rheumatic immune disease
Introduction
Introduction to rheumatic immune diseases Rheumatic immune disease is a series of diseases in the field of hospital internal medicine, mainly researching and treating rheumatic immune diseases. Treatment of rheumatic immune disease diseases include rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, primary Sjogren's syndrome, osteoarthritis, gout, and the like. Rheumatoid immune diseases refer to diseases that mainly invade the soft tissues around the joints, muscles, bones and joints, such as tendons, ligaments, bursae, fascia and the like. Common autoimmune connective tissue diseases, systemic vasculitis, bone and joint lesions. Rheumatology has a history of hundreds of years in the world, but it is the youngest professional discipline in my domestic science. The development of rheumatology and immunology in China can be traced back to the 1959 national selection of doctors to study in the former Soviet Union, but due to the "Cultural Revolution", China's rheumatology and immunology was basically stagnant from 1960 to 1980. After the reform and opening up, China's medical undertakings have developed rapidly, and rheumatology and immunology has also made great progress. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Causes of rheumatic immune diseases
1. Accidental trauma. Unexpected trauma is inevitable at work, in sports, and even in everyday life. For example, a sprained waist at work, a fall in sports, an accident in the elderly, or a child may be an external cause of rheumatism.
2. The living environment and working environment are damp. Many people with rheumatism have lived in a dwelling house or in a humid environment. For people who are frail and sick, those with a faster "blood sedimentation rate" may have rheumatism if they have a little sprain, overwork, or even a cold. According to expert statistics, among the 100 rheumatoid patients, 27% were affected by the dampness of the living environment. Therefore, the damp environment is an important factor that can not be ignored inducing rheumatism and rheumatoid disease.
3. Frail and sick. Chinese medicine believes that weak and sick people with poor immune function, often cold, fever, easily lead to increased white blood cells, blood tests, "c-reactive protein", anti-streptolysin "o" antibody units increased, inflammatory response is very sensitive. If the treatment is not timely, it will turn into chronic rheumatism and rheumatoid arthritis.
Confinement 4. Women are pregnant and "confinement" is often used for cold water and overwork. There are two important changes in women's body during pregnancy: "One is increased blood volume and fibrinogen, and the other is the action of endocrine hormones. The pelvic ligament is relaxed, the trunk is dry and the tendons are elastic, and the ligaments are elastic. slack, muscle strength is weakened, and it is extremely vulnerable to injury. If you are too tired or use cold water for a long time, it will form "moon disease" and "postpartum cold". Women are suffering from rheumatism.
5. Deal with water for a long time. Long-term dealing with cold water may cause rheumatism.
6. Poor blood quality causes microcirculatory disorders. For various reasons, the blood of the human body can cause lesions, resulting in a large blood concentration, a decrease in the ability to pass through the capillaries, a rapid sedimentation rate of red blood cells, and easy occlusion of narrowed capillaries, causing microcirculatory disorders of the capillaries. When a large number of capillaries are blocked in a joint or joints, the joints and joints around the joints produce sterile inflammation due to lack of nutrients and oxygen. In turn, it causes bone and joint disease and suffers from rheumatism.
7. Genetic factors. According to the statistics of rheumatologists: rheumatism has a certain hereditary nature, and roughly 17% of patients with rheumatism suffer from congenital rheumatism due to heredity.
8. Drug factors. It is a three-point drug, and Chinese and Western medicines, especially Western medicine, for treating rheumatism have a very significant negative effect. When taking medicine for a long time, the digestive function of the stomach is reduced, the functions of various parts are decreased, the immunity of the human being is degraded, and the constitution is worse. It is an acute accidental trauma, a cold, a fever, and an inflammatory reaction. However, because the nutrition can not be replenished in time, the immunity is even worse, and the cold, dampness and heat are easy to take advantage of, and become chronic rheumatism.
9. Work out. Strain damage is muscle fatigue injury. When people are engaged in a single exercise for a long time, repeat a certain single action in the work, or sit and exercise for a long time, there will be strain-type cervical spondylosis, low back pain or other diseases.
10. Infectious factors. Infection is an important cause of a variety of rheumatoid arthritis. For example, joint inflammation caused by invasion of joints by various pathogens such as bacteria, viruses, molds, mycoplasmas, and spirochetes.
Prevention
Rheumatic immune disease prevention
1. Strive for early diagnosis and early treatment. Although the disease is highly disabling, patients with joint swelling and pain can maintain their vigilance, early diagnosis and early and reasonable treatment to control their development, reduce disability and even cure.
