Rheumatoid arthritis so far there is no specific treatment, still stay in the treatment of inflammation and sequelae, take a comprehensive treatment, most patients can get some effect.
The aim of the current treatment is to.
1.Control the inflammation of the joints and other tissues and relieve the symptoms;
2.To maintain joint function and prevent deformity;
3, repair damaged joints to reduce pain and restore function.
I. General treatment
Fever, joint swelling and pain, systemic symptoms should be bed rest until the symptoms basically disappear. After two weeks of improvement, activities should be gradually increased to avoid prolonged bed rest, which may lead to joint disuse and even promote joint ankylosis. Adequate protein and vitamins should be included in the diet, and small blood transfusions can be given to those with significant anemia.
Second, drug treatment
1.Non-steroidal anti-inflammatory drugs
The mechanism of action is mainly to inhibit the enzyme cyclooxygenase so that the inhibition of prostaglandin production, in order 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: can anti-rheumatic, anti-inflammatory, antipyretic, 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: It is a class of drugs that can replace aspirin, including ibuprofen, naproxen, and fenbufen, which have similar effects to aspirin and have similar efficacy with less digestive side effects. Commonly used doses: 1.2-2.4g of ibuprofen per day, divided into 3-4 doses, and 250mg of naproxen per dose, twice daily. Side effects include nausea, vomiting, diarrhea, peptic ulcer, gastrointestinal bleeding, headache and central nervous system disorders such as irritability.
(4) Anti-acid drugs: They are o-aminobenzoic acid derivatives, and their effects are similar to those 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.Golden preparation
Currently recognized for rheumatoid arthritis has a positive effect. Commonly used gold sodium thiomalate. If there are no adverse reactions, 50mg per week will be given afterwards. 300-700mg of the total amount will be effective for most patients, and 600-1000mg of the total amount will be stable and improve the condition. Because of the possibility of relapse after discontinuation of the drug, the maintenance dosage is used overseas for many years, and it 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, rash, stomatitis, tight damage, etc., which can be recovered after stopping the drug.
Oral gold preparations Jinuofen is a hydroxy 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
It is a kind of amino acid drug containing sulfhydryl group, which has certain effect in treating chronic rheumatoid arthritis. 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 improvement of symptoms with a small dose maintenance, the course of treatment is about one year.
4.Chloroquine
It 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. Each oral dose is 250-500 mg twice daily. There are often more gastrointestinal reactions such as nausea, vomiting and loss of appetite during the course of treatment. Long-term application must pay attention to the degenerative changes of the retina and optic nerve atrophy, etc.
5.Levamisole
It can reduce the pain and 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.Immunosuppressant
In the case of discontinuation or hormone reduction, azathioprine is commonly used, 50mg per dose, 2-3 times daily. Cyclophosphamide 50mg twice a day. After improvement of special symptoms or laboratory tests, the dosage is gradually reduced. 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, decrease in 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 and improve bone erosion, 5-15mg per week intramuscularly or orally for 3 months as a course of treatment. Side effects include anorexia, nausea, vomiting, stomatitis, alopecia, leukopenia or thrombocytopenia, drug-interstitial pneumonia and rash. May become another palliative drug of choice after gold and penicillamine.
7.Adrenocorticotropic hormone
Adrenocorticotropic hormone on joint swelling and pain, control inflammation, anti-inflammatory and pain-relief effect is rapid, but the effect is not lasting, and has no effect on the cause and pathogenesis. They have no effect on the cause and pathogenesis of the disease, and relapse once the drug is stopped for a short period of time. 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-inflammatory Schisandraxon Tebutin acetate, a long-acting corticosteroid suitable for intra-articular administration, with a single dose of 10mg and 30mg for the knee joint.
8.Rehmannia
After years of clinical application and experimental research in China 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, tretinoin 60mg / d, 1 to 4 weeks can appear clinical effects. Side effects include menstrual disorders and menopause in women, reduced sperm count in men, rash, leukocyte and platelet reduction, and abdominal pain and diarrhea. It can be eliminated after discontinuation of the drug.
Kunming Shanghang, 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 treatment
Thymidine, plasma removal therapy, etc. have yet to be explored.
Physical therapy
The purpose is to use heat therapy to increase local blood circulation, relax muscles, achieve anti-inflammatory, swelling and analgesic effects, while using exercise to maintain and improve joint function. Physical therapy methods include the following: hot water bags, hot baths, wax baths, infrared rays, 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. In the acute stage, after the symptoms have subsided, as long as the patient can tolerate it, he/she should make active or passive joint exercise activities regularly at an early stage.
IV. Surgical treatment
In the past, 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 ineffective by salicylate treatment. 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 and advanced cases can die from secondary infection.
V. Food treatment
Since the 80s, in some countries in the United States, Japan and Europe, shark cartilage powder began to be used as a part of the replacement therapy for clinical treatment. Some European countries recognized the extract of shark cartilage as a medicine. Some medical institutions in Japan, on the other hand, have chosen companies to provide clinical grade pure natural shark cartilage powder. Not only is the stability of the efficacy of pure natural shark cartilage powder proven, but more importantly, it does not have all the terrible side effects of conventional drugs and is gradually gaining popularity in developed countries.