Diagnosis, treatment and prevention of generalized wandering pain
Overview
Wandering pain: pain that occurs alternately in various parts of the body (including muscles, joints, skin, etc.), usually with irregular onset.
It can be broadly classified into the following categories according to the cause of the disease.
Systemic autoimmune diseases (immune).
Degenerative osteoarthrosis, chronic strain (metabolic).
Peripheral neuropathy (neurological).
Sympathetic chain syndromes (neurological).
Menopausal syndromes (metabolic).
Osteoporosis (metabolic).
Others such as gout, anxiety disorders, central diseases induced dystonia.
Systemic autoimmune diseases
These are diseases caused by the body’s immune response to its own antigens, resulting in damage to its own tissues. It mainly involves the skin, mucous membranes and synovial membranes throughout the body. Painful manifestations occur mostly in joints and muscles. The joints are the most common.
Mostly occurs in joints of.
Rheumatoid arthritis, rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, idiopathic arthritis.
Mostly occurring in muscles, skin.
Polymyositis.
Rheumatic polymyalgia.
Multiple manifestations in joints, muscles, skin.
Systemic lupus erythematosus.
Systemic autoimmune diseases.
Clinical features of rheumatoid arthritis
Clinical features are wandering joint and muscle soreness, heaviness, and pain, mostly starting with acute fever and joint pain.
There is no deformity or dysfunction of the joints.
Recurrent attacks and cardiac involvement are possible.
It is an allergic disease.
It is one of the main manifestations of rheumatic fever.
Systemic autoimmune diseases
Rheumatoid arthritis diagnosis based on
1. History of hemolytic streptococcal infection 1-4 weeks before onset.
2.Acute wandering large arthritis, often accompanied by other manifestations of rheumatic fever such as myocarditis, annular erythema, subcutaneous nodules, etc.
3.Serum anti-streptococcal hemolysin “0” coagulation potency is significantly elevated.
4. Positive pharyngeal swab culture and blood leukocytosis, elevated sedimentation and CRP.
Systemic autoimmune diseases
Clinical features of rheumatoid arthritis
Chronic, systemic disease dominated by synovitis.
Most frequent in small joints of hands and feet.
Symmetric, aggressive joint inflammation.
Often associated with extra-articular organ involvement.
Positive serum rheumatoid factor.
Joint deformity and loss of function.
Systemic autoimmune diseases
Diagnostic basis for rheumatoid arthritis
The American College of Rheumatology revised the classification criteria for RA in 1987 as follows ≥ to confirm the diagnosis of RA
Diagnosis based on
1.Morning stiffness for at least one hour (≥ 6 weeks)
2, swelling of 3 or more joints (≥ 6 weeks)
3 Hand joints (wrist, MCP or PIP joints) involvement (≥ 6 weeks)
4.Symmetrical arthritis (≥ 6 weeks).
5.X-ray film changes.
6.Have rheumatoid subcutaneous nodules.
7, positive serum rheumatoid factor (titer) 1:32).
Systemic autoimmune diseases
Clinical features of ankylosing spondylitis (AS)
Long-term persistent lumbosacral back pain.
Predominantly small spinal joint lesions.
Severe limitation of spinal function, often accompanied by aseptic necrosis of the femoral head is an autoimmune disease.
Strong association with HLA-B27.
Systemic autoimmune diseases
Reactive arthritis (RCA)
It is a type of arthritis that occurs after infection at certain specific sites. In recent years, it has been found that most biological infections can cause reactive arthritis.
Therefore, reactive arthritis in the broadest sense is a broad spectrum, such as pharyngitis, cholecystitis, and reactive arthritis in the closest sense only refers to a type of peripheral arthritis that occurs in the short term after a specific genitourinary or gastrointestinal infection.
Reiter’s syndrome is the classic of classical reactive arthritis.
Clinical features of reactive arthritis (RCA)
The first symptoms are mostly acute arthritis.
It is mostly single or oligoarthritis, asymmetrically distributed, presenting with periarthritis of the salami-like fingers (toes).
It mainly involves large joints of the lower extremities such as knee and ankle. The shoulder, wrist, elbow, hip, and small joints of the hand and foot may also be involved.
The affected joints are hot, swollen, painful and painful to the touch. There are a few patients who do not have redness or swelling in the joints. Soreness and nocturnal pain, depression and anxiety predominate.
Reactive arthritis mostly follows the classification criteria proposed by Kingsley and Sieper in 1996.
1, peripheral arthritis: asymmetric oligoarthritis predominantly in the lower extremities.
(2) Evidence of antecedent infection: (1) laboratory evidence may or may not be present if there is clinically typical diarrhea or UTI 4 weeks prior; (2) laboratory evidence of infection must be present if clinical evidence of infection is lacking.
(3) Exclude other causes of mono- or oligoarthritis, such as other spondyloarthritis, infectious arthritis, Lyme disease and streptococcal reactive arthritis.
(4) HLA-B27 positivity, extra-articular manifestations of reactive arthritis (e.g., conjunctivitis, iritis, skin, cardiac and neurological lesions), or clinical manifestations of typical spondyloarthritis (e.g., inflammatory lower back pain, alternating hip area pain, tendon telangiectasia, or iritis) are not required for the diagnosis of reactive arthritis to be confirmed.
Systemic autoimmune diseases
Clinical features of idiopathic arthritis
Idiopathic arthritis is a common nodal tissue disease in children under 16 years of age, characterized by chronic arthritis. 30% of patients may present as ankylosing spondylitis in adulthood.