2. Strengthen exercise and enhance physical fitness. Regularly participate in physical exercise or production labor, strengthen physical fitness, improve disease ability and defense against wind, cold, dampness and invasion.
3. Avoid wind, cold and dampness. After the patient's labor or exercise, do not take a warm-up sweat to enter the cold water bath, do not blow the wind; pad, cover should be washed frequently to keep clean and dry; underwear should be replaced in time after sweating. The living environment is not sunny and the air is circulated.
4. Pay attention to work and rest. Overworked, the righteousness is vulnerable, and the wind, cold and dampness can be taken advantage of. Therefore, it is very important to achieve a combination of work and rest, a diet, a regular life, and no effort to do, and moderate activities and rest.
5. Maintain a normal state of mind. Clinical patients have confirmed that mental stimulation, excessive sorrow, mood depression, etc. are also one of the important factors inducing the disease, and after suffering from the disease, mood swings often make the condition worse. Therefore, maintaining a normal psychological state plays an important role in maintaining the normal immune function of the body.
6. Prevent and control infections. Some rheumatism is caused by infectious diseases such as tonsillitis, pharyngitis, sinusitis, chronic cholecystitis, caries, etc. It is believed that this is due to the human body's immune response to the pathogens of these infections. Therefore, it is also important to prevent infection and control infections in the body.
Complication
Rheumatic immune disease complications Complication
Symptom
Rheumatic immune disease symptoms Common symptoms refers to (toe) numb joint swelling and low fever
Fever
It is a common symptom of rheumatic immune disease, which can be low fever, moderate fever, or high fever. It can often be characterized by irregular fever, generally no chills, antibiotics are ineffective, and blood sedimentation is fast, such as systemic lupus erythematosus, adult sex Disease, acute neutrophilic fever, panniculitis, etc. can be fever as the first symptom.
2. Pain
It is the main symptom of rheumatic immune disease and an important cause of dysfunction. In the pain of rheumatic immune diseases, pain originating from the joint and its accessory structures is the most common, but pain in the limbs and trunk is also seen in the visceral and nervous system lesions. Joint pain, neck and shoulder pain, low back pain, and heel pain are often the main manifestations of rheumatism, sometimes accompanied by swelling of the joints. Rheumatoid arthritis often has symmetrical joint swelling and pain, especially in the finger joints and wrist joints; ankylosing spondylitis has low back pain, aggravation at rest, may be accompanied by heel pain, red eye; rheumatic polymyalgia Neck and shoulder pain, pain in the limb muscles and muscle weakness. Joint pain, swelling, check the high blood sedimentation, positive wind-like factor is the performance of rheumatism. Rheumatic immune diseases often cause anxiety disorders.
3. Skin mucosal symptoms:
Systemic lupus erythematosus, dermatomyositis/polymyositis, Behcet's disease, panniculitis, and dry syndrome may include rash, light sensitivity, mouth ulcers, vulvar ulcers, eye symptoms, reticular cyanosis, and skin ulcers.
4. Reynolds's sign:
When the finger (toe) is cold or emotional, it appears white, then it is purple, red or accompanied by numbness and pain of the finger (toe). Severe skin ulceration can be seen in scleroderma and rheumatoid. Arthritis, mixed connective tissue disease, systemic lupus erythematosus.
5. Muscle
There may be muscle pain, muscle weakness, elevated muscle enzymes, electromyography manifested as myogenic damage, such as dermatomyositis/polymyositis, mixed connective tissue disease, systemic lupus erythematosus.
6. System damage:
Some rheumatic immune diseases, especially autoimmune connective tissue diseases such as systemic lupus erythematosus, rheumatoid arthritis, etc. can have multiple organ damage, such as manifested as carditis (carditis, myocarditis, endocarditis), kidney Damage (proteinuria, hematuria, edema, hypertension, renal failure), blood system (leukopenia, red blood cell reduction, thrombocytopenia, blood transfusion, etc.), respiratory system (interstitial pneumonia, pulmonary hypertension, pleural effusion), Digestive system (liver function damage, jaundice) and so on.
7. Often have autoantibodies:
Antinuclear antibodies, anti-ds-DNA antibodies, anti-ENA antibodies, anti-platelet antibodies, anti-cardiolipin antibodies, rheumatoid factors, and the like.
8. Systemic vasculitis.
It is a type of inflammatory disease with vascular inflammatory response as the main pathological change, including arteritis, giant cell arteritis, nodular polyarteritis, and Weg's edema. The symptoms are more complicated, and there are often symptoms such as rapid blood sedimentation, fever, system damage, etc., which requires an experienced professional doctor to diagnose.
