cubic mm), the proportion of neutrophils also increased significantly, up to 80-90%, and some nuclear left shift phenomenon.
2. ESR and C-reactive protein are elevated. ESR and C-reactive protein are usually indicators of various inflammations. In the acute phase of rheumatoid arthritis patients, ESR can reach 90 mm/hr or more; C-reactive protein is also 30 mg / liter (30 g / ml) or more, after the acute period (about January to February) gradually returned to normal.
3, joint fluid examination, often exudate, light white blood cell count can be close to normal, heavy can reach 80 × l09 / liter (80000 / cubic millimeter) or more, most of them are neutrophils, bacterial culture is negative.
4. Both rheumatoid factor and antinuclear antibodies are negative.
Rheumatoid arthritis
1, the duration of pain is short, usually 12-72 hours, the longest is only 3 weeks, and mostly with large joints, such as knees, elbows, shoulders and other joints.
2, migratory pain, that is, after a joint pain has improved or not yet significantly improved, the other joint has been affected and pain.
3, joint pain accompanied by redness, swelling, tenderness around the joints, refused to press.
4, symmetrical pain, lesions can simultaneously invade the same joints of the bilateral limbs, such as the knees, the elbow joint can occur at the same time.
5, while the pain, the skin may be accompanied by ring erythema or subcutaneous nodules.
6. Pain can occur simultaneously in multiple joints.
7. After the pain subsides, the joints are not strong or deformed, and the joint function can be restored.
Rheumatoid arthritis is an allergic disease which is one of the main manifestations of rheumatic fever. It is usually caused by acute fever and joint pain. The typical manifestation is mild or moderate febrile migratory polyarthritis. The affected joints are mostly knees. Shoulder, elbow, wrist and other large joints are often transferred from one joint to another. The lesions are red, swollen and hot, and severe pain. Some patients also have several joints at the same time. Atypical patients have only joint pain and no other. Inflammation, acute inflammation usually subsides in 2-4 weeks, without sequelae, but often recurrent, if rheumatism affects the heart, it can occur myocarditis or even left heart valve disease.
Differential diagnosis
1, rheumatoid arthritis, for multiple symmetry refers to small arthritis and spondylitis.
2. Migratory arthritis caused by sepsis often has the symptoms of the original infection, blood and bone marrow culture is positive, and the intra-articular exudate has a purulent tendency, and pathogens can be found.
3, tuberculous arthritis, mostly involved in a single joint, occurs in the joints of frequently moving hands rubbing or weight bearing.
4, tuberculosis infection allergic arthritis.
5. Lymphoma and granuloma.
6. Lyme arthritis, an epidemic caused by ticks.