The typical manifestations of arthritis are pain, swelling, and limitation of movement.
There is often a skin rash, enlargement of the liver, spleen and lymph nodes, systemic symptoms such as pleurisy and pericarditis, and visceral damage.
Most have a good prognosis, but a few can lead to permanent joint damage and chronic iridocyclitis, which is a major cause of disability in pediatric patients.
Systemic autoimmune diseases
Idiopathic arthritis
The clinical manifestations of this disease are extremely varied. According to the clinical manifestations of the first six months of the disease, it can be divided into three types.
1, systemic type also known as still disease
2.Polyarticular inflammation
3, oligoarticular inflammation
Where systemic symptoms or arthritic symptoms persist for more than 6 weeks and other diseases can be excluded, the disease should be considered.
Systemic autoimmune diseases
Clinical features of polymyositis (polymyositis)
A non-purulent inflammatory lesion with a predominantly lymphocytic infiltrate involving mainly the transverse muscles, with or without multiple skin lesions.
Polymyositis refers to this group of disorders without skin damage.
The muscles of the proximal extremities are damaged earlier, and the muscles of the scapular and pelvic girdles are usually the first to be affected, and the lesions are often symmetrical, with progressive muscle weakness.
The lesions are often not parallel to the degree of muscle involvement.
The lesions are often not parallel to the degree of muscle involvement and show purplish-red puffy patches, Gottron’s sign and rigid dilated capillary erythema of the nail root crease.
Systemic autoimmune diseases
The diagnosis of polymyositis (polymyositis) is based on
1. Acute or subacute muscle weakness in the proximal extremities and pelvic girdle with pressure pain. Weak or absent tendon reflexes.
2.Serum CK is significantly increased.
3, electromyography shows myogenic damage.
4. Biopsy shows typical pathological manifestations of myositis.
5, accompanied by typical skin damage.
The diagnosis of PM is made by having the first four criteria, and DM is made by having three or more of the first four criteria and the fifth one at the same time. immunosuppressive therapy is effective to support the diagnosis. malignant neoplasm should be excluded in patients over 40 years old.
Systemic autoimmune diseases
Rheumatic polymyalgia clinical features
Symmetrical proximal joint and muscle pain and soreness and morning stiffness are the hallmarks.
The shoulder, neck, and pelvic girdle muscles are the most prominent.
Sometimes the distal muscles and joints may also be involved.
The lesions are mainly characterized by tendonitis and synovitis.
There is no muscle weakness or atrophy and no muscle redness or heat.
Generally self-limiting disease with a 2-year history
Systemic autoimmune disease
Rheumatic polymyalgia is diagnosed on the basis of
1. Age of onset >50 years.
2, at least 2 muscle pains and morning stiffness in the neck, scapular girdle and pelvic girdle areas for ≥ 1 week
3, Elevated ESR and/or CRP.
4, Small dose of hormone (prednisone ≤15mg/day) is effective.
5, No muscle weakness or muscle atrophy and muscle redness and heat.
6, Exclude other lesions similar to PMR manifestations such as RA, myositis tumor and infection.
7, If the above six items are met, the diagnosis of PMR can be confirmed.
Systemic autoimmune diseases
Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is an autoimmune inflammatory connective tissue disease involving multiple organs that occurs mostly in young women, with an increasing number of early, mild and atypical cases.
The skin and mucous membranes can be broadly divided into two categories: atopic and non-atopic.
1. The atopic lesions are pteroid erythema, subacute cutaneous lupus erythematosus, discoid erythema and neonatal lupus.
2. Non-specific lesions include photosensitivity, alopecia, oral ulcers, cutaneous vasculitis, Raynaud’s phenomenon. Urticaria-like rash and, rarely, lupus lipofuscinosis or deep lupus and lupus erythematosus with herpetiformity.
Arthralgia, arthritis, joint deformity (10% of X-rays have destruction) and myalgia, muscle weakness.
The nervous system, digestive system, hematologic system, respiratory system, heart, and kidneys can be involved. Adverse manifestations occur.
Systemic autoimmune diseases
Systemic lupus erythematosus is diagnosed on the basis of.
1. cheek erythema
2.Disciform erythema
3.Photosensitivity
4, Oral ulcers
5.Arthritis
6.Plasmacytitis: pleurisy or pericarditis
7, renal damage: urine protein 0, 5/24 hours or 3+ or cellular tubular type
8.Nervous system abnormalities: convulsions or psychosis
9, hematologic abnormalities: hemolysis or leukocytes <4000/mm3 or lymphocytes <1500< span=""> or platelets <103/mm3
10. Immunological abnormalities: dsDNA antibody or anti-cardiolipin antibody+ or anti-Sm antibody
11. Positive antinuclear antibodies
Diagnosis can be made with 97% sensitivity and 89% specificity if at least 4 of the above 11 items are positive sequentially or simultaneously.
Systemic autoimmune diseases
Treatment principles.
Maintenance of joint function, elimination of the cause (immunogen), control of inflammation
Treatment methods.
1, Western medicine: non-steroidal anti-inflammatory drugs, immunosuppressants, glucocorticoids, Yunque therapy
2, Chinese medicine treatment: related to wind, cold, damp, heat
Generally can be divided into wind-cold-damp type, wind-damp-heat type, qi-blood deficiency, spleen-kidney yang deficiency, liver-kidney yin deficiency
3.Minimally invasive treatment: joint lavage, radiofrequency
4.Other treatments: physical therapy, acupuncture