Rheumatoid arthritis To date, there is no specific treatment, but still stays on the treatment of inflammation and sequelae, taking a comprehensive treatment, most patients can get some effect. The current treatment aims to: (1) control inflammation of joints and other tissues to relieve symptoms; (2) maintain joint function and prevent deformity; and (3) repair damaged joints to reduce pain and restore function. (a) General therapy: Those with fever, swollen joints and systemic symptoms should rest in bed until the symptoms basically disappear. After two weeks of improvement, activities should be gradually increased to avoid prolonged bed rest leading to joint disuse and even promoting joint ankylosis. Adequate protein and vitamins should be included in the diet, and small blood transfusions can be given to those with significant anemia. (B) drug treatment 1, non-steroidal anti-inflammatory drugs (NSAIDS) for the first or mild cases, its mechanism of action is mainly to inhibit cyclooxygenase so that the inhibition of the production of prostaglandins to achieve the effect of anti-inflammatory for pain relief. However, it cannot stop the natural process of rheumatoid arthritis lesions. This class of drugs because of the different metabolic pathways in the body, they can interact with each other is not advocated for joint application, and should pay attention to individualization. (1) Salicylic acid preparations: anti-rheumatic, anti-inflammatory, antipyretic and analgesic. The dose is 2-4g per day, if the efficacy is not satisfactory, the dose can be increased at your discretion, sometimes 4-6g per day is needed to be effective. It is usually taken after meals or used together with acidulants, and enteric tablets can also be used to reduce gastrointestinal irritation. (2) Indomethacin: an indole acetate derivative with anti-inflammatory, antipyretic and analgesic effects. Patients who cannot tolerate aspirin can switch to this drug at the usual dose of 25mg 2-3 times a day, and side effects are likely to occur when 100mg or more is used daily. Side effects include nausea, vomiting, diarrhea, gastric ulcer, headache, vertigo, mental depression, etc. (3) Propionic acid derivatives: a class of drugs that can replace aspirin, including ibuprofen, (ibuprofen) naproxen (naoproxen) and fenbufne (fenbufne) have similar effects to aspirin, with similar efficacy and fewer digestive side effects. Commonly used dose: 1,2~2,4g of ibuprofen per day, divided into 3~4 doses, and 250mg of naproxen per dose, twice a day. Side effects include nausea, vomiting, diarrhea, peptic ulcer, gastrointestinal bleeding, headache and central nervous system disorders such as irritability. (4) Anti-acid: It is a derivative of o-aminobenzoic acid and its effect is similar to that of aspirin. Anti-acid 250mg each time, 3 to 4 times a day. Clomid acid 200-400mg per time, 3 times a day. Side effects include gastrointestinal reactions, such as nausea, vomiting, diarrhea and loss of appetite. Occasionally, rash, renal impairment, headache, etc. 2, gold preparations currently recognized for rheumatoid arthritis has a positive effect. Commonly used gold thiomalate (gold, sodium thiomalate myochrysin). If there is no adverse reaction, then 50mg per week. 300-700mg in total, most patients will start to see the effect, and 600-1000mg in total, the condition can be improved stably. Because of the possibility of relapse after discontinuation of the drug, the maintenance dosage is used overseas for many years, and the straight line is lifelong. The earlier the gold preparation is used, the better the effect. The effect of gold preparation is slow, and it takes 3-6 months to be effective, so it should not be used with immunosuppressive or cytotoxic drugs. If the total amount of treatment process has reached 1000mg, and the disease does not improve, should stop the drug. The effect of oral gold preparation is similar to that of gold injection. Side effects include increased stool frequency, skin rash, stomatitis, tight damage, etc., which can be recovered after stopping the drug. Oral gold preparations gold Norfen (Auranofin) is a hydroxyl compound of gold phosphide. The dose is 6mg once a day, 2-3 months after the beginning of the effect. It is more effective in patients with a short course of early disease. Side effects are lighter than injections, commonly diarrhea, but for a transient, remission rate of 62,8%. 3, penicillamine is an amino acid drug containing sulfhydryl group, the treatment of chronic rheumatoid arthritis has a certain effect. It can selectively inhibit certain immune cells to reduce IgG and IgM. Side effects include thrombocytopenia, leukopenia, proteinuria, allergic rash, loss of appetite, optic neuritis, muscle weakness, increased transaminases, etc. Dosage 250mg per day orally for the first month and 250mg per time twice daily for the second month. No significant effect third month 250mg each time three times a day. Total dose up to 750mg per time is the maximum dose. Most of the clinical symptoms improve within 3 months, after the symptoms improve, use small dose to maintain, the course of treatment is about one year. 4. Chloroquine has certain anti-rheumatic effect, but the effect is very slow, often 6 weeks to 6 months to reach the maximum effect. It can be used as an adjunct to salicylic acid preparations or decreasing corticosteroid doses. 