Systemic lupus erythematosus arthritis
Introduction
Introduction to Systemic Lupus Erythematosus Arthritis Systemic lupus erythematosus arthritis is a manifestation of systemic lupus erythematosus in the period of disease, while systemic lupus erythematosus is an autoimmune disease with multi system damage as its clinical manifestation. The main manifestations are fever, rash, alopecia, arthralgia or arthritis, nephritis, serositis, hemolytic anemia, leukopenia, thrombocytopenia and central nervous system damage. The prognosis of patients with visceral (kidney, central nerve) damage is poor, and most of them are women of childbearing age from 20 to 40 years old. In recent years, the incidence of systemic lupus erythematosus has increased in China. Early diagnosis and comprehensive treatment can significantly improve its prognosis. Basic knowledge Prevalence rate: 0.001% Susceptible population: women of childbearing age from 20 to 40 years old Mode of infection: non infectious Complications: suppurative arthritis vasculitis arterial embolism
Cause
Etiology of systemic lupus erythematosus arthritis
pathogeny:
Systemic lupus erythematosus arthritis is a manifestation of systemic lupus erythematosus disease in the active period, while systemic lupus erythematosus is a chronic inflammatory disease, which can involve many organ systems, such as skin, nerve and serosa. The etiology is not yet clear, and may be related to heredity, environment (sunlight or ultraviolet rays, drugs, microbial pathogens, etc.), immunity, The interaction of estrogen and other factors leads to the disorder of immune function.
Prevention
Prevention of systemic lupus erythematosus arthritis
Active treatment of systemic lupus erythematosus and prevention of joint involvement are the key to the prevention and treatment of this disease. In addition to symptomatic treatment during the activity period, the treatment of systemic lupus erythematosus is mainly due to the treatment of causes, mainly to prevent its possible causes.
Complication
Complications of systemic lupus erythematosus arthritis complication Suppurative arthritis vasculitis arterial embolism
The femoral head, talus head, and humeral head of this disease are often damaged and dead. The incidence of osteonecrosis is increased in patients receiving steroid treatment, of which the most common is accompanied by idiopathic osteonecrosis: it has serious teratogenicity, and its etiology may include vasculitis, vasospasm, abnormal coagulation mechanism, arterial embolism, abnormal bone metabolism, and glucocorticoid use, It often occurs in weight bearing joints and most often involves the femoral head. Almost all patients with osteonecrosis have a history of glucocorticoid treatment.
In other cases, systemic lupus erythematosus may be associated with purulent arthritis, fungal arthritis, viral arthritis, etc., which may be related to the use of glucocorticoids and immunosuppressants.
Symptom
Symptoms of systemic lupus erythematosus arthritis common symptom Joint effusion, morning stiffness, joint deformity, osteoporosis, asymmetric arthralgia, soft tissue Swelling pathological nerve injury leukopenia hemolytic anemia thrombocytopenia
Systemic lupus erythematosus arthropathy is one of the manifestations of disease activity, mainly manifested as arthralgia, nonspecific arthritis and idiopathic osteonecrosis.
1. Arthritis and arthralgia
Mild arthralgia with morning stiffness is the most common initial manifestation of systemic lupus erythematosus. Most patients can eventually develop into arthritis with obvious symptoms, some of which have joint effusion. The most frequently involved joints are the proximal interphalangeal joint, wrist joint, knee joint. The joints involved in systemic lupus erythematosus are mostly symmetrical, insidious, and gradually aggravated, with half accompanied by morning stiffness, It may show wandering and dysfunction.
2. Joint deformity
The vast majority of joint lesions in systemic lupus erythematosus do not cause joint deformity. Someone once described a characteristic hand deformity in systemic lupus erythematosus (flexion of metacarpophalangeal joint, ulnar deviation and subluxation, excessive extension of interphalangeal joint of thumb), which has no active inflammation and is considered to be the involvement of periarticular tissues, namely joint capsule, ligament and tendon, It is caused by ligament relaxation and tendon imbalance, rather than erosive deformity. The "swan neck" deformity can be seen in about 1/3 of patients with systemic lupus erythematosus hand involvement. The foot joint involvement of systemic lupus erythematosus is parallel to the hand joint involvement. Some people think that the most common abnormalities of lupus feet are foot thumb valgus, foot anterior widening and hammer toe.
3. Joint effusion
Joint effusion is rare in this disease. The decrease of complement level is a specific change of joint fluid in systemic lupus erythematosus.
4. Radiographic performance
The imaging manifestations of systemic lupus erythematosus arthritis are less, early soft tissue swelling, periarticular osteoporosis and extensive osteoporosis can be seen; Serious malformations can be seen in the late stage, but there is often no imaging evidence of bone erosion.
SLE can be confirmed by antinuclear antibody test: most of the antinuclear antibodies in SLE active phase are positive. If the antinuclear antibody is negative, the possibility of this disease is ruled out. The sensitivity of antinuclear antibody test can replace lupus cell test to diagnose whether SLE exists.
Examine
Examination of Systemic Lupus Erythematosus Arthritis
For patients with systemic lupus erythematosus complicated with arthritis, in addition to swelling of soft tissue and signs of diffuse osteoporosis around the joint, joint cartilage or bone damage is relatively rare during X-ray examination. A few patients may have erosive joint lesions similar to rheumatoid arthritis. When combined with joint effusion, the amount of effusion is usually small, and its appearance is clear, The protein content and cell count are low. Generally, the white blood cell count is less than 3x109/liter, mainly lymphocytes, and the total complement level in the effusion is reduced. Different from rheumatoid arthritis, 7% - 10% of patients have rheumatoid nodules, which are similar to the distribution of rheumatoid arthritis, and are common in the extended surface of the eagle's mouth and metacarpophalangeal joint.
The disease can also be confirmed by the antinuclear antibody test: most of the antinuclear antibodies in the active phase of SLE are positive. If the antinuclear antibodies are negative, the disease is ruled out. The sensitivity of the antinuclear antibody test can replace the lupus cell test to diagnose whether SLE exists. X-ray examination shows that there is no bone destruction in most joints.
Diagnosis
Diagnosis and differential diagnosis of systemic lupus erythematosus arthritis
1. Diagnosis of systemic lupus erythematosus arthritis
Systemic lupus erythematosus joint disease has no specific diagnostic conditions and no characteristic signs, but it is generally believed that non erosive and non deformable arthritis is the difference between systemic lupus erythematosus arthritis and rheumatoid arthritis, and its characteristics are that the articular surface and joint space are always intact.
2. Differential diagnosis
Systemic lupus erythematosus arthritis needs to be differentiated from rheumatoid arthritis. Polyarthralgia and polyarthritis in the early stage of systemic lupus erythematosus are easily misdiagnosed as rheumatoid arthritis. The joint disease of the latter is persistent and severe, with long morning stiffness, more deformities, and less systemic damage. X-ray shows erosive arthritis.
