Low awareness, high disability rate
”I didn’t know I should have come to your rheumatology department, if I had known, my disease would not have been delayed!” During outpatient visits, rheumatologists often hear this from patients. In the minds of many people, the rheumatology department is to see rheumatism, rheumatism is to wind and rain leg pain, in fact, not quite. The people’s knowledge of rheumatism and immune diseases is still very insufficient. Rheumatic immune disease is the general name of a large group of diseases, there are more than 200 kinds, mainly including rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, dry syndrome, dermatomyositis, scleroderma, gout, osteoarthritis, etc., are a kind of rheumatic immune disease.
These diseases are low in awareness but extremely disabling. In rheumatoid arthritis, for example, the early manifestations are only joint pain and swelling, but if not controlled by effective methods in a timely manner, joint inflammation will continue to progress, and eventually joint deformity, disability, and then unable to walk, and eventually bedridden – a long and painful process for patients to suffer, for this reason rheumatoid Arthritis and ankylosing spondylitis, which are autoimmune diseases, were once called “the cancer that won’t die.
According to the 2006 National Sample Survey of Persons with Disabilities, of the 2.6 million people with physical disabilities in China, two groups account for the largest proportion: cerebrovascular disease and joint disease. Especially for women, joint disease is the biggest “culprit” leading to the loss of women’s ability to live a normal life.
Data show that 75% of rheumatoid arthritis patients can develop bone destruction within two years of onset, and up to 80% of patients become disabled after 20 years of illness; the average retirement age of ankylosing spondylitis patients is 39.4 years; the mortality rate of rheumatoid immune disease population is higher than the general population.
Patients have difficulty accessing medical care, and the discipline is not common
Preliminary statistics show that there are no less than 50 million patients with rheumatic diseases in China. Among them, rheumatoid arthritis patients amount to 5.3 million, systemic lupus erythematosus patients 1 million, ankylosing spondylitis patients 4.5 million, dry syndrome patients 8 million, and patients with different degrees of osteoarthritis more than 30 million. The demand is so big, but the number of rheumatologists is very small, and many hospitals in the country do not have rheumatology specialists at all.
From May to August 2007, the Department of Rheumatology and Immunology of the People’s Hospital of Peking University conducted an on-site survey of 181 cases of rheumatoid arthritis patients in the outpatient clinic. Among 181 patients, 58 patients chose orthopedics for their first visit, and 13 were diagnosed; 45 patients chose internal medicine, and 25 were diagnosed; 18 patients chose Chinese medicine, and 12 were diagnosed; only 4 patients chose surgery and other departments were diagnosed; 42 patients chose rheumatology, and 40 were diagnosed.
It is the unpopularity of rheumatology specialties, so that many patients do not get the guidance and treatment of rheumatologists, delaying the disease. In fact, not only patients, even many non-professional doctors do not know much about rheumatism. “They are confused when they see rheumatism and don’t know how to diagnose it because it is too specialized. Patients like rheumatoid, lupus erythematosus, dry syndrome, ankylosing spondylitis, etc. are a very special group of diseases. If they don’t meet a specialist in time, they are often misdiagnosed and mistreated, delaying their condition.”
Therefore, to improve the current situation of rheumatic immune disease diagnosis and treatment, it is imperative to strengthen the construction of rheumatic immune disease specialists and physician teams so that patients can go to specialists to receive standardized diagnosis and treatment. Patients should be reminded that as long as there is persistent joint pain, especially joint swelling and pain that does not go away, they should go to the rheumatology and immunology departments of regular hospitals as soon as possible and undergo relevant examinations.
Rheumatism can be completely relieved
If the medication is used strictly in accordance with the doctor’s requirements, any rheumatic immune disease condition should gradually remit within a few months, rather than fluctuate continuously and repeatedly. If there is no remission, the problem is not with the doctor, but with the patient, indicating that the doctor’s treatment plan should be adjusted or this patient is not following the doctor’s instructions. In the last 20 years, there have been significant advances in research on rheumatic immune diseases. The philosophy of treatment has evolved from diagnosing the disease, relieving symptoms and alleviating patient suffering to early diagnosis, inhibiting disease progression and completely relieving the disease.