250-500 mg per dose orally twice daily. Gastrointestinal reactions such as nausea, vomiting and loss of appetite are common during the course of treatment. Long-term application must pay attention to the degeneration of the retina and optic nerve atrophy, etc. 5, levamisole can reduce pain, shorten the time of joint stiffness. The dose is 50mg once daily for the first strike, 50mg twice daily for the second week, and 50mg three times daily for the third week. Side effects include dizziness, nausea, allergic rash, hypopthalmia, drowsiness, granulocytopenia, thrombocytopenia, liver function impairment, proteinuria, etc. 6.Immunosuppressants For patients with severe rheumatoid arthritis in whom other drugs are ineffective, in case of drug withdrawal or hormone reduction, azathioprine is commonly used, 50mg per dose, 2-3 times daily. Cyclophosphamide 50 mg twice daily. The dosage is gradually reduced after improvement of special symptoms or laboratory tests. The maintenance dose is 1/2 to 2/3 of the original therapeutic dose and is used continuously for 3 to 6 months. Side effects include bone marrow suppression, decreased white blood cells and platelets, hepatotoxic damage and gastrointestinal reactions, alopecia, amenorrhea, hemorrhagic bladder inflammation, etc. Methotrexate (MTX) has immunosuppressive and anti-inflammatory effects, can lower blood sedimentation, improve bone erosion, 5-15mg per week intramuscularly or orally, 3 months as a course. Side effects include anorexia, nausea, vomiting, stomatitis, alopecia, leukopenia or thrombocytopenia, drug-interstitial pneumonia with rash. May become another relief drug chosen after gold and penicillamine. 7, adrenocorticotropic hormone adrenocorticotropic hormone on joint swelling and pain, control inflammation, anti-inflammatory and analgesic effect is rapid, but the effect is not lasting, the cause and pathogenesis of the disease has no effect. Once the drug is discontinued for a short period of time, it will relapse. There is no improvement on RF, blood sedimentation and anemia. Long-term application can lead to serious side effects, so it is not used as a routine treatment, limited to severe vasculitis caused by extra-articular damage and affect the function of vital organs, such as eye complications that may cause the risk of blindness, central nervous system lesions, heart block, joints with persistent active synovitis, etc. can be applied for a short time, or by NSAIDS, penicillamine and other treatment effect is not good, heavy symptoms, affecting daily life If the treatment is not effective, small doses of corticosteroids can be added on top of the original drugs. If the effect is not good, it can be increased as appropriate. After the symptoms are controlled, the dose should be gradually reduced to the minimum maintenance amount. Hydrogen prednisone acetate suspension can be used as a local intra-articular injection for certain single large joint intractable lesions, 25-50mg per intra-articular injection, to prevent intra-articular infection and bone destruction. De-inflammation Shu Song Tebutin acetate, is a kind of long-acting corticosteroid suitable for intra-articular administration, one time amount of 10mg, 30mg for the knee. 8, Lei Gong Vine by domestic clinical application and experimental research for many years has good efficacy. There are non-steroidal anti-inflammatory effects, and immunosuppressive or cytotoxic effects, can improve the symptoms, so that the blood sedimentation and RF potency is reduced, Lei Gong Doside 60mg / d, 1 to 4 weeks can appear clinical effects. Side effects include menstrual disorders and menopause in women, reduced sperm count in men, skin rash, leukocyte and platelet reduction, and abdominal pain and diarrhea. It can be eliminated after discontinuation of the drug. Kunming Shanghuang, similar in action to Leigongtang, 2 to 3 tablets each time, 3 times a day. The course of treatment is more than 3 to 6 months. Side effects dizziness, dry mouth, sore throat, loss of appetite, abdominal pain, amenorrhea. 9.Other treatments Thymidine, plasma removal therapy, etc. have yet to be explored. (C) physical therapy The purpose is to increase local blood circulation with heat therapy to relax muscles and achieve anti-inflammatory, swelling and analgesic effects, while using exercise to maintain and improve joint function. Physical therapy methods include the following: hot water bag, hot bath, wax bath, infrared ray, etc. Physical therapy is followed by massage to improve local circulation and relax muscle spasm. The purpose of exercise is to preserve the function of joint movement and to strengthen the strength and endurance of muscles. After the acute symptoms have subsided, as long as the patient can tolerate it, early and regular active or passive joint exercise activities should be performed. (iv) Surgical treatment Previously, it was thought that surgery was only applicable to advanced deformity cases. At present, early synovectomy can be tried for those who have only one or two joints that are heavily damaged and where salicylate treatment is ineffective. In the later stage, the lesion is stationary and the joint has obvious deformity, osteotomy correction is feasible, and joint ankylosis or destruction can be done as arthroplasty or artificial joint replacement. For weight-bearing joints, joint fusion can be performed. Generally speaking, most of the patients recover better if they are treated actively and comprehensively at an early stage. If only a few joints are involved and the systemic symptoms are mild, or if the joints involved are not symmetrically distributed, the disease is often short-lived, and about 10% to 20% of patients become disabled due to untimely treatment. The disease does not directly cause death, but severe advanced cases can die from secondary infection.