rheumatic diseases
Introduction
Introduction to rheumatic diseases Rheumatic diseases generally refer to a group of diseases that affect bones, joints and surrounding soft tissues, such as tendons, bursae, and fascia. The causes are diverse, such as infectious, immune, metabolic, endocrine, degenerative, geographical, and genetic. Sexuality, etc., caused by various causes of arthritis, but rheumatic diseases are limited to arthritis. Rheumatic diseases are a group of musculoskeletal diseases mainly based on 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. More and more data indicate that genetic factors are closely related to rheumatism. The "connective tissue disease" or "collagen disease" referred to in the past is a part of rheumatic diseases, and they are not completely equivalent to "rheumatic diseases". The purpose of treatment for rheumatic diseases is to improve symptoms and change the condition, and to suppress progress. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: heart failure cataract
Cause
Causes of rheumatic diseases
Tissue damage (30%):
Involved in the interstitial tissues of the whole body, connective tissue is the most important lesion in rheumatic diseases. Whether it is dense connective tissue such as cartilage and tendon, or loose connective tissue, it can have a wide range of damage. The characteristics of loose connective tissue damage are: mucoid edema, fibrin-like degeneration, granuloma formation, inflammatory cell infiltration, late transparency or sclerosis, vasculitis is widespread, especially in arterial system , manifested as vascular endothelial cells and epithelial cell hyperplasia or full-thickness inflammation.
Immune damage (30%):
It plays an important role in the pathogenesis of rheumatic diseases, and many rheumatic diseases are at least partly due to tissue damage caused by immune abnormalities. Immunological damage can be divided into four basic types: allergic type I response, which can be local or systemic; antibody-mediated type II response, characterized by antibodies that can interact with native cell surface antigens or absorb antigens attached to the cell surface. Binding, immune complex type III reaction, characterized by localized deposition of immune complexes on the surface of cells or tissues; cell-mediated type IV response, the result of direct contact of sensitized T cells with specific antigens, no antibody required for the reaction process And complement, these types are not mutually exclusive and may exist in some patients at the same time.
Advances in immunogenetics and studies of HLA antigens and related diseases have increased the understanding of the pathogenesis of rheumatic diseases. Many rheumatic diseases associated with the MHC gene are autoimmune, and the HLA-B27-encoded gene is closely related to ankylosing spondylitis.
Genetic factors (30%):
As early as 1889, it was pointed out that rheumatism 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 rheumatism. 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 rheumatism. Finnish rheumatoid patients have a majority of HLA-BW35, while British rheumatoid patients have a small number of HLA-BW15. Therefore, the relationship between rheumatism 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 rheumatism is a genetic disease. With the interpretation of human genetic code, the development of molecular biology, the relationship between genetics and rheumatism will be more and more recognized by humans, and gene therapy will become a reality.
Prevention
Rheumatic disease prevention
Improve immunity
Pay attention to ensure adequate sleep, maintain emotional optimism, limit drinking, participate in sports properly, and pay attention to appropriate supplements of high-quality protein and various vitamins.
Active treatment of infectious lesions
Infection is one of the important factors that aggravate or worsen symptoms of rheumatoid arthritis. Such as caries, alveolar pus, tonsillitis, paranasal sinusitis, chronic otitis media are important sources of infection, must be cured in time.
Avoid incentives
Cold, dampness, mental stress, excessive fatigue, insomnia, trauma (such as joint sprains, falls and fractures) are all predisposing factors for the aggravation of rheumatoid arthritis and must be avoided. In addition, the treatment of drugs should be carried out in strict accordance with the provisions of the doctor's advice, medication irregularities, unauthorized withdrawal is also a factor that induces or aggravates.
Pay attention to diet regulation
To emphasize the nutrition of the diet, we must pay attention to the balance of food. Sudden changes in food species are important factors in aggravating rheumatoid arthritis or worsening symptoms, and high-calorie, high-protein, high-fat diets may also lead to recurrence of rheumatoid arthritis.