A large number of clinical trials at home and abroad have confirmed that the occurrence and progression of rheumatoid immune diseases such as rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis are mainly attributed to the abnormal activation and proliferation of pathogenic T cells, B cells and other immune cells, as well as the resulting production of various inflammatory mediators, cytokines and autoantibodies. It is these cells and inflammatory factors that cause immune inflammatory lesions such as synovitis and vasculitis.
By understanding the cause of the disease, we can treat the cause. There is reason to believe that rheumatologic diseases are not invincible. However, the current situation is that many patients still hold the stereotype that rheumatism is “incurable” and there is no medicine to cure it, or they are overly worried about the side effects of western medicine and refuse formal treatment and turn to charlatan doctors for treatment, as a result, they lose valuable treatment opportunities and their conditions recur.
In 2002, the Rheumatology Branch of the Chinese Medical Association issued guidelines for the treatment of rheumatoid arthritis and 21 other rheumatic diseases, standardizing the clinical treatment of these diseases. Clinically, the use of disease-modifying anti-rheumatic drugs (DMARDs) or immune agents can lead to a reduction in disease activity and maximum disease control in most patients, resulting in long-term stability or little progression of the disease; or complete remission, i.e., the disappearance of all active signs and symptoms. With maintenance doses of medications, patients are fully able to work and live as normal.
Early treatment, aggressive, individualized therapy
”To achieve the goal of complete remission of the disease, patients must establish three concepts: confidence, patience and standardization”, said Professor Li, for rheumatic immune diseases, patients must first have confidence, to believe that rheumatic diseases can be controlled very well; secondly, patience, most rheumatic diseases need weeks or even months of regular treatment to be controlled; of course The most important thing is still standardized treatment, that is, early, active and individualized treatment.
First of all, early treatment, research has proved that early medication can make rheumatism patients’ disease controlled at the beginning of the disease. The earlier the diagnosis, the easier it is to stop the medication. In rheumatoid arthritis, for example, patients with rheumatoid arthritis treated early with disease-relieving antirheumatic drugs (DMARDs) have a significantly better prognosis than those who delay medication for 3 to 6 months. Most patients with rheumatoid arthritis that is fully controlled can stop taking the medication in three to six months, and very few patients are not controlled for more than six months to a year. Therefore, once the diagnosis of rheumatoid arthritis and lupus erythematosus is clear, treatment such as DMARDs or immunosuppressants should be given early.
The next step is active treatment. In the treatment of diseases such as rheumatoid arthritis and lupus erythematosus, the remission rate of combination drugs, intensive therapy and multi-target therapy regimens is significantly higher than that of conventional therapy. With no adverse effects, aggressive and standardized medication can undoubtedly lead to remission in more patients with rheumatic immune diseases.
Again, each patient has a different cause of disease, different clinical manifestations, and individual differences in response to medications. Therefore, special attention should be paid to finding the most appropriate, effective, and safe treatment plan for each patient and adhering to the medication for a sufficient period of time, so that the patient’s condition can be remitted.
Hormone abuse is too common
Many patients believe that they have to rely on long-term hormone application to maintain remission is wrong because hormones do not have a curative effect and have many side effects. There are many kinds of drugs used in the treatment of rheumatic immune diseases, which are roughly divided into two categories: those that treat the symptoms and those that treat the root cause. The former controls the symptoms and the latter controls the progression of the disease. Only with the correct use of both types of drugs can a patient’s condition be completely relieved. In addition to conventional drugs, there are now biological agents, which are targeted therapeutic drugs targeting disease-causing factors and are more effective and therapeutic, but more expensive.
Many patients believe that hormones are very effective in treating all the symptoms. If you really need to use them, you must apply them in small doses for a short period of time under the guidance of a doctor, but never for a long time.