9. Patients with mixed connective tissue disease
Clinically, there are often many symptoms at the same time, such as swelling fingers, Raynaud's phenomenon, vasculitis at the tip of the finger, muscle pain, joint swelling and pain, stalking when eating, lungs, heart and even Renal damage is similar to systemic lupus erythematosus, scleroderma, myositis, and rheumatoid arthritis, but it cannot be clearly diagnosed as any of these diseases, and high titers of anti-ribonucleoprotein antibodies can be detected in the patient's blood. This type of patient is often diagnosed with mixed connective tissue disease.
Patients with MCTD, some patients, mixed connective tissue disease manifested as an independent disease, some patients can gradually evolve into typical scleroderma or systemic lupus erythematosus, while mixed connective tissue disease is only scleroderma or system Pre-existing performance of lupus erythematosus. Therefore, some people think that mixed connective tissue disease is not an independent disease. The treatment of mixed connective tissue disease mainly uses different drugs based on the outstanding clinical manifestations of a certain period.
10. Pulmonary interstitial fibrosis
Patients with pulmonary hypertension often have a severe condition and should be treated aggressively.
Rheumatoid immune disease is a group of musculoskeletal diseases mainly caused by medical treatment, including diffuse connective tissue diseases and soft tissues around the joints and joints caused by various causes, including diseases such as muscles, tendons and ligaments. A growing body of data indicates that genetic factors are closely related to rheumatic immune diseases. As early as 1889, it was pointed out that rheumatic immune diseases can often occur among members of the same family. Since then, it has also been found that the familial incidence rate is higher. Children with rheumatism in their parents have a higher incidence than children with no rheumatism.
Studies on single-oval twins suggest that one of them has rheumatism, and another 20% of them may also develop the disease. Therefore, after a lot of research on rheumatism patients, some scholars believe that the susceptibility of rheumatism is related to autosomal recessive genes, but it has not been further confirmed by other scholars. Another study of 40 pairs of twin-oval twins had only two identical medical history of rheumatic immune diseases.
The human leukocyte antigen system (HLA), which is genetically innervated on the short arm of chromosome 6. HLA has been performed in patients with rheumatism, demonstrating that HLA-BW35 is associated with susceptibility to rheumatic immune disease. Finnish rheumatism patients account for the majority of HLA-BW35, while British people with rheumatoid immune disease HLA-BW15 account for a small number. Therefore, the relationship between rheumatic immune disease and HLA type may also be related to race.
The patients with rheumatoid arthritis have higher HLADR1*0405 alleles than the general population; the loss of C1q, C2, and C4 genes in patients with systemic lupus erythematosus is higher than that of the general population, indicating the presence of susceptible genes. Susceptible genes not only enhance susceptibility but also affect the severity of the disease.
Therefore, it is believed that the incidence of rheumatism is closely related to heredity, or genetic inheritance is a predisposing factor for the onset of rheumatism, but there is still insufficient evidence to prove that rheumatic immune disease is a genetic disease. With the interpretation of human genetic code, the development of molecular biology, the relationship between genetics and the pathogenesis of rheumatic immune diseases will be more and more recognized by humans, and gene therapy will become a reality.
Examine
Rheumatism immune disease examination
1. routine inspection
2. General immune indicators
Immunoglobulin, ESR, Complement, Circulating Immune Complex, C-Reactive Protein, ASO, RF, Beijing, China-Japan Friendship Hospital, Zheng Chengwu
3. Autoantibodies
ANA, dsDNA
anti-ENA antibody (Sm, SSA, SSB, Jo-1, Sc1-70, U1-RNP, r-RNP)
Anti-histone antibody, anti-nucleosome antibody (AnuA), anti-centromere antibody, anti-nucleoside antibody, anti-nuclear membrane antibody
anti-AKA antibody, anti-cyclic proline polypeptide antibody (CCP)
Antiphospholipid antibody: anticardiolipin antibody (ACL antibody)
Anti-neutrophil cytoplasmic antibody (ANCA) and anti-GBM antibody
Smooth muscle antibody (ASMA), anti-liver kidney microsomal type 1 antibody (anti-LKM1)
Anti-mitochondrial resistance (AMA, AMA2)
4. Synovial fluid testing
5. Genetic marker examination: such as HLA2B27, HLA2DR2, HLA2DR3, HLA2B5, HLA2B7, etc.
6. Image examination
Joint imaging examination
Arthroscopy
Angiography
7. Pathological examination
Renal biopsy
Rheumatoid nodule biopsy
Fiberoptic bronchoscopy lung biopsy
Labial gland biopsy and parotid angiography
Diagnosis
Diagnosis and diagnosis of rheumatic immune diseases
