Rheumatism
Introduction
Introduction to rheumatism Rheumatism is a group of diseases that invade joints, bones, muscles, blood vessels, and related soft tissues or connective tissues, most of which are autoimmune diseases. The incidence is more concealed and slow, the course of disease is longer, and most of them have a genetic tendency. Diagnosis and treatment are difficult; more autoantibodies can be detected in the blood, which may be related to different HLA subtypes; there are better short-term for non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids and immunosuppressive agents. Or long-term palliative response. basic knowledge The proportion of sickness: 0.2% Susceptible people: no special people. Mode of infection: non-infectious Complications: rheumatoid arthritis, rheumatic fever
Cause
Cause of rheumatism
Immune response (20%):
The exogenous or endogenous antigenic substance is stimulated directly or by macrophage, which activates the corresponding T-cells. Some T-cells produce a large number of various inflammatory cytokines, causing various degrees of damage to various tissues and organs. Destruction; Part of T-cells reactivate B-cells, producing large amounts of antibodies that bind directly or in combination with antigens to form immune complexes that damage or destroy tissues or organs. In addition, monocyte chemotactic proteins (such as MCP-1) produced by monocytes can also participate in the inflammatory response. Most rheumatic diseases, either due to exogenous antigenic substances produced by infection, or due to endogenous antigenic substances produced in the body, can initiate or exacerbate this autoimmune response, and multiple antibodies can be present in the serum.
Genetic background (10%):
Recent studies have shown that some rheumatic diseases, especially connective tissue diseases, genetic and patient susceptibility and disease expression are closely related, have certain significance for early or atypical cases and prognosis of the disease; among them HLA (human tissue) Leukocyte antigens are the most important.
Infection factor (20%):
According to years of research, a variety of infectious agents, antigens or superantigens produced by microorganisms can directly or indirectly stimulate or initiate an immune response.
Endocrine factors (20%):
Studies have shown that the imbalance of estrogen and progesterone is related to the occurrence of various rheumatism.
Environmental and physical factors (10%):
Such as ultraviolet light can induce SLE.
Other (10%):
Some drugs such as procainamide, some oral contraceptives can induce SLE and ANCA-positive small vasculitis.
Prevention
Rheumatism 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 complications Complications rheumatoid arthritis rheumatic fever
Rheumatism is a systemic disease characterized by chronic, non-suppurative inflammation of multiple joints. It has a lot of damage to the body. Many people think that rheumatoid is not very serious. If you take a break, you will have no need for treatment. In fact, this is very wrong. Rheumatism can cause many complications if left untreated.
1. Pneumonia. Due to decreased immunity and bacterial infection, patients often have pneumonia.
2. Urinary system infections. Patients with rheumatoid arthritis are often prone to urinary tract infections if they do not pay attention to their daily lives or suffer from a cold.
3. Cushing's syndrome. If the patient takes too long a hormone, it is often caused by the inhibition of adrenal function in the body and the Cushing's syndrome. Common symptoms include full moon face, buffalo back, and 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. Kidney. Liver enlargement, jaundice, liver pain and chronic active hepatitis may occur.
7. Heart. It is easy to cause heart disease such as pericardial friction, heart enlargement, and increased heart rate.
8. Joints. The joints of the whole body are prone to pain, swelling, stiffness, and loss of deformity.
9. Digestive system. It is easy to cause indigestion, and even digestive diseases such as gastrointestinal perforation, hemorrhage, and intestinal obstruction.
10. In severe cases, abnormal bone stiffness and even joint dislocation may occur.
Symptom
Symptoms of rheumatism Common symptoms Lipiditis Muscle muscle weakness Joint pain Fever Dermatomyos Gott... Osteophytes
Common symptoms:
1. Rheumatism mostly has joint lesions and symptoms, which can be as high as 70-80%, about 50% only pain, heavy red, swollen, hot, pain and functional impairment, etc.; mostly multi-joint involvement. Invasion of joint size varies depending on the disease.
2. Heterogeneity, that is, the same disease, there are different subtypes. Due to the genetic background, the causes of the disease are different, and the mechanisms are different. Therefore, the types of clinical manifestations, symptoms, severity, and treatment response are also different.
3. Rheumatism is mostly a multi-system disease. The pathology of many diseases overlaps and the symptoms are similar. For example, MCTD is typical of this kind of performance.
4. Multiple antibodies and immune complexes (CIC) are present in the serum and can be deposited in tissues (skin, synovium) or organs (kidney, liver).
5. Raynaud's phenomenon often occurs in this type of disease, such as SLE, MCTD.
Rheumatoid arthritis: is a chronic, inflammatory synovitis-based systemic disease of unknown etiology. It is characterized by multiple joints, symmetry, and invasive joint inflammation of the hand and foot facet joints, often accompanied by extra-articular involvement and serum rheumatoid factor positive, which can lead to joint deformity and loss of function.
Ankylosing spondylitis: a disease characterized by inflammation of the ankle joint and spinal attachment point. Strong association with HLA-B27. Certain microorganisms, such as Klebsiella, have a common antigen with the susceptible tissue and can trigger an abnormal immune response. It is a chronic inflammatory disease characterized by large joints of the extremities, fibrosis and ossification of connective tissue near the annulus fibrosus and its ankylosis. Ankylosing spondylitis is a category of rheumatism and is a type of seronegative spondyloarthropathy.
Systemic lupus erythematosus:
Systemic lupus erythematosus is the most severe form of all types of lupus erythematosus. The vast majority of patients have multiple systemic manifestations at the time of onset, and a small number of patients develop from other types of lupus erythematosus. Some patients are also accompanied by other connective tissue diseases, such as scleroderma, dermatomyositis, Sjogren's syndrome, etc., forming various overlapping syndromes. Systemic lupus erythematosus has a variety of clinical manifestations, complex and more serious, which can endanger patients' lives due to lupus nephritis, lupus encephalopathy and long-term use of drugs.
Dermatomyositis: also known as skin heterochromic dermatomyositis, is one of the autoimmune connective tissue diseases, is a non-suppurative inflammatory lesion mainly involving striated muscle, mainly lymphocyte infiltration, with or without There are a variety of skin damages, but also a variety of visceral damage. Polymyositis (PM) refers to a group of patients with no skin damage.
Examine
Rheumatism check
Laboratory inspection
(1) Routine examination: Rheumatism is a disease that affects multiple organs and multiple organs in the body, so it is necessary to conduct a comprehensive examination of the patient, blood, urine, stool, erythrocyte sedimentation rate, CRP, comprehensive biochemical examination (liver function, renal function, muscle enzyme). Spectrum, etc.).
(2) Serological examination: 1 General: RF, C3, C4, CH50, CIC, IgG, IgA, IgM, IgE. 2 Specificity: a. Anti-nuclear antibody spectrum is very important for the diagnosis and differential diagnosis of rheumatic diseases. Generally do ANA first, such as titer > 1:40, you should further check other items. b. HLA: Although HLA is closely related to rheumatism, it is still not well understood. Commonly used, such as HLA B-27, the positive rate of AS can be as high as 81.8%. The levy can reach 40%, only 10% in psoriasis; the positive rate of DR4/DR1 to RA is 49-79%, JRA is 7%, but the Dw4 of JRA is 26%, Dw14 is 47%, DR3 is in SLE It is only 2.7%, and the pSS is 5.6%. Only 3.3% of Behcet's disease is positive for HLA B5. c. Others: such as anti-keratin antibody (AKA), anti-histone antibody (anti-histone antibody), anti-phospholipid antibody, anti-peripheral factor (ANCA), etc. have diagnostic reference value for some diseases.
(3) Joint fluid examination: Fresh joint fluid is very important and should be routine, cultured, serological and immunological.
Film degree exam
(1) X-ray plain film: generally used positive, lateral position, size joints, limbs, shoulders, spine, tendon joints; according to different diseases and parts, there may be different requirements for bone damage or Proliferative lesions are generally clear, but due to overlapping images, early small lesions are difficult to see; the synovial membrane, joint capsule, cartilage, meniscus, and ligament are not displayed.
(2) Computed tomography (CT): It can accurately display the small differences in tissue density in a cross section. It is an ideal method for observing small lesions of bone and soft tissue. Mostly used for AS ankle, spine; cartilage and meniscus lesions of the knee joint, brain changes in SLE; early interstitial lung changes.
(3) Magnetic resonance imaging (MRI): It has higher resolution than X-ray and CT for bone and joint and soft tissue lesions, and is superior to CT for soft tissue imaging. It is often used to observe the diagnosis of bone, cartilage, meniscus and fascia; it is also helpful for brain tissue and myelopathy.
(4) Contrast: 1 joint angiography: generally use filtered air or organic iodine solution, can also use two kinds at the same time, called double contrast angiography. It can display structures such as articular cartilage, meniscus, synovium and ligaments. It is helpful for the diagnosis of intra-articular lesions. It is mostly used for large joints of the extremities, but it has been used less frequently. 2 angiography: divided into angiography and venography, which is helpful for the diagnosis of aortitis or vasculitis.
(5) Arthroscopy: It is of great significance to directly observe the lesions of various tissues in the joint, especially the diagnosis and differential diagnosis of synovitis. Synovial biopsy and surgical treatment can be taken when necessary.
(6) Biopsy: For cases with difficult diagnosis, such examination can assist in the diagnosis. Such as skin, lip mucosa, kidney, liver, joint synovium, blood vessels, muscles, bones, cartilage and so on. Sometimes immunohistochemical staining is also required.
(7) Isotope bone scan: It is helpful for the identification of osteoma (primary or secondary), myeloma.
(8) Ultrasound examination: The joint capsule, cartilage, synovial thickness and effusion can be judged.
Diagnosis
Diagnosis and diagnosis of rheumatism
Because rheumatism is diverse, medical history should be collected in detail, in addition to personal history, including family history; comprehensive physical examination, in particular, attention to joint symptoms, skin and mucosal lesions, presence or absence of Raynaud's phenomenon, vasculitic lesions. According to the medical history, different diseases can be initially diagnosed.
Diagnosis can be based on the cause, symptoms and related tests. Clinicians must consider the possibility of rheumatism in the differential diagnosis of anemia, especially in young and middle-aged women.