In the case of rheumatoid arthritis, for example, hormones are not the drug of choice, and most patients with rheumatoid arthritis do not need hormone therapy. In addition to causing patients to gain weight, long-term hormone use can also lead to osteoporosis or fractures. Generally speaking, the correct use of NSAIDs in combination with disease-modifying anti-rheumatic drugs will enable most patients to have their disease effectively controlled. The Guidelines for the Treatment of Early Rheumatoid Arthritis, jointly published by the British Society for Rheumatology and the British Association of Rheumatology Practitioners, give clear advice on the use of hormones, stating that they should be used in small doses for short periods of time strictly according to indications, and that local administration such as intra-articular use is advocated.
Another example is systemic lupus erythematosus, where patients with mild disease usually do not need long-term oral hormones. Most patients only need to take medium or small doses of hormones, and short-acting hormone preparations should be chosen. It should be taken daily in the morning to minimize its side effects, and the dose should be reduced as soon as the symptoms are controlled. For patients with SLE who have only mild skin lesions such as rashes, even topical topical hormones alone can be considered to relieve symptoms and monitor changes in the disease. In addition, erroneous long-term use of long-acting hormones such as dexamethasone is relatively common in China and should be avoided.
A rapidly developing discipline
The Rheumatology Branch of the Chinese Medical Association (CMA) was founded in 1985 as the Rheumatology Section of the Chinese Medical Association’s Society of Internal Medicine, which was established in 1982. Rheumatology and immunology is a broad discipline, and medical practice shows that it interpenetrates with various disciplines such as nephrology, orthopedics, dermatology, gastroenterology, and respiratory medicine.
Because of the large number of patients and the development of many basic researches such as immunology and genetics research support the development of the discipline, rheumatology is developing rapidly and has a bright future. In terms of scientific research, both basic research and clinical research have made great progress, and some of them have a place in the international arena. The system is gradually formed.
In recent years, the Rheumatology Branch of the Chinese Medical Association has not only been invited to participate in many important international conferences, with Chinese experts and scholars either chairing or giving keynote speeches, but the Rheumatology Branch of the Chinese Medical Association has also hosted many domestic and international conferences. Through exchanges, China’s influence in the international rheumatology community has been further expanded, and research results and levels have been internationally recognized.
Many misconceptions worry people
1, misconception: “rheumatism can not be treated”
Harm: lack of confidence, give up treatment
Interpretation: with the rapid development of rheumatology disciplines, rheumatism is no longer an incurable disease. As long as it can be found in time, seize the opportunity to give positive and correct comprehensive treatment, most patients can be completely controlled, keep the joints do not deform, like normal people work and live, but if not standardized treatment, it is possible to develop into a serious disability, bringing great harm to patients physically and mentally.
2, misconception: “rheumatic diseases can be cured”
The danger: the disease to seek treatment
Interpretation: most of the rheumatic diseases diagnosed, including systemic lupus erythematosus, rheumatoid arthritis and dry syndrome, are difficult to be completely cured, but regular treatment can completely control the disease, the active period of the disease may take more drugs, but the disease control can completely reduce the type and dose of drugs taken, so that patients in the case of taking maintenance drugs to maintain the “disease-free “state.
3, misconception: “joint pain is rheumatoid “
The danger: patients misdiagnosed and mistreated
Interpretation: not necessarily every patient with joint pain is rheumatoid, systemic lupus erythematosus, ankylosing spondylitis, osteoarthritis, etc., can also appear swollen and painful joints. Must be clearly diagnosed first, the treatment of each disease is different each has its own treatment methods.
4, misconception: “long-term use of painkillers”
Harm: the condition is not relieved
Interpretation: some people are pessimistic and disappointed in the treatment, no confidence, they go to the pharmacy to buy some painkillers to eat, stop the pain even, and sometimes arbitrarily increase the dose, which is wrong. Although many painkillers can relieve joint pain and swelling, but the symptoms do not cure the root cause, can not stop joint destruction and deformation.
5, misconception: “discomfort, stop the drug”
Harm: lead to relapse of the disease
Interpretation: any drug may have adverse reactions. Rheumatoid arthritis treatment with drugs, for example, the occurrence of adverse reactions is relatively low, the vast majority of patients taking drugs is safe. The key is that the doctor must be clear to the patient, pay attention to the observation of drug adverse reactions, found after the timely reflection to the doctor or discontinued, not because a drug adverse reactions do not dare to try to apply other drugs.