limb stiffness
Introduction
Introduction Stiffness and dysmotility are common in rheumatism. When the patient starts to move in the morning, or when the body changes to another posture after being in a certain posture for a long time, the affected parts such as joints, limbs, and waist are often felt. Stiffness and pain. Most of them are caused by immune reaction. The immune response: 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. Various types of tissues and organs are damaged or destroyed to varying degrees; some T-cells reactivate B-cells, produce a large number of antibodies, directly or in combination with antigens to form immune complexes, which 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.
Cause
Cause
1. Immune response: 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 to cause various tissues and organs. Different degrees of damage or destruction; some T-cells reactivate B-cells, produce a large number of antibodies, directly or in combination with antigens to form immune complexes, damage or destruction of 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.
2. Genetic background: Recent studies have shown that some rheumatic diseases, especially connective tissue diseases, genetic and patient susceptibility and disease expression are closely related, and have certain significance for early or atypical cases and prognosis of the disease; Among them, HLA (human tissue leukocyte antigen) is the most important.
3. Infectious factors: 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.
4. Endocrine factors: Studies have shown that the imbalance of estrogen and progesterone is related to the occurrence of various rheumatism.
5. Environmental and physical factors: such as ultraviolet light can induce SLE.
6. Others: Some drugs such as procainamide, some oral contraceptives can induce SLE and ANCA-positive small vasculitis.
Examine
an examination
Related inspection
Rheumatism laboratory test item rheumatoid factor limbs and joint movement function Geislan test
1. Pain: Pain and soreness are the most important clinical manifestations of rheumatism. The disease is different, and the location, nature and extent of pain are also different. Acute trauma, acute inflammation, nerve compression, and malignant tumors often show severe knife-like pain; chronic strains and chronic inflammation are mostly mild pain or pain. The pain of organic diseases is long, prolonged and persistent, and the pain site often reveals the lesion. At the same time, in rheumatism, the pain of many diseases changes with climate change.
2, tenderness: tenderness is also a very important clinical manifestation, even more objective and more specific than pain. Some functional diseases often have no obvious tender points or tenderness, and most organic diseases can often find the lesion more accurately according to the tender point. The degree of tenderness can often roughly reflect the severity of the lesion.
3, swelling: rheumatism mostly refers to non-concave swelling, there are many reasons for swelling, and its clinical manifestations are not the same. It is swollen due to the increase in bone mass. It is hard like a bone and cannot move. Swelling caused by hypertrophy of soft tissue around the joint or around the joint is different from that of healthy tissue. The swelling caused by effusion or hemorrhage has a fluctuating feeling.
4, stiffness and activity disorders
Common rheumatism such as rheumatoid arthritis, ankylosing spondylitis, etc., when the patient starts to move in the morning, or when the body changes to another posture after being in a certain posture for a long time, the joints, limbs, and waist are often felt. If the affected part has stiffness and pain, the stiffness and pain can be alleviated or even disappeared after a period of activity. At the same time, due to joint pain, bone destruction, joint attachment structure lesions lead to joint movement disorders.
Diagnosis
Differential diagnosis
Rheumatism contains more than 100 diseases. Although there are many symptoms, the bones, joints and soft tissues around them are often painful. The episodes are upset, restless, and encounter sudden changes in the weather or other causes. At the time, the affected muscles and joints will have an inflammatory reaction and pain. The patient reports that the body is a meteorological station. These lesions are often called rheumatic pain.
There are many causes of muscle and joint pain. For example, joint pain from 1 week to 4 weeks after sore throat should be considered as a result of rheumatic fever caused by bacterial infection.
If there is symmetry pain in the hands and feet, do not hold the hands in the morning, the stiffness and pain will be better after the activity, you should consider the possibility of rheumatoid arthritis; if the young women have unexplained fever, joint pain, accompanied by hair loss If there are butterfly-like erythema on the face, and symptoms such as aggravation after sun exposure, you should be alert to lupus erythematosus; if young men have low back pain, they may get heavier at night or in the morning, and they can be relieved after the activity, or accompanied by heel and deep hip pain. You should be alert to the possibility of ankylosing spondylitis.
If the elderly, postmenopausal obese women have joint pain, or long-term, excessive use of certain joints due to occupational relationships, such as the hands of textile workers, the feet of ballerinas, etc., can be relieved after rest, Should be thought of whether it is articular cartilage lesions, excessive hyperplasia of the bones, also known as bone spurs; or severe pain in the toes that suddenly occur after drinking and binge eating at night, and red and swollen, you should first consider acute gouty arthritis. It is the "joint pain that comes out" that is usually said.
If there is pain in the muscles and joints, and the hands and feet can't be lifted, there is no strength to walk. If you wash your face in the morning and can't lift your hands, you should consider the possibility of myositis.
1. Pain: Pain and soreness are the most important clinical manifestations of rheumatism. The disease is different, and the location, nature and extent of pain are also different. Acute trauma, acute inflammation, nerve compression, and malignant tumors often show severe knife-like pain; chronic strains and chronic inflammation are mostly mild pain or pain. The pain of organic diseases is long, prolonged and persistent, and the pain site often reveals the lesion. At the same time, in rheumatism, the pain of many diseases changes with climate change.
2, tenderness: tenderness is also a very important clinical manifestation, even more objective and more specific than pain. Some functional diseases often have no obvious tender points or tenderness, and most organic diseases can often find the lesion more accurately according to the tender point. The degree of tenderness can often roughly reflect the severity of the lesion.
3, swelling: rheumatism mostly refers to non-concave swelling, there are many reasons for swelling, and its clinical manifestations are not the same. It is swollen due to the increase in bone mass. It is hard like a bone and cannot move. Swelling caused by hypertrophy of soft tissue around the joint or around the joint is different from that of healthy tissue. The swelling caused by effusion or hemorrhage has a fluctuating feeling.
4, stiffness and activity disorders
Common rheumatism such as rheumatoid arthritis, ankylosing spondylitis, etc., when the patient starts to move in the morning, or when the body changes to another posture after being in a certain posture for a long time, the joints, limbs, and waist are often felt. If the affected part has stiffness and pain, the stiffness and pain can be alleviated or even disappeared after a period of activity. At the same time, due to joint pain, bone destruction, joint attachment structure lesions lead to joint movement disorders.