Complication
Rheumatic disease complications Complications heart failure cataract
Complications: heart failure, cataract, gastrointestinal bleeding.
Symptom
Symptoms of rheumatic diseases Common symptoms Joint stiffness Joint deformity Joint pain erythema (Boundary clear eye muscle paralysis Gastrointestinal bleeding Heart enlargement Dyspnea Heart murmur similar to urticaria skin...
Most rheumatic diseases are chronically ill, and the clinical manifestations of the same disease may vary widely in different individuals or at different times. The course of the disease was recurrent and relieved.
First, pain syndrome
Joint, muscle, and tendon pain are quite common, and the joints of both limbs and joints can be involved, with symmetrical joint pain. Morning stiffness and Renault signs are important concomitant symptoms. The onset, nature, location, duration of the pain, systemic symptoms, and age at onset vary from patient to patient. For example, a gout attack suddenly sudden, and the toe joint pain is more common. Rheumatoid joints are slow onset, affecting the wrist, metacarpophalangeal, proximal interphalangeal joints and cervical vertebrae. Ankylosing spondylitis begins with low back pain almost without exception. When the surrounding joints are affected, most of them are large joints of the lower extremities. In addition to joint pain, systemic lupus erythematosus has a more pronounced systemic performance. Some patients eventually have joint stiffness, deformity, loss of function, and some patients have joint swelling and pain, but no distortion.
Second, skin performance
Most patients have skin changes that are specific or non-specific. Various manifestations, urticaria, ring erythema, papular erythema, polymorphous erythema, nodular erythema, facial erythema and so on. The pathological basis of skin lesions is vasculitis, the most important of which is leukocyte rupture vasculitis. The size of the affected blood vessels, the intensity of the reaction, the duration, the extent of involvement and the pathological changes vary according to different skin lesions.
Third, eye performance
Ocular symptoms can occur months or years before systemic symptoms. Some are prominent manifestations in the course of the disease, the lesions may involve the cornea, retina, pigmented layer, symptoms of dry eyes, increased intraocular pressure, cataracts, diaphragmatic muscles, eye muscle paralysis, vision loss or even blindness.
Fourth, lung performance
Dyspnea is a common complaint, due to pneumonia, eosinophilic lung infiltration, pulmonary hemorrhage, focal granuloma formation, fibrotic alveolitis, interstitial pneumonia, and pleural effusion.
V. Digestive system performance
Because the basic pathological changes are extensive small vasculitis, the digestive system is also affected, such as gastrointestinal bleeding, perforation or intestinal obstruction, can be life-threatening, liver involvement is more common, and may be a prominent manifestation of the disease, showing liver Large, jaundice, liver pain, nausea, vomiting, in the form of chronic active hepatitis.
Sixth, cardiovascular system performance
Myocardium, endocardium, pericardium, conduction system, arteries and veins can be affected. Clinical manifestations of heart enlargement, increased heart rate, systolic murmur in heart valve area, pericardial friction, high blood pressure and various arrhythmias, severe heart failure.
Seven, kidney performance
Renal lesions are quite common, with renal interstitial inflammation, fibrosis, membranous nephropathy, glomerular basement membrane thickening, amyloidosis, and the like. There are edema, polyuria or oliguria, proteinuria, hypertension and acute and chronic renal failure.
There may be hemolytic anemia, thrombocytopenia, oral ulcers, parotid swelling, otitis media, hyperpigmentation and the like.
Examine
Rheumatic disease examination
First, the blood
Often mild to moderate anemia, combined with hemolysis, anemia increased. Some patients have leukopenia and / or thrombocytopenia, or complete blood cell reduction.
Second, immunological examination
It is an important test for rheumatic diseases. A variety of autoantibodies can be positive. Antinuclear antibodies (ANA) generally refer to a class of antibodies with various nuclear components. Because of different nuclear antigens, they are classified into different kinds of ANA, such as antinuclear proteins. Antibodies (anti-DNP antibodies), anti-DNA antibodies, including two major classes, antibodies against single-stranded DNA (denatured DNA) (anti-ss-DNA antibodies) and anti-double-stranded DNA (native DNA) antibodies (anti-ds-DNA antibodies) Anti-extractable nuclear antigen antibody (anti-ENA antibody) has anti-riboprotein antibody (anti-RNP antibody) and anti-Sm antibody, anti-RNA antibody, anti-cytoplasmic antibody and anti-nuclear antigen antibody.
The detection rate of various antibodies is different in different rheumatic diseases.
The rheumatoidoid factor (RF) is a macroglobulin autoantibody that reacts with the Fc fragment epitope of denatured or agglutinated lgG molecules. RF is mainly lgM type antibody, and also has lgG type and lgA type. Rheumatoid arthritis has the highest RF detection rate in rheumatic diseases, about 70-90%, systemic lupus erythematosus, sclerosis mixed connective tissue disease, and Sjogren's syndrome can also be positive. Others such as viral infection, parasitic infection, chronic inflammation, tumor radiotherapy and chemotherapy, etc. have positive findings.
Third, other
ESR is often increased, C-reactive protein is positive, hypo-complementemia, hyperuricemia, and immune complexes are positive. The blood immunoglobulin is increased or decreased. Depending on the degree of organ damage, there are changes in urine, kidney function, and heart function. In rheumatic diseases, there are characteristic or non-characteristic changes in joint X-slices, which must be considered in combination with clinical data and laboratory tests.
Diagnosis
Diagnosis and diagnosis of rheumatic diseases
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
The disease should be identified with the following diseases:
(1) Arthritis of other causes
Rheumatoid arthritis
For multiple symmetry refers to small arthritis and spondylitis. The characteristics are accompanied by "morning stiffness" and swollen finger swollen shape, and joint deformities appear later. Clinically, there is less cardiac damage, but echocardiography can detect pericardial lesions and valvular lesions early. X-ray showed joint surface destruction, joint space narrowed, and osteoporosis adjacent to bone tissue. Serum rheumatoid factor positive, immunoglobulin IgG, IgM and IgA increased.
2. Distracted arthritis caused by sepsis
There are often signs of primary sensation, blood and bone marrow culture is positive, and intra-articular exudate has a purulent tendency, and pathogens can be found.
3. Tuberculous arthritis
Mostly involved in a single joint, it occurs in joints that are often exposed to friction or weight, such as hip, thoracic vertebrae, lumbar vertebrae or knee joints, joint pain but no redness, no heart lesions, often other areas of tuberculosis. X-ray shows bone destruction and nodular erythema can occur. Anti-rheumatic treatment is not effective.
4. Tuberculosis infection allergic arthritis (Poncet disease)
There are exact tuberculosis infections in the non-articular parts of the body, and there are often repeated arthritis manifestations, but the general condition is good, and the X-ray shows no bone destruction. Symptoms of salicylic acid treatment can be alleviated but recurrent, and the symptoms subsided after anti-tuberculosis treatment.
5. Lymphoma and granuloma
It has been reported that leukemia can have symptoms of fever and acute polyarthritis in 10% of cases, and arthritis can precede changes in peripheral blood, leading to misdiagnosis. Similar reports have been reported for other lymphomas and benign granulomas.
6. Lyme arthritis (Lyme disease)
The disease is an epidemic caused by ticks. Symptoms usually appear 3 to 21 days after a bite. Clinical manifestations of fever, chronic migratory skin erythema, recurrent asymmetry of arthritis, occur in large joints, may have heart damage, affect the conduction system, ECG shows different degrees of atrioventricular block, may also appear Neurological symptoms such as chorea, meningoencephalitis, myelitis, facial nerve spasm, etc. The laboratory examined positive circulating immune complexes and increased erythrocyte sedimentation rate. Serum-specific antibody assays can be identified.
