An elderly female patient from Henan Province was wheeled to Beijing Hospital by her family. The patient’s history showed that she had been suffering from rheumatoid arthritis (rheumatoid arthritis for short) for more than 10 years and had been taking medication at a local hospital, but her condition was always good and bad. The company’s main business is to provide a wide range of products and services to its customers. The company’s main goal is to provide a good solution to the problem. The actual fact is that the effect is quite good, the joint does not hurt anymore. So she bought many more boxes at once and insisted on eating them for 3 years. Recently, Yu Da Ma suddenly felt persistent pain in the root of her right thigh, and her walking was also affected. The family members took her to the local hospital for examination and found that she was suffering from femoral head necrosis. The first thing you need to do is to get a good idea of how the femoral head is necrotic. The company’s main business is to provide a wide range of products and services to its customers. Then open the capsule, only to see the red and green inside, is actually a variety of pill powder mix. Cheng Yongjing analysis, these capsules are obviously not regular pharmaceutical production, which is likely to be mixed with unknown doses of glucocorticoids, non-steroidal anti-inflammatory drugs and other western drugs. If patients take an excessive amount of hormones, although the symptoms are temporarily improved, but also easy to trigger serious adverse drug reactions, and even femoral head necrosis. Cheng Yongjing said, suffering from rheumatoid arthritis must go to a regular hospital for standardized treatment, and under the guidance of doctors to use drugs, so as not to delay the disease, or cause more harm to health. The key to standardized drug therapy Cheng Yongjing pointed out that in the clinic often encounter patients with rheumatoid arthritis (RA) due to a lack of basic medical knowledge and the wrong treatment, many so-called “ancestral secret recipes” are harmful because the patient took an unknown dose of glucocorticoids for a long time, resulting in a number of adverse reactions that should not have occurred. The reason why many so-called “ancestral recipes” are so harmful is that the patients take unknown doses of glucocorticosteroids for a long time, resulting in many adverse reactions that should not occur and delaying treatment. In fact, the majority of rheumatoid arthritis patients can achieve control of the disease and improve joint function and prognosis after standard treatment. Rheumatoid arthritis treatment includes general therapy, medication, surgery, and other treatments. Drug therapy should be long-term for patients with rheumatoid arthritis, emphasizing the principles of early treatment, combination of drugs and individualized treatment. There are five main categories of drugs commonly used for treatment: non-steroidal anti-inflammatory drugs, anti-rheumatic drugs to improve the condition, biological agents, glucocorticoids (commonly known as hormones), and botanical preparations. NSAIDs, commonly known as “painkillers”, are the first line of symptomatic anti-inflammatory drugs and play an important role in relieving joint swelling and pain and improving systemic symptoms. The main adverse effects of NSAIDs include gastrointestinal symptoms, liver and kidney impairment, and a possible increase in cardiovascular adverse events. The following points should be noted in the use of NSAIDs: pay attention to the individualization of their types, doses and dosage forms; use the lowest effective amount and short course of treatment as much as possible; generally choose one NSAID first, and add to the full amount when there is no obvious efficacy for several days to 1 week of application, and then switch to another preparation if it is still ineffective, avoid taking 2 or more NSAIDs at the same time; for those with a history of peptic ulcer, it is appropriate to use Selective COX-2 inhibitors or other NSAIDs plus proton pump inhibitors; the elderly can use NSAIDs with short half-life or smaller doses; cardiovascular high-risk groups should be cautious with NSAIDs, if needed, acetaminophen or naproxen is recommended; NSAIDs should be used with caution in renal insufficiency; pay attention to regular monitoring of blood routine and liver and kidney function. The anti-rheumatic drugs to improve the condition (DMARDs) Cheng Yongjing said, this class of drugs than NSAIDs slow action, about 1-6 months, so also known as slow-acting anti-rheumatic drugs. These drugs do not have obvious pain relief and anti-inflammatory effects, but can slow down or control the progress of the disease. Anti-rheumatic drugs commonly used to treat rheumatoid arthritis with the aim of improving the condition include methotrexate, salazosulfapyridine, leflunomide, antimalarials (including hydroxychloroquine and chloroquine), elamorphine, penicillamine, quinupristin, azathioprine, cyclosporine A, and cyclophosphamide. For patients with rheumatoid arthritis early application of anti-rheumatic drugs that improve the disease should be emphasized. In patients with severe disease, multiple joint involvement, extra-articular manifestations or early joint destruction and other poor prognostic factors, the combined application of 2 or more disease-modifying anti-rheumatic drugs should also be considered. “The importance of these drugs in the treatment of rheumatoid arthritis is summarized by Cheng Yongjing as “they should be used, early and long-term. “Because the biggest danger of rheumatoid arthritis to people is joint destruction and disability, and this class of drugs can effectively prevent joint bone destruction, inhibit the progress of the disease, the effectiveness of treatment can reach 95 percent.” Biologics may be added when remission is not seen after 3 months to 6 months of treatment with disease-modifying antirheumatic drugs, or when there are risk factors for poor prognosis. The main biologics used to treat rheumatoid arthritis include tumor necrosis factor (TNF)-alpha antagonists, interleukin (IL)-l and IL-6 antagonists, anti-CD20 monoclonal antibodies, and T-cell co-stimulatory signaling inhibitors. This class of drugs can clearly inhibit bone destruction in rheumatoid arthritis, inhibit disease progression, and have a rapid onset of action, making them promising drugs developed in recent years. However, their use in clinical practice is limited due to their high price and out-of-pocket expenses. In addition, patients who apply such drugs should be alert to the risk of developing tuberculosis and tumors. Glucocorticoids “Like many so-called ‘ancestral secret recipes’ sold on the street that claim to cure rheumatoid arthritis, they are actually added with more or less hormones.” Cheng Yongjing said that although glucocorticoids can quickly improve joint swelling and pain and systemic symptoms, but due to the obvious side effects of long-term use, the principle of hormone therapy for rheumatoid arthritis is a small dose, short course of treatment, and not as a routine drug for rheumatoid arthritis treatment. Only patients with severe rheumatoid arthritis and extra-articular involvement of the heart, lungs or nervous system should be considered for use. In addition, there are strict indications and rules for the application, reduction and discontinuation of glucocorticoids. Generally, the principles of early adequate dose, gradual reduction, slower and slower reduction, and small dose maintenance are followed. Avoid long-term high dose application and sudden discontinuation. Botanical preparations Cheng Yongjing pointed out that the common clinical use of tretinoin is effective in relieving joint swelling and pain, but there is a lack of research on whether it can slow down joint destruction. Its main adverse effect is gonadal suppression, leading to male sterility and female amenorrhea, so it is generally not used for patients in their reproductive years. Other botanicals include total paeoniflorin and cyanophylline. Avoiding treatment misconceptions to ensure safety In addition to cases like Yu’s mother, who was duped by superstitious prescription wandering doctors, there are many misconceptions about rheumatoid arthritis treatment among patients in China. The chief physician of the Department of Rheumatology and Immunology at Peking University People’s Hospital, Jia Yuan, introduced several common clinical situations to the reporter. Myth 1: It is the same whether you take medicine or not, and whether you treat it or not. Some patients believe that rheumatoid arthritis is an “immortal cancer” and that it is the same with or without medication and treatment, so they simply do not treat it. The rheumatoid arthritis is often irreparable damage to the joints, although each person’s disease progresses at different rates, but if not treated, the joints will eventually become deformed and disabled. Surveys have shown that without treatment, the disability rate for rheumatoid arthritis can be as high as 50% in two years and 70% in three years. However, standardized drug treatment can significantly delay the progression of the disease, stop the destruction of joints and avoid disability. Myth #2: Stop taking medication instantly if it doesn’t hurt. Some people take medication for a period of time, the symptoms are relieved, the joints are not so painful, so they think that the arthritis is cured, no longer continue to take medication, this is not true. Rheumatoid arthritis is a chronic disease, the swelling and pain of the joints can quickly subside after drug treatment, but it does not mean that the disease has been cured, the bone destruction in the joints may still exist for a long time, so drug treatment can not be achieved overnight. Jia Yuan stressed that after long-term drug treatment, some of the patients’ conditions are under control, and only then can the dosage be reduced or even discontinued for observation, as appropriate. Myth 3: Treat the “symptoms” but not the “root”. The so-called “symptoms” refers to rheumatoid arthritis treatment only with anti-inflammatory painkillers, without improving the condition of the anti-rheumatic drugs, that is, no treatment “root”. Rheumatoid arthritis patients should avoid long-term reliance on non-steroidal anti-inflammatory drugs for pain management, such drugs have many adverse effects on long-term use. One is the stimulation of the gastrointestinal tract, serious can cause gastrointestinal bleeding; second is in the cardiovascular side effects, such as coronary heart disease, myocardial infarction, etc.; third is damage to the kidneys. Myth 4: Hormones can and must be used. Some patients believe that as long as they have rheumatoid arthritis, they need to use hormone therapy, and hormones have many side effects, so they are not willing to go to the hospital to receive regular treatment. Jia Yuan explained that not every patient should be treated with hormones, but the clinical emphasis is on individualized treatment plans. Generally, for patients with severe disease and prominent systemic symptoms, initial treatment with hormones on top of anti-rheumatic drugs to improve the condition can rapidly improve the patient’s symptoms. Hormones can also be used for local injections in the joints, and their side effects on the whole body are much less. Myth 5: Drugs have side effects, so you can take less of them. Some people are always worried about the adverse effects of drugs and have poor compliance with medication. For example, the doctor told to take two tablets, they only eat one. The effect of such irregular treatment is not good. Jia Yuan believes that, in general, the more prominent side effects of rheumatoid arthritis treatment drugs are liver function damage, gastrointestinal tract irritation and the impact on the blood picture, so patients can regularly monitor liver and kidney function and blood picture when receiving long-term treatment, and pay attention to gastrointestinal discomfort, etc., so that adverse drug reactions can be detected and dealt with in a timely manner. ”In short, it is important to treat on time, in the right amount and with a full course of treatment; delayed treatment and wrong treatment are the main causes of disability in patients with rheumatoid arthritis.” Jia Yuan emphasized.